There are phases in life when everything seems to weigh a little heavier. The fatigue persists, concerns become recurrent, interpersonal relationships can become more difficult, or there simply arises the feeling that something is not right, even when it is not easy to identify exactly what it is.

It is not always easy to distinguish between emotional experiences that are part of life and situations that would benefit from more careful evaluation.

It is in this context that psychology can play an important role.

What is psychology?

Psychology is the science that studies psychological processes and human behavior, including how we think, feel, and act.

In clinical contexts, the psychologist uses scientific knowledge and methods of psychological assessment and intervention to help each person better understand what they are experiencing, identify patterns that repeat themselves, and develop more appropriate ways of dealing with different difficulties.

It is not about providing ready-made answers. It is about providing a space for reflection in which it is possible to think, feel, and understand one's own experience more clearly.

It is not necessary to be in crisis to seek psychological support

Many people postpone the first psychology consultation because they believe that what they feel “is not serious enough”.

Psychological support, however, is not intended only for situations of crisis or disruption. It can be sought in periods of change, doubt, or emotional strain, as well as when there is a desire to better understand certain personal patterns and promote greater self-knowledge.

Situations that may lead a person to seek psychological support include:

• persistent anxiety or worry;
• Prolonged sadness or a sense of hopelessness;
• Stress that persists over time and signs of exhaustion;
• difficulties in personal, family or love relationships;
• processes of loss, separation or other phases of transition;
• insecurity or low self-esteem;
• changes in sleep patterns or difficulties with concentration;
• questions related to personal or professional progress.

Not all psychological distress has the same expression.

Feeling anxiety, sadness, or frustration is part of the human experience and, by itself, does not necessarily mean the existence of a psychological disorder.

It is important to consider the intensity of the symptoms or discomfort, their duration, and how they interfere with daily functioning.

When the discomfort persists for several weeks, intensifies, or begins to affect important areas of life, such as work, rest, interpersonal relationships, or an interest in previously meaningful activities, it may be appropriate to seek psychological support.

What happens in a psychology consultation?

The first consultation is primarily a moment of evaluation and mutual knowledge. The goal is to understand the reason why the person sought support, the context in which difficulties arise, and what they expect from this process.

Based on this initial assessment, the follow-up is defined together, taking into account the needs, the pace and the goals of each person.

Throughout the sessions, psychotherapy can contribute to a better understanding of the sources of stress, to the identification and expression of emotional states that are not always easy to recognize, to the development of strategies for emotional regulation, and to the construction of more appropriate interpersonal boundaries.

Psychological changes do not necessarily occur immediately. Often, the process begins with the possibility of looking at experiences, thoughts, and patterns that are already part of a person's life in a different way.

Psychological support in different stages of life

Emotional and psychological difficulties do not manifest themselves in the same way in all ages or contexts.

In childhood and adolescence, they can manifest themselves through behavioral changes, difficulties in school performance, emotional changes, or challenges in relationships with others. In adulthood, they may be associated, among other factors, with the professional context, interpersonal relationships, family demands, or the different transitions that occur throughout life.

For this reason, psychological support can be directed to adults, children and adolescents, couples, families or groups, with an approach tailored to the characteristics and needs of each situation.

A safe space to think and understand

Seeking psychological support is not a sign of weakness, nor does it necessarily mean that there is something “wrong” with the person.

It may simply mean that the time has come to stop, better understand the source of the discomfort and explore what changes, greater or smaller, could contribute to a more balanced relationship with oneself and with daily life.

At Integrativa, in Restelo, Lisbon, adult psychology, child and adolescent psychology, personal and professional coaching, and career guidance constitute different areas of support within a space dedicated to reflection on psychological well-being, self-knowledge, and personal development.

Understanding psychology from an integrative perspective

Psychological support can take different forms and respond to different needs throughout life. Rather than identifying a specific moment when it is “necessary” to seek support, it is important to recognize when suffering or discomfort persists, interferes with daily life, or prompts a need to better understand what is happening.

Seeking a psychological assessment can, in this sense, constitute an opportunity to understand the individual experience in greater depth and identify paths of change suited to the needs of each person.

“I have sciatica” is a phrase that is heard frequently. The term is used in everyday life to describe almost any pain that travels from the lower back or hips to the leg. The problem is that “sciatic pain” is not a diagnosis: it is a description of a symptom. And many of the pains that people call sciatica actually have another origin.

Understanding the difference is essential because the treatment depends on the cause, and not just the location where the pain is felt.

What is the sciatic nerve?

The sciatic nerve is the largest nerve in the body. It is formed by the junction of nerve roots that exit from the lumbar spine and the sacrum (from L4 to S3), passes through the groin region, descends along the back of the thigh and splits, usually above the knee, into two branches that continue to the leg and foot.

What is sciatica pain?

Sciatic pain is pain that extends along the path of the sciatic nerve or one of the nerve roots that form it. In clinical terms, the most rigorous designation is lumbosacral radicular pain, because in the vast majority of cases the problem lies in the nerve root near the spine, and not in the nerve along the leg.

Typically, sciatic pain:

• It affects only one leg
• It descends below the knee, often to the foot, following a well-defined path.
• It is felt in the leg with the same or greater intensity than in the back
• It is described as a pain in a “shock,” a burn, or an “electric shock.”
• It may be accompanied by tingling, numbness, loss of strength or decreased reflexes

When these neurological signs are present, it is referred to as radiculopathy, meaning that the nerve root is not only irritated but also exhibits changes in its function.

What is the most common cause?

In about 90% of the cases, sciatic pain is associated with a lumbar disc herniation that affects a nerve root, mainly at the L4-L5 and L5-S1 levels (Koes et al., 2007). Other possible causes include narrowing of the channels through which the nerves pass (stenosis), degenerative changes in the spine, or, more rarely, the slipping of a vertebra (spondylolisthesis).

It is important to know that pain is not solely the result of mechanical compression. The material of the herniated disc also causes an inflammatory reaction around the nerve root, which plays an important role in the symptoms (Ropper & Zafonte, 2015). This helps to explain why the pain may improve even when the hernia remains visible on the scans.

Does a hernia always explain the pain during an examination?

No. Changes such as protrusions and herniated discs are very common in people without any pain, and their prevalence increases with age (Brinjikji et al., 2015). Therefore, an imaging examination only makes sense when it is interpreted in conjunction with the symptoms and clinical evaluation. Finding a herniation on magnetic resonance imaging does not, by itself, mean that it is the cause of the pain.

So, all the pain in the back of the leg is sciatica?

No. Several structures can cause pain in the groin and the back of the thigh without there being involvement of a nerve root. This is the so-called referred somatic pain, sometimes popularly referred to as “pseudocathartic”. Among the most frequent causes are:

• Lumbar spine joints (facetal joints)
• Sacroiliac joint
• Muscles of the gluteal region, Including the so-called deep gluteal syndrome, in which the sciatic nerve can be irritated during its passage through the groin
• Tendinopathy of the sciatic muscles, near the ischium (the bone where we sit)
• Pain in the lateral region of the hip, in the trochanter area
• Hip joint articulation, which can refer to pain in the groin and thigh

The referred somatic pain usually has characteristics different from sciatic pain: it is more diffuse, difficult to locate precisely, it usually occurs above the knee and is not accompanied by changes in sensitivity, strength or reflexes.

There are also other less frequent situations that can also cause leg pain and require medical attention, such as peripheral arterial disease, in which pain occurs when walking and eases when stopping due to lack of circulation, and rarer causes such as tumors, infections, or certain gynecological conditions.

How is sciatica pain different from other types of pain?

