Hello & Welcome! I'm so excited to share this discussion with a leader in the field of sports medicine, who brings her personal experience as a high performance athlete, her vast clinical experience and her research insights to today's conversation. I'm talking about Dr Fiona Wilson,who as well as all of the above is also a Deputy Editor of the BJSM; the highest ranking sports and exercise medicine journal globally. She is also a professor of physiotherapy in Trinity College Dublin, as well as Deputy Editor of the Journal of Science and Medicine in Sport, leading their Injury Prevention subsection, and she is on the editorial board of the Journal of Sport Sciences and the German Journal of Sports Medicine.

Her research focus is the role of sport and exercise on low back pain (LBP) and on brain health, and she's published many clinical practice papers that are changing how we manage back pain in athletes, as well as a growing interest in menstrual pain in athletes (she was a coauthor on the Harrison 2026 paper that I discussed in a recent episode on menstrual pain, as well as a co-author on Dr Ciara Everard's paper on menstrual health (check out episode 113 where I chatted with Ciara about that paper)

In today's episode, Fiona shared her personal journey from becoming an elite rower to transitioning into sports medicine research, including her experience with a career-ending back injury that motivated her to study athlete-specific approaches to back pain management.

Our conversation focused on how athletes' back pain differs from general population back pain due to the unique nature of using their bodies as tools for performance, and the importance of keeping athletes' voices centered in research rather than relying solely on average population data.

We discussed the specific challenges female athletes face with menstrual pain and pelvic health issues, highlighting gaps in knowledge and the need for better support systems. Fiona emphasised the importance of precision rehabilitation approaches that consider multiple factors including biomechanics, systemic inflammation, and the athlete's individual circumstances rather than using generic interventions like static exercises (planks - we are talking to you!)

Our conversation also covered the stigma surrounding menstrual health in sports and the need for athletes to lead conversations about normalising these issues, with Fiona noting that better support could help retain female athletes who might otherwise drop out of sports during their periods.

Some of Fiona's publications that we talked about today include:

Whittaker JL, Schulz JM, Galarneau JM, Moore IS, Ackerman KE, Butler M, Dane K, Dubé MO, Ferraz Pazzinatto M, Gomez CD, Hayden KA, Marmura H, Mizuta R, Mosler AB, Schneider G, Schneider KJ, Sharma S, Trease L, Wilson F, Thornton JS, Crossley KM, Emery CA., Prevention strategies and modifiable risk factors for spine, chest, abdominal and/or pelvic injury and pain: a systematic review and meta-analysis for the Female, woman and/or girl Athlete Injury pRevention (FAIR) consensus., British Journal of Sports Medicine, 2025

"The pain isn't the hardest challenge...it’s the frustration at how much it affects my day-to-day life, my mental health and my ability to train”: a qualitative thematic analysis of elite athletes’ lived experiences of persisting low back pain'' Trease et al 2026

'“I'm breaking my back for this sport and they're not supporting me” Trease et al 2024

Fiona is an absolute legend in the world of sports medicine - for good reason, I'm sure you'll agree after listening to this episode!

Want to learn more about supporting female athletes? When you join the online course 'The Menstrual Detective'. you'll get access to the bonus course 'Pelvic Health for the Young Female Athlete' for free! All the details are at CelebrateMuliebrity.com

Until next time, Onwards & Upwards! Mx #celebratemuliebrity

Hello & Welcome to today's episode, where I'm delighted to welcome my friend & colleague Hannah Poulton back to the podcast, to continue our discussion about all things scar assessment and treatment

This was a very comprehensive discussion about scar assessment and management, and we discussed the effects that scars can have on both physical and mental health.

Hannah, who owns HLP Therapy in Leicester and is pursuing a part-time PhD at Loughborough University examining C-section scarring, detailed the key components of effective scar assessment including asking the right questions, identifying the patient's primary problem (P1), using validated outcome measures like POSAS and SCAR-Q, and taking proper photographs.

We discussed the high C-section rates (40-45% in some areas reaching up to 70%) and how women are often not adequately informed about post-surgical care and scar management.

Hannah shared her approach to prehabilitation for C-section patients, including hydration, nutrition, and preparation strategies, while emphasizing the importance of proper assessment rather than routine compression garment use.

The conversation covered Hannah's upcoming international work, including free webinars and a course at Johns Hopkins University in Baltimore, as well as the launch of her Scar Therapy Network platform and upcoming appearances at the Therapy Show and SCAR Symposium.

