Show Notes
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“Children aren’t mini adults” is a phrase we hear a lot to highlight the differences in Paediatric physiotherapy to remind clinicians that children and young people have different needs and require different care. Yet Paediatric musculoskeletal (MSK) services around the country continue to be left in the shadows of adult MSK. Despite 1 in 3 adolescents experiencing MSK pain [2] and 1 in 10 seeking healthcare annually for MSK symptoms [6], Paediatric physiotherapy services remain significantly under-resourced. Unlike in adult MSK services, those who work in paediatric clinics are often expected to see patients with not only musculoskeletal complaints but also stay skilled in neurological and developmental assessments. Most Paediatric physiotherapy teams do not have their own department but share spaces with adult teams which can be unsuitable for a younger population. Teams can also sit under many care groups in NHS services such as family health or adult physiotherapy, showing inconsistency between services. I am a Paediatric physiotherapist in the North East of England and remember starting my exciting new career path with limited knowledge and awareness of Paediatric MSK. With no teaching provided at university and just a 5-week placement to go on, I took the plunge into Paeds. What I didn’t expect to find was a love and passion for MSK and Orthopaedic Paediatric care. And what I really didn’t expect was being one of only three clinicians who saw MSK patients in a team that covered a large geographical area. Other staff members could cover here and there as required but not by choice. They felt they lacked confidence in MSK caseloads and their area of interest lay more with the neurodisability caseload. As time has passed, and the more opportunities that have come up to network with neighbouring teams, I have found this is a very common theme and is impacting children’s services around the country. Many Paediatric physiotherapists are comfortable treating neurodisability and developmental caseloads but can lack the confidence to see MSK caseloads. Sometimes this may be due to personal interest but otherwise can be down to lack of training and opportunities to work with these patients. Within Paediatric physiotherapy teams you may have a staff member working with a neurodevelopmental caseload one day and an MSK caseload the next. Would we see this happening in adult physio? Would you ask your Stroke Rehab colleague to cover your MSK clinic if you were short staffed?
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