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Healthcare's best-kept secret - the pelvic floor (and why every therapist needs to know about it) · MSKMag OutLoud

• 0:04
  SPEAKER_00: It always struck me as bizarre that sports medicine
• 0:12
  SPEAKER_00: and musculoskeletal specialties deal with pain and dysfunction from head to toe in
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  SPEAKER_00: the human body, yet offer little health, literacy or inclusion of the pelvic floor.
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  SPEAKER_00: Traditionally considered taboo and someone else's remit,
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  SPEAKER_00: men and women with issues affecting the pelvic floor have largely suffered
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  SPEAKER_00: in silence.
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  SPEAKER_00: Thankfully, change is afoot and healthcare is finally evolving.
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  SPEAKER_00: There is much more awareness,
• 0:35
  SPEAKER_00: inclusion and understanding of this unique body area and the role it plays.
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  SPEAKER_00: For anyone playing catch-up,
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  SPEAKER_00: the pelvic floor is a group of muscles spanning the base of the pelvic outlet
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  SPEAKER_00: in layers.
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  SPEAKER_00: While both men and women have a pelvic floor,
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  SPEAKER_00: the pelvic outlet is wider in females than in males and it also contains
• 0:51
  SPEAKER_00: an extra orifice, the vagina.
• 0:54
  SPEAKER_00: That's right, we went there.
• 0:56
  SPEAKER_00: We said the V word because just like vulva or vestibule,
• 1:00
  SPEAKER_00: the vagina is simply an anatomical term.
• 1:03
  SPEAKER_00: It needn't be embarrassing or taboo.
• 1:05
  SPEAKER_00: Some of you will be long enough in the tooth to remember when the word breast was taboo.
• 1:10
  SPEAKER_00: However,
• 1:11
  SPEAKER_00: with healthcare campaigns for breast cancer and breastfeeding,
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  SPEAKER_00: this term became an anatomical norm.
• 1:16
  SPEAKER_00: We need to do the same for the pelvic floor and its related anatomy and physiology.
• 1:21
  SPEAKER_00: What does the pelvic floor do?
• 1:24
  SPEAKER_00: In both men and women,
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  SPEAKER_00: the pelvic floor serves to control the bladder and bowel ,
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  SPEAKER_00: empty the bladder and bowel and support sexual function .
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  SPEAKER_00: In women, the pelvic floor also plays an important role in pelvic organ support.
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  SPEAKER_00: Remember that extra orifice I mentioned earlier?
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  SPEAKER_00: Well, this area is high risk for connective tissue laxity and defects,
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  SPEAKER_00: meaning that the pelvic organs can descend into the vaginal cavity,
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  SPEAKER_00: causing symptoms of heaviness, pressure, and a sensation of something in the vagina.
• 1:58
  SPEAKER_00: What are the signs and symptoms of pelvic floor dysfunction?
• 2:02
  SPEAKER_00: If the pelvic floor is not doing its job, any of its roles can become compromised.
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  SPEAKER_00: This may manifest in leaking from the bladder or bowel,
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  SPEAKER_00: inability to fully empty the bladder or bowel,
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  SPEAKER_00: pain down there,
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  SPEAKER_00: sexual dysfunction,
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  SPEAKER_00: compromised erection,
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  SPEAKER_00: dyspareunia,
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  SPEAKER_00: pain with climax, or heaviness and pressure in the vaginal region for women.
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  SPEAKER_00: A full list of sex-specific signs and symptoms
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  SPEAKER_00: of pelvic floor dysfunction can be seen in Table 1,
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  SPEAKER_00: provided, and you can see that on Substack.
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  SPEAKER_00: Who gets pelvic floor dysfunction?
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  SPEAKER_00: Pelvic floor dysfunction can affect any man, woman, or child.
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  SPEAKER_00: However,
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  SPEAKER_00: it is particularly problematic for women,
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  SPEAKER_00: especially during transitional life events such as pregnancy and childbirth and
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  SPEAKER_00: the menopause.
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  SPEAKER_00: One in three women will experience pelvic floor dysfunction,
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  SPEAKER_00: and for those that engage in sport,
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  SPEAKER_00: the prevalence of symptoms varies according to the low demands of the activity.
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  SPEAKER_00: For example,
• 2:59
  SPEAKER_00: 61% of netballers leak urine,
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  SPEAKER_00: up to 43% of female rugby players leak, and 32% of gymnasts experience incontinence.
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  SPEAKER_00: Structural changes associated with vaginal childbirth and aging,
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  SPEAKER_00: as well as lower levels of estrogen to lubricate and bulk out the tissues,
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  SPEAKER_00: can increase the odds of experiencing pelvic floor dysfunction.
