by Ms. Marina Vecino Specialist Physiotherapist at Koster Clinic

It is estimated that the 50% of the pregnant women have low back pain… but if you give a look to my schedule the percentage has increased!

This pain, known as lumbago or lumbociatalgia, is located in the lower part of the back, on the sides of the sacrum and towards the buttocks, and can even extend to the back of the thighs, sometimes worsens while standing, walking, bending the trunk, when lifting objects, and turning while sleeping in bed can become a real challenge…

It is well known that the prevalence of low back pain can increase the risk of incontinence due to the link of both conditions with the pelvic floor!

Due to the body modifications during the pregnancy, low back pain can appear BUT THIS DOESN’T MEAN THAT IS NORMAL! We can get rid of it with the proper help. It is very important to solve the low back pain when it starts as once the dysfunction is stablished it is more difficult to fix it.

Contrary to the popular belief… the low back pain does not disappear by itself once you deliver. The distension in the abdomen, the modification of the posture and the decrease of the physical activity foments the pain in the lower back area… keeping an active lifestyle and taking care of our body during this stage we will improve the symptomatology.

As you may know, during the pregnancy and the postpartum we might need to do some modifications in our workouts to avoid unnecessary risks and to compensate the modifications that appear in our bodies.

This is a fantastic moment to start to take care of the pelvic floor because as the main part of the CORE this is going to help us keep our stability. Maintaining a healthy pelvic floor is going to reduce the possibilities of suffering from low back pain.

Ideally, you should put yourself in the hands of a physiotherapist who specializes in obstetrics and urogynecology because everybody needs an individualized program … for example, some women need to strengthen certain areas that other should stretch!

There are certain things that you can start doing:

1. Try to keep a proper posture. This doesn’t mean that you have to sit straight ALWAYS. Actually, it’s more recommendable to keep changing your posture avoiding long periods in a static position.

2. Keep active! If your OBGYNE doesn’t recommend that you rest. One of my favorite activities I recommend to pregnant women with low back pain is water exercises but you have to choose whatever makes you happier… some women prefer prenatal yoga or Pilates… and if you love weight lifting… LIFT! Let me help you find the perfect activity for you.

3. When you sleep, try to do it on your side, with one or both knees bent and placing a pillow between them. As your gut grows, it is advisable to use a wedge-shaped cushion under the abdomen to support it.

4. Prenatal massage is always a good option! Be sure that you find a specialist in the area and do not hesitate to ask if you are not really sure about where to go.

5. Different techniques of stretching can be applied depending of the type of pain that you have… I can help you to find which one is better for you. If you already know which exercises are the best for you because maybe you have suffered from this before, just take in to consideration that due to the relaxing hormone your range of motion can vary. Take it easy and know your limits.

These tips don’t replace the medical recommendations that you may have, as mentioned before it’s important to individualize your recovery or even better… program the prevention care that suits you better!

A prenatal session usually becomes a mine of advisees… when to start with the perineal massage, how to choose the best exercise for you , when can you use the EPINO… so do not hesitate to contact us to book an appointment. Both if you want to prevent future symptoms or if you want to get rid of them, it is never too late to start!



by Dr. Amal Badi and Dr. Koster

Cyclic pelvic pain occurs monthly and is associated with menstrual periods, whereas chronic pelvic pain lasts for at least six months. Although chronic pelvic pain can be caused by a variety of different organ disorders (gastrointestinal, urologic, musculoskeletal and neurological systems), with approximately 20% of women suffering from chronic pelvic pain, the cause is gynaecologic and related to menstrual cycles. Some of the gynaecologic causes of pelvic pain include: Uterine Fibroids, Pelvic Inflammatory disease and Pelvic adhesions.


The cyclic pain is usually caused by conditions called Endometriosis and Adenomyosis. Women who are affected with Endometriosis often have Adenomyosis and vice versa.
Endometriosis is a condition in which endometrial tissue (the tissue that normally lines the inside of the uterus) is present outside of the uterus, most commonly: the ovaries, fallopian tubes and the tissue covering the pelvic organs behind and around the uterus. Some women with endometriosis have no symptoms, while others experience marked pain and may have problems with fertility.
Adenomyosis is a condition in which endometrial tissue grows inside the uterine walls. It causes an enlarged uterus and heavy, painful periods. With endometriosis, the endometrial-like tissue acts as endometrial tissue would, it bleeds with each menstrual cycle. But because this tissue has no way to exit the body, it becomes trapped, causing endometriosis nodules. When it involves the ovaries, cysts called endometriomas will form. If the nodules occur outside the uterus, the surrounding tissue can become irritated, eventually developing scar tissue and adhesions (when pelvic tissues and organs stick to each other).


