Latest / The STA Clinician Podcast / Ep242 ''Pregnacy Related Back & Pelvic Pain‘ - Reflection with Emily Sweet

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Ep242 ''Pregnacy Related Back & Pelvic Pain‘ - Reflection with Emily Sweet · The STA Clinician Podcast

0:00
Music.
0:10
How are you doing? Welcome to episode 242 of the Sports Therapy Association podcast.
0:17
My name is Matt Phillips, creativerunchatlive.com. And as always,
0:21
this episode has been recorded live at eight o'clock on a Tuesday on the Sports
0:24
Therapy Association YouTube channel.
0:27
So in this eighth episode of our reflection series, I will be chatting very
0:33
shortly with physiotherapist Emily Sweet, who will be reflecting on episode 229,
0:38
entitled Pregnancy-Related back and pelvic pain that was recorded earlier in
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February this year with the wonderful Michelle Lyons, who,
0:47
as you may have seen on social media today, is going to be one of the speakers
0:51
at the STA Southwest Conference, which is happening in Exmouth this September the 20th and 21st,
0:58
in collaboration with the ST School and Hands On Hub.
1:02
As you will have seen, tickets are now on sale at thestschool.co.uk.
1:07
There is a very generous, substantial early bird discount valid until the end of June.
1:13
And also there is an STA member discount, which you can find out what that is
1:18
if you go to the Facebook member page.
1:21
And if you don't use Facebook, you listen to this on YouTube.
1:24
Then email in or check your STA newsletter emails.
1:30
I think it will be on there. but yeah find out and you get a little bit extra
1:33
off but it does have to be used before the end of june so don't hang around
1:36
get your ticket now if that tickles your fancy there we go right so before we
1:42
start this week's episode i must give a huge thanks to my last week's guest.
1:47
Sports massage therapist hannah tabram who reflected
1:50
on episode 87 menopause transition
1:54
soft tissue implications that was recorded as part
1:56
two of our women's health month back in february 2022 how can that be so long
2:02
ago with special guest jenny bowell of bowell education it's available as all
2:05
of the episodes on any popular podcast app and youtube and at the sta.co.uk
2:11
so yeah do check it out and if you do please leave a rating and a review.
2:16
Right then, people who have joined us live are coming through the door.
2:19
Just say hi to a few people. Nicky Mansfield says, evening, you're lovely.
2:22
Can't say that, Nicky. It's a children's show, but nice to see you here.
2:25
Angela Thompson says, hello, this is my first live SDA podcast.
2:29
Angela Thompson, thank you very much for joining us live. We hope you enjoy
2:32
it. Do feel free to ask questions in the comments and watch out for Nicky Mansfield.
2:36
Nicky Mansfield has come back. I'll say, congratulations, Angela.
2:39
Welcome to the Heckle Lounge. It's not the Heckle Lounge, Angela.
2:42
This is exactly what I mean about watching out for Nicky Mansfield.
2:45
But anyway cecily hisstop is in the room saying get on my beauties oh my god
2:49
it's a little bit walkers tonight angela thompson brilliant right let's just
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leave these comments now we're leaving to it but anyway if you have come in
2:55
tonight in the live lounge do feel free to ask questions
2:58
i have told emily if you see something interesting up there then
3:02
to cut me short and bring you in because it is all about you guys who have joined
3:06
us live to join in with the episode so back to tonight's show episode 242 let
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me bring up physiotherapist emily sweet who will be reflecting on episode 229
3:18
pregnancy related back and pelvic pain.
3:21
Music.
3:33
How are you doing? I'm okay I'm a little bit worried about our live audience
3:38
tonight I'm sure it's no slow on you at all we just seem to have attracted some
3:42
of the rabble some of the riffraff kind of come to the door but that's fine
3:45
we'll treat them like any other individual,
3:47
Nikki Mansfield says that's me told I'm joking I love you all right thank you
3:51
so much for joining us really nice to see you again yeah and you thank you for
3:55
having me well you're a wonderful.
3:57
Reflectioner because you were last here in december 2024 reflecting
4:02
on therapy expo 2024 part of the panel there
4:05
so so yeah very keen to have you back for you to show
4:07
your thoughts once again which brings me to my first question
4:10
because i'm really i'm happy that you are a physiotherapist because
4:13
we do get questions on the show like do i have to be an sdma member to come
4:17
up and and it's lovely having you here because it shows one that you don't have
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to be an sdma member two you don't have to be a soft tissue therapist you can
4:25
be a physio chio osteo um so thank you thank you for doing that no you're welcome
4:30
thank you again thank you for having me you've released some,
4:33
gems of information so i am a yeah key listener to everything so it's great
4:38
but we all want the same information and we want to learn so i don't think it
4:42
matters where what area you come come from that is my soundbite sorted out for
4:47
tonight so wonderful we get that out of social media Yeah.
4:50
I'm interested actually, and I will be asking you a few times because a lot
4:53
of our listeners are not physios, they're not allied health professionals.
4:56
And we've talked a lot about kind of imposter syndrome and the fear that if
5:00
you're not an allied health professional, then you miss out on so much.
5:03
But for example, reflection, is that something which as part of physiotherapy
5:07
or course you were taught to do to kind of look back and think?
5:11
Yeah. So actually, what was it? The first year of uni.
5:15
So I've been, yeah, I've qualified now for four years so I'm still still a baby
5:19
physio this early in my career but yeah going back to the first year of uni
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our actual first module was on like reflective practice so they do start it sort of right away.
5:31
And as well, throughout our placements, it's part of our sort of criteria and
5:37
like mark, I suppose, for us to provide reflections each week on sort of any patients that we saw,
5:45
any conditions that we, you know, that we looked at as well.
5:49
And for us to sort of look into the evidence base a little bit of that.
5:52
But yeah, they do start it in uni and get you doing it really regularly,
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especially whilst you're on placement.
