Show Notes
Chewy and Jim are back and so is the theme tune. Now I am not usually one to call out Chewy’s mum for bias but apparently she is in a grump about the lyrics. Yes maybe we do omit ‘Chewy’s dashing looks’ but there is reference to his ‘gags’ which of course are absolutely dreadful and often unpublishable trash. Chewy and Jim is best watched in full via the video above (so you can check out Jim’s dashing looks) or you can listen on the usual podcast players. In this recording, Chewy and Jim cover a lot of ground relating to clinicians identity, conflicts of interest and the perils of social media. Are We Accidentally Creating a Two-Tier MSK System? Every few years, MSK seems to rediscover an old argument and insist it’s new. Hands-on versus hands-off. Manual therapy versus exercise. Biomedical versus biopsychosocial. Pick your side, sharpen your acupuncture needles, and head to social media. But while everyone is busy refighting those wars, a quieter shift appears to be happening under our noses. One that’s less about techniques and more about identity. Not how we treat, but what kind of clinician we are becoming. Not in the sense of ‘good’ and ‘bad’ clinicians, or evidence-based obsessives versus charlatans. But in the sense of two diverging professional trajectories: the interventionalist and the health-coach generalist. “I almost saw it as being those that were really trying to hark back to diagnostic specificity [that were getting more into interventions].” - Chewy Jim asks Chewy this very interesting and insightful question: are we drifting towards a two-tier MSK system? “I think that there maybe are the crap ends of each of those spectrums.” - Chewy When we talk about conflicts of interest, we tend to think about obvious commercial ones: paid endorsements, sponsored products, affiliate links. But many of the most influential conflicts in MSK are reputational rather than obvious receipt of piles of cash. “Strength and conditioning I see a lot of people doubling down on because it’s grabbing attention.” - Jim Is Two-Tier MSK Inevitable? Perhaps some degree of stratification is unavoidable. We do need interventionists. We do need clinicians with advanced technical skills. And we do need generalists who can guide patients through long-term behaviour change. “The multi-disciplinary clinics are doing very well because they can have some specific components to but also provide a more general service where you can cross refer.” - Jim Good MSK care exhausts proportionate options before escalation. It recognises uncertainty. It manages expectations. It acknowledges bias. It remains flexible enough to change course without defending an identity. Of course clinical topics aren’t Jim’s only strengths; he can also make fantastic puns using Chewy’s name. Get involved in the features ‘Would Chew Rather?’ And ‘Who Are Chew?’ Would Chew Rather see lots of complex patients every 30 minutes or just one person for a whole week? And who would Chew like to have dinner with? The answers will likely surprise you… Let us know yours. If you have any ‘Would Chew Rather?’ or ‘Who Are Chew?’ questions put them in the comments or email them to us [email protected]
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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