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Your clinical shield

The most important part of the first time you see a patient is communication and listening. But what happens when we're doing all the right things, we're really present for our patients and doing a great job. 8 hours a day. It's easy to get burnt out. Building your therapeutic alliance can be hard work, ensuring trust, that you're listening and you're with them through the body language you use and how you question.

If you've been on my live courses you know I'm passionate about getting this right at the start. If you haven't seen Mark Bowden's Ted Talk it's a great place to start (followed by his books). 


Meeting the person with an open, "I carry no weapons" pose, using a upward eyebrow movement of positive interest, focus, and welcome. Making sure you set up your clinic room to dethreaten the situation as much as you can by placing the patient closest the door, without obstructions. If you can brighten the room with things that make it less clinical,...

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Slow recovery and growth in 2022

Welcome to 2022!


I’m trying to start this year with positive intentions. Its easy to get lost in the fog of living in uncertainty, but I’m hopeful. Even in the bleakest of situations we can hold onto hope, hundred of patients living through their worst times have shown me this. And their stories of recovery have fuelled my hopefulness. There is always light where there is shade.


I’ll be honest, last year was a blur of survival. I find myself with two small funny toddlers wondering how we all got here. And where I am in all of this. No doubt pandemic isolation has heightened the murkiness of this transition to working motherhood. The struggle is real. How have women done this for decades?! I am coming to understand that the world of work was set up for men who had wives at home to do everything for them. If only we had a wife at home!... Any words of wisdom in navigating this transition are gratefully appreciated.
I used to love sitting still in January planning,...

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My review of Cystitis Unmasked by Prof. Malone Lee in JPOGP 2021

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Paradigm shifts within medicine happen slowly: surprisingly it takes 17 years for clinical practice to catch up with the evidence. This book presents a logical argument for chronic urinary tract infections (cUTI) as the cause of interstitial cystitis/bladder pain syndrome (IC/BPS) arising from 20 years of hard-fought scientific exploration, and it’s time that we pay attention. This is a must-read for those treating incontinence, repeat urinary infection and bladder pain syndrome, with the understanding that the biomedical model presented is but one important element of a complex and dynamic disease process that affects the whole lived experience of the person sat in your in clinic.

 

But this is more than a textbook, it’s a personal account of the work of Professor James Malone Lee’s team. They became prominent in 2015 with the closure of their controversial LUTS (lower urinary tract symptom) clinic and the subsequently successful patient-led high court battle...

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Pacing in Burnout - Welcome to 2020

In some ways being a pelvic health physio is very similar to being a counsellor – we have the same exposure to emotional trauma and provide emotional support. This article on burnout popped out at me the other day. Unlike counsellors we don’t get training and resources to tell you what to do, and it’s not spoken about.

When my Dad was dying I found myself completely overwhelmed by the needs of others. I love my job, I love the profession, but I was surviving one clinic to the next. I was head-down dug-in, just getting through each interaction and trying to stay alive, keep my Dad alive and support my family practically and emotionally. I was multitasking at an exponential rate; running clinic, running my business, running his medical situation. Working through emotional exhaustion I took everything personally, beating myself up for not ‘giving’ enough to support a patient and therefore taking their lack of progress, their hurt, their need for me to...

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I think I’ve got Vulvodynia or Vaginismus, what can I do?

Watch the video here.

Have you got Vulvodynia or Vaginismus?

Vaginismus is basically just tight pelvic floor muscles, which makes getting a tampon in or having penetrative sex painful or difficult. Your pelvic floor can be generally tight all the time (think about how tight your hamstrings get when you’ve been sat driving all day, the day after a run or you’ve never stretched them until that yoga class and down-dog was an experience..). Your pelvic floor muscles can also go into spasm when thinking about or having anything penetrate the vagina (like when your calf goes into cramp in the night). Both aren’t pleasant, and both are totally treatable. Treatment is exactly what you’d do with any other muscle – learn to relax them and give them a gentle (and regular) stretch. It shouldn’t hurt.

Vulvodynia is a pain in and on the vulva, where tests have shown there to be nothing ‘wrong’. I like to think of vulvodynia in these terms: your...