6:00
So again if there's any sort of students listening or anyone
6:04
to be honest the reflective practice is so important because
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that's how you learn and improve but any any
6:10
patient that was tricky or anything just reflect on it
6:13
and say what you learned from it what you did well
6:16
if you were to see them again so if you were to see yeah someone that presented
6:20
like that what would you ask next time because then it just helps you sort of
6:24
install those habits and also picking up patterns as well yeah it is installed
6:28
into us quite early on and then with the hdpc like registration as well.
6:36
For sort of evidence of cpd reflections reflections
6:40
count for that so it's a case of if you ever got called up
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and you need to demonstrate what cpd you've
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done if you're getting into the habit of
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trying to write a reflection say maybe you know once every couple
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of weeks or even if it's just like once a month on
6:55
something that you've you've learned about or yeah
6:58
you've you've had a bit of a tricky patient then if they
7:01
did call you up for it then you've got all your evidence there anyway so it's
7:06
a kind of thing obviously for your own self-reflection for you to keep improving
7:09
but also if you do have that don't call up you're not in that wild panic like
7:14
before that's true i mean that's and sometimes it's good to have big brother
7:18
watching you know it's kind of healthy.
7:20
In a lot of non-allied well i think really all
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non-allied health professionals where there's no there's no real
7:27
need to be part of a professional association or organization you
7:30
can get you don't have to do it's not legal but it's kind of cool if
7:33
you are and then you know that they're going to
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ask you like where's your cbd this year because we need a
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bit of that sometimes i think as well it's like it
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depends what environment you work in but i'm like really lucky i've
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got a brilliant team around me and then I find that
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you're constantly reflecting anyway because if
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you're chatting about like I said like patients that are a
7:53
bit tricky or you're like oh I've tried that but it hasn't really worked or
7:57
just any any questions then you're constantly asking each other oh what would
8:02
you do if you had this or oh I've tried this but it hasn't really worked you're
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you're constantly reflecting anyway so I think if you are you know if you are
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in a like a team environment
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you're more than likely doing that without even knowing which is a bit of a
8:15
challenge if you are working on your own a little bit because sometimes it's
8:19
it's the same thing is you don't know what you don't know until someone does
8:23
it differently or you've spoken about it so that again is that prompt of,
8:28
you're doing things and yeah, you've just got to keep, keep reflecting because
8:33
then that's just how you're going to improve.
8:35
Very cool. Great advice. That's Isla Cell Physio. Yes.
8:39
Yeah. Team, we'll give them a shout out. Isla Cell. Not Isla,
8:43
as I keep saying, it's Isla, but it's spelled I-S-L-A. But anyway, yeah, great.
8:47
Yeah, it's true. A lot of, I think that's one of the problems.
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A lot of soft tissue therapists are by themselves.
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They might be renting a room and they do miss out on that kind of,
8:55
first of all, having people around them.
8:58
And second of all, realizing that when you do ask somebody else,
9:00
it's not embarrassing and they might not know the answer either,
9:03
or just confirm that what you're doing is fine.
9:05
The amount of times when I was younger, I was lucky to just be in it for 10
9:09
years in a team with physios, osteos, podiatrists.
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So any question I had at the beginning, it's like, oh, this knee is weird,
9:16
it's dodgy, am I doing the right thing?
9:18
And you know what, 9.9 out of 10 times,
9:21
it's like, Matt you're doing fine just keep doing what you're doing you've done all the
9:24
tests there's nothing there just keep doing your loading this and blah blah and
9:27
it's fine and I was like yes literally and I
9:29
think as well that goes down to like personality traits I think
9:32
I'm that person as well that I'm kind of I'm wanting
9:36
to yeah I'm like a people pleaser so I'm
9:39
like right kind of you know I want to do things right and I'm sure everyone
9:42
else as well you know you want to get the best out of your patients so sometimes
9:45
it's things that you're doing oh you're like oh this isn't quite working or
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isn't quite fitting so like they're relying on me here like I need to do my
9:53
best to think of any other thing that I can I can provide and I'm due with.
9:58
So, yeah, sometimes as well at the start, you've got that, like,
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especially when I was starting off and still to this day, sometimes I think,
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oh, God, that imposter syndrome feeling.
10:09
That's why, yeah, podcasts as well like this are brilliant ways that if you
10:13
are working on your own, if you, again, you're listening to people and,
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you know, these podcasts, you always talk about like case studies or ways that
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they explain conditions.
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You think that's brilliant next time i have someone
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that comes in with that i'm going to use you know
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how they how they worded that so again that's a
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way of reflecting excellent no lovely
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it's really healthy so we could do a whole show about reflection i think that'd
10:37
be great rally but maybe not tonight maybe another time but no
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really healthy to hear it and and great advice and
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this is why if people are alone then you
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do need some collaboration with other therapists you know
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just pick up the phone go and visit each other don't see
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them as competition it's like andy hosgood
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who's going to be at the conference as well as saying you know collaboration over competition
11:00
will always win you know don't try and reinvent the answer to something which
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someone down the road has answered already go and see them have a cup of tea
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oh look like nice clinic and you you advance so much so right let's put a little
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pin in in the chat about and reflection and collaboration apart from tonight's reflection.
11:18
So I'm interested out of 240 episodes or so of the Sports Therapy Association
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podcast, you chose episode 229, Pregnancy-Related Back and Pelvic Pain with
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the wonderful Michelle Lyons.
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Apart from the fact that Michelle Lyons, who obviously is a fantastic reason
11:33
in itself, what else is it about that, the queen? Yeah.
11:36
What else about that episode in particular kind of resonated with you?
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So um it came such a right time for
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me when it was released so sort of
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a year ago i sort of like specialized in msk outpatient
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stuff and then within the nhs where
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i work as well you then have sort of specialized rotations within
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msk so you have like women's health rotation rheumatology
12:00
like burns and plastics that those sort
12:03
of bits and i really wanted to
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do the women's health rotation so which is great so
12:09
I've got that confirmed for September but in order
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to sort of go through that as well you mean we have competencies
12:15
to be able to see pregnant ladies and I
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was working through those from the beginning of the
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year really from Christmas and through so it
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was just on my radar obviously working through those and
12:26
beginning to see pregnant ladies on my caseload so that's
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why I really wanted to listen to the episode and pick this because
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obviously we do see it a lot and I
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wanted to make sure that the way I explained things
12:39
to patients was correct I was obviously up to date with the latest.