Hannah's links:

Three Free Webinars and Johns Hopkins Course: https://www.hlp-therapy.co.uk/usacoursesScar Therapy Network (free patient platform and private membership for scar professionals):www.scartherapynetwork.comScar Symposium (March 12th 2027):https://www.hlp-therapy.co.uk/scar-symposium-2027

Want to learn more about a bio psychosocialand lifestyle approach to women's health, with an evidence based clinical toolbox to translate the research into practice? I have a suite of online courses, from The Menstrual Detective (with FREE access to Pelvic Health for the Young Female Athlete, Perinatal Pelvic Rehab, (pre-conception, pregnancy & postpartum recovery), The Menopausal Toolbox, Hysterectomy Prehab to Rehab, Women's Health & Bowel Health, Women & Back Pain, Female Pelvic Pain Rehab, Female Pelvic Oncology Rehab & Breast Cancer Rehab - all of the details are at CelebrateMuliebrity.com and you can follow my continuing adventures in women's health on instagram @michellelyons_muliebrity

Until next time, Onwards & Upwards! Mx #celebratemuliebrity

Hello and welcome to today's solo episode!

I recently came across two 2026 articles that really got me thinking about how menstrual pain may be the missing link in phase based training...and so I thought a podcast episode would be a good idea!

In this episode, I discuss the overlooked impact of menstrual pain on female athletic performance, arguing that pain may be a more significant performance variable than hormonal cycle phases that currently receive much attention in sports science.

My goal was to highlight that primary dysmenorrhea affects approximately 60% of female athletes, with 50-100% reporting performance limitations due to period pain, yet this issue is often addressed through medication rather than comprehensive treatment approaches.

I wanted to emphasise that pelvic rehabilitation should be incorporated into discussions about menstrual cycle management, as pain affects brain processing, movement, breathing, and decision-making in ways that can substantially impact sporting performance.

I propose a "menstrual audit" consisting of seven simple questions to better assess and address menstrual pain symptoms rather than focusing solely on cycle phases, and of course if you want to learn more...this is exactly why I created my online course "The Menstrual Detective" for clinicians and coaches working with female athletes - to improve menstrual literacy, to understand how to have the MC health conversation and how to identify and manage menstrual dysfunction - when it hurts, when it's too much and when it disappears.

All the info is at CelebrateMuliebrity.com - or if you have questions about the course, you can find me on instagram at @michellelyons_muliebrity

Until next time, Onwards & Upwards! Mx #celebratemuliebrity

Hello and Welcome to this episode of the podcast, where I'm in conversation with Elizabeth Davies, author of 'Training for your Old Lady Body'

We had a great chat, covering the dangers of 'skinnytok' and the mythology around 'bulking up' with strength training, as well as discussing strategies for behaviour change and strength training for women approaching menopause.

Elizabeth shared her personal journey from a non-fitness background to becoming a personal trainer after experiencing a mortifying incident of incontinence during exercise in 2016. They discussed practical strategies for overcoming barriers to gym attendance, including starting with small achievable goals, using specific scheduling rather than general plans, and implementing "domino actions" that trigger the full exercise routine.

Unsurprisingly, we discussed the importance of addressing pelvic health concerns and how to normalise the conversation around pelvic health, as well as signposting women on how to get the help they need - I was so delighted that Teresa Waser's brilliant paradigm ,TIIPPSSFC, can really help bring about change - if you're not familiar, go back and have a listen to the interview I did with Teresa in Episode 30!)

We also talked about demystifying strength training for women who may be intimidated by gym environments (spoiler - its more about asking for help and less about worrying what other people think!)

The conversation also covered how to make exercise sustainable by pairing it with enjoyable activities and being compassionate with oneself when plans don't go perfectly.

So many pearls of wisdom, not only about the benefits of strength training at menopause but also about using behaviour change strategies to make exercise realistic, sustainable and enjoyable

Make sure you're following Elizabeth on instagram @thiswomanlifts and her book is available for purchase - highly recommended!

And...if you're listening on the day this drops, you're running out of time to take advantage of my summer sale - make sure you are using the code JUNE26 at checkout to apply a €100 discount on any/all of my online courses - you can find them all at CelebrateMuliebrity.com

Until next time, Onwards & Upwards, Mx #celebratemuliebrity

Hello and welcome to today's episode where I'm delighted to share my conversation with Dr Rachel Selman, all about better pelvic health conversations with athletes.

Rachel is a physical therapist and coach, who shares her experience integrating pelvic health into sports medicine practice and discussed her upcoming book aimed at educating athletes about pelvic health issues.

