Show Notes
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My interest in MSK healthcare grew out of my obsession with combat sports. In 2002 I was in the final stages of completing a maths PhD. In that same year, I became one of the first women in the UK to compete in Mixed Martial Arts (MMA) – which was at the time a small and niche sport often referred to as ‘cage fighting’. One of the first things I learned about combat sports injuries is that it was almost impossible back then to get good advice on how to get back to fighting after an injury. When I mentioned my sport to a doctor or physiotherapist, they’d look at me like I’d grown another head and suggest it was a bad idea. So, as with most things about MMA back in those days, we tried to figure it out for ourselves. As a result, my knowledge of combat sports rehab grew from an eclectic mix of things learned from books, the early internet, S&C coaches, a sports therapy course, and a lot of trial and error. A few years later I went back to university to study osteopathy, which added a more systematic understanding of clinical examination, anatomy and pathology, but I can still trace the foundations of what I do in clinic every day to those early years spent in the gym and on the mat. Know your combat sports Rehabilitation is about developing tolerance for the physical demands of an activity. For a sport like football, a lot of work has already been done to analyse these requirements. We know how to get people running, jumping or changing direction. Combat sports, on the other hand, are full of weird movement patterns and unpredictable forces. There are a plethora of injury mechanisms that don’t exist in other sports. Athletes are not just facing the risk of accidental injury; they’re also up against an opponent intending to do them physical harm. Structures ranging from the knee to the lower back find themselves loaded in positions rarely found outside of combat sports, or possibly a dungeon. And that’s before we talk about the risks associated with chokes, concussions and weight cutting induced dehydration. This means that the threshold for getting fighters back to competition level following an injury is high. Too often I see athletes who have been given a generic rehab plan, and once the pain has settled, figured that they were good to go. Even those who undergo more specific rehabilitation are rarely progressed to the intensity needed for their sport. In my experience, the majority of rehabilitation failures with this patient group are related to underloading in crucial movement patterns. The first step for any MSK practitioner wanting to treat fighters is to find out what is involved. Each discipline has its own individual set of demands. A detailed understanding of biomechanics isn’t required – but having watched a match or two, understanding some key movement patterns and being able to picture what they are doing in training goes a long way. Ask lots of questions! When it comes to getting a patient to buy into your rehab plan, demonstrating that you have an appreciation for where they need to get to is non-negotiable. Key things to find out:
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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