12:41
Evidence base so I think she yeah
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I was kind of the perfect target audience but when she
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said you know she was like I just want to start spreading the word and
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getting people confident with talking about
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it and I was like that is that's me that
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was me right now at this stage of my career I'm starting to
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see these people now I want to make sure I'm doing
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everything that I can to obviously be explaining things.
13:07
Right and yeah so being able
13:10
to give them a plan eventually fantastic so
13:14
I guess then I'm interested what
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when you listen to the episode is there anything in particular which
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either stood out as something you didn't know or if
13:23
you prefer something which you kind of did know but it was
13:26
nice to hear reinforced so it was
13:29
really nice to hear that was reinforced around the the
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infographic that i think that she said towards the end to sort
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of direct us to so i did i have sort of like printed it
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out if people haven't seen it i mean
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it's not it's not the best but
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i'll see if i can hold it up onto the screen so it's not very big essentially
13:47
it's the beliefs around sort of reframing pelvic
13:50
pain which yeah i knew
13:53
knew about those anyway but the main message is that it's safe to move that
13:59
your pelvis is stable and that it's self-manageable so that was really nice
14:04
to hear it reinforced again that they're stepping away from that approach that
14:09
it's sort of hormone driven so.
14:12
As well it's it was good to like know that a lot of women actually have it so
14:17
I wasn't aware that 75% of pregnant ladies have it because I was just new to
14:22
seeing these these patients but it is really yeah it's really prominent it sounds
14:28
like from the podcast in the past a lot of.
14:31
Pregnant ladies haven't had it explained to them and like
14:34
the reassurance provided for them that it
14:37
will get better and I think the biggest driver that Michelle
14:40
was saying was that hope so like right away the first
14:43
thing I want to say to to people as they come and it's like it's
14:46
okay we can that we can do something about this we've got a plan
14:49
and yeah and I think that was the biggest takeaway that
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I got from it is just reinforcing
14:56
those messages of belief of hope
14:59
it was the first big step for them to even come in
15:02
and have an appointment because it can be quite scary and nerve-wracking because
15:05
they think they might be alone and that the only people who feel
15:08
it and that they've got sort of something wrong with them but actually we can
15:12
be like no the evidence of you know 75 percent of people who are pregnant have
15:16
this and you can just really layer that to make them feel empowered and that
15:22
they can manage this and they don't have to deal with it alone.
15:28
It's really interesting listening to you saying
15:32
this because you know what i can't i'm putting myself in the
15:36
position of a patient who's pregnant it's not
15:38
easy for me but i'm trying to do it and and
15:41
i'm feeling like you know what you're
15:44
talking about and i'm feeling calm i can feel my shoulders going
15:47
down and i'm wondering whether because
15:51
the fact is you haven't had children no and
15:54
you're a woman so you're closer than me in that sense but some
15:57
people might think have you ever thought yourself maybe that oh
16:01
i haven't had kids and even if they don't know i
16:03
haven't had kids I know I haven't had kids and so what why have
16:06
I got to tell these people it's gonna be okay is that question right
16:09
literally yeah and I think as well not only
16:12
with with patients but also like the like my
16:15
people who have taught me about this like you know topic
16:18
and going through things with me because they have all
16:21
also had children and so when I was like
16:24
you know learning about this and all of that it was kind of not
16:27
like they would assume that I know but you know a lot of the terminology and
16:31
things for me around like questions that we would ask oh my god I don't even
16:36
know what that is like I haven't I yeah I haven't gone through pregnancy I don't
16:41
know how the you know how the body changes or it's that thing of.
16:46
You want to try build as much rapport with with your
16:49
patients as you can and like you said I but you
16:53
said Matt like being a female they automatically think yeah she's
16:56
gonna you know she's gonna know so I
16:58
think as well that's why I really wanted to you know
17:02
educate myself as much about it because
17:05
I can't go back on past experience because I
17:08
don't know what it feels like to have a child and
17:12
yeah the people who were sort of yeah chatting me through it and
17:15
teaching me essentially would you know
17:17
yeah you say things and you know what
17:21
that means I'm like no I don't you're gonna have to
17:23
go through it with me yeah I haven't been there I
17:26
haven't done it so yeah it's like that I
17:29
think that was the thing first of all having have like building
17:32
that confidence really because I yeah you don't have that experience like self-experience
17:36
through it I guess in reality though a lot of issues which you deal with whether
17:43
it's something to do with somebody who's had a hip replacement or they're suffering
17:47
from a particular injury or stress fracture whatever.
17:50
You probably haven't been through it and yet there we don't kind of feel so
17:54
paranoid but when it comes to something this kind of big we're kind of like
17:58
oh my god inside but it's no different really is it i know and i think it's
18:02
just the thing of oh my gosh you have a like you have a child growing,
18:06
that is that's what makes it scary i think because you yeah you're obviously
18:11
thinking about the you know you want to look after the mom obviously but again
18:16
i think all the past beliefs around,
18:19
exercising when you're pregnant because it's going to impact the baby and everything
18:24
like that so you are also i think that's maybe why i was feeling you know a
18:29
little bit anxious and things because you do,
18:34
you are thinking about two people as well. Or baby mum. Yeah, exactly.
18:39
That's the biggest thing on the mum's mind as well, isn't it?
18:43
She loves that baby or babies and you just want to make sure that she feels
18:50
so confident because she wants to do what is best for her and her babies. Yeah.
18:57
But I think that's where, and from listening to you, I think you've already
19:00
got it because sometimes you can, when I feel kind of safe listening to someone,
19:05
then it's normally because of the way they're talking. It's because of their
19:07
hand gestures, because of the pauses and the reflection stuff.