We explored challenges in communicating with athletes about pelvic health topics, including the need for sport-specific subjective questionnaires and annual in-services (for sports AND pelvic health pro's) to normalize these discussions. Rachel explained her approach to making complex pelvic health concepts accessible to athletes and coaches, emphasizing the importance of connecting pelvic health to overall performance rather than treating it as a separate specialized field.

We discussed the role of stress and anxiety in exacerbating pelvic floor symptoms, particularly during high-stakes competitions. Our conversation also highlighted the need for better integration between pelvic health and sports medicine professionals, emphasising the importance of training coaches and athletes to recognise and discuss these symptoms preventatively, comparing it to how they would address other orthopedic concerns. Rachel is doing her part to change the narrative, and is planning to release her first book, Floor It, this autumn and it is available for pre-order now!

Make sure you're following Rachel on instagram @dr.rachelselman for her amazing anatomy education and exercise strategies

Aaaaand...don't forget, my Summer Sale is still on for a few more days, so if you're interested in helping female athletes with their pelvic health, check out The Menstrual Detective, which includes the course 'Pelvic Health for the Young Female Athlete' for free! The code JUNE26 can be used for a €100 discount on ALL of my online courses, from Perinatal Pelvic Rehab, The Menopausal Toolbox, Female Pelvic Oncology and more - but only until June 30th!

All of the course info is at CelebrateMuliebrity.com or you can find out more on my instagram feed, a haven for women's health nerds, @michellelyons_muliebrity

Until next time, Onwards & Upwards, Mx! #celebratemuliebrity

'Why Do I Still Have Pain After My Endo Surgery?' This can be such a frustrating (and complex) situation that so many people with endometriosis find themselves in...but why?

I'm sharing this excerpt from the endometriosis updates in my online Female Pelvic Pain Rehab course - mainly because I've heard it so many times over the years, both from patients and the clinicians who are trying to help them.

There's actually been some interesting new research looking at why this happens and how we can actually help people restore quality of life and improve THEIR functional goals, so I really wanted to make this available even if you're not a student on this course (but if you work with people who have pelvic pain diagnoses like endometriosis, vulvodynia, dyspareunia...I hope you'll consider joining us!)

There are so many potential drivers of abdominopelvic pain that can amplify endometriosis associated pain, along with central sensitisation and pelvic floor dysfunction, including issues like IBS, neuropathic pain, hernias, hip problems and more.

I hope you find this excerpt from the course helpful AND if you're listening to this episode before the end of June... you can use the code JUNE26 at checkout for a €100 discount on any of my online courses, from Female Pelvic Pain Rehab to The Menstrual Detective, The Menopausal Toolbox and more. All of the course info is at CelebrateMuliebrity.com or if you have questions, you can send me a DM on instagram (@michellelyons_muliebrity) or email me at [email protected]

Enjoy the episode and if you found it useful, I would love it if you can rate, review and subscribe to the podcast!

Until next time, Onwards & Upwards! Mx and don't forget to #celebratemuleibrity

Hello & Welcome To Today's Episode! Today's guest has a unique perspective as she's both a high performance athlete AND a pelvic physio who is passionate about keeping girls and women involved in sport.

Clodagh McIntyre is a rising star in physiotherapy who is both an inter-county camogie player for Tipperary and a pelvic health physiotherapist. Clodagh discussed her journey from UCD graduate to working in private practice, her experiences with stress incontinence as an athlete, and the lack of pelvic health education in physio training programs.

We explored how pelvic health issues affect female athletes, with statistics showing 7 out of 10 athletes leaving sport due to bladder leakage, and discussed the taboo nature of discussing these topics within sporting teams.

We discussed the importance of education and support around pelvic health issues for female athletes, highlighting the lack of standardization in GAA and potentially LGFA, as well as emphasising the need to normalize conversations about these issues and prevent them from deterring athletes from participating in sports.

Clodagh shared her upcoming trip to Kenya with Warriors for Humanity and Self-Help Africa, where she plans to plant trees and help communities, for which she is fundraising.

Please see linked below to her fundraiser! https://www.idonate.ie/fundraiser/clodaghmcintyre 

Our shared passion is definitely showcasing the conversation and embedding pelvic health into female athlete wellbeing : there's SUCH a need for better education about pelvic health at undergraduate and postgraduate levels, as well as within sporting organizations, to support female athletes and prevent them from dropping out of sport due to pelvic health issues.

