Show Notes
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¡Buenos dias! I’ve been in Valencia for a few days to explore the city, get in some runs and fit in my obligatory new-city stadium tour. I heard all the best teams are 14th in their league this season so don’t even worry about it, Valencia C.F. This was a solo trip because every few years I like to push myself out of my comfort zone and also read the maximum possible amount of books. This one truly was a voyage of discovery because it involved my bank card being blocked and an Airbnb host with far too many boundaries for someone who shares her apartment with strangers on the regular. It was not relaxing - but I’ve realised that when I travel abroad, I’m never relaxed - and not for the obvious travel stress reasons. I’m never relaxed because it’s important for me to be the perfect tourist. Specifically the top British tourist of all time. I will need to develop eyes in the back and both sides of my head so that I do not hold up any cyclist or pedestrian whilst checking a map. I have practiced some local phrases and even if the only word I can recall is the one for ‘thank you’, you can bet your bottom euro that I’ll be using that liberally, whether the situation calls for it or not. I am a polite person but on holiday I am falling over myself to ensure locals for years to come will be saying “wow, we were so wrong about the English”. Did it work? Well just ask the restaurant owner who cleared up the glass of my upturned cerveza that I knocked over while having a diabetic hypo. Or the aforementioned Airbnb host in whose bathroom I used (and I pray you all won’t judge me for this incredible faux pas) THE INCORRECT HANDTOWEL. Or the fact that I feel like I need a holiday to recover from my holiday in which I was basically a main character on set the whole time. And of course I left the Airbnb host five stars - not because it was an entirely five-star experience but because it felt easier and I didn’t want to cause any issues…but mainly because I was a bit afraid of her. Which is where my being nice turns into conflict avoidance and people pleasing. And that leads me perfectly to this month’s MSKMag. James Horner is so spot on in his article ‘Physios are nice…and it’s killing our profession’ that I can’t believe it wasn’t written about me specifically. But it’s not all agreement and polite nodding. We’re also seeing a growing appetite for doing things differently; in this issue it’s shockwave therapy and where it fits in modern MSK care. Have a read of Dominic Smith’s article ‘Shockwave Therapy: A Love-Hate Story, and Everything In Between’. Elsewhere we have articles about those who naturally don’t fit the mould. Sue Julians has written about elite performance but she’s not talking about Olympians, more so ‘The Corporate Athlete’ who balances sport with their city job. And when you think shoulder pain you might well think rotator cuff…except if the patient in your clinic room is in their teens, warns Angela Jackson in her article ‘Do Adolescents Get Rotator Cuff Tendinopathy?’ If there’s one area where trying to make people fit the mould has caused more harm than good, it’s in chronic pain. Offering a clearer framework and points not to miss, Ben Whybrow’s full Chronic Widespread Pain Diagnosis Guide is published this month alongside his article detailing the inspiration behind it and its scientific backing. So perhaps the goal this month isn’t to be the nicest physio in the staffroom or the tourist in the taverna who never gets it wrong. Maybe it’s less about being nice, and more about being genuine, kind and constructive - even when that feels way less comfortable in the moment. MSKMag this month though? No overthinking needed. That’s a genuine five stars from me.
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