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In terms of Breivik et al. (2006), about 50% of the chronic pain patients felt tired all the time, and around 40% of them felt that their pain let them can't concentrate on things and they felt impotent and could not function like normal people; more than 30% of people said that they could not remember what it was like without pain; about 21% of persistent pain patients had been diagnosed with depression because of their pain, and around 16% of patients felt that they wanted to die because of the pain.

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The dream... I have always loved Health Sciences because of the impact they have on our lives. For as long as I remember myself, I have wanted to become a doctor, "heal people" as I used to say...Through the ages, I realized that physiotherapy suited me perfectly, as it is the most communicative profession in...

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The dream... I have always loved Health Sciences because of the impact they have on our lives. For as long as I remember myself, I have wanted to become a doctor, "heal people" as I used to say...Through the ages, I realized that physiotherapy suited me perfectly, as it is the most communicative profession in...

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Welcome to my physiotherapy blog.

On my series of blogs, I will discuss the core of our physiotherapy treatment which is EXERCISE. I will try to answer the following questions. Can exercise be a stand-alone treatment for musculoskeletal pain? Will it be effective and efficient enough to address the pain problem using the biopsychosocial approach? I will tap into my own experience as a mature physiotherapist and reflect on my journey as a practitioner.

Available evidence supporting exercises will be discussed. Also, barriers to exercise adherence and how we can address these problems will be covered on my next blogs. These important topics will need attention to answer the questions mentioned in this blog.

I am Jenny, a registered physiotherapist in the UK with roots from the Philippines. My professional practice started when electrotherapy and passive treatment was still the norm. As a mature practitioner, I have collected a wide variety of treatment tools throughout my career. However, my practice is becoming more bias to exercise therapy.

I cannot say I'm a "hands off" physiotherapist. I use my collected skills and techniques from years of practice. But the core of my treatment is exercise. I wonder if my results will change if I just purely offer exercise therapy to my patients.

Exercise Is Therapy

Exercise is the mainstay of physiotherapy treatment. I can say that because of our background knowledge and practice, exercise prescription should be our forte.

The definition of exercise is a physical activity that is planned, structured, and repetitive for the purpose of conditioning any part of the body. Exercise is used to improve health, maintain fitness and is important as a means of physical rehabilitation.

The history of exercise therapy started as early as 600 BCE when Susruta of India was the first recorded physician to prescribe moderate daily exercises. Hippocrates of Greece was the first recorded physician to provide a written exercise prescription for a patient suffering from consumption (Tipton, 2014). Many years after, physiotherapy profession was developed. According to Chartered Society of Physiotherapist it is a professional who helps people affected by injury, illness or disability through movement and exercise, manual therapy, education and advice.

Exercise: What is the evidence?

There is massive evidence in literature which supports exercise as an effective modality in treating chronic musculoskeletal related pain. These evidences will be highlighted below. I will discuss the evidence for low back pain, neck pain, osteoarthritis and fibromyalgia because these are the common MSK conditions we encounter in practice. I know literature review can be tedious. But please bear with me.

Low back pain is one of the common if not the most common musculoskeletal conditions we treat. The key role of exercise and importance of self management was very much emphasised in the November 2016 NICE guidelines update on low back pain management. Manual therapy and cognitive behavioural therapy were also considered but these were adjuncts to treatment instead of the main treatment.

There is currently also a good level of evidence regarding effectiveness of exercise whether land based or aquatic exercises in treatment of osteoarthritis. Land-based exercise reduced hip pain, improved physical function and range of movement among people with symptomatic hip osteoarthritis. Manual therapy provided no further benefit except higher patient satisfaction (French et al. 2013).

This is also the same for knee osteoarthritis as there is high quality evidence supporting land based in reducing pain and improving quality of life (Fransen et. al, 2015). There is moderate quality evidence that aquatic exercise may have small, short-term, and clinically relevant effects on patient-reported pain, disability, and quality of life in people with knee and hip OA (Bartels et. al. 2016).

These evidences have greatly influenced management of osteoarthritis patients. I tend to favour aquatic exercises for these patients before. But the evidence suggests that variety of exercises can be beneficial. These will help cater to patient's exercise preferences and can reassure patients that any type exercises will be beneficial given the proper supervision and monitoring by professionals.

Some more evidence....

The other common chronic MSK problem we see in practice is fibromyalgia related pain. Apart from widespread MSK pain, a high number of patients also have depression (Ranzolin et. al, 2016) which makes this condition very challenging to treat. There are some inconsistencies in evidence from different organisational body regarding the level of recommendation for different treatments of this condition (Thieme et al, 2017). However despite inconsistencies, there is still enough evidence supporting exercise as an effective treatment for fibromyalgia. There is also a strong evidence to support that exercise is an evidence based treatment for depression (Schuch et. al, 2016) which was underestimated by previous meta analysis due to publication bias.