Want to learn more about supporting the Female Athlete, and promoting pelvic and menstrual health? The Menstrual Detective online course comes with FREE access to the course 'Pelvic Health for the Young Female Athlete, where we look at all the potential drivers for pelvic health dysfunction, beyond isolated strengthening for the pelvic floor muscles. All the details at CelebrateMuliebrity.com

Until next time, Onwards & Upwards! Mx #celebratemuliebrity

Hello & welcome to this episode, where I thought it might be good to see out the end of Pelvic Pain Awareness month with an extract from my new Female Pelvic Pain online course updates to share some great articles from 2026 that I think are moving the conversation forward.

We start with an overview of female pelvic pain assessment, focusing on evidence-based assessment frameworks and clinical strategies. I'm exploring a key research paper from 2026 by As Sanie et al. on chronic pelvic pain evaluation, which recommends an organ-system-based approach considering gynecologic, gastrointestinal, musculoskeletal, urologic, neurologic, and vascular sources, and we'll also explore the 2026 EAU Guidelines in the course conten

I do emphasise the importance of trauma-informed care, including creating safe environments, obtaining ongoing consent, and validating patient experiences.

I've outlined a comprehensive assessment protocol in the course updates, covering external physical examination of the pelvic floor, vulvar structures, and abdominal wall, incorporating strategies to check for issues like hernia and ACNES, the importance of Carnett's test, along with the use of patient-reported outcome measures like the Central Sensitization Inventory and Pain Catastrophizing Scale.

The discussion also highlights the need to address nociplastic pain mechanisms, central sensitization, and the interplay between peripheral pathology and central pain amplification in chronic pelvic pain management.

Some of the talking points:

• Review and utilize the VAMP protocol in the vulvar pain module for assessment of vulvar, anorectal, musculoskeletal/myofascial, and perineal/periurethral structures in relevant patients.
• Ensure inclusion of trauma-informed care principles in all patient interactions, including ongoing consent, patient-led goal setting, and environmental safety considerations.
• Screen patients for risk factors and comorbidities such as obesity, physical inactivity, depression, anxiety, sleep disturbance, ACEs, and genetic/epigenetic factors as part of the pelvic pain assessment.
• Use and recommend appropriate patient-reported outcome measures (e.g., Central Sensitization Inventory, Pain Catastrophizing Scale, DAS, PSEQ, Tampa Kinesiophobia Scale) to guide treatment planning and monitor progress.
• Encourage the use of bowel and bladder diaries to identify patterns and connections between symptoms and lifestyle factors in patients with chronic pelvic pain.
• Provide pain neuroscience education to patients, emphasizing the role of central sensitization and the importance of addressing inflammatory load through sleep, stress management, and non-nociceptive movement.
• Review and reference the section on pelvic venous disorders in the vulvar pain module when assessing patients with post-coital pain, heaviness, or dragging sensation with prolonged standing.
• Consider the use of 3D anatomy models during patient education to facilitate understanding and empowerment.
• In the module, provide a detailed review of the physical exam, including tests for the abdominal wall (e.g., screening for hernias, Carnett's test).
• Emphasize the importance of a holistic, interdisciplinary, and patient-centered approach to goal setting and treatment planning for chronic pelvic pain patients.

Want to learn more? The updated Pelvic Pain Assessment module is live now - if you're already enrolled, you have access to it now, and if you'd like to join us to explore the new modules on assessment, vulvar pain and sexual health as well as the upcoming new and expanded module on endometriosis, bladder pain syndrome and pudendal neuralgia then visit CelebrateMuliebrity.com and join us before the price increases next month to reflect the extra content (for clarity, if you're already a student, you'll automatically get the upgrade!)

Hello and welcome to today's episode, where I'm discussing neuropathic pain, particularly the Sciatic & Pudendal nerves, with Thomas Dekkers - Tom's background includes his 18-year clinical experience as a spine specialist physiotherapist, his PhD research on athletic back pain, and current role as a clinical specialist in neurosurgery at Cork University Hospital.

In our conversation today, we explored how dermatomes can be unreliable for diagnosis, particularly with pelvic pain conditions, and discussed the role of neuroinflammation in persistent pain states.

Tom shared his approach to managing neuropathic pain, emphasizing the importance of first avoiding activities that aggravate symptoms before gradually reintroducing movement and exercise.

We also discussed the problematic nature of the "core stability" terminology in physiotherapy and the need for more biopsychosocial approaches to patient care.