Through a careful clinical evaluation, which includes:

• A detailed conversation about the onset, course, type of pain, and factors that worsen or relieve it
• Tests of spinal mobility, hip mobility and sacroiliac joint mobility
• Neurodynamic tests, which assess the sensitivity of the nervous system to movement, such as the extended leg lift test (Lasègue test) or the slump test
• Evaluation of sensitivity, muscle strength and reflexes
• Specific tests for the other structures that can cause leg pain

In most cases, imaging tests are not necessary in the first few weeks. Magnetic resonance imaging is indicated primarily when there are warning signs or when symptoms do not improve with conservative treatment and another intervention is considered (NICE, 2020).

When should you seek urgent medical help?

Some situations require immediate medical evaluation:

• Numbness in the genital area, the buttocks or the inner thighs (“heel area”)
• Difficulty urinating, loss of control over urination or stool
• Cranial pain in both legs simultaneously
• Progressive loss of strength, such as difficulty lifting the tip of the foot
• Fever, unexplained weight loss or a history of cancer
• Pain after a fall or major trauma

The first three signs may indicate a syndrome of the equine tail, a rare condition that requires urgent treatment.

What is the usual evolution of sciatica pain?

In most people, the evolution is favorable. A large proportion improves significantly within the first weeks to months with conservative treatment (Koes et al., 2007). Even when there is a herniated disc, it is common for the size to decrease over time.

How is it treated?

Treatment should be directed towards the cause identified in the assessment and adjusted to each individual. According to current clinical recommendations (NICE, 2020), the initial approach includes:

Staying active

Prolonged rest in bed is not recommended. Maintaining daily activities adapted to the pain promotes recovery.

Therapeutic exercise

Guided and progressive exercise is one of the foundations of treatment, helping to restore mobility, strength, and confidence in movement.

Manual therapy

Manual therapy, performed within the framework of Physiotherapy or Osteopathy, can be used to relieve pain and improve mobility, always integrated into a plan that includes exercise.

Education

Understanding what is happening, that most cases progress favorably and that pain does not necessarily mean injury, reduces fear and helps the person resume their activities.

Medication

The decision about medication rests with the doctor. It is important to know that in sciatica pain, the effect of many analgesics and anti-inflammatory drugs is limited, and that some frequently used medications are not recommended by current clinical guidelines.

Other options

When the pain is intense and persistent despite conservative treatment, infiltration or surgery may be considered by medical indication. Surgery tends to relieve pain more quickly, but in the long term the results are similar to those of conservative treatment in most people (Peul et al., 2007). In the presence of severe or progressive neurological signs, surgical evaluation is a priority.

During pregnancy, is leg pain sciatica?

In most cases, no. True sciatica caused by a herniated disc is uncommon during pregnancy. The pain in the groin and the back of the thigh that many pregnant women experience is usually related to the pain in the pelvic girdle, which involves the joints of the pelvis. This distinction is important because the approach is different, and pelvic physiotherapy can play a relevant role here.

The approach in Integrative Medicine

Sciatic pain is a symptom, not a diagnosis. It indicates that a nerve root or the sciatic nerve are involved, but it does not say where or why. On the other hand, many pains in the groin and leg are not sciatica and have their origin in joints, muscles, or tendons. Only a careful evaluation allows us to distinguish these situations and define the appropriate treatment.

In other words: sciatica pain isn’t everything, and not everything is sciatica pain.

In Integrative Medicine, each case begins with a detailed clinical evaluation, which seeks to identify the source of the pain, detect warning signs, and understand the factors that may be contributing to the problem, such as sleep, stress, physical activity, and the life context, based on principles of Clinical Psychoneuroimmunology. The follow-up combines Osteopathy and Physiotherapy and, when indicated, can be combined with Clinical Pilates for progressive recovery and the prevention of relapses, and with the doctor whenever necessary.

If you experience pain in the lumbar region, the groin or the leg, an individualized assessment allows us to understand the source of your pain and define a plan tailored to your needs. Schedule your consultation at Integrativa.

Returning from vacation isn’t always easy. Fatigue, irritability, difficulty sleeping, disinterest, or anxiety can arise in the first few days of returning to routine. Most of the time, these are temporary. But sometimes they can also be a sign that there’s something about the relationship with work or the pace of life that deserves closer scrutiny.

Returning from vacation involves a sudden change in rhythm.

For a few days or weeks, there is usually more freedom to choose hours, to rest, to be with other people, to spend time away from home, or simply to do less. Then, almost simultaneously, the alarm clock, commitments, messages to be answered, meetings, travel, and the organization of family life return.

It is understandable that the body and mind need some time to adjust.

In the early days, some people experience increased fatigue, irritability, difficulty concentrating, changes in sleep patterns, decreased motivation, or a feeling of sadness associated with the end of the holidays. This experience is often referred to as the post-holiday syndrome, although it does not correspond to a formal clinical diagnosis.

A phase of transition

The discomfort that may arise upon returning to work does not necessarily mean that there is a psychological problem or that the person is dissatisfied with their profession.

Often, it is simply a response to change.

We have moved from a period of greater autonomy and less pressure to a daily routine structured by schedules, responsibilities, and demands. Even when we enjoy our work, this transition can require a few days of adaptation.

Among the most frequent signs may be:

• less energy;
• difficulty in resuming the usual rhythm;
• irritability;
• changes in sleep;
• anxiety;
• a sense of discouragement;
• less ability to concentrate;
• little willingness to return to usual tasks.

In most people, these sensations tend to decrease gradually as schedules, sleep, and routines return to normal.

Because it can be so difficult to return

The end of vacation doesn’t just mean returning to work. Often, it also means having to manage multiple demands at the same time.

There are tasks that have accumulated, decisions that have been postponed, emails that need to be answered, and projects that once again require your attention. At the same time, it is necessary to resume organizing the house, family schedules, the activities of the children, or returning to school.

Therefore, the impact can be particularly intense when several changes occur simultaneously.

There is also another important contrast: during vacations, many people manage to regain some rest, sleep better, or feel less pressure. When they return to their usual context, the stress factors that were temporarily removed are again present.

Holidays can help recharge energy. But they do not necessarily eliminate the conditions that cause stress throughout the year.

Not all discomfort is the same

Feeling little desire to return to work for a few days is not, in itself, a cause for concern.

The most important thing is to observe three aspects: how much it costs, for how long, and to what extent it interferes with everyday life.

It is different to feel some fatigue and disinterest during the first few days or to experience intense anxiety, persistent sadness, or significant changes in sleep for several weeks.

It also deserves attention when the discomfort begins to clearly affect professional performance, personal relationships, the ability to rest, or interest in activities that are usually important.

In these cases, it may be useful to determine whether we are simply dealing with a more difficult adaptation or whether there are other factors involved, such as prolonged stress, professional burnout, anxiety, or depressive symptoms.

Making the return more gradual

It is not always possible to choose how to return to work. Nevertheless, small decisions can make this change less demanding.

Create some days of transition.
When possible, returning from a trip before the last day of vacation allows you to reorganize the house, recover schedules, and prepare for the start of the week without having to do everything at once.

Regularize sleeping schedules again

If the schedules have changed significantly during the holidays, it may be helpful to gradually bring them closer to the usual routine in the days before returning.

Choosing priorities

The first day doesn't need to resolve everything that has accumulated. Identifying what is truly urgent helps to avoid the feeling that all tasks are of equal importance.

Avoid an overly busy schedule

Whenever there is room for it, leaving some space between meetings and commitments can facilitate the adjustment to the work rhythm.

Maintain habits that have worked well

Taking a walk, exercising, eating more calmly, spending time outdoors, or reserving moments without technology don’t have to disappear when the holidays end.

Having planned pleasant moments

Well-being should not be focused solely on the holiday period. Having enjoyable activities distributed throughout the week helps to avoid the feeling that you have to wait several months to get back to resting or enjoying the weather.

And when you return, does it always cost?

There are situations in which the difficulty of returning does not occur only for a few days.

If every year the end of the holidays causes a very intense discomfort, or if this feeling appears every Sunday, every morning, or whenever we think about work, it can be useful to look at the situation differently.