On the topic of neck pain, Fredin and Loras (2017) concluded that combined treatment of manual therapy and exercise therapy does not seem to be more effective in reducing neck pain intensity at rest, neck disability or improving quality of life in adult patients with grade I-II neck pain, than exercise therapy alone. This was also supported by Bertozzi (2013), stating that exercise therapy as a stand-alone treatment was beneficial in reducing neck pain short and intermediate term.

Conclusion

It is widely supported by evidence that exercise has beneficial effects for management of chronic musculoskeletal pain. There is also evidence that it is more effective than other treatment options such as manual therapy. The recommendation and level of evidence varies but there is one thing that is consistent. Exercise has a very important part to play in addressing musculoskeletal pain.

Exercise is the bread and butter of physiotherapy profession. We should strive to be the best in exercise prescription. Because our profession has a key role to play in addressing chronic pain management in the society.

Join me on my next blog when I will discuss, exercise a biopsychosocial treatment.

Comments are welcome.

References

Bartels, Juhl, Christensen et.al (2016) Aquatic exercise for the treatment of knee and hip osteoarthritis. Cochrane Database Systematic Reviews, 23(3)

Bertozzi, Gardenghi, Turoni et al. (2013) Effect of therapeutic exercise on pain and disability in the management of chronic non specific neck pain: systematic reviews and meta analysis of randomised trials. Physical Therapy 93: pp 1026-1036

Fransen M, McConnell S, Harmer AR, et. al (2015) Exercise for osteoarthritis of the knee: a Cochrane systematic review. British Journal of Sports Medicine 49: pp 1554-1557

Fredin and Loras (2017) Manual therapy, exercise therapy or combined treatment in the management of adult neck pain - A systematic review and meta-analysis. Musculoskeletal Science and Practice. 31: pp 62-71

French, Cusack, Brennan et.al (2013) Exercise and manual physiotherapy arthritis research trial for osteoarthritis of the hip: a multicenter randomized controlled trial. Achieves of Physical Medicine and Rehabilitation. 94(2): pp 302-314
https://www.nice.org.uk/guidance/ng59
Ranzolin A, Duarte AL, Bredemeier M et al. (2016) Evaluation of cytokines, oxidative stress markers and brain-derived neurotrophic factor in patients with fibromyalgia - A controlled cross-sectional study. Cytokines, 84: pp 25-28

Schuch, Vancampfort, Richards et.al (2016) Exercise as a treatment for depression: A meta analysis adjusting for publication bias. Journal of Psychiatric Research 77: pp 42-51

Thieme, Mathys and Turk (2017) Evidenced-Based Guidelines on the Treatment of Fibromyalgia Patients: Are They Consistent and If Not, Why Not? Have Effective Psychological Treatments Been Overlooked? The Journal of Pain: Journal of American Pain Society. 18 (7): pp 747-756

Tipton (2014) The history of "Exercise Is Medicine" in ancient civilizations Advances in Physiology Education. 38( 2): 109-117

Images

http://www.elemis.com/wp/wp-content/uploads/2017/05/ELEMISeveryday-wellness-header.jpg (14/11/2017)

http://www.glasbergen.com/gallery-seach?/tag=exercise(14/11/2017)

http://www.theravid.com/wp-content/uploads/2013/07/Evidence-Based-Practice.jpg (14/11/2017)

http://www.efsa.europa.eu/sites/default/files/styles/news_individual_node_image/public/news/evidence_block.jpg?itok=(14/11/2017)

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Welcome to my physiotherapy blog. On my series of blogs, I will discuss the core of our physiotherapy treatment which is EXERCISE. I will try to answer the following questions. Can exercise be a stand-alone treatment for musculoskeletal pain? Will it be effective and efficient enough to address the pain problem using the biopsychosocial approach?

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This is your very first post. Click the Edit link to modify or delete it, or start a new post. If you like, use this post to tell readers why you started this blog and what you plan to do with it.

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This is your very first post. Click the Edit link to modify or delete it, or start a new post. If you like, use this post to tell readers why you started this blog and what you plan to do with it.

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I am Olabisi, a physiotherapist trained in Nigeria and currently undergoing a master's in physiotherapy programme at the University of Nottingham, United Kingdom.

This blog is a platform on which I can share my honest opinions and physiotherapy related matters. I hope you get to gain a lot from me. Sit back, relax and enjoy as we commence this journey.

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I am Olabisi, a physiotherapist trained in Nigeria and currently undergoing a master's in physiotherapy programme at the University of Nottingham, United Kingdom. This blog is a platform on which I can share my honest opinions and physiotherapy related matters. I hope you get to gain a lot from me.

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Biomechanics is the science which applies the laws of mechanics to biological movement. This isn't new and has been around since the days of Aristotle. Physiotherapy has had a long-standing affiliation with this concept and is very much seen as an integrated part of the profession - or so it would seem. As we transit from a biomedical to a biopsychosocial profession, the debate as to whether biomechanics matters, is facing its biggest test; has it been handed its death sentence?

