Show Notes
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If you mention the words ‘elite performance’, most people will think of sport, but I think of the corporate sector. Both elite groups have talent, skill and can perform at maximum capacity. Both environments are highly competitive, deadline driven and with high stakes. But only the elite sportsperson works at the extreme of physical capability, developing problems when even their highly trained system cannot tolerate the physical demand placed upon it. Contrast this with the corporate athlete, whose mental load is so high it dramatically reduces their ability to tolerate minor or more moderate physical loads. Where these two groups experience their symptoms may be similar, and examination may come to the same diagnostic conclusion. But, given the differences in the reason for onset, their successful management, including return to activity and prevention of recurrence, will look very different. In the office the elite capability is mental and the load is continuous. To survive in this environment, you need to satisfy the demand for elite performance over long hours, day after day, month after month, year after year. Those who thrive enjoy the challenge and the competition, loving the work, the camaraderie, and of course their success. But many work at their limit of tolerance; constantly, and often unpredictably, permanently on call, and perilously close to burnout. Driven and academically gifted, these workers excel at school and elite universities. They are then thrown into the rigour of postgraduate training and onboarding programmes which instantly involve long hours, high stress, high accountability, tight deadlines and the constant, urgent need for accuracy. When junior, this group often fly the plane whilst building it, and when senior, manage a team and the clients’ expectations whilst managing caring responsibilities (in both directions) and experiencing an age- or menopause-related drop in physiological resilience. Everyone they work with (and compete with) was best in class too: they need to maximise their performance and keep it there to keep their job and stay in the game. They may work flat out for several months, only pausing for breath between cases, deals or deadlines. Many routinely work late into the evening, during the weekends and on holiday. They can be permanently on call. Additionally, with many companies going global, the traditional working day has been turned on its head: for some this can mean waking up for Asia, not logging off until America and working 80-120 hours per week. [1] For others the sheer volume of the work can result in their employer paying for ‘roundabout’ taxis: a ride home with the taxi waiting so they can shower and change and come straight back to the office. [2] Even away from these extremes, in these types of occupation a working week of 70-75 hours is very much the norm. [3,4] Welcome to my working world.
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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