Perhaps the question should no longer be just “How do I get used to the routine again?” but also “What is it about this routine that is weighing on me?”.

The answer may lie in the workload, the professional environment, a lack of autonomy, relationships within the team, difficulty in setting boundaries, or the feeling that there is little space left for other important areas of life.

This does not always mean that it is necessary to change careers or make immediate decisions.

It could simply mean that it is worth understanding better where the discomfort comes from and realizing that changes, big or small, could make everyday life more sustainable.

When seeking support

If the symptoms persist for several weeks, if they become progressively more intense, or if they begin to significantly interfere with work, sleep, relationships, or daily activities, seeking psychological support may be helpful.

Psychological support can help identify sources of stress, understand recurring patterns, develop anxiety management strategies, and establish more realistic boundaries.

In some cases, it also allows exploring issues related to professional satisfaction, balance between different areas of life, or career decisions.

It’s not about eliminating all experiences of fatigue, frustration, or disengagement. They are part of life. It’s about realizing when they are temporary and when they indicate that something needs to change. Returning to routine doesn’t have to happen on autopilot.

In Integrative Psychology for Adults, personal and professional coaching and career guidance can help to better understand these transition phases and find more sustainable ways to cope with work, time, and the various demands of everyday life.

Posture influences a large part of the movements we perform throughout the day. Sitting, walking, lifting objects, working on a computer, or simply breathing are actions that depend on how the body organizes, coordinates, and controls movement.

For many years, the idea prevailed that there would be an ideal posture and that any deviation from that alignment could be directly related to the onset of pain. Currently, scientific evidence points to a more complex reality. There is no single correct posture that applies to all people, nor is there a simple and direct relationship between a particular body position and the presence of symptoms.

More important than maintaining a specific alignment is having the physical ability to adapt the posture to different tasks, vary positions, move the body efficiently, and adequately tolerate the demands of daily life.

It is in this context that Clinical Pilates can play an important role in Physiotherapy. Through individualized and guided exercise, it seeks to develop strength, mobility, motor control, balance, and body awareness, contributing to a more efficient physical function and, in some people, to better pain management.

What does it mean to have good posture?

The concept of posture has evolved significantly. Instead of seeking a body position considered universally perfect, the current approach values above all the ability of the body to adapt to the requirements of each activity.

A functional posture is one that allows you to perform everyday tasks comfortably and efficiently, with an adequate distribution of loads and the ability to change position whenever necessary.

Among the aspects associated with good postural control are:

• The ability to remain in different positions without significant pain or fatigue
• Proper coordination and muscle control
• Joint mobility compatible with the requirements of the activities performed
• Efficient distribution of loads throughout the body
• Stable enough to perform everyday tasks
• Ability to easily switch between different positions and movement patterns

In this sense, an idea often used in Physiotherapy is that the best posture can be the next one. Rather than trying to remain immobile in a position considered ideal, it is important to regularly vary the way the body organizes itself and moves.

What is Clinical Pilates?

Clinical Pilates is a therapeutic exercise modality based on the principles of the Pilates method and adapted to the context of Physiotherapy, according to the functional and clinical needs of each person.

Unlike a general Pilates class, this approach is usually preceded by an individual assessment. The physiotherapist analyzes factors such as mobility, strength, motor control, movement patterns, the presence of pain, functional limitations, and individual goals.

Based on this assessment, the exercises can be selected and progressively adapted to the person's condition and physical capabilities.

This individualization allows Clinical Pilates to be adapted to different ages, levels of physical condition, and functional contexts.

Clinical Pilates can be integrated in situations such as:

• Rehabilitation of musculoskeletal injuries
• Lumbar or cervical pain
• Changes in function and postural control
• Imbalances
• Functional recovery after surgery
• Injury prevention strategies
• Promoting physical capacity and quality of life

How can Clinical Pilates influence posture?

The goal of Clinical Pilates is not to correct a posture considered incorrect nor to force the body to maintain a certain position permanently.

The intervention primarily seeks to develop a stronger, more mobile body capable of controlling movement, increasing the ability to adapt to the different physical demands of everyday life.

It can contribute to better pain management

Posture alone rarely explains the presence of pain. The painful experience is complex and results from the interaction of multiple biological, psychological, and social factors.

This means that a certain body position should not be automatically interpreted as the cause of neck, lower back or other musculoskeletal complaints.

Nevertheless, improving strength, mobility, coordination, physical capacity, and confidence in movement can contribute to better tolerance of daily activities and a reduction in symptoms in some people.

Clinical Pilates can therefore be integrated into an individualized strategy when there is pain or functional limitations, always based on the evaluation performed by the physiotherapist.

Improves body awareness

Body awareness is one of the central principles of Clinical Pilates.

During the exercises, the physiotherapist guides the execution of the movements and provides information on positioning, breathing, control, and coordination. This process helps the person better recognize how they organize their body and identify different movement strategies.

Greater body awareness can facilitate the adaptation of posture to everyday tasks and allow for the recognition of less efficient movement patterns, modifying them when necessary.

The goal is not to constantly monitor the position of the body, but to develop greater ability to adjust movement according to the task, the context, and individual sensations.

Strengthens the muscles involved in stability

Postural control depends on the interaction between different muscle groups and the ability of the nervous system to coordinate them during movement.

Clinical Pilates works on several muscles involved in the stability and control of the trunk, spine, pelvis, and shoulder girdle. Among these are the transverse abdominus, the multifidus, the pelvic floor, the diaphragm, the glutes, and the stabilizing muscles of the shoulder blades.

Rather than strengthening a muscle in isolation, the goal is to improve the coordination between different muscle groups and their ability to respond to the demands of each task.

This work can favor greater dynamic stability and more efficient execution of movements.

Promotes mobility

Limited mobility in certain regions of the body can make some tasks difficult and lead to the use of compensatory strategies.

Clinical Pilates can include exercises aimed at promoting mobility of the thoracic spine, hips, shoulders, and chest, among other regions, according to the needs identified in the assessment.

When there is mobility that meets individual needs, it becomes easier to change positions, reach different ranges of motion, and perform daily activities with greater freedom.

However, mobility must be considered in conjunction with strength, control, and stability, since these components function in an integrated manner.

Develops motor control

Clinical Pilates is not limited to the development of muscle strength. One of its main components is the learning and improvement of movement control.

Motor control corresponds to the ability of the nervous system to organize and coordinate muscle activity in accordance with a specific task.

In practice, it involves using the available force in a coordinated manner, adjusting the muscle activation, the amplitude, the speed, and the direction of the movement to the needs of each situation.

This ability is relevant in everyday tasks such as walking, lifting objects, climbing stairs, carrying loads, or remaining seated for extended periods.

It can help improve balance

Balance results from the integration of information from different sensory systems with the ability to produce appropriate motor responses.

By challenging postural control and simultaneously working on strength, coordination, stability, and proprioception, Clinical Pilates can contribute to improving different components related to balance.

This work can take particular importance in older people or individuals with changes in motor control; the exercises should be adjusted to the functional capacity and the level of safety of each person.

Who can benefit from Clinical Pilates?

Because of the possibility of individualizing the exercises and their progression, Clinical Pilates can be suitable for people of different ages and levels of physical fitness.

It can be considered, among other contexts, for:

• People with lower or upper back pain
• People who remain seated for many hours during work
• People with difficulties related to mobility, strength, or postural control
• Older people who intend to work on balance and other factors related to the risk of falls
• Women in the postpartum period, when clinically indicated
• People recovering from injuries
• Athletes who intend to develop strength, mobility, motor control and physical fitness

The appropriateness of the exercises should depend on the individual assessment, the defined goals, and the functional evolution over the course of the follow-up.

How to maximize the benefits of Clinical Pilates?

