As part of our 50th anniversary celebrations, this is the first of a series of historical articles looking back over the last 50 years on all the relevant topic and treatment areas covered by the ICS and our disciplines. We hope you enjoy them!
Physiotherapy and in particular pelvic floor muscle training (PFMT) is nowadays first-line management for pelvic floor dysfunction (PFD). PFMT is originally attributed to Dr Arthur Kegel, hence the term Kegel exercises. Indeed, he was the first one to report success with this intervention in treating stress urinary incontinence in his paper ‘Progressive resistance exercise in the functional restoration of the perineal muscles’ back in 1948 (Kegel 1948). However PFMT actually entered modern medicine in 1936 courtesy of Margaret Morris, a physiotherapist at St Thomas’ Hospital (London).
Margaret Morris wrote in her paper the importance of teaching the conscious control of tension and relaxation of the pelvic floor muscles for the prevention and treatment of urinary and faecal incontinence. She encouraged women to practice trying to ‘invert the sphincters… until it becomes habitual’ and that this should be performed to the strains of Schubert’s waltzes 16, no. 2 (Morris 1936).
Similarly Miss Minnie Randell OBE, Principal of the School of Massage and Medical Gymnastics at St Thomas’ introduced many ideas related to continence care that are used currently. These measures include the squatting position to aid defecation, the use of PFMT with concomitant muscles and the functional use of PFMT before activities that increase intraabdominal pressure (Randell 1941; Randell 1948).
The beginnings of the role of a continence physiotherapist as we know it today was facilitated in the 1970’s by encouragement of the physiotherapist Dorothy Mandelstam, or the Queen of Continence, as she was affectionately called. Dorothy joined ICS in 1975, and rapidly became an enthusiastic and productive contributor, much admired and respected within the membership. She initiated the change in continence care in the UK whilst working for the Disabled Living Foundation. She was the first non-medical member and the first physiotherapist to be admitted to the ICS in 1975.
Jo Laycock joined Dorothy at the ICS in 1985 at the London meeting and together with Jeannette Haslam, Marijke Slieker ten Hove, Kari Bø and others encouraged the participation at the meetings of many other physiotherapists. In 1988 the first research papers by physiotherapists Kari Bø and Jo Laycock were presented at the ICS annual scientific meeting. Marijke was awarded the best clinical abstract for podium presentation in 2004 in Paris, the first such award to a physiotherapist. The title was “Distribution of Pelvic Organ Prolapse (POP) in the general population: prevalence, severity, eitology and relation with the function of the pelvic floor muscles. These ladies were the trailblazers in their academic pursuits in this field being awarded PhDs for their research - since which time many others have followed the academic pathway. Each has played a major part in stimulating friendship and co-operation of physiotherapists internationally, also raising educational standards regarding physiotherapy and continence management within the UK and world-wide. It is unlikely that this would have happened without the inspiration and thirst for knowledge engendered by being a member and attending many ICS conferences.
Jo Laycock wrote in the ICS History book published in 2010 “My first ICS was in London in 1985; memorable for me, as it was the year that Stan Plevnic introduced vaginal cones. I thought to myself - why didn't I think of that!! Anyway, it got me thinking and I used to return from every ICS meeting after that charged with ideas for research. I believe the only other physiotherapist in ICS in 1985 was Dorothy Mandelstam who has sadly died. I believe that there were no more than 5 papers relating to physiotherapy and pelvic floor re-education in 1985. Nowadays, there are many, many more. Ted Arnold, Angela Shepherd and Bob Freeman (and others) made me feel very welcome, and I tried in turn, to welcome all new physiotherapists in later years and introduce them around. The ICS can be very daunting. I remember that there were several nurses at the 1985 meeting. My first presentation was in Oslo (1988) and I remember being very nervous. To help new physio members, the Physiotherapy Round Table was started. This was organised by Marijke Slieker ten Hove, and consisted of a half-day session before the workshops and conference. New members were encouraged to present research in a 'non-threatening' environment. Kari Bo was also involved in the early days. It was a great way to get to know people. I think that including physios and nurses within the multidisciplinary membership of ICS helped to give a wider appreciation of patient care. It also encouraged nurses and physios to do 'proper' research; previously, only audit was carried out. ”
Since those days when physiotherapy was poorly understood, the physiotherapy committee at ICS has grown, and a high number of physiotherapy studies and accepted abstracts with many receiving awards, has catapulted and consolidated our role in continence care.
There is no doubt that our profession has moved forward because of our involvement in research. Bø and Stein (1994) proved Minnie Randell’s hypothesis about the use of abdominal, gluteal and adductor muscles with PFMT fifty years later. Similarly Miller et al (1998) demonstrated the effectiveness of the functional bracing of the pelvic floor muscles before activities that increase intraabdominal pressure, currently known as “The Knack”, that Minnie Randell suggested more than fifty years ago. Considering this, it does not seem that our interventions have changed that much in the last fifty to eighty years yet we can now confirm that they are effective treatment interventions. What is in the future for us? Virtual physiotherapy? In order to maintain our position as first-line continence care providers, it is imperative that we continue to demonstrate that our interventions are cost-effective. As Janette Haslam (Laycock and Haslam, 2002 p.88) very eloquently stated “Research must continue to search for truths, but we have the responsibility to acknowledge the influence of the past and ensure that future research is of relevance and high quality.”
Article by Paula Igualada-Martinez
Picture provided with thanks from the Margaret Morris Movement International Ltd