19:10
I think that's the principles of coaching, isn't it? if you're
19:13
a good listener and you just reflect and
19:16
summarize and you don't just offload a load information like didn't
19:19
you know this and i saw this on michelle lies broadcast and did you know then then
19:22
regardless of what that human being in front of you is going through
19:25
it doesn't matter if you haven't been through it yourself empathy comes
19:29
from just listening and reflecting and letting
19:32
that person know that you are listening and that person's
19:35
free to talk and and you're not judging
19:38
basically isn't it so i think that's what hopefully makes
19:41
it a little bit easier i think as well like it's obviously
19:45
talking a lot about like pain science sort of.
19:49
Education that actually it's you know the
19:52
nervous system is up regulated it's a
19:55
sensitivity in the tissues and we
19:58
we talk a lot about you know that element
20:02
of um reducing that pain
20:04
application trying to calm the nervous system down
20:07
we talk about that with loads of other
20:10
patients say that have like chronic low back pain or anything so
20:13
I'm like no I know I can talk about that
20:16
topic and it's you can apply that to
20:20
like pregnancy related back pain that it
20:23
is the that sensitivity the upregulation of
20:26
the nervous system that actually I know
20:30
pain is real it's completely real and
20:33
you definitely that's that's a really another really good point that Michelle
20:36
was saying that yeah you don't want to just say to people it's all
20:38
in all in your head we need to let them know yeah we hear you it is but actually
20:44
just sometimes those signals for your pain they can just they can just be a
20:49
little bit off sometimes that can that dial can just be turned up a little bit and we want to.
20:57
Explore ways that we can reduce that
21:00
because sometimes those threat signals just
21:03
aren't accurate if that makes sense and
21:06
we we do that a lot with all of our patients anyway
21:09
so yeah why is you know why is
21:12
this patient population different in the sense of discussing those things and
21:17
you know when we chat to patients as well we're always wanting to know you know
21:23
that their hobbies their lifestyle what things they enjoy what things they do
21:26
to relax all of that and that's this can be applied exactly to this population as well.
21:33
Yeah and rather than focusing on
21:36
I suppose like what I think it was
21:39
a really nice thing where she was saying like rather than thinking of like what are
21:42
the issues is why are these coming about and
21:45
if you ask why that then goes nicely
21:49
into sort of picking up the drivers of that sort
21:52
of pregnancy related pain which yeah she
21:55
did list off and I think the drivers
21:58
that you have anyway actually when you're
22:01
just conversing with the patient you pick up
22:04
a lot on those things anyway when you're finding out you know there's the
22:07
social history if she has any other children is she
22:10
working so is that that job that's just about the
22:13
dissatisfaction like factor
22:17
to it and as well yeah if she has any
22:20
other children then michelle was saying like obviously
22:23
you've got sort of reduced capacity like you're you're
22:26
not going to have as much sleep so that your your energy already.
22:29
Is like like your resilience is lower
22:32
compared to if it was your first pregnancy maybe
22:36
and i think we like we're brilliant
22:39
at being detectives so i think we anyway just through
22:42
you know chatting to the patient you get
22:45
all this information anyway and I think
22:48
then when Michelle was chatting about that these are
22:51
the drivers for it you think oh I actually was picking up on them those things
22:56
anyway and then it sets you off quite nicely of where you want the conversation
23:01
to go or okay she's you know she's not sleeping as well maybe let's focus on chatting to her about.
23:09
You know sleep hygiene or things to do to
23:11
maybe try and improve her sleep yeah those sort
23:15
of bits if that makes sense oh massively no really
23:18
really well summarized and it's so nice to hear you know you reflecting
23:21
and picking up on those things yeah no
23:24
wonderful i mean you made yeah two really important points there
23:27
the one where michelle says that one of the biggest drivers is
23:30
having had a baby before and i think i just
23:33
imagine because we've got somebody who believes it's because
23:35
of the hormones because of relaxing it's because of this they've got an unstable.
23:38
Pelvis they're feeling insecure about their body if you
23:41
can plant the seed not just offload it but if you can plant the
23:44
seed and give them a little bit of kind of reassurance that actually the
23:47
fact you've got another child you're not sleeping very
23:50
well this is to be expected yeah your body's strong
23:53
it's just we have to do something about these and i love the analogies you
23:56
use as kind of the dial and stuff and i love the way
23:59
you reinforce it's not really in your head because that's a really important thing
24:02
which maybe you know we weren't quite so good at kind
24:05
of eight ten years ago so no it's really healthy
24:08
stuff it can make a massive difference and also the
24:10
other thing michelle said which you remind me of is that one of
24:13
the biggest predictors in helping women
24:17
without pregnancy if they've got related pain is yeah
24:21
giving them the belief that it will get better will help
24:24
just that and that sounds so crazy doesn't it but it's yeah and it it does that's
24:29
a thing it sounds so so simple but yeah clearly something that just hasn't been
24:35
hasn't been yeah said enough and I think it was yeah the sort of the belief
24:39
that we can help them really reinstall that hope.
24:43
Like anxiety and stress is another thing as well and again that's something
24:48
that I sort of routinely ask anyone because we know with sort of like you know
24:53
your yellow flag factors and things and we know that I sort of explain it to
24:59
again to patients that if you have a sort of a lot of your.
25:02
Unhappier hormones in your body in terms of like your
25:05
stress levels if you're not prioritizing
25:09
things that are going to help you relax or things that make you
25:11
happy so getting those feel-good hormones in your
25:14
body then those unhappier ones
25:17
of stress and anxiety again do the opposite effect
25:20
they sort of dial things up they dial up that sensitivity when
25:25
actually if we can really help try and relax focus
25:28
on things that you enjoy trying to make
25:31
time for yourself and yeah certainly going
25:34
sort of down the other way and getting those things that are going
25:37
to try help relax or make you feel a bit better again it
25:40
then dials things down so that's another
25:43
thing that we you know talk about to sort of any any
25:46
patient that is that is in you know in pain actually we
25:50
can apply that to this population as well and i
25:53
think as she was talking about sort of factors of
25:56
like weight management and smoking again that's sort of part of your pillars
26:02
of health so you'd be chatting to them about again any other sort of population
26:06
and the reason for those is that sort of increases that inflammation which again
26:11
will just dial up that sort of tissue sensitivity.