Clinical Pilates should be framed within a globally active lifestyle. Its potential benefits can be complemented by behaviors that favor physical health and the body's ability to adapt.

Some relevant strategies include:

• Regularly vary your body position throughout the day
• Interrupt prolonged periods of sitting
• Practicing physical activity in a way that is regular and appropriate to individual ability
• Maintain consistent sleep habits and seek an adequate duration and quality of sleep
• Developing stress management strategies
• Complying with the exercise program set out in conjunction with the physiotherapist

Consistency is one of the factors relevant to adaptation to exercise. Progression should be gradual and adjusted to the individual response, avoiding both prolonged periods of inactivity and increases in load that are inappropriate for the person's capacity.

Understanding Clinical Pilates and posture from an integrative perspective

The available evidence supports the use of exercise as a relevant strategy to improve different components of physical function. In this context, Clinical Pilates can contribute to developing mobility, strength, motor control, stability, balance, and body awareness when the exercises are appropriately selected and individualized.

Regarding posture, the goal should not be to achieve a perfect body position or maintain rigid alignment permanently. A more modern approach focuses on the ability to vary positions, adapt movement to different tasks, and tolerate the loads inherent in daily activities.

Rather than merely modifying the appearance of the posture, it is important to develop a body capable of responding to the demands of everyday life with greater efficiency, comfort, and confidence in movement.

When guided by a physiotherapist and tailored to individual characteristics, Clinical Pilates can integrate an exercise-based approach aimed at promoting functional capacity, supporting pain management, improving movement quality, and fostering safer and more autonomous participation in daily activities.

There are women who, a few weeks after giving birth, start to feel comfortable in their bodies again. Others need more time. And others continue to experience changes months later, even when, apparently, “everything should be fine” by now.

The belly is different. The scar is bothersome. The back or pelvis hurts. The pelvic floor doesn’t seem to respond the same way. There are urine losses, a feeling of heaviness, or discomfort during sexual intercourse. Returning to exercise isn’t going as smoothly as you hoped. Or there’s just a difficult-to-explain feeling: the body still doesn’t really feel like your own.

Physiotherapy after childbirth can play an important role in this process. Not only when there is a specific symptom, but also to understand the changes that have occurred and to monitor the progressive return to movement.

Postpartum does not end when the puerperium ends

There is a very common idea that, after the first six weeks, the body should already be recovering.

But six weeks does not mean that all the body’s structures have recovered or that all women should feel like they did before pregnancy.

Pregnancy and childbirth cause significant changes in the body. The pelvic floor, the abdominal wall, the pelvis, the spine, the tissues, and the scars undergo different processes of adaptation and recovery.

And there is another change that is often forgotten.

After giving birth, the woman begins to carry, feed, bottle-feed, and care for a baby. She sleeps less, spends a lot of time in certain positions, holds the baby numerous times a day, and may stop moving in the usual way.

The body is not only recovering from childbirth; it is also adapting to a completely different life.

Not everything should simply be accepted as “postpartum normalcy”

It is true that some changes are common after pregnancy and childbirth. But just because they are common doesn't mean they need to be ignored.

Losing urine when coughing, running, or jumping, feeling a weight in the pelvic region, having persistent pain, feeling discomfort during sexual intercourse, or difficulty resuming certain activities are situations that deserve evaluation.

It doesn't necessarily mean that there is a serious problem. It just means that there is a symptom that deserves to be understood. You don't have to wait for the discomfort to be intense or to interfere too much with daily life to seek help.

The pelvic floor also needs to recover

During pregnancy and childbirth, the pelvic floor undergoes significant changes.

Then you need to get back to doing very different tasks: picking up the baby, holding it in your arms, walking, running, jumping, training, or simply standing for several hours.

Therefore, recovering the pelvic floor does not just mean having contractions.

It is important to understand how muscles contract, but also how they relax, how they coordinate with breathing and with the abdominal wall, and how they respond to the different demands of everyday life.

It is here that pelvic physiotherapy after childbirth can play an important role: in assessing the function of the pelvic floor, in restoring muscle coordination, and in gradually returning to the activities that are part of each woman’s life.

A good recovery isn’t just about contracting a muscle; it’s about using it in a way that’s appropriate to what the body needs.

And the abdominal diastasis?

Abdominal diastasis is one of the changes that most concern some women after pregnancy. But a diastasis is not just a matter of measuring how many centimeters there are between the abdominal rectus muscles. It is also important to understand how the abdominal wall works, how it generates pressure, and how it responds to movement and different loads.

Two women can have a similar distance between their muscles and experience completely different experiences. Therefore, assessing the functioning of the body is more important than looking at a number alone.

Physiotherapy can help assess the abdominal wall and guide the progression of movement and exercise according to the needs of each woman.

The scar is also part of the body

A cesarean scar, episiotomy scar, or a laceration is not just a mark on the skin. Depending on the case, there may be changes in sensitivity, tissue mobility, tension, or discomfort. The scar should be observed in the context of the entire body and not in isolation.

Similarly, a cesarean section does not mean that recovery should focus solely on the abdomen; just as a vaginal delivery does not mean that the focus should only be on the pelvic floor. The body functions as a whole.

Physiotherapy can integrate the assessment of the scar with the rest of the body's function, taking into account the symptoms and the activities that the woman intends to recover.

When sexual intercourse becomes uncomfortable

Pain or discomfort during sexual intercourse can also be part of the experience of some women after childbirth.

Changes in the tissues, dryness, scarring, muscle tension or fear of movement can contribute to this experience.

But that doesn't mean the woman has to get used to the pain.

When there is persistent discomfort, understanding what is contributing to it can be the first step in finding an appropriate way to address it.

Pelvic physiotherapy can be part of this evaluation, always integrated into the woman's individual history and needs.

Returning to exercise is also a recovery

After childbirth, there may be a desire to quickly regain strength or return to the exercise that was done before pregnancy. But recovery is not a race.

Exercise can be part of the postpartum period and is important for physical and mental health. However, progression should take into account each woman's history, the type of delivery, the present symptoms, the previous level of activity, and what you intend to resume doing.

There is no single moment when all women are ready to run, jump, do certain exercises, or return to the previous training routine.

There is a path between rest and a full return to activity, and this path can be different for each woman. Physiotherapy can help assess this path and define an appropriate progression, respecting the body's response.

When is it worth seeking evaluation?

It is not necessary to be “very ill” to seek help. Persistent pain, loss of urine or stool, a feeling of pelvic heaviness, discomfort during sexual intercourse, changes in the scar, difficulty resuming exercise, or simply the feeling that the body is not responding as it used to are valid reasons to seek evaluation.

The assessment can be done as part of postpartum physiotherapy, including, when indicated, a pelvic physiotherapy approach. And it is not necessary to wait for a serious problem to exist, but to understand what has changed and how the body can be helped to adapt again.

Recovery does not mean returning to the body of before

Perhaps this is one of the most important ideas. The goal of postpartum recovery doesn't need to be to recover the body that existed before pregnancy. That body went through a tremendous experience.

The goal may be another: to feel comfort, confidence, and security in one's own body again; to walk again without pain; to run again without losing urine; to be able to hold the baby without feeling pain in the back; to feel strength again; to resume exercise in a progressive way; to feel comfortable in sexual relations; to feel the scar as part of the body, without it determining what is possible to do. These are different goals for each woman.

Listening to the body does not mean being afraid of it

After becoming a mother, it’s easy to start interpreting every feeling as something that “went wrong”. But the body doesn’t need to be seen as a problem to be taken care of. It needs to be observed. Recognizing what has changed, what bothers you, what has improved, and what we still haven’t been able to do as we would like can be the first step towards a more conscious recovery.

Because postpartum is not just the period when the body recovers from childbirth. It is also the period when a woman learns to know her body again, this time after everything has changed.

And maybe the question isn’t “When will my body return to normal?” Maybe it’s “What is my body trying to tell me?”