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  SPEAKER_00: However,
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  SPEAKER_00: even young adolescent females can leak urine due to the For example,
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  SPEAKER_00: in athletics and gymnastics,
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  SPEAKER_00: stress urinary incontinence the involuntary leakage of urine
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  SPEAKER_00: during activities involving high levels
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  SPEAKER_00: of intra-abdominal pressure is commonly experienced,
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  SPEAKER_00: yet no one is doing anything about it.
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  SPEAKER_00: No one is screening,
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  SPEAKER_00: no one is signposting,
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  SPEAKER_00: no one is educating these younger athletes that pelvic floor symptoms are not
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  SPEAKER_00: to be expected and normalized,
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  SPEAKER_00: or that they simply indicate that the sporting demands exceed the load capacity of
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  SPEAKER_00: the pelvic floor.
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  SPEAKER_00: If this was any other area of sports or MSK practice,
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  SPEAKER_00: would we settle for a low capacity that does not meet the demands of sport?
• 4:00
  SPEAKER_00: Why is this relevant to every therapist, no matter the discipline?
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  SPEAKER_00: If a patient slash client you are supporting has pelvic floor dysfunction,
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  SPEAKER_00: it will undoubtedly impact their engagement and progression
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  SPEAKER_00: with your rehabilitation,
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  SPEAKER_00: no matter the bodily region or complaint that you are treating.
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  SPEAKER_00: It is like a silent assassin working in the background, Unbeknownst to you.
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  SPEAKER_00: For example,
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  SPEAKER_00: the 50-year-old woman with knee pain that you are trying to progress
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  SPEAKER_00: through weighted squats or progressive impact activities who is stalling
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  SPEAKER_00: or apprehensive and not making the expected headway may be stalled due to fear
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  SPEAKER_00: of heaviness,
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  SPEAKER_00: pressure or leaking and not necessarily capped by their knee pain or function.
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  SPEAKER_00: The competitive 15-year-old sprinter
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  SPEAKER_00: with hamstring tendinopathy may be inhibited more by the fear of leaking than
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  SPEAKER_00: the ability to push into their sprint.
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  SPEAKER_00: Layer that with the environmental considerations of access to toilet facilities,
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  SPEAKER_00: or lack thereof,
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  SPEAKER_00: where the athlete is training or engaging in rehabilitation,
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  SPEAKER_00: and you open a complex domain of biopsychosocial and environmental considerations
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  SPEAKER_00: that impact your patient's presenting complaint.
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  SPEAKER_00: Further to this,
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  SPEAKER_00: there are the overlap between pelvic floor dysfunction and low energy availability.
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  SPEAKER_00: The latest IOC consensus statement on relative energy deficiency in sport,
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  SPEAKER_00: or REDS,
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  SPEAKER_00: recognized that urinary incontinence as a potential indicator of That is where
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  SPEAKER_00: an athlete is expending more energy than they are consuming.
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  SPEAKER_00: Non-necessarily bodily processes will be deprioritized,
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  SPEAKER_00: which is why females with reds experience alterations or complete loss
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  SPEAKER_00: of their menstrual cycle,
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  SPEAKER_00: as well as compromised bone health that carries an increased risk
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  SPEAKER_00: of bony stress injury.
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  SPEAKER_00: But did you know that the musculoskeletal and neuromuscular integrity of
• 5:37
  SPEAKER_00: the continence mechanism may also be impacted?
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  SPEAKER_00: If you support female athletes and are screening them for REDS,
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  SPEAKER_00: recognizing urinary incontinence as a potential sign is essential.
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  SPEAKER_00: Moreover,
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  SPEAKER_00: differentially diagnosing and clinically reasoning whether this leakage is related
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  SPEAKER_00: to REDS or caused by a dysfunctional pelvic floor should be part of our role.
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  SPEAKER_00: One of the most important reasons I believe that all therapists should be aware of
• 6:02
  SPEAKER_00: and screening for pelvic floor symptoms is because you may be
• 6:05
  SPEAKER_00: that individual's only chance to get these TAPU symptoms recognized and addressed.
• 6:10
  SPEAKER_00: As rehabilitation professionals,
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  SPEAKER_00: we have the opportunity to build therapeutic alliances with our clients.
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  SPEAKER_00: We get to spend time with them, build trust, and engage in rapport.
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  SPEAKER_00: Therefore,
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  SPEAKER_00: you may be the first person to introduce the topic of pelvic floor dysfunction
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  SPEAKER_00: and create a safe space for them to disclose symptoms.
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  SPEAKER_00: Screening is easy!