26:17
You're a physio so obviously you know you read flags
26:20
back to front yeah so i mean because that's something which
26:23
i know our listeners are going to be adds to their worry
26:26
and their anxiety of what have i missed this what if i missed this so yeah
26:29
i'm wondered as a physio what are
26:32
some of the kind of red flags which we
26:35
do have to look out for because we must just get too blase and say
26:38
oh don't worry it's just because your kid's keeping your weight what
26:41
are some of the things we need to keep an eye out for and and what
26:44
are some of the symptoms which should flag that yeah so
26:47
i know michelle highlighted sort of two of them
26:50
in the podcast so one of them was sort of dvts so
26:54
it's of really important that you're going
26:57
to want to screen for sort of any redness any heat at all just really trying
27:03
to get those questions going and you know I just I would just ask you know yeah
27:10
how does it feel down below essentially trying to it's trying to get rid of that taboo isn't it and.
27:17
If they do say yes, it's just knowing where to escalate and who to escalate that to.
27:23
So again, I would always say if you're on your own, then you're going to want
27:25
to definitely get them to sort of the GP.
27:27
So it'll be like, you know, like writing a letter to support or yeah,
27:31
just sending them through there because you definitely want to get that stopped
27:34
or highlighted as soon as possible, those warning signs.
27:38
But again, if I was in like where I am now, like a team environment,
27:42
if they were sort of saying yes, I'd be like, oh, do you mind if I chat this
27:45
through with, you know, with someone else?
27:47
Just to double check but yeah you don't want to screen
27:51
for those and also that's a really interesting
27:54
point because like dvts audience are familiar with because on
27:57
any course you're kind of told about the dvt but obviously
28:00
any dvts you're told about is look at the car look at the low leg but
28:03
what you've said because people go oh dvt yeah i'm familiar with
28:06
that they're feeling a bit better yeah obviously this is a taboo
28:09
area because you're talking about potential dvt and
28:12
the swelling could be on the labby or something which people don't even want
28:15
to say that word but i think Michelle mentioned this was the importance of asking
28:19
if the person's been for visual has somebody actually looked at this if you've
28:23
got the symptoms of you know and that's that's that should be easy enough to
28:26
do shouldn't it just have you had anyone check it out have a look at it like GP.
28:30
Yeah so important signposting isn't it exactly exactly um and sort of the other
28:36
one as well was that I don't know if I pronounced it right but that trans transient
28:40
osteoporosis sounds good to.
28:43
Transient transient that's great yeah but again
28:46
i think because that can appear as sort of pain in the
28:49
in the deep groin as well so obviously very
28:52
sort of common with your anterior
28:55
pelvic girdle pain that they could be coming in sort
28:58
of to see you with around like your three deep synthesis area but i
29:01
what i got a lot from that was it was more as
29:04
well sort of asking her history so you know
29:07
has has she had reds in the past so relative energy
29:10
deficient deficiency sort of excuse me any like eating disorders potentially
29:16
it does she have low bone density has she had any previous fractures before
29:22
has she ever taken any steroids alcohol use yeah so those questions,
29:29
if if they you know if she had said yes to
29:32
quite a few of those and i think it would raise your suspicions a
29:35
little bit more so yeah I would definitely dive into a
29:38
little bit more about her past if you
29:42
if you're querying this as well but I think it's that
29:45
sort of again it would be that unremitting pain which
29:49
would be really really sore on weight bearing so
29:52
I think if you have those two two factors you know she can't settle there is
29:56
no comfortable position at all and then once you start diving into a little
30:00
bit of her history and ask around those sort of questions if she's sort of answering
30:05
yes to any of those then yeah I would think yeah we need someone to someone
30:09
else to be involved here and have a look.
30:12
Brilliant. I'm sure that sounds reassuring to me. I hope that's reassuring to listeners as well.
30:16
Yeah, it's classic stuff, which you'll probably all be aware of with other parts
30:21
of the body, like sudden pain, unexplained pain, swelling, that sort of stuff.
30:26
But there are sort of a few others to sort of be aware of as well.
30:30
And I think if, yeah, she came in, so you'd want to know if there was any sort
30:34
of abnormal vaginal bleeding at all.
30:37
So yeah always asking always asking that and
30:40
again if there is then sort of
30:43
where we are we like in sort of the NHS department then
30:46
we would sort of send them down to triage but again I would get
30:49
them on the phone to like their midwife or again
30:52
just just escalating it because then that's sort of like ah this isn't this
30:56
isn't a you know a physio or sport therapist will support my problem now we
31:01
need to get someone else involved and just check this out so I'd always ask
31:04
in sort of around that any sort of preeclampsia as well so that's sort of like your blood pressure.
31:10
Or pressure they're going to want to know about that and it's
31:14
mainly sort of asking around these questions of you know have have
31:18
you had your midwife appointment like is are you a midwife led
31:21
pregnancy or are you consultant led that's always
31:24
quite a good question to ask because if they are sort of consultant led
31:28
then again that could be a reason why could
31:30
they're potentially a bit more complex so.
31:34
It's worth asking that if they've had any
31:37
history of sort of any spontaneous miscarriages in the
31:40
past as well that's worth worth noting
31:43
just just to add to their history are they anemic
31:47
are they epileptic it just adds
31:50
to that that complexity a little bit around yes the
31:53
pregnant population and if they have like a any sort
31:57
of low-lying placenta so i think it's called placenta previa
32:00
as well so again that would be just some
32:03
signs if there was any sort of like early warning labor because
32:08
like your service would open yeah prematurely and
32:11
as well it's always just good to see what the you know
32:14
are the fetal movements like is the baby kicking as
32:17
regular is it you know is it normal or has there
32:20
been any significant reduced fetal movements
32:23
and if that was a yes again I would think right yeah you need to go on and chat
32:27
to someone about this but they're sort of our sort of specific questions we
32:33
ask on sort of our like antenatal sheets or when we see them in the NHS so I
32:38
think that's a good yeah a good thing for people to be aware of.