Taking care of the body after becoming a mother is also giving space to that question.

In Integrative Medicine, postpartum physical therapy and pelvic physical therapy allow for the individualized assessment of the changes and symptoms that may arise after pregnancy and childbirth. The follow-up is tailored to the needs, goals, and pace of each woman, promoting a gradual and safe return to daily activities and exercise.

The start of the school year can bring excitement, but also nervousness, irritability, difficulties sleeping, or physical complaints. Not all of these signs are worrying. The important thing is to recognize when they are part of the adjustment process and when they start to significantly interfere with the child’s life.

September changes the rhythm of many families. Schedules return, mornings become more rushed, homework takes over, activities increase, and the need to reorganize days in accordance with school becomes more pressing.

For some children, this change is received with enthusiasm. For others, the first few days can be more difficult.

It is common for parents to have questions: will it be normal to be more irritable? And the stomach aches before leaving the house? And when does he start saying that he doesn’t want to go to school?

Most of the time, some discomfort is part of the adaptation process.

Not all anxiety is a problem

Starting a new school year means dealing with several changes at the same time.

Even when the school remains the same, teachers, classmates, classrooms, schedules, and what is expected of the child can change.

It is natural that there may be some apprehension.

And in children, anxiety does not always manifest itself in phrases like “I’m worried” or “I’m anxious”.

It can appear through the body and behavior: difficulty falling asleep, headaches, stomach aches, increased irritability, a need to be closer to parents, or resistance when leaving the house.

When these signs are mild and decrease as the days pass, they tend to be part of the adaptation to the new routine.

When you need to be more attentive

What is more important than an isolated behavior is to understand how it evolves.

There are three aspects that help distinguish a transient reaction from a difficulty that deserves greater attention: the intensity, the duration, and the interference with daily life.

A child may be more nervous during the first few days and still manage to go to school, play, sleep, and maintain their usual activities.

It is different when the fear increases, lasts for several weeks, or begins to limit what the child can do.

Systematically refusing to go to school, sleeping poorly for a long time, withdrawing from friends, presenting frequent physical complaints, or living with great distress in the mornings are signs that deserve to be understood with greater attention.

The way adults respond also matters

In the face of a child's anxiety, it is natural for parents to want to reassure her immediately.

But helping does not always mean removing the discomfort.

Often, the most important thing is to show willingness to listen and to help the child put into words what they are feeling.

Simple questions can make this conversation easier: “How was your day?”, “Which was easier?”, “Was there anything you didn’t like?”

The child won't always respond right away. And that's okay.

Rather than insisting, it’s important to create an environment where you know you can talk when you need to.

It is also useful to remember that returning to school doesn’t just affect children. Adults can also feel more pressure at this time.

There are schedules to coordinate, travel arrangements, activities, work, and many practical decisions that need to be made at the same time.

The children perceive this tension.

Therefore, the way adults deal with their own concerns can influence the way they live theirs.

It is possible to recognize some uncertainty without turning it into a threat: “We are also getting used to this new routine. We will gradually figure out how it works best.”

This availability helps the child to feel that they don't need to have everything resolved right from the very first days.

Having some predictability helps

When there are many changes, knowing what will happen next can bring security.

Relatively stable schedules for waking up, eating, doing homework, playing, and sleeping help to organize the day and reduce the feeling of unpredictability.

This does not mean creating a rigid routine.

A useful routine is one that provides references, but still allows for adjustments when the day doesn’t go exactly as planned.

Whenever possible, it can be positive to involve the child in this organization. Choosing the clothes the night before, preparing the backpack, or arranging for some of the daily activities in advance are small ways to give them greater participation and autonomy.

Cell phones: it's not just a matter of screen time

The presence of mobile phones in the lives of children and teenagers has also become an important issue in the school context.

Limiting the use of these devices during the school day can help create more space for other experiences that are part of growth.

Leisure time, for example, is not just a break between classes.

It is a time to talk, play, move around, resolve small conflicts, observe others, and learn how to be in a group.

When much of this time is spent on the phone, other experiences may end up falling by the wayside.

The issue does not therefore lie in treating technology as something negative. It lies in helping children and adolescents learn when it makes sense to use it and when it is important to turn it off.

This process does not depend solely on the school's rules.

It is also built at home, through consistent boundaries, by example from adults and opportunities to be screen-free without it being seen as a punishment.

Learning to tolerate some inconvenience, waiting, talking without interruptions, or choosing another activity are also skills that can be trained.

When to seek psychological support

When anxiety persists, increases, or begins to clearly limit the child's life, it may be important to seek help.

The first question is not just “how to end anxiety?”, but understanding what is causing it.

The same phrase “I don’t want to go to school” It can have very different meanings.

There may be a fear of being away from parents, difficulties in learning, conflicts with peers, fear of failure, problems with integration, or simply a greater need for time to adjust.

Understanding the context makes a difference, because different causes require different forms of intervention.

In psychological follow-up, skills such as recognizing emotions, identifying what increases anxiety, finding ways to cope with more frightening thoughts, solving problems, and gradually facing situations that had begun to be avoided, can be worked on.

The way of working should always be adjusted to the age, personality and needs of each child.

The parents are part of the process

When a child is anxious, involving the family is often an important part of the follow-up.

What happens outside the consultation has significant weight.

Small changes in the way adults respond to fear, insecurity, or avoidance can help the child gain confidence and autonomy.

It's not always easy to find the balance between protecting and letting them experiment.

Sometimes, helping too much can unintentionally convey the idea that the child is unable to handle a given situation. On the other hand, pushing too hard can further increase anxiety.

The goal is to monitor without doing everything for the child and to support without turning every difficulty into a sign of alarm.

When necessary, it can also be useful to have communication between the family, the school, and the professionals who are accompanying the child, always respecting confidentiality.

The goal is not to eliminate anxiety

Anxiety, fear, and frustration are part of development.

Therefore, the goal is not to prevent a child from feeling these emotions again.

It is helping her to understand what she is feeling, to discover ways to cope with that discomfort, and to realize that she can continue to move forward even when some anxiety is present.

It is this experience, repeated over time, that helps build confidence.

If returning to school is proving particularly difficult and anxiety starts to interfere with the well-being of the child or family, seeking support can help understand what is behind this discomfort. In Integrative Psychotherapy, psychological support for children, adolescents, and adults is based on the history, needs, and context of each person.

Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by pain, stiffness, and a progressive loss of shoulder mobility. Simple activities such as putting on a sweater, combing your hair, putting on your seatbelt, or reaching for an object on a shelf can become difficult and painful.

Although in many cases there is a progressive recovery over time, the evolution varies from person to person. The pain can be intense, the stiffness persists for several months and some functional limitations may persist.

Physiotherapy can play a relevant role in recovery through education, therapeutic exercise, progressive recovery of mobility and resumption of daily activities. The intervention should be adapted to the intensity of the pain, the available mobility, the stage of the evolution and the goals of each person.

What is frozen shoulder or adhesive capsulitis?

Frozen shoulder is characterized by pain, stiffness, and progressive limitation of shoulder movements, both in movements performed by the person themselves and in certain movements passively assessed by a healthcare professional.

The shoulder joint is surrounded by a joint capsule that contributes to stability and movement. In adhesive capsulitis, inflammatory and fibrous changes occur in this structure, which can become thicker and more contracted. These changes contribute to pain and reduced mobility.

One of the most important clinical features is the limitation of external rotation of the shoulder. Other movements, such as raising the arm or placing the hand behind the back, can also be compromised.

The diagnosis is predominantly clinical. Evaluation of symptoms, active and passive mobility, and other possible causes of shoulder pain is fundamental. Imaging tests are not always necessary, although they can be used when there are doubts about the diagnosis or suspicion of another condition.

What are the symptoms of frozen shoulder?

