Show Notes
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I took a phone call from a friend this month. She’s been called up for HCPC audit and we both run very similar sole practitioner clinics. A great deal of my replies to her questions about whether I had x, y or z policy in place were “erm… no?” Sure, I have consent forms for patients and a plan in place for the patient who comes in with unexplained bladder retention and bilateral leg pain… but you want to see my non-clinical policies? Written down? Give me 2–3 working days and I’ll, um, unearth them. My friend was dubious about this. For some reason - and perhaps it’s because we’re all encouraged to project this image - she presumed I was running the perfect clinic. Policy after policy filed alphabetically in a folder, always to hand. We have so much in common, but this folder - and my apparent drive to have created and maintained it - is our great divider. This folder does not exist. Somewhat related, I am currently reading a book called Doppelganger by Naomi Klein. Klein is a journalist and documentary-maker and also wrote the excellent Shock Doctrine about how governments use fear within populations. Klein is frequently confused online with another Naomi - Naomi Wolf - who has built a name and reputation as a conspiracy theorist and mass spreader of misinformation. It is - and I am merely paraphrasing Klein here - not ideal. In MSK, we all have our doppelgängers. Sometimes they look like us - only much, much better. And sometimes they’re just like us, only clearly getting it wrong. They rely too heavily on manual therapy, whereas we are, of course, more enlightened. Or perhaps they’re a totally hands-off maniac, while we sit comfortably in the skilled middle. Klein uses the example of her dog, Smoke, catching a glimpse of himself in a glass door and barking ferociously. ‘And this is the catch-22 of confronting your doppelganger’, writes Klein. ‘Bark all you want, but you inevitably end up confronting yourself’. This month’s MSKMag is full of these reflections: versions of us, past and present, held up for critique. Our new feature looks exactly like us…only from 2014. We hold The Physio Matters Podcast Episode 10 featuring Ann Gates speaking on exercise promotion to scrutiny to see if the messages still hold true. Check it out in Core Memories. If you’ve ever been on a ski forum online and thought wow, that sounds like Orthopaedic surgeon Jonathan Bell giving advice! It wasn’t his doppelganger, it was him. And he’s back to talk about expertise and why the more of it he gathers, the less he’s reaching for the scalpel. Read all about it in ‘What is Expertise?’ If you can’t tell one dynamometer apart from the next, Claire Minshull’s piece ‘The Best Dynamometer for Clinical Practice’ and her associated new website is for you. If you’ve ever thought that physiotherapy graduates should look a little less identical and a whole lot more specialised from the off, Jeff Morton is putting forward his case for MSK to be a separate degree in ‘Trained to Struggle’. Katie Knapton has been to two conferences of late, covering digital transformation in the NHS and investment - but while the conference themes might have looked comparable, there was one vital thing missing. Find out what in ‘Industrialised Rehabilitation’. And if you’re envious of your doppelganger who just sold their clinic, check out our article by Verilo’s Joshua Catlett ‘How To Build Something Worth Selling’. Whether it’s our past ideas, our professional identity, or the clinics we build, we’re not really arguing with something new. Just a version of ourselves we’d rather not see too clearly.
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