Musculoskeletal and Pelvic Health Across the Lifespan
Musculoskeletal and Pelvic Health Across the Lifespan
Expect questions spanning adolescence through older adulthood. Know pelvic girdle pain presentations (anterior and posterior), symphysis pubis dysfunction, sacroiliac dysfunction, coccydynia, and lumbopelvic mechanics, plus how hormonal transitions-menarche, pregnancy, perimenopause, menopause-alter tissue behavior and symptom expression. In older adults, consider genitourinary syndrome of menopause, pelvic organ prolapse, hip and spine degeneration, and fall risk as interacting factors.
Understand load and capacity reasoning: symptoms often reflect demand exceeding tissue tolerance, so management includes both reducing provocative load and building capacity. Know that pelvic floor function is not isolated-it interacts with respiratory diaphragm, transversus abdominis, and hip musculature.
Traps: attributing all pelvic pain in pregnancy to "normal pregnancy" and missing serious pathology; assuming pelvic floor weakness is the only mechanism (overactivity and myofascial pain are common); overlooking that prolapse symptoms often worsen with end-of-day load rather than being constant; and applying adult strengthening paradigms unchanged to adolescents or frail older adults.
Rule of thumb: ask what changed in load, hormones, or tissue capacity recently-the answer usually points to the mechanism and the intervention target.
Worked example: A perimenopausal patient reports new leakage and pelvic heaviness that is worse in the evening. Rather than assuming isolated weakness, consider prolapse, tissue changes, and cumulative daily load; assessment should include a positional symptom history and a support/loading strategy.