Symptoms can arise gradually and vary over time. The most common include:

• Shoulder pain
• Pain during the night, with possible interference with sleep
• Progressive stiffness
• Difficulty in raising the arm
• Difficulty reaching objects above the head
• Difficulty putting the hand behind the back
• Difficulty in putting on or taking off clothes
• Restrictions while driving
• Decreased ability to perform professional, domestic or sporting tasks

As mobility decreases, some people also begin to use their affected arm less. This reduction can contribute to a loss of strength, a decreased confidence in movement, and greater difficulty in resuming usual activities.

What are the stages of frozen shoulder?

Adhesive capsulitis can present different characteristics throughout its course. It is often described through three clinical phases.

Painful phase

Pain tends to be the predominant symptom and can increase progressively. Mobility also begins to decrease.

At this stage, the goal should not be to force the shoulder to recover its full range of motion quickly. The priority is to manage the symptoms, maintain tolerated movement, and avoid loads that would cause a significant worsening of the pain.

Stiffness phase

The pain may become less predominant, while mobility limitation takes on greater importance.

It may be possible to gradually increase the amount of mobility work, taking into account the more limited movements, the response to exercises, and the activities that the person intends to resume.

Recovery phase

Mobility and tolerance of movement begin to gradually improve.

Rehabilitation can progress to strengthening exercises, functional tasks, and more demanding activities, seeking to recover not only the range of motion, but also the ability to use the arm in daily, professional, and sporting activities.

What is the role of physiotherapy in frozen shoulder?

Physiotherapy can contribute to the management of symptoms and the functional recovery of the frozen shoulder.

The main goals may include managing pain, maintaining or recovering progressive mobility, improving arm function, restoring strength, increasing confidence in movement, and resuming activities.

The available evidence supports the inclusion of therapeutic exercise in this approach. However, the intensity, frequency, duration, and progression of the exercises must be adjusted to the clinical situation and the stage of development of each person.

How can physiotherapy help with the recovery of the frozen shoulder?

Education and management of pain

Understanding what is happening in the shoulder is an important part of rehabilitation.

During the evaluation, the physiotherapist can explain the usual progression of the condition, identify movements and activities associated with worsening symptoms, and help find ways to continue using the arm within tolerable levels.

Managing pain is particularly important in the early stages. When pain is severe, there may be a tendency to avoid certain movements. Although this response is understandable, excessive reduction in arm use can contribute to greater loss of function.

Therapeutic exercise

Therapeutic exercise is a central component of physiotherapy, but it must be adapted to the individual’s clinical situation.

The exercise program should consider:

• The level of pain
• The available mobility
• The phase of evolution of the condition
• The presence of other injuries or health problems
• The functional capabilities
• The individual goals

This individualization allows the selection and progression of exercises to be adjusted to each person's response.

Progressive recovery of mobility

Loss of mobility is one of the most noticeable characteristics of frozen shoulder. It can affect movements such as raising the arm, reaching for objects above the head, or putting the hand behind the back.

Physiotherapy can seek to progressively restore range of motion through specific mobility exercises and, when clinically appropriate, manual therapy techniques.

The intensity and progression should respect individual tolerance. The goal is not to force a rapid recovery of all mobility, but to promote a progressive evolution that is appropriate to the shoulder response.

Recovery of strength and muscle capacity

When the shoulder remains painful and limited for some time, there is often a reduction in arm use.

As pain and mobility improve, progressive strengthening exercises can be introduced, according to the functional needs of each person.

The goal is to improve the shoulder's ability to respond to the demands of everyday life, whether at work, driving, household chores, physical exercise, or sports.

Resume of daily activities

Functional recovery is a central component of physiotherapy in frozen shoulder.

Improving range of motion is important, but it must translate into greater ability to perform activities such as:

• Getting dressed
• Comb or wash your hair
• Reach for objects
• Working with fewer limitations
• Drive
• Performing household tasks
• Practicing physical activity
• Sleeping more comfortably

Rehabilitation should gradually move towards activities that are relevant to each person.

Is it necessary to feel pain during frozen shoulder physiotherapy?

It is not necessary to cause intense pain for physiotherapy to be adequate and effective; on the contrary. Some exercises or mobilization techniques can cause some discomfort, especially when there is significant limitation of mobility. However, greater pain intensity does not necessarily mean a better clinical response.

Excessive load can worsen symptoms and make it more difficult to participate in the rehabilitation program. For this reason, the intensity of the exercises should be adjusted according to the individual response.

It is important to consider what happens during the exercise, but also the way in which the symptoms evolve in the following hours and the day after.

When should you seek professional evaluation for shoulder pain and stiffness?

Not all shoulder pain is due to adhesive capsulitis. Pain and stiffness can be related to different conditions, including changes in the rotator cuff, osteoarthritis, traumatic injuries, or other musculoskeletal problems.

It is advisable to seek professional evaluation when:

• The pain persists or worsens
• There is a progressive loss of mobility
• Pain interferes with sleep
• There are difficulties in everyday activities
• The symptoms appeared after a trauma
• There is weakness or significant loss of function

Appropriate clinical evaluation allows for the determination of whether the condition is compatible with adhesive capsulitis and the appropriate approach is determined based on the characteristics of each individual.

Understanding the frozen shoulder from an integrative perspective

Frozen shoulder can significantly interfere with activities that were previously performed without difficulty.

Recovery tends to be gradual and not always linear. Physiotherapy can contribute to managing symptoms, to the progressive recovery of mobility and strength, and to resuming important daily activities.

The available scientific evidence supports a personalized approach, with particular relevance to therapeutic exercise and functional recovery, and may include other strategies when appropriate.

It is also important to recognize that the evidence has limitations and that there is no single protocol or dose of exercise that is appropriate for all people.

The combination of clinical assessment, education, therapeutic exercise and other appropriate interventions can enable the development of a rehabilitation plan tailored to the needs, capabilities and goals of each individual.

In the presence of persistent pain and stiffness in the shoulder, evaluation by a physiotherapist or other healthcare professional can help clarify the source of the symptoms and guide the recovery process.

In Integrative Medicine, clinical assessment seeks to understand the origin, behavior, and functional impact of symptoms, allowing for the development of a physiotherapy plan tailored to the individual’s condition, abilities, and goals.

Bell's palsy often appears unexpectedly. Within a few hours, the smile can become asymmetrical, the eye may fail to close completely, and simple everyday movements become more difficult.

In the early days, many questions arise: Will I recover? Should I exercise? Can I massage my face? Is there anything I should avoid?

These are some of the questions that come up most often during the sessions.

What is Bell's Palsy?

It is a peripheral facial paralysis of sudden onset, usually on one side of the face.

The facial nerve is compromised, reducing or preventing the movement of the muscles of facial expression.

What should I do when it appears?

Seek medical evaluation as soon as possible.

It is important to confirm the diagnosis and rule out other causes of facial paralysis. When indicated, treatment with corticosteroids should ideally be started within the first 72 hours after the onset of symptoms.

My eye won't close. What should I do?

Eye protection is a priority.

When the eye does not close completely, the cornea is more exposed and must be protected according to medical or ophthalmological advice.

If pain, significant redness or a change in vision occurs, you should seek medical evaluation.

Will I recover?

In most cases, the outlook is favourable.

However, the recovery time varies from person to person and depends on the degree of facial nerve involvement.

The first movements may appear in the first few weeks, but not always. Some people recover earlier and in others the process takes longer.

Should I start exercising right away?

Not necessarily.

If there is still no movement, making faces, trying to smile repeatedly or shutting the eye tightly will not make the nerve recover any faster.

So the face doesn't need to be strengthened?

Not in the way it is often thought.

In the acute phase, the problem is not simply a lack of muscle strength, but an alteration in facial nerve function.

Therefore, the approach should not be based on forcing it or increasing the number of repetitions, but rather on respecting the recovery phase and, at the appropriate time, introducing facial neuromuscular re-education.