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Men have pelvic pain too. Let’s talk about it.

You can watch my interview with Karl Monahan here.

I’ve been wanting to talk about male pelvic pain. Men have pelvises and get pelvic pain. Why does it remain a taboo? This one is for both patients and clinicians.

Karl and I have been friends for a while. He’s a wonderful human, therapist, pain expert, collaborator… he generally defies labels. From a background in sports and advanced clinical massage therapy and specialist training in Arvigo Techniques of Maya Abdominal Therapy (ATMAT)  he’s built a wonderfully holistic clinic and practice that serves men with pelvic pain. You can find out about Karl here and his clinic here.

It speaks volumes that only in the last few years have we made the transition from “Women’s Health” physiotherapy (with physios who also treat men) to “Pelvic health physiotherapy” – a much more apt name for the treatment of pelvises, regardless of gender identity nor anatomy. It’s a...

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Guest blog: Recovering from urinary retention, Laura’s update

After delivering her first baby Laura went into Urinary Retention which caused an acute bladder injury. She was unable to pass urine and had no feeling that she needed to go. After an initial period of time with a catheter she has had to use Intermittent Self Catheterisation (ISC) to pass urine throughout the day.  If you haven’t read her last blog you can read it here.

We’ve been working together for a number of months and she’s making fabulous progress! I’ll let her tell you…

In my first ever blog post, I shared my story of retention post child birth. My journey of recovery is ongoing. I am still not completely ‘fixed’ yet but I am well on the way and now truly believe that I will get there in the end…whenever the end might be. There has been exciting highs but also really disheartening lows. Although I feel like it has been a lifetime since having a normal functioning bladder (when in reality, it’s only been 7 months),...

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Guest blog: Laura's childbirth and bladder injury story

Laura really wanted to share her story so that other women who have problems with rentention can know they’re not alone, and know how to find help. Reading her frank and at times devastating account of the first few weeks of her son’s life isn’t easy, especially as a health professional who can see where and when she’s been failed. I’ve been inspired by her resilience at a time where she should be enjoying motherhood. With persistence she’s making great progress, and I really do feel the future’s going to be fine.

Not being able to open your bladder, or going into “retention” can sometimes happen with childbirth. If it isn’t caught quickly the bladder can overfill, overstretch and become injured. Sometimes this leads to kidney injuries too. Not being able to go to the toilet at all can be quite dangerous for the bladder and kidneys, so people are often taught to drain their bladders with a small disposable catheter....

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Neurocentric approaches to treating pelvic pain with Dr Sandy Hilton

You can watch our chat here.

This is a Really exciting time in pelvic health where our understanding of the brain, pain and how we can change someone’s experience are all evolving. By this I don’t just mean in the psychological way, but in a true “pain experience” sense as well as thinking about how we can change biological markers and antecedents to pain, such as inflammation, with our words and how we approach people with chronic pain.

Sandy Hilton is a Doctor of Physical Therapy based in Chicago, America. She has contributed to multiple book chapters, papers, and co-authored “Why Pelvic Pain Hurts” and is an international instructor and speaker on treating pelvic pain for professionals and for public education. She’s also a regular contributor on health related podcasts, and is co-host of the Pain Science and Sensibility Podcast with Cory Blickenstaff, which I can wholly recommend as both a source of evidence and a great lesson in how...

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Practising fierce, compassionate self-care in 2019

You can watch our chat here.

I first met Katie Kettner at a Happy Bladder Course in 2018. I found her enthusiasm for our profession and passion for collating ways in which she can help people rehabilitate utterly inspiring. She is a Women’s Health Physiotherapist based in the North East of England with a diploma in counselling, is currently working towards a diploma is psychosexual Medicine and is studying a pastoral certificate via Loyola University in Chicago including the study of the psychology of human development and our quest for meaning.

She says of herself

“I have a deep and fierce passion for Women! Since working in this field, I have developed a huge compassion and empathy towards Women’s health and feel enthusiastic to not just help Women, but to celebrate them and honour them; and encourage them to do the same. This desire has led me to some fascinating discoveries from all sorts of fields, including neuroscience and psychology which is helping...

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