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  SPEAKER_00: Similar to screening for red flag,
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  SPEAKER_00: neurological,
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  SPEAKER_00: rheumatological,
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  SPEAKER_00: or even psychological determinants of symptoms,
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  SPEAKER_00: we can easily screen for pelvic floor dysfunction.
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  SPEAKER_00: This carries no pressure or weight for therapists to know how
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  SPEAKER_00: to manage pelvic floor dysfunction if it is identified.
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  SPEAKER_00: Like red flags,
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  SPEAKER_00: neurological signs and the like,
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  SPEAKER_00: we screen to identify and signpost to the appropriately qualified professional,
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  SPEAKER_00: e.g., pelvic health physiotherapist, urogynaecologist, or GP.
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  SPEAKER_00: Before you think this will create an extra need or more work,
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  SPEAKER_00: all you need to do is ask five simple questions.
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  SPEAKER_00: The PFD Sentinel is a sports-specific screening tool that is simple and user-friendly.
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  SPEAKER_00: For the faint-hearted therapist who doesn't want to venture into using
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  SPEAKER_00: the V-words just yet,
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  SPEAKER_00: you can even hand the tool to your patient
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  SPEAKER_00: and have them tick what symptoms are present.
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  SPEAKER_00: Easy.
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  SPEAKER_00: You can see the PFD Sentinel again on Subtack.
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  SPEAKER_00: Differential diagnosis.
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  SPEAKER_00: Is it the pelvic floor, the hip, or the groin?
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  SPEAKER_00: Anyone assessing the hip and groin pain should be aware of the pelvic floor
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  SPEAKER_00: in their differential diagnosis.
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  SPEAKER_00: The hip, groin, and pelvic floor are anatomically linked.
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  SPEAKER_00: For example,
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  SPEAKER_00: the shared muscle represented by obturator internus is a lateral hip rotator and
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  SPEAKER_00: a lateral intra-pelvic muscle of the greater pelvic floor,
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  SPEAKER_00: or the common bony insertion that the adductor muscles and pelvic floor connect to,
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  SPEAKER_00: the pubic bone.
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  SPEAKER_00: Frustrated by siloed thinking and practice,
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  SPEAKER_00: we put out a call to action in 2025 in the British Journal
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  SPEAKER_00: of Sports Medicine called Hiding in Plain Sight,
• 8:01
  SPEAKER_00: the Pelvic Floor in Hip and Groin Pain.
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  SPEAKER_00: Further to this,
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  SPEAKER_00: my esteemed colleague, Dr.
• 8:05
  SPEAKER_00: Helen McKeever,
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  SPEAKER_00: presented a detailed overview of differentially diagnosing the source of hip
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  SPEAKER_00: and groin pain in a new scientific book chapter.
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  SPEAKER_00: Individual Reflection.
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  SPEAKER_00: As you read this,
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  SPEAKER_00: I want you to consider whether you have ever screened for symptoms
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  SPEAKER_00: of pelvic floor dysfunction in the populations you serve.
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  SPEAKER_00: Did you already know that this was a potential issue that could be interfering
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  SPEAKER_00: with your rehabilitation success?
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  SPEAKER_00: Would you settle for reduced load capacity at any other bodily region
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  SPEAKER_00: if it was impacting your patient's progression and quality of life?
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  SPEAKER_00: Did you ever consider that you may be the first
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  SPEAKER_00: or only person they disclose these intimate symptoms to?
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  SPEAKER_00: I call on you to be the difference that makes the difference and include
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  SPEAKER_00: the consideration of pelvic floor function in your clinical reasoning and practice.
• 8:49
  SPEAKER_00: It is sure to elevate your game.
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  SPEAKER_00: Want to learn more?
• 8:53
  SPEAKER_00: If you can't tell by now,
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  SPEAKER_00: this topic is a huge passion area of mine,
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  SPEAKER_00: so I edited an entire scientific textbook on it.
• 9:00
  SPEAKER_00: Sports Medicine and the Pelvic Floor Science to Practice was published in May 2026
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  SPEAKER_00: and it has already achieved bestsellers
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  SPEAKER_00: Pitch to the non-pelvic health or fitness professional,
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  SPEAKER_00: it includes everything you need to know to include the pelvic floor
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  SPEAKER_00: within your sports medicine practice.
• 9:22
  SPEAKER_00: Jack Chew even sat down to discuss this book with me on Chewing It Over.
• 9:25
  SPEAKER_00: And if you want to find out more and even better,
• 9:28
  SPEAKER_00: MSK Mag readers can access 30% off using discount code Biomed30.
• 9:34
  SPEAKER_00: So that's B-I-O-M-E-D-3-0 at Elselvia.
• 9:40
  SPEAKER_00: Check out if they purchase the paperback option.