What is facial neuromuscular retraining?

It is one of the foundations of physiotherapy specialised in facial palsy.

It seeks to recover selective, coordinated and functional movements, respecting what the nerve is already able to do at each stage.

When the first movements appear, we work on their precision and control, rather than simply looking for larger or stronger movements.

Current scientific evidence supports an individualised approach, centred on movement quality and neuromuscular re-education.

Does this mean doing lots of exercise at home?

No.

In neuromuscular re-education, the quality of movement is more important than the quantity of repetitions.

Generic facial mime exercises, repeated grimaces or forcefully executed movements, without guidance, are not recommended.

Forcing a movement that does not yet happen does not accelerate nerve recovery.

Should I chew chewing gum? And blow up balloons or blow through a straw?

No.

Chewing gum primarily works the chewing muscles and does not constitute a specific workout for the muscles of facial expression.

Inflating balloons or blowing through a straw are also not recommended as generic facial recovery exercises.

The goal is not to make the muscles work harder, but to recover proper and coordinated movements.

Can I massage my face?

There may be an indication for manual therapy, but not with the aim of “waking up” the nerve.

The technique and intensity must be adapted to what is observed in the first session assessment.

What about electrostimulation?

Electrostimulation is not recommended in the rehabilitation of facial palsy.

The most recent international consensus among facial palsy rehabilitation specialists excludes electrical stimulation from the recommended modalities, including in the flaccid phase.

Triggering a muscle contraction via an electrical current does not mean improving nerve recovery. The approach should favour individual assessment and, when movement is present, facial neuromuscular re-education.

What then is the role of physiotherapy in the acute phase?

At this stage, physiotherapy does not consist of handing over a list of exercises.

During the sessions we evaluate facial function, eye closure, tissue mobility and movement evolution.

From there, we advise on what should be done at home, what should be avoided and the most appropriate care for that phase.

When the first movements appear, neuromuscular re-education is introduced and adapted to the evolution of the face, focusing on the quality and selectivity of movement.

Is it normal not to notice improvements every day?

Yes, facial nerve recovery does not happen in a linear way. There may be periods with very few visible changes and others when small progress begins to appear.

Therefore, it is not necessary to constantly check your face in the mirror.

After all, what should I avoid during the acute phase?

Avoid forcing movements, making grimaces repeatedly, performing dozens of repetitions, using chewing gum or balloons as “facial exercise” and starting techniques or devices on your own initiative.

The current approach favours an individualised intervention, adapted to the stage of recovery and focused on movement quality, rather than generic facial strengthening programmes.

In the acute phase of Bell's palsy, the most important thing is not to do more, but to do what is appropriate for each stage of recovery.

Early medical assessment, eye protection when necessary and specialist follow-up make it possible to guide the evolution of facial function and avoid strategies that bring no benefit.

As movement begins to emerge, the approach should be adjusted, focusing on quality, control and coordination of movement.

If you have doubts about the progression of your facial palsy or do not know what you should do at this stage, a specialist assessment can help you understand what stage of recovery you are at and which care measures are most appropriate.

Digestive health has a significant impact on well-being and quality of life. Symptoms such as abdominal bloating, reflux, constipation, diarrhoea or discomfort after meals can interfere with your daily routine and, in some cases, be associated with specific conditions of the digestive system.

Diet can play an important role in the management of these symptoms. However, there is no single dietary strategy that suits everyone. Nutritional support should be based on an individual assessment, taking into account each person's clinical condition, symptoms, dietary habits, lifestyle and needs.

In Integrativa, this is the basis of Nutrition consultation dedicated to digestive health.

In which situations can nutritional counselling be useful?

The Nutrition consultation can integrate the approach to various gastrointestinal symptoms and conditions, including:

• irritable bowel syndrome (IBS); 
• SIBO; 
• gastro-oesophageal reflux; 
• gastritis; 
• constipation; 
• diarrhoea; 
• bloating and abdominal distension; 
• intolerances and digestive difficulties; 
• malabsorption syndromes; 
• inflammatory bowel diseases; 
• diverticulosis; 
• hepatic, pancreatic or biliary tract disorders. 

Each of these situations presents different characteristics. Even among people with the same diagnosis, symptoms, food tolerances and nutritional needs can vary considerably.

For this reason, nutritional intervention must always be tailored to each case.

Much more than removing food

When digestive symptoms are present, the idea that it will be necessary to eliminate various foods from the diet often arises. But an appropriate nutritional approach should not automatically start with restriction.

Before any changes, it is important to realise what is happening, what the symptoms are, when they appear and how they relate to the person's diet and routine.

In some cases, it may be necessary to temporarily adjust certain foods or food groups. In others, the focus may be on the quantity, frequency, preparation of the food, distribution of meals or the overall balance of the diet.

Whenever a restriction is deemed necessary, there must be a clear reason for its use and an appropriate strategy to avoid unnecessary nutritional limitations.

The aim is not to make eating progressively more restrictive, but to find a way of eating that is simultaneously nutritionally adequate, well tolerated and sustainable in daily life.

A consultation tailored to each person's reality

During the initial consultation, a detailed assessment of the individual context is carried out. In addition to dietary habits, digestive symptoms, health history, existing diagnosis, medication or supplementation, routine, preferences and goals are all taken into account.

Previous examinations and tests may also be important for a better understanding of the clinical context.

An individualised nutritional strategy is defined from this assessment.

This means that two people with similar symptoms do not necessarily receive the same recommendations. Diet must be adjusted not only to the clinical condition, but also to what each person can realistically apply in their life.

Digestive health and irritable bowel syndrome

A irritable bowel syndrome, for example, can present in very different ways. Some people predominantly have constipation, others diarrhoea, and others alternate between the two. Bloating, gas and abdominal pain are also frequent.

In these cases, a detailed dietary assessment makes it possible to identify potential patterns and establish a strategy appropriate to the symptoms.

Depending on the situation, aspects such as fibre intake, hydration, meal distribution, tolerance to certain foods, or other specific nutritional interventions can be addressed.

More restrictive dietary protocols, when indicated, should be used judiciously and with supervision, avoiding prolonged eliminations without necessity.

And in the case of SIBO?

O SIBO — Small Intestinal Bacterial Overgrowth, or small intestinal bacterial overgrowth, is another situation where questions related to diet frequently arise.

Bloating, gas, changes in bowel habits and abdominal discomfort may be present, but these symptoms can also occur in other digestive conditions.

Therefore, it is not advisable to start highly restrictive diets based on symptoms alone. Medical evaluation and diagnosis, when necessary, should accompany the nutritional intervention.

The role of nutrition is to adapt the diet to the individual situation, seeking to improve digestive tolerance while simultaneously ensuring an adequate nutritional intake.

Reflux and gastritis: the diet must also be personalised

In gastro-oesophageal reflux and gastritis, it is common to find long lists of foods considered “forbidden”. In practice, not everyone reacts to the same foods in the same way.

Beyond food choices, factors such as meal sizes, timing, consuming certain foods together, and habits related to meals can influence symptoms.

Once again, the strategy must start from individual experience and symptomatology rather than imposing generalised restrictions.

Specialist digestive health care at Integrativa

At Integrativa, consultations Nutrition are carried out by Nutritionist Joana André, whose training includes MSc in Nutrition and Digestive Diseases, by the ICNS – Institute of Nutrition and Health Science.

The monitoring is based on an individualised approach to nutrition, seeking to understand not only the symptoms, but also the person, their habits and their reality.

The goal is to build balanced and sustainable dietary strategies, suited to the clinical condition and nutritional needs of each person.

When there is a diagnosed gastrointestinal disease or symptoms that require investigation, nutritional support must complement rather than replace medical evaluation and guidance.

A diet appropriate for your condition

Living with digestive symptoms doesn't necessarily mean living on a diet full of restrictions.