32:42
Yeah that's good so i was thinking yeah like some of these questions
32:45
could be on a kind of a specific kind
32:49
of parkour questionnaire yeah but if not there
32:51
are ones which as you listen to your
32:54
client during the subjective you need to start picking up with and
32:57
just guiding the conversation for them giving them a chance to
33:00
come out with the fact that you know this is happening and
33:03
and they haven't done this and i was a bit worried because i'm not
33:05
bothering to see so and so because i just haven't got the time and i'm too
33:08
busy and yeah and i love the way that you you're
33:11
kind of hopefully empowering the listeners to make them realize you're
33:15
not dealing with this it's not in your scope of practice you just ask
33:18
giving them a chance to reveal these flags themselves
33:21
and then you signpost them just say you know what probably worth
33:24
doing this we're going to see so and so which is lovely like again
33:27
it's just that detective work isn't it you're just essentially
33:30
it's that screening and it's just because
33:34
if they you know if they were sort of answering yes to
33:36
those one that's the priority isn't
33:39
it like mom and baby health is the priority and also
33:43
you're just like oh maybe maybe the pet
33:45
you know is is this something that we can help with
33:48
or actually that is what they just need to go
33:51
sort yeah first off so i
33:54
would yeah always sort of ask about about those and
33:57
again it just depends how much depth you want to go
34:00
into it but just checking you know if they've
34:02
had their regular scans and just essentially at
34:06
their mid you know appointments and things is everything.
34:09
Going as they would expect it to essentially great stuff.
34:13
And i think it's probably we've talked.
34:16
About this a few times on the show but women unfortunately
34:21
maybe because of our patriarchal society whatever kind
34:24
of put into position where they think i should just
34:27
deal with it it's just typical this is some pain it's going to hurt it's
34:30
pregnancy and stuff and they kind of maybe downplay and don't want
34:33
to bother somebody they don't want to be that person who's nagging but i
34:36
think this is i mean we've had alistair beverly on the show a few times and
34:40
he's he kind of signposted the fact that diagnostic overshadowing which is where
34:44
they might have gone to see a gp who's kind of gone oh these it's just because
34:48
you're pregnant it's because this and that don't worry about it and unfortunately
34:51
if someone else had presented with these symptoms and they weren't pregnant,
34:55
you know, then they would have kind of been flags for further investigation.
34:59
So I think sometimes a lot of women, you.
35:02
Don't want to kind of make too much of pain they're feeling so
35:05
what would you how do you distinguish those that
35:09
uncomfortness of being pregnant with something which needs
35:12
to be investigated like the 75 percent of pelvic girdle
35:15
pain you were mentioning i think like you again
35:19
like you you don't want to just be like oh this is just because
35:22
they're pregnant so i would still have your sort of your differential diet
35:25
you know like think about your differentials of you know
35:28
you'd want to check the if they were saying about symptoms going
35:31
down the back of their legs that are presenting maybe a bit more sciatica or
35:35
nerve nerve irritation then you
35:37
want to have that as a differential in time
35:40
again like you said you don't want to just reason
35:44
everything because they're pregnant and i think that's again when you sort of
35:49
get the the subjective history when did it start actually has this been going
35:54
on before they were pregnant you know their onset could have been like a year
35:59
ago or six months before they were pregnant so actually is it
36:02
is it pregnancy related you know or it could be a combination now you had some,
36:08
other issues before maybe had some hip pain before and you didn't really ever
36:13
get it sorted and now you've become pregnant and if you had pain beforehand then again we know that
36:18
sensitivity of the tissues already sort of goes up so that dials already up
36:23
a little bit so I think it's yeah when you go into sort of your more subjective assessment and.
36:29
Is doing it exactly how you would anyone else in
36:32
the sense of knowing when it starts what are
36:34
their aggravating factors what are their easing factors does it
36:37
fit with your sort of your pregnancy related pelvic
36:41
pain or are you thinking well actually it could
36:44
be sort of more my differentials do I maybe need to do a neuro assessment
36:47
because they're reporting pins and needles they're reporting numbness
36:50
so I know that's and I find
36:53
that really hard because I think i have i can see a bump i have
36:56
a pregnant lady sat in front of me it must be because of
36:59
that but actually sometimes i i
37:02
do just have to think now i'm just gonna go go for
37:05
ask ask my questions like i would anyone else see what
37:09
the see what the answer is and yeah does does
37:11
that sort of fit in with the pregnancy if that
37:15
makes sense yeah no it's really cool no definitely
37:18
you have got to not just put everything down for the
37:21
fact they're pregnant but also give them permission to
37:24
to kind of just say i don't think this pain is actually
37:26
normal it's more than they you know because they
37:29
might just not like they might for a lot of our massage
37:32
therapists they may just come in because they want a massage to feel good to get
37:35
away from things for maybe the only hour they're going
37:38
to have in that month but this is where
37:40
you have a little chat and say this pain you're talking
37:43
about is it kind of just come and go is it kind of continuous you
37:47
know and then open up these questions of have you got any swelling or
37:50
have you got any of this and that and then discover something
37:53
which they're trying to just not bother anyone with i.
37:56
Think that's part of it isn't it and i i think like the the soft tissue stuff
38:00
as well that you mentioned and i know michelle was saying about like with manual
38:04
therapy that actually i love the way she said it was like oh it's like a you
38:08
know like conversing with the nervous system and i was like that is so nice
38:11
i really like that i'm gonna definitely take that because.
38:14
Again, it was just that thing of explaining to the, you know,
38:18
your ladies in front of you that it's not to become reliant on this,
38:22
this man, you know, it's any sort of manual therapy is not there to,
38:26
you know, realign you or make your pelvis stable.
38:30
You know, those messages don't want to come across at all.
