Show Notes
This is a free preview of a paid episode. To hear more, visit mskmag.substack.com
Putting the finishing touches to this article, I skim back over the Writer’s Guide. It encourages me to write boldly and to not be too afraid to offend because… “you’ll be surprised how polite professional challenges are in our industry.” We are a caring bunch…and this is exactly the problem.
Three years into my Physiotherapy career I rotated onto an orthopaedic ward and attended the morning trauma round. It’s a cramped office in a quiet and worn out section of the hospital. X-ray after X-ray flashes up on a large projector at the front of the room and one-by-one the consultants discuss their patients and what intricate method of carpentry they will be using. It starts smoothly; there are not many questions and this silence appears to be taken as consent to continue by those presenting. But Case 5 is different. Heads look up, Candy Crush is paused and the temperature of the room heats up. Multiple consultants pile in, questioning and attacking the proposed management. The presenter fights back… “I’ve managed dozens like this non-operatively!” “Look at the posterior fragment!! If this was your ankle, you’d fix it.” “The displacement is minimal.” “That’s nonsense! If this displaces further, that’s on us.” “And if it gets infected, that’s also on us!” I catch the eye of an OT and we share a nervous wince. The ‘nonsense’ comment seemed to cross a line. However, a few minutes later the meeting ends and instead of any awkwardness or anger, the same consultants who were tearing chunks out of each other minutes before leave together, talking about the Six Nations score at the weekend. Not one hard feeling between them… and I thought it was brilliant. Only weeks before I had been on an MSK Outpatient rotation where one of our *cough* more experienced *cough* Band 8As had been training for a half marathon and developed some hamstring pain. They were complaining during team training about how they’d tried everything to resolve it without avail. ‘EVERYTHING’ seemed to be that they had been doing frictions on their hamstring… But instead of professional disagreement or debate, there was just meek silence from us all. Just a few quiet comments later in private. Some even played along at the time, humouring the outdated practice. We are a caring bunch… but we can be incredibly fragile.
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