Show Notes
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I recently spent some time with my five-year-old nephew on a family trip. As is often the case when travelling with children, my brain was put to work early. It was 7.30am at breakfast when I was drawn into a round of ‘Guess Which Animal I Am’. “It’s usually a dinosaur,” my sister-in-law had warned me, advising that my first question should be, “Are you extinct?” But no; today my nephew was not extinct. He was an amphibian, native to Mexico, currently endangered, and found in a surprising variety of colours. He was an axolotl. Have you ever come across axolotls? They are extraordinary creatures. Most remarkable of all is their ability to regenerate. Lose a body part and they can regrow bone, nerve and other tissues by reverting specialised cells back into a stem cell-like state. Unlike humans, who of course largely respond to injury by laying down scar tissue, the axolotl can regenerate entire structures. It can even regrow parts of its brain. Listening to my nephew enthusiastically explain the wonders of the axolotl, and then re-reading the five articles that make up July’s MSKMag, I found myself thinking about adaptation and evolution. The story of modern MSK practice may be one of evolution rather than revolution: small changes over time that have fundamentally altered who we are and how we practise. Like the axolotl, our profession has shown a remarkable capacity to adapt and reinvent itself. From the scandals of massage in the nineteenth century leading to the formation of the Society of Trained Masseuses and, ultimately, the CSP; from protocol-led care to complex clinical reasoning and independent practice; and now into advanced practice, first contact roles and business ownership, physiotherapy has continually evolved in response to the environment around it. This month’s articles capture that evolution perfectly: interventions that require us to understand new physiology, radiological findings that challenge our assumptions, complex presentations that remind us to think beyond the obvious, reflections on advanced practice roles, and a history of the literal evolution of the Physiotherapy degree and the changing world that our new graduates are entering. First up, ‘The Zebra Farm’: a new regular delve into James Noake’s upcoming book on those tricky cases that weren’t what they initially seemed. I believe the phrase goes: when you hear hooves, think horses, and when you hear regenerated hooves, think axolotls. Next, take a trip back in time with Tamsin Baird as she describes how we got to the physiotherapy degree as it is today, as well as posing the question about our new grads: ‘Physiotherapy Education: Getting Graduates Ready for What Exactly?’ Nick Ilic guides us as we stick our noses into the talar beak - an imaging finding that might point you in the direction of a tarsal coalition IF you spot it, in ‘The Beak is the Breadcrumb’. Mick Hughes cautions us about the evolution of testosterone from an anabolic steroid to be disparaged, to now sitting within the ‘wellness’ industry as an acceptable adjunct in ‘The Soft Tissue Cost of Testosterone’. Giles Hazan examines the changes happening right now in advanced practice and sets out his ideas for a brighter future in ‘Is This the Writing on the Wall for First and Advanced Practitioners in the NHS?’ And, as well as our usual feature, this month sees the first installment of ‘The Market Read’; a new segment from HMDG that we hope will become your dashboard of how the MSK market is performing. Ever wondered if everyone else is quiet this month or just you? Or why you’re seeing so many running injuries this week? HMDG will give you insights to keep your finger on the pulse. By the end of breakfast I knew far more about axolotls from my nephew than I had ever expected (thanks a lotl). By the end of this issue, I suspect you’ll have the same feeling about the ever-evolving world of MSK practic
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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