38:33
It's actually, if this is a, you know, if this is something in our toolbox that
38:37
we can use alongside sort of the education and exercise,
38:41
and if that's going to help, I think it was yeah she was saying if we can calm
38:45
things down first and then build them up so actually yeah if if the massage
38:51
and things is going to help settle that nervous system down.
38:55
Makes them feel comfortable make them be able to
38:58
feel ready to engage in the exercise and that's
39:01
what we that's what yeah we want to add that one
39:04
add in if it's appropriate to then
39:07
allow us to build on that so they feel happy to
39:10
sort of do do exercise and things but
39:12
yeah it was just not to become reliant or
39:16
send the message across that we're doing anything to their
39:19
pelvis at all it's it's fine how how it is but actually if it's just going to
39:24
help reduce that um sensitivity a little bit then it can be really helpful very
39:29
cool very cool and this is such a good example i think of interdisciplinary
39:33
kind of care of massage therapists looking after because,
39:36
somebody else maybe a women's health physio has kind of said like this person's
39:41
really wound up and and decent what did you say conversing with the nervous
39:44
system they need some of that they're just working together i mean that's what
39:48
people need so great stuff right well.
39:52
It's always the same with these great topics um
39:54
sarah jones in the comments i've noticed you sarah jones
39:57
says so late had to squeeze in a run hey you know i
40:00
mean that's a great excuse sir it's fine you're forgiven nikki mansfield
40:03
has also been supported saying oh it's a good one sar emily's
40:06
amazing there you emily and i'm definitely
40:10
going to go back and watch the original episode sounds like i missed an absolute
40:13
lion's classic yeah it's one
40:16
of the lions classics one of the four i think she's done and sarah says all
40:19
smart catch up tomorrow that's brilliant that's what we want to do we want to
40:22
kind of help people who have missed out one of the other episodes to go back
40:25
and listen to it's a nice one good job angela thompson says i do a group workshop
40:30
for non-complex PGP within my support role in pelvic and obstetric physio.
40:35
Most information and exercise components, some really nice peer-to-peer moments
40:38
in the group setting. Great.
40:40
We love a bit of communication. It's good to hear, Angela. Fantastic.
40:45
We couldn't finish this episode,
40:49
without talking about Michelle's favorite topic, constipation.
40:53
She just wouldn't. I would have an email within five minutes.
40:55
So what are we going to say about constipation? Why is Michelle super legitimate?
41:00
So again, it's that taboo subject, isn't it? And I think it was more at the start of the episode.
41:07
She sort of used the example of, you know, when we're sort of screening for
41:12
Corda Aquina and things, that we ask all those red flags or scary,
41:16
scary questions, you know have there been any changes to your bladder or
41:19
bowel movements or anything like that and if they
41:21
say yes you're like oh oh god you know
41:25
I've got to do something about this now and I think it's the
41:28
same thing is that we just need to get confident with
41:31
asking about it because as
41:35
well if we don't maybe give them the open space to to say
41:38
about it then again that they won't and they may think that
41:41
why am I like this am I the only person like this if they haven't asked
41:44
me about it is it is it important is it
41:47
even relevant so I think even just asking the question
41:50
again it just opens up that field for
41:53
them to yeah for them to talk about but yeah
41:56
I got sort of the sort of key things to take away from that
41:58
is again going back to sort of basics around asking around
42:01
hydration of everything and as
42:05
well you sort of your your pelvic floor muscles
42:08
are very heavily linked and connected to
42:11
sort of your stress levels so again it's everything is is really really tight
42:15
and again we all know how horrendous it is if you feel constipated it just makes
42:21
you feel awful anyway so again if you if you have that and then you're on top of you know lack of sleep.
42:31
This the pelvic pain you can't do anything that you used to enjoy because it's
42:35
it's so painful it is going to be one of those things that again is going to
42:39
add to that what amplifies your pain system so yeah we definitely just want
42:44
to I want to ask about it because as well there's,
42:48
then we can then suggest things that can help so yeah keeping up with hydration
42:53
is like the biggest one and as well it probably seems like a really simple.
42:59
Idea but like even if they are going toilet
43:02
and they're struggling that thing of like getting them
43:05
to have a stool so then they raise their legs up so again it
43:08
just makes that bowel movement feel more comfortable but it
43:11
could be an absolute game changer for somebody but they just because
43:14
nobody asked them about you know their bowel movements or
43:17
anything again they just haven't thought about their position on the
43:20
toilet yeah there are a couple of of
43:23
those bits and i think as well it's it's
43:26
a like on reflecting it's something
43:29
that i want to again learn more
43:33
about around it because before i listened
43:36
to this podcast episode i was one of
43:38
those people where i would probably yeah oh if
43:41
you have any bladder or bowel changes and i've probably been a bit more focused on
43:44
the bladder side of things because of like
43:48
your pelvic floor in in terms of leakaging and
43:51
all of that I was kind of more and I think that it's great
43:55
because it's got a lot of oh not screen time what
43:58
I try to say a lot more people are talking about it now you know sort of yeah
44:02
bladder leakages and things and that is something that people say is like a
44:06
bit of a passive comment you know when when you're pregnant like aren't you
44:10
to go to the toilet more and everything so I think urinary stuff is spoken a
44:14
little bit more and I thought that was kind of more of the,
44:17
a bit more of the important vibe, but actually after, you know, listening.
44:21
Like you said, Michelle was talking so much about bowel movements and I thought,
44:26
yeah, this is something for me
44:27
where I need to do a little bit more listening and reading into so I can.