Women suffering from Endometriosis and/or Adenomyosis can have pain during menstruation, urination, deification and intimate relations, whilst some will have difficulty getting pregnant. Women with Adenomyosis may have long and heavy menstruations that can lead to anaemia in severe cases.
Signs and symptoms of endometriosis may temporarily improve with pregnancy and may disappear completely with menopause, except when taking oestrogen.


Although there are different possible explanations, the exact cause of endometriosis is not certain. If one or more relatives (mother, aunt or sister) have endometriosis, you may be at a higher risk of having it too.


Sometimes, it is difficult to detect the specific cause of chronic pelvic pain because a number of different conditions can cause it, but if the pain is cyclic, it is mostly caused by either Endometriosis or Adenomyosis, so it is very important for you to give a good description of your symptoms and for your doctor to ask about the location of your pain during a pelvic examination. Often, it’s not possible to feel small areas of endometriosis during examination.

Vaginal ultrasound is used to get the best view of the reproductive organs. A standard ultrasound won’t definitively tell your doctor whether you have endometriosis and only doctors with highly specific training would be able to identify the appearance of Adenomyosis and the location and size of Endometriosis nodules.
MRI is another modality that can help with surgical planning, giving your surgeon detailed information about the location and size of endometrial implants.

Laparoscopy was the gold standard to diagnose Endometriosis, but not anymore, since a vaginal ultrasound in the hand of well-trained doctors will identify the disease. Today, Laparoscopy is used to treat endometriosis and often, with proper surgical planning, your surgeon can fully treat endometriosis during the laparoscopy so that you need only one surgery.

Treatments depend on specific symptoms and often includes lifestyle changes, medications and surgery.
For more information, please visit www.kosterclinic.com, email [email protected] or give the super-friendly team a call on 04 388 1887.

Information about PCOS by Dr. Amal Badi, one of the best gynecologists in Dubai.


Information about PCOS by Dr. Amal Badi, one of the best gynecologists in Dubai.

PCOS Nutrition Tips by Jordana Smith

PCOS is a lifelong, genetic condition affecting 1 in 10 women or around 10% of women and it may affect their overall health and appearance.


1- Genetic. You can inherit the risk for PCOS and family members of women who have PCOS are also at higher risk for developing the same metabolic abnormalities.
2- Insulin resistance: It means that the glucose cannot enter the cells, and therefore your pancreas will produce more insulin, resulting in higher levels of insulin in the blood. This can have several negative effects including weight gain, difficulty losing weight and even affecting your ovaries, leading to lack of ovulation and higher levels of male hormones, called androgens
3- Higher levels of androgens interfere with or even cause anovulation (lack of normal ovulation)
4- Anovulation will cause irregular periods, absence of menstrual cycles, infertility and small cysts in the ovary


  • Most women will have irregular or late and heavy menstruations
  • Difficulty to get pregnant
  • Acne
  • Increased hair growth mainly in the face (and other male distribution areas)
  • Hair thinning with male pattern hair loss
  • Weight gain or difficulty to lose weight, but there are lean women who have PCOS


There is no single test to diagnose PCOS. Medical history to know your symptoms and a proper medical examination plus ultrasound and some hormone level blood tests are used in combination to diagnose PCOS

How is it treated – Management

Lifestyle modifications are first line treatment and include the following:
A. Diet
B. Exercise
C. Weight loss


Oral Contraceptive agents
Antiandrogens (Spironolactone, finasteride)
Hypoglycemic agents (Metformine)
Clomiphene citrate if you wish for pregnancy

You and your doctor will work on a treatment plan based on your symptoms and needs. The treatment will depend on what the symptom are, for example in case of infertility, you need to stimulate ovulations.
For irregular periods you can use contraceptive pills or other hormones to regulate it.
If you want to loose weight, diet and exercise can not be stressed enough but addition of metformin and hormonal therapy may help.

In all cases, hypoglycemic diet and being active are very important factors in controlling PCOS symptoms.

Long term effect:

  • Insulin resistance can lead to diabetes and weight gain
  • Anovulation can cause cessation of menstruation and increase in the thickness of the endometrium which increase risk of endometrial cancer
  • Women with PCOS are at higher risk for high blood pressure, stiff and clogged arteries, high levels of heart-damaging LDL cholesterol and low levels of protective HDL
  • Anxiety, distress, depression and eating disorders are more common in women with PCOS