Show Notes
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Here in the North East of England, we are emerging from Great North Run season. Hosting the biggest half marathon in the world on our doorstep naturally creates a few more new patient appointments and a little less space on the path of your regular running route. I have done the Great North Run once, two years ago. This was also my final time doing the Great North Run, mostly because of the associated Great North Logistical Headache. Do not let me put you off - it is a fantastic event with a great atmosphere and tens of thousands of runners in turn raising hundreds of thousands of pounds for charity. However, in my experience, the Great North Run is one (very demanding) thing. The Great North Portaloo Queue is quite another. Same too the Great North Return Bus Journey, or, if unlike me, you haven’t seriously pissed off your IT band and fancy it, the Great North Walk to South Shields Metro Station, followed by the Great North Standing Room Only Trip Back to Newcastle in the shadow of a fellow runner’s Great North Armpit. Now I understand that an A to B half marathon route is naturally going to place you 13.1 miles away from where you started but unfortunately what I didn’t reckon with was standing for an hour in the pouring rain in the 2024 starting pen, then an arduous 21 kilometres, THEN boarding what turned out to be Harry Potter’s Knight Bus, realised namely when we were practically scaling the walls of tunnels at speed and then hammered home when I threw up some electrolytes I would rather have kept to myself into my hastily-emptied goodie bag. Despite the best efforts of Ernie Prang and Stan Shunpike, this journey took the same 2 hour 22 minute duration that it took me to go the opposite direction on foot. I mention the half marathon only briefly on purpose because it was eclipsed by the logistics of the day. You deserve a medal for braving the whole day start to finish. You deserve a new technical T-shirt for making it back home, plus or minus some bodily fluids. In this month’s MSKMag, our articles talk about the smallness of a singular appointment and the patient’s label such as ‘runner’ or ‘tight scar’, the pelvic floor that has placed you back at the end of the aforementioned Great North Portaloo Queue, but that no one taught you about, how we can run small business hustles alongside our full time jobs and family lives, and the breadth and depth of how to seek or provide a good second opinion when that singular appointment isn’t going to plan. ‘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’ opens Grainne Donnelly, ‘yet offer little health literacy or inclusion of the pelvic floor.’ In her piece ‘Healthcare’s best-kept secret - the pelvic floor’, Grainne addresses the much-neglected anatomy that feels forgotten in the big event. Jonathan Bell and Claire Robertson team up to write ‘First-Rate Second Opinions’ and share how to both ask for and provide a good one. Can we follow the thread far enough back to tell why a race isn’t going to plan? In ‘Scar Scepticism’, Hannah Poulton takes on the evidence to address whether there is merit in soft tissue therapy for the treatment of scars. In an area where clinicians tend to be firmly based on one side of the argument or the other, Hannah will stretch your brain wider than the Felling Bypass to see the bigger picture. In an article that fits my metaphor better than most, Aidan O’Flaherty shares what he has learned from treating runners and teaching other clinicians in his running injuries course. It’s not just about the ITB or the Achilles but getting into the runner psyche of the human being wedged into the trainers. Read more in ‘Running Injury Rehab: The Diagnosis Is Only Part of the Story’. And finally, our very own Jack March is well known for his main events - Ops Lead at Physio Matters
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