The conversation highlighted the challenges of managing chronic pain conditions and the importance of proper patient education and goal-setting in treatment plans, including neuroinflammation, when compression can lead to inflammation throughout the nervous system, including glial cell activation in both the dorsal horn and thoracic spinal cord.

We talked about that when patients completely color in body maps, it raises concerns about nociplastic pain, particularly given the anatomical proximity of nerve roots and the potential for irritation to spread.

Tom explained how he helps patients understand that pain can be influenced by multiple factors beyond just anatomy, including sleep, stress, and social aspects, and described his process of developing individualized treatment plans with patients, setting realistic expectations about pain management over 6-12 months, and focusing on improving functionality rather than achieving complete pain elimination.

We also covered:

Sciatic vs Pudendal Pain

Neurodynamics Testing and Applications

Nerve Glide Pain Management Discussion

Nerve Pain Management Approach

Core Stability Terminology Discussion

While pain knowledge has advanced significantly, treating chronic pain patients remains challenging due to the complexity of widespread pain patterns and the need to identify key contributing factors rather than addressing every symptom - I hope this conversation has given you some food for thought and some actionable steps to steer away from overwhelm when you're working with people with persistent pain.

You can find Tom on instagram @tdekkersphysio and info about his courses at thomasdekkers. com

Want to learn more about managing female pelvic pain? My online course, Female Pelvic Pain Rehab course is going through a major overhaul, update and expansion. Already enrolled? you'll get access as the new modules are available - the vulvar and sexual pain modules are available now, and you can look forward to new modules on endometriosis associated pain, bladder pain syndrome, pudendal and other neuralgias and more, through an up to date evidence based framework, that takes you from understanding pathophysiology, assessment and treatment strategies. Want to learn more? All of the course info is at CelebrateMuliebrity.com

Until next time, Onwards & Upwards, Mx! #celebratemuliebrity

Hello & Welcome to today's episode where we are focusing on new research that really helps us change the conversation about bladder leakage in runners, and why we need to move beyond isolated pelvic floor muscle exercises...

I'm in conversation with Natalia Cardoso Campos, who published a really interesting paper in 2025 'Inefficient impact absorption and reduced shock attenuation in female runners with stress urinary incontinence'

Natália is a physical therapist from Brazil, and in our chat we presented findings from her master's thesis showing that female runners with urinary incontinence have poor shock absorption capacity at the ankle and significantly reduced shock attenuation compared to continent runners.

Her research revealed that while continent runners had shock attenuation values of around -29, incontinent runners had values of only -6, indicating much more energy reaching the pelvic region.

We discussed how this biomechanical imbalance could explain why some runners experience urinary leakage despite having normal pelvic floor strength, suggesting that the problem originates in the lower kinetic chain rather than the pelvic floor itself. We explored:

urinary incontinence research in runners

shock absorption & shock attenuation in runners

foot strike patterns, ankle injuries and asymmetry & how conditions like REDS (Relative Energy Deficiency in Sport) and bone stress injuries can exacerbate these issues

Some key takeaways for me were the importance of looking beyond the pelvic floor muscles when we are working with women, especially athletes, with pelvic health issues - considering the ankle, knee and hip as well as systemic issues like hypermobility and REDs.

I can't wait to see what Natalia's PhD research on this topic reveals!

We also talked about a new paper she was a co-author on, 'Sexual Trauma and Pain: A Study of Women’s Experiences With Vaginal Dilators and Perineal Massage in Trauma-Informed Pelvic Floor Physical Therapy' (Modesto et al 2026)Natália shared insights from this qualitative study on women's experiences with vaginal dilators and perineal massage in trauma-informed pelvic floor physical therapy,   underscoring the significance of patient rapport and validation in treatment.

Want to learn more? My online course, The Menstrual Detective, comes with FREE access to the course 'Pelvic Health for the Young Female Athlete, which covers many of the topics discovered in today's conversation. If Female Pelvic Pain Rehab is more your zone of interest, then make sure you're staying up to date by joining us on my online course, Female Pelvic Pain Rehab is undergoing an update - I've just renovated the vulvar pain modules (lots of great new research and how to apply it clinically. I really wanted to structure these updates in a logical way - understanding the condition, assessment & treatment pathways so clinical reasoning is central. New updates coming on endometriosis and blaffer pain syndrome and neuropathic pain (the enigmatic pudendal nerve in particular!) All of the course info is at CelebrateMuliebrity.com

Until next time, Onwards & Upwards, Mx! #celebratemuliebrity