However, I feel biomechanics still has an important role to play, at times, in the management of musculoskeletal patients. In this particular post I will attempt to highlight a way in which I think appreciating and changing biomechanics matters, by looking at fear. Try to imagine a 30-year-old male who has ruptured his ACL. He has a reconstruction and comes to see you in clinic. He's fearful about exercising and movement and has pain. To try and explain why I think biomechanics matters here, let me take you to the top of the Macau Tower in China...

At 233m, it plays host to the world's highest bungee Jump. As the next person is about to jump, you explain that there are no ropes left and ask them if they are they afraid to jump? Their response is "yes, of course I'm going to die". Fear of injury is at this point one of their main drivers, which interestingly has been shown to be a contributing factor in those who go on to sustain a re-rupture - following ACL reconstructive surgery (Tagesson and Kvist, 2016). I do acknowledge the fact that fear is just one component in this case and for the purposes of this post I am just focusing on this aspect. Pain we know is an output of the brain and any input- whether it be exogenous, endogenous, cognitive (fear), social, or contextual can increase the likelihood, intensity of, or drive pain (Lotze and Moseley, 2015).
Simple Fix - Just give them a rope...
Fear is why they won't jump and is something that must be addressed, but similarly you have to look at why they have that fear in the first place. In this case its probably going to be the sudden stop at the end - i.e. the biomechanical force that plays out on the body, which will only confirm their fears on impact. This leads you to a patient who is fearful of not being able to handle the anticipated load on their body.

Some would argue this doesn't matter and you just have to get them exercising with high loads and they'll eventually cope. However, high abduction loads and increased knee valgus has been shown to be factors in ACL ruptures among athletes, who generally have higher neuromuscular stability at the knee, than in those of your average non-sporting population (Hewett et al., 2005). Exposing them to high loads, from which their injury likely originated, is possibly going to increase their fear of movement.

So, you have to establish what the rope represents and in this case it is a tool to manage the anticipated biomechanics.
Do they have the right length of rope...?
Repeated exposure can help to reduce fear (Carleton, 2016) and so in theory those who regularly jump with the correct rope length and not had their fears validated by hitting the floor, are less fearful and will continue to jump. Those who haven't had that exposure, maybe more fearful and will need more convincing to jump. Go back to the ACL patient. Ask him to perform a single leg squat and he might be fearful of re-injury - especially if he has never performed it before. Also he may physically lack the tools to do it, which in this case could be strength. In other words, he hasn't got the right length of rope.
Give them options
Gluteus Medius, Hamstring and Quadriceps strength seem to be very important when trying to produce a single leg squat (Claiborne et al., 2006)

So, if the patient hasn't got strength in these muscles, then why are we asking him to perform it? He hasn't got the available tools to cope with the forthcoming load. Therefore, we must address this prior to him performing the task. This is where biomechanics you could argue, not only matters but becomes a requirement.
Reduce the jump height...?
In its simplest form, jumping from the Victoria Falls Bridge in Zambia at 155m should be far less scary and risky to the jumper than jumping from 233m. Perhaps they injured their knee through a single leg landing, which they may feel in replicating that action could cause it to re-rupture. They may also simply lack the strength to perform it as discussed earlier. Either way, if a single leg squat is unfeasible at the time, could you adapt the exercise to reduce the load and the patient's perceived risk of injury - i.e. a double leg squat? Giving the patient the appropriate tools to carry out tasks with reduced risk is important not only psychologically but biologically to.

It has been demonstrated for example that a single leg landing with a flexed trunk can significantly reduce patellar tendon force and subsequent injury (Scattone Silva et al., 2017). This is one way of altering biomechanics. It can help address fear by offering someone a different way to move and load, that is both protective biologically and perceived by the person as safer in practice.

Changing biomechanics, you could argue does matter for some of the more fearful patients. By giving them options to move differently it may help to reduce their fear and therefore encourage them to do just that. This can only work however, if you have given them the correct tools to make that change. Not only that, but it may also protect the patient from potential re-injury.
Images:
https://dailytimes.com.pk/static/uploads/original/b2f1c4cf522b875c80a6c7f86b22ee06.jpg [Accessed 29.10.17]

https://www.macautower.com.mo/wp-content/uploads/2015/12/Bungy1.jpg [Accessed 29.10.17]

https://st.depositphotos.com/1695366/1395/v/950/depositphotos_13950483-stock-illustration-cartoon-bungee-jump-accident.jpg [Accessed on 30.10.17]

http://www.travelstart.co.za/blog/adventure-activities-victoria-falls/ [Accessed 06.11.17]
References:
Carleton, R.N., 2016. Fear of the unknown: One fear to rule them all? J. Anxiety Disord., Fearing the Unknown 41, 5-21. doi:10.1016/j.janxdis.2016.03.011

Claiborne, T.L., Armstrong, C.W., Gandhi, V., Pincivero, D.M., 2006. Relationship between hip and knee strength and knee valgus during a single leg squat. J. Appl. Biomech. 22, