Show Notes
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Is it normal to assume that whenever someone cancels their appointment, despite explicitly thanking you and saying they’re feeling better, you’ve actually made their pain worse, ruined their life, and they’re simply too polite to tell you how terrible a clinician you are? What about when someone cancels their 8.30am appointment late the night before because they have to see their workplace clinician instead and then never responds to your email reminding them of the late cancellation policy whereby there is a fee to pay? Is it normal to assume they hate you and will be telling all their friends and colleagues to avoid? Now imagine this clinician receiving an actual email that says ‘you did not meet my expectations and therefore I’d like to cancel my appointment’. It’s me; this is my inbox. A patient whom I’d seen once a few weeks ago was now detailing that they had expected hands-on treatment and advice to use TENS. When I looked back through the notes, I knew what my response had to be. I couldn’t apologise for the treatment offered because I’d still do the same thing today - there seemed no soft tissue that warranted hands on treatment - and TENS wouldn’t have been my go-to either. I think a past iteration of me would have wanted to make things right straight away - ushering this patient back in for some poorly reasoned manual therapy; in fact, it’s on the house! Instead, I located the stomach that had dropped out of my backside on receiving essentially a rejection email, thanked the patient for their honest feedback and wished them well with their recovery. For me this is the classic expectation mismatch that we’ve seen throughout MSK care - certainly since I’ve been qualified: the patient arrives with expectations of traditional (and sometimes outdated) treatments while we attempt to balance their preference with evolving evidence. For years, MSK clinicians have grown comfortable challenging expectations around passive treatments. We’ve become better at explaining why imaging isn’t always necessary, why hands-on therapy may not be indicated, or why pain isn’t synonymous with damage. But the landscape is shifting again. Patients are no longer arriving armed only with outdated beliefs; increasingly they arrive influenced with information, wearable data, AI-generated advice and wellness narratives that often sound sophisticated, evidence-based and empowering. So what about future treatments? What about now in 2026 when patients arrive with expectations of new interventions and technologies? The challenge for modern clinicians is no longer simply rejecting outdated ideas. It’s learning how to critically appraise the endless stream of new ones. Cue June’s MSKMag. Up first, Jack Chew puts freshly hyped, package-style lifestyle medicine under the spotlight and explores where innovation risks becoming performance and packaging in ‘Beware Concierge Healthcare’. Tim Colledge makes the case for being open to the friction smoothing and meaningful improvements to care that AI can bring to health professionals in ‘AI in MSK Care: Useful Tool or Clever Distraction?’ In her piece ‘Fighting Talk: Grappling with Combat Sports Rehab’, Rosi Sexton reminds us that unfamiliar sporting populations require genuine expertise, not generic rehab principles. Staff writer Tom Jesson returns to bring us back to fundamental clinical awareness on the topic of Peripheral Artery Disease in his article ‘Notes on PAD’. Finally, Natasha Miszewski of Splose shares her practical advice on changing your practice management software with behind the scenes expertise. Read about what questions you should be asking in ‘Switching MSK Practice Management Software: what it actually involves’. The uncomfortable reality of modern MSK care is that sometimes good clinicians will disappoint patients, and sometimes convincing ideas will turn out not to be very good ones at all. But whether it’
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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