Show Notes
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Happy New Football Season to all who celebrate! And godspeed to all my fellow Newcastle United fans. For those of you fortunate enough to not have endured the comings and goings and goings and goings of the Newcastle squad this summer, let me give you a brief overview. Following a few seasons of success featuring our first domestic trophy since 1955 and two qualifications to the Champions’ League, we had a pretty terrible season ending in May 2026. I’m not even going to relive it; just know that sleep, points and a certain amount of pride were lost. With the appointment of a new manager, a handful of new players and the designation of a new captain, this has been a summer described by many as one of transition. Let me report to you live from deep inside the cocoon on the eve of the Premier League season that it feels more like a summer of metamorphosis. We just don’t know if what will emerge is a stunning butterfly or a terrifying, lopsided moth, destined to fly in chaotic circles until it dies. My fear as a Newcastle fan of 25 years is not that we will be bad this season. Even last season pales into insignificance when compared to the time I moved back to the city from university only to find us relegated, or the time I got up in the middle of the night in New Zealand to watch games a few years later, only to watch us be relegated again. My dad will tell you these in turn are small fry compared to the torrid pre-Keegan years. Time, anxiety disorders and Newcastle United have each taught me a great deal about accepting the things I cannot control, and the performance of eleven men and the decisions made about those eleven men by other men in a boardroom fall firmly in that camp. No, what worries me is that my fellow Toon fans and I, fuelled by bruised egos, clickbait, and the usual culprits, sorry, pundits, judge this season based on past successes. What might be even more important than points this season, is resetting our expectations for a new team, not the old one, and to recalibrate our brains to hold not just what’s happening on the pitch in front of us, but the bigger picture too. Our authors are showing us the bigger picture and reaching for new scales in this month’s MSKMag. First up, our latest staff writer Angie Jackson cautions against using the embedded reasoning we use for adult patients when it comes to paediatric cases in her article ‘Children Are Not Mini Adults: Rethinking Sudden Anterior Knee Pain in the Skeletally Immature Athlete’. Caelum Trott of Preve shares his experience creating better AI solutions in healthcare, widening the net from just note-writing to ways in which it can improve both the clinician and patient experience in ‘AI Solved Our Notes - But Can it Improve Care?’ Is your slow, heavy loading getting your tendons to nowhere but a plateau? Daniel Morgan will stretch your thinking more effectively than collagen in ‘Tendons: What’s Load Got to Do With It?’ Sue Julians has been in the field on investigative journalism duty, putting her biases and cardiovascular system to the test as she checks out a private preventative medicine screening clinic in ‘MSKMag goes to... Neko Health’. And Jack Chew wants to readdress how we reward good practice and how we manage consequences for bad in ‘MSK’s Lost Carrots & Sticks’, which features less donkeys than you are picturing right now. We’ve also stepped back in time in this month’s Core Memories feature to see how well Ian Horsley’s 2014 podcast episode on the Rugby Shoulder holds up against contemporary evidence. So as we - clinicians and football fans alike - head into a new season of the unknown, September’s MSKMag encourages us to treat what’s in front of us, rather than measuring it against past iterations of the same line up.
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