A careful nutritional assessment can help to understand which changes really make sense and to build a more comfortable, balanced diet suited to each person's needs.

At Integrativa, you can book an in-person or online Nutrition consultation and undergo an individualised assessment of your digestive health.

The squat is one of the most fundamental movement patterns in strength training and human movement. It is present in sports training, rehabilitation, physiotherapy and exercise programmes aimed at the general public. Despite its widespread use, it continues to be associated with various myths, fears and misinterpretations regarding how it should be performed.

Understanding the role of the squat, its potential benefits and the principles guiding proper execution allows this exercise to be integrated more safely and tailored to each person's characteristics.

What is the squat?

The squat is a functional movement pattern, that is, a movement with correspondence in various everyday activities. Sitting down and standing up from a chair, lowering the body to pick up an object from the floor or carrying out certain tasks that require flexion of the lower limbs are examples of movements that share biomechanical components with the squat.

From a physical and functional standpoint, the squat requires the interaction of muscular strength, joint mobility, stability and neuromuscular control. During the movement, there is a coordinated action of the hip, knee and ankle joints, together with the musculature responsible for controlling the trunk and the lumbopelvic region.

Because it simultaneously involves multiple muscle groups and joints, the squat is a relevant exercise for the development of strength and functional capacity.

Main benefits of the squat

Strength training

The squat recruits several muscle groups of the lower limbs and trunk, with particular involvement of the glutes and quadriceps, accompanied by the action of the hamstrings and the trunk-stabilising muscles.

When performed with appropriate load and progression, it can contribute to the development of strength, muscular endurance, and the ability to produce force in functional movements.

Joint mobility improvement

Performing the squat through a range of motion appropriate to individual characteristics can help to maintain or develop the functional mobility of the hips, knees and ankles.

The range achieved depends on various factors, including individual anatomy, joint mobility, motor control, training experience and the squat variant used.

Improvement of physical performance

Strength development through squatting can transfer to different physical capacities, particularly when integrated into a properly structured training programme.

This adaptation may be relevant in actions such as jumping, running, accelerating, decelerating and changing direction, although the results depend on the specificity of the training, individual level and the demands of the sport practised.

Stability, balance and motor control

The controlled execution of the squat requires coordination between the trunk and lower limbs, contributing to the development of stability and movement control.

In older people, lower limb strength exercises can be part of programmes aimed at maintaining functional capacity and reducing the risk of falls, especially when combined with specific balance, mobility and coordination exercises.

Increased energy expenditure

Because it involves a significant amount of muscle mass, the squat can represent a relevant stimulus from an energetic standpoint, particularly when performed in sets with appropriate volume and intensity.

However, the reduction of fat mass does not depend on an isolated exercise. Body composition results from the interaction between diet, overall physical activity level, training, sleep, metabolic factors and energy balance over time.

Bone health and tissue adaptation

Progressive overload resistance training constitutes a relevant mechanical stimulus for bone tissue. When integrated regularly into an appropriate programme, it can contribute to the maintenance or improvement of bone mineral density, depending on factors such as age, health status, exercise intensity and training history.

Tendons and other tissues involved in movement also exhibit the capacity to adapt to progressive mechanical load. This adaptation must be built up over time, respecting individual capacity and avoiding abrupt increases in demand.

Day-to-day functionality

Training the squat pattern can help improve the ability to carry out everyday tasks that require lower limb strength and control, such as sitting down, standing up, or performing downward and upward body movements.

The maintenance of these capabilities assumes particular importance throughout ageing, since lower limb strength is directly related to autonomy and functional independence.

Squat technique: fundamental principles

There is no single squat technique suitable for everyone. Execution must be adapted to individual anatomy, available mobility, exercise goals, training experience and the possible presence of pain or functional limitations.

Nevertheless, there are general principles that can guide a controlled and efficient execution.

Starting position

• Place your feet approximately shoulder-width apart or slightly wider, depending on individual comfort
• Point your toes slightly outwards when this position facilitates the natural movement of your hips and knees
• Keep the torso aligned and the spine in a stable and comfortable position
• Keep the head aligned with the torso and the gaze in a natural position

2. Start of the movement

• Initiate a coordinated flexion of the hips, knees and ankles
• Allow the pelvis to move downwards and slightly backwards, depending on the variant used and individual anatomy
• Activate the core musculature to provide stability during movement
• Allow a moderate forward lean of the trunk when necessary, maintaining spine control

Trunk inclination should not be considered, in itself, a technical error. Its degree varies depending on body proportions, mobility, the position of the load and the type of squat performed.

3. During the movement

• Keep your knees aligned with the direction of your feet
• Maintaining a stable foot support, avoiding the involuntary elevation of the heels
• Control the speed of movement and avoid abrupt changes in alignment
• Distribute the pressure evenly across the foot throughout the descent and ascent

The exact position of the knees relative to the toes can vary. In many people, it is normal for the knees to move past the toes during a deep squat, provided there is sufficient mobility, control of the movement and an absence of relevant symptoms.

4. Range of motion

• Descend to the depth where control, stability and comfort can be maintained
• Use, when appropriate, ranges of motion close to or below the position where the thighs are parallel to the floor
• Tailor the depth to individual mobility, anatomy, experience and goals

Squat depth should not be imposed universally. Greater range of motion is not necessarily better if it compromises movement control or provokes symptoms.

5. Upload

• Apply force against the floor while maintaining stable foot support
• Maintain control of the torso throughout the ascent
• Coordinate the extension of the hips and knees
• Return to the starting position in a controlled manner, avoiding excessive extension of the lower back at the end of the movement

Respiration

For light or moderate resistance exercises, a common strategy is to inhale before or during the descent and exhale progressively during the ascent.

With heavier loads, breathing and trunk stabilisation strategies may differ. In these contexts, the technique must be adapted to the level of experience and the demands of the exercise.

Common squat mistakes and how to avoid them

Some technical changes may arise during the squat. Their relevance should be interpreted according to the context, as minor movement variations do not always represent a problem.

Loss of control of the spine or trunk

A marked and uncontrolled change in trunk position, particularly when associated with high loads, can increase the mechanical demand on certain structures.

Forward trunk lean, on the other hand, is part of many squat variants and should not automatically be considered incorrect.

Knees turning in excessively

A slight inward collapse of the knees can occur naturally during some phases of movement. However, a pronounced and uncontrolled movement may indicate difficulties with lower limb strength, coordination or control.

In these cases, it may be useful to adjust the load, amplitude or exercise variant.

Excessive load without technical expertise

Increasing the load before there is adequate movement control can compromise execution quality and unnecessarily increase the demand on muscles, joints and other tissues.

The progression of the load must keep pace with the development of strength, technical capacity and individual tolerance.

Involuntary heel elevation

Raising the heels during a squat may be related to limitations in ankle mobility, anatomical characteristics, foot position or execution technique.

The case must be assessed individually before assuming there is only one mobility limitation.

To force a depth greater than individual capacity

Depth should be determined by the ability to maintain control, stability and comfort. Forcing ranges of motion that exceed available mobility can alter movement mechanics and increase the load on certain structures.

The range of motion can be increased gradually where clinically indicated.

Understanding the squat from an integrative perspective

The squat is a movement pattern relevant to strength, mobility and physical function. When properly selected, adapted and performed, it can be integrated into exercise programmes aimed at improving physical capacity, performance and functional independence.

It should not be considered an inherently dangerous movement, nor is there a single way to perform it correctly for everyone. The technique must respect anatomy, mobility, goals, experience and individual response to the exercise.

The gradual progression of load and range of motion, combined with movement control, is particularly important for a safe and sustainable practice. In the presence of persistent pain, significant mobility limitations, a history of injury, or doubts regarding execution, an assessment by a properly qualified health or exercise professional can help to adapt the squat to individual needs.