Show Notes
I look around the waiting room. There’s an average BMI of about 40. I observe oedematous ankles and a variety of walking aids (some flowery so you know they’re not a temporary feature). I can almost smell the inflammatory soup. A young person sits glued to an iPad, headphones shielding them from the world. No doubt an ADHD diagnosis inbound. The health of the nation has changed, and not for the better. And I wonder, when did MSK care become less about sprained ankles and bad backs, and more about metabolic disease and mental health? But who is responsible for this decline? Scanning the room, my instinct is to lay responsibility at the door of the individual. The media will have us believe that our beloved health service is failing the nation but is it in fact the nation who is failing the health service? As someone who works hard to maintain a healthy, balanced lifestyle, I am of the belief that I need to be accountable for my own health. Not every condition is avoidable or preventable, but I feel that I need to at least do my bit. I’m no teetotal, clean-living vegan, but nor am I held together with statins and gabapentin. Don’t misunderstand me, as a healthcare professional, of course I believe that access to healthcare is important, but with such a high incidence of people living in poor health (89% of deaths in the UK are attributed to non-communicable diseases) surely, we all need to step up and do our bit? I am not, however, optimistic. ‘The Spectrum’, overwhelm, body positivity, and food noise are just some of the reasons one can choose to justify an external locus of control. But these are avoidance tactics. Avoidance of the difficult, the uncomfortable. Avoidance of Responsibility. I hear the food noise; I can hear the packet of biscuits seductively calling me but I’m not a labrador and am able to exercise a degree of self control. Is it always easy? No. The same way that curling up on the sofa might feel more appealing than heading out for a run. We all have choices, and we are all capable of autonomous thought (even if these days we seem not to exercise that particular skill). Before judgement completely takes over however, and I am able to reach the lofty heights of the moral high ground, I am pulled back by the sight of a physiotherapist escorting a patient with magnetic knees back to the waiting room (if you aren’t familiar with magnetic knees, they are the kind that due to years of deconditioning and lack of proper use, are drawn to each other as if the medial femoral condyles are polar opposites!). The patient has just undergone a steroid injection and the physio gives them some instructions about a couple of days rest, then hands them a sheet of exercises. Patient and physio part company like a couple of England football fans*; both hopeful for success, both expecting disappointment. And my judgement shifts, from the patient to the physio. Like a warning light on the dashboard of your car, the focus here seems to be on turning the light off, rather than addressing what triggered the alert in the first place. Corticosteroid and a few clam shells aren’t going to address years of deconditioning, poor diet and social isolation. And I ask myself again, who is responsible? While I still stand by the importance of taking care of our own health, we can only do so if we are educated - if we understand what is going on in our bodies and are aware of our choices. With so much access to information and misinformation it can be a minefield for an individual to navigate. But I see MSK services stuck in the past. Clinicians still treating knees and backs in isolation and failing to treat people. Failing to acknowledge the complexity, and failing to have honest, albeit difficult, conversations. And clinicians have their own set of excuses. Their own reasons for absolving responsibility. No time; out of scope; it only says ‘knee’ on the referral. The system is s**t. Now I do agree that time pressures in MSK services are a limit
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
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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