44:33
Feel more confident with asking questions but I
44:36
think the first step for me was actually yeah just opening the floor to
44:39
it and a couple of simple things that I
44:41
know I can talk about around hydration and yes maybe some
44:44
positions that might make it feel a bit more comfortable
44:47
and if I need more help then that's
44:50
when I'll yeah I'll go and go and ask my you
44:53
know my other colleagues and things of all what things do you find
44:56
is helpful for constipation and things great
45:00
yeah yeah it's a wonderful example isn't
45:03
it of taboo topics and things you shy away from but i think
45:06
what you said at the beginning as well just letting that person know that it's
45:09
very common okay they don't have to not talk about
45:11
it because i think it's just them and it's embarrassing it happens loads and
45:14
if it happens loads there's probably things which can help because you
45:17
know when lots of people have got this going on there's going to be kind of solutions so
45:21
and i like the point michelle said about actually preparing
45:24
you for birth because if you can help this person have
45:27
i mean michelle puts it wonderfully um but yeah
45:30
if you can help that person have a healthy happy bowel movement then
45:33
there's get that's going to reflect later on when they're actually giving birth because
45:36
they will have already worked out ways of just relaxing and looking at
45:39
their breathing and and looking for a position which
45:42
is going to make things and not just putting up with it you know so no good
45:45
on you michelle we like the fact which you are channeling this yeah it's very
45:51
cool right well look it's 8 49 i try and make these i always say i try to make
45:55
these shorter but it's such a great topic and and it's been such a pleasure
45:59
listening to you reflecting on it so thank you for that.
46:02
Really appreciate it there's so much more in
46:05
there you know what the thing with michelle lyons episodes is you know
46:08
i've made some notes down here and there's so many other tips which we're
46:10
not going to go through now but revolving around positioning and
46:13
pillows and scar massage and shoe
46:16
size and and bra fitting i mean
46:19
it just goes on and on and on looking at balance there's so much
46:22
isn't it she just yeah I think literally I think all those little bits I was
46:27
like looking at more of a definitely took away it was more like a whole body
46:31
approach so again even though they've come in to you with you know low back
46:36
pain actually there's so many
46:38
other things that we can work on that is going to help and I think that.
46:42
The conversation around strength training that actually
46:45
that max contraction equals max relaxation and
46:49
you don't have to be focusing on just
46:52
any movement is good movement if it
46:55
makes them feel feel good and we're
46:58
you know it's non-threatening to the nervous system so
47:01
again they're just feeling at ease feeling comfortable
47:04
with movement but yeah it doesn't always have
47:07
to be focused around the lower back actually i
47:10
think she was saying you know yeah if we're getting our foot
47:13
muscles involved so our calves or like rotate calves are
47:15
doing some upper body work some rows because those
47:19
are still stabilizing muscles again if
47:22
they're sort of it's just for your
47:24
body to then learn what it feels like to
47:27
contract and relax and you don't have to focus on the muscles just
47:30
around the back which i thought was a really good good takeaway
47:34
as well yeah because you were saying when you have a bit
47:36
you know you can't see your feet like i'm scoffing so
47:39
it's again just keeping in tune with your with your
47:42
whole body which is really good and yeah advocating for that sort of strength
47:46
training and keeping moving and just trying to yeah reduce that sort of regulation
47:54
of the nervous system trying to find ways for them to move in a safe and comfortable way essentially.
48:03
Great stuff okay right everyone
48:06
thank you so much for joining us live for people who are listening including
48:09
you podcast listeners we have been reflecting on
48:12
episode 229 pregnancy related back and pelvic
48:15
pain that was recorded early in february this year with special guest
48:17
michelle lyons if you are interested in
48:20
courses about what we're talking tonight michelle lyons has got something
48:23
for everyone at celebratemooliebrity.com and
48:28
that includes her online female hormonal health master class which
48:31
has got three separate modules into menstrual health maternal health
48:34
and pelvic girdle health she's got the menopausal health
48:36
course with the three big life stages exercise library manual therapy pathophysiology
48:41
loads of information go along to celebrate ruleability.com not only is it great
48:46
information it's just put forth as only michelle lions can so and like we said
48:50
before michelle will be at the sta southwest conference as well so check out the st school at KodaUK.
48:56
And for details on that, tickets are on sale Saturday the 20th and Sunday the
49:01
21st of September later on this year.
49:04
There is an STA member discount as well. So make sure you're using that.
49:07
But you've got to use it for the end of June. But that'll be in the members area. STA members.
49:13
Right then. Thank you, Emily Sweet.
49:15
Physiotherapist Emily Sweet for your reflection. Really appreciate it.
49:17
Thank you so much. Yeah, thank you for having me on. Brilliant. Really good topic.
49:21
If people want to follow you, which I'm sure a lot of people will now they've
49:25
heard you, where are you most active? You're on Instagram?
49:28
Instagram. Yeah, that's where I'm most active. Yeah. So it's at eSuitePhysio.
49:34
Simple, E-Suite Physio. And then we've got Isla Cell Physio as well, which is ISLA.
49:40
That's it. Yeah, I was just going to get her handle up as well.
49:45
So that is, yeah, at Isla Cell Physio.
49:48
Very organized. Very easy to remember. Brilliant. Thank you.
49:53
Next Tuesday, 8 o'clock on May the 27th.
49:57
Yes, that'd be right. My reflection guest will be clinical massage therapist
50:01
Jessica Jannerman of Ease Therapies,
50:03
who's going to be reflecting on episode 222 a
50:06
therapist's guide to hypermobility that was
50:09
recorded in december 2024 with special
50:12
guest bonnie southgate so if that is of interest to you then that join us live
50:17
if you can that'll be next tuesday at o'clock on the sports therapy association
50:21
youtube channel and thanks again everyone who joined us and cecily hisslop you're
50:26
not with cecily you're lovely and i'll check and she says thank you both some
50:29
great insights And Sir Glenn Murphy, MBE,
50:33
has said, Emily was fabulous. Well done. There you go.
50:36
Just being congratulated by a knight. Is a sir a knight this year?
50:39
Is a sir? So there you go. Bucket list. Cross that off. Wonderful.
50:43
Thanks, people, for joining us live. Really appreciate it. And thanks for sharing
50:46
questions and your acknowledgement of the great Emily Street.
50:50
Really appreciate it. Bye, people.
50:52
Take care. Hopefully see some of you live next Tuesday at 8 o'clock.
50:56
But until then, as always, take care of each other.
50:59
Music.