Show Notes
This is a free preview of a paid episode. To hear more, visit mskmag.substack.com
Are physiotherapy graduates ready for practice? If you’ve ever asked this question, you’re not alone. The quick answer? No. But they’re not meant to be. The longer answer? Well that starts in 1894… The Start of Physiotherapy Education [Image 1: Almeric Paget Military Massage Corps [8]] Four women drew a line. Stories in the national press were warning the public about ‘unscrupulous’ people offering massage as cover for something else entirely. They set up the Society of Trained Masseuses because the work deserved better. They established a curriculum and examinations. Standards mattered from the very beginning. What followed was a profession that proved itself through necessity. When World War I broke out in 1914, physiotherapists were quickly deployed to military hospitals. They went where the need was greatest. This community instinct, going where people are and working in the places where health matters, was not a policy position. It was simply what the profession did. Recognition followed practice: it always has. So, what does ‘being ready’ really mean for a profession that has always gone where people needed it, and found a different answer every time? Ownership In its earliest years, the physiotherapy classroom and clinic were never far apart. Learning happened close to the work, even without a formal structure. By 1955 that structure arrived in the form of a national syllabus for physiotherapy [1]. Every UK student physiotherapist followed this one pathway - a three-year curriculum taking place in schools attached to a hospital. After an initial six months of training, they spent 1,500 hours or more treating patients under the supervision of qualified physiotherapists, accounting for 10-30 contact hours a week. The final exams were entirely practical, and they assessed and treated patients in the hospital. Assessment papers were sent directly to the professional body to be moderated against a national standard. There was no gap between education and practice because the two had never been separated, everything taking place under one roof. [Image 2: 1955 CSP Syllabus [1]] Interestingly, the syllabus described the preparation of students as “a graduated process of education leading to admission to membership.“ Not admission to a qualification, but admission to a community. To qualify was to join. The professional body set the standards, ran the examinations, and held the membership. Regulation and professional identity were, in practice, the same thing.
More from MSKMag OutLoud
It always struck me as bizarre that sports medicine and musculoskeletal specialties deal with pain and dysfunction from head to toe in the human body, yet offer little health literacy or inclusion of the pelvic floor. Traditionally considered taboo and someone else’s remit, men and women with issues affecting the pelvic floor have largely suffered in silence. Thankfully, change is afoot, and healthcare is finally evolving. There is much more awareness, inclusion, and understanding of this unique body area and the role that it plays. For anyone playing catch up, the pelvic floor is a group of muscles spanning the base of the pelvic outlet in layers. While both men and women have a pelvic floor, the pelvic outlet is wider in females than in males and it also contains an extra orifice – the vagina [1]. That’s right, we went there. We said the ‘V’ word. Because just like vulva, or vestibule, the vagina is simply an anatomical term. It needn’t be embarrassing or taboo. Some of you will be long enough in the tooth to remember when the word ‘breast’ was taboo. However, with healthcare campaigns for breast cancer and breastfeeding, this term became an anatomical norm. We need to do the same for the pelvic floor and its related anatomy and physiology. What does the pelvic floor do? In both men and women, the pelvic floor serves to control the bladder and bowel (maintain continence), empty the bladder and bowel (voiding and defecation) and support sexual function (arousal and climax). In women, the pelvic floor also plays an important role in pelvic organ support. Remember that extra orifice I mentioned earlier…well this area is high risk for connective tissue laxity and defects meaning that the pelvic organs (bladder, uterus, rectum) can descend into the vaginal cavity causing symptoms of heaviness, pressure and a sensation of ‘something in the vagina’. What are the signs and symptoms of pelvic floor dysfunction? If the pelvic floor is not doing its job, any of its roles can become compromised. This may manifest in leaking from the bladder or bowel, inability to fully empty the bladder or bowel, pain ‘down there’, sexual dysfunction (compromised erection, dyspareunia, pain with climax) or heaviness and pressure in the vaginal region (for women) [2]. A full list of sex-specific signs and symptoms of pelvic floor dysfunction can be seen in Table 1. Table 1 - signs and symptoms of pelvic floor dysfunction in men and women Who gets pelvic floor dysfunction? Pelvic floor dysfunction can affect any man, woman or child, however it is particularly problematic for women, especially during transitional life events, such as pregnancy/childbirth and the menopause [1]. One in three women will experience pelvic floor dysfunction [3] and for those that engage in sport, the prevalence of symptoms varies according to the load demands of the activity. For example 61% of netballers leak urine [4], up to 43% of female rugby players leak [5], and 32% of gymnasts experience incontinence [6]. Structural changes associated with vaginal childbirth and aging, as well as lower levels of oestrogen to lubricate and bulk out the tissues can increase the odds of experiencing pelvic floor dysfunction. However, even young adolescent females can leak urine due to the load demands of their sport. For example, in athletics and gymnastics, stress urinary incontinence (the involuntary leakage of urine during activities involving high levels of intra-abdominal pressure) is commonly experienced. Yet no-one is doing anything about it. No one is screening. No one is signposting. No one is educating these younger athletes that pelvic floor symptoms are not to be expected and normalised. Or that they simply indicate that the sporting demands exceed the load capacity at the pelvic floor. If this was any other area of sports or MSK practice, would we settle for a load capacity that does not meet the demands of the sport?! Why is this relevant to every therapist, no matter their di
This is a free preview of a paid episode. To hear more, visit mskmag.substack.com
This is a free preview of a paid episode. To hear more, visit mskmag.substack.com
This is a free preview of a paid episode. To hear more, visit mskmag.substack.com
This is a free preview of a paid episode. To hear more, visit mskmag.substack.com