Show Notes
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Expertise is special skill or knowledge that is acquired by training, study, or practice. I follow an Orthopaedic surgeon from the US who is of a similar vintage and much of what he posts aligns with my current thinking. I like his posts because they ooze expertise. He is extremely considered when it comes to non-operative care and he himself states how much less he operates these days, as he has become more experienced. Yesterday, I met an extremely experienced health entrepreneur who’s worked on the business side of healthcare for decades. We were discussing how I am managing the latter part of a surgical career. I was explaining that I don’t learn a huge amount from additional surgical procedures these days but I still learn an immense amount from seeing my patients. Don’t get me wrong, I’m not giving up surgery at all. I still see patients regularly that really make me have to think hard. The harder I think, the less I operate. Why is it that the more expertise I have, the less I operate? It reminded me I had got thinking about expertise - there I go again – as far back as 2012. My question was, ‘can patient forums offer expertise?’ so I started looking at them online. I came across people with a condition who would have had plenty of experience or ‘practice’ in living with their condition. Many would have become very knowledgeable compared to the general population. There were, in addition, many who commented and gave advice that was way out of their lane of training. I don’t want to single out any allied health professionals but there were some who would have been trained for example in anatomy and manual therapies but virtually nothing to suggest they were people with the right expertise to advise on getting an MRI scan. The problem was that these two groups may have had huge experience of practice within MSK but that experience was not matched by training and study in the subject. Exposure without prior study, learning and reflection could not be called expertise. I started to think about where expertise sits in the treatment pathway. I followed what we all do from the moment we start seeing a patient. I came up with a progression from acquisition of many single points of data e.g. twisted knee, medial pain, medial tenderness, swelling. All those data points when put together assume a pattern leading to information e.g. MCL tear, meniscus tear, osteoarthritis. That list is unranked i.e. equal weight is given to all diagnoses. This is where it then starts to get interesting. When that data and information is viewed by someone with knowledge and expertise, they can start to rank them into a list that floats the most likely diagnosis to the top of the pile. The application of training, study and practice improves the ranking. They draw on prior knowledge and experience from exposure to start to see the patterns. Without this, treatment plans are like throwing spaghetti at the wall to see what sticks. In other words, a bit hit and miss. A bit like when we all did our first day at work and floundered to apply our study and training in a meaningful way. Those of you reading this who have qualified will remember how poorly equipped we all were on that very first day. So back to my original question: can patient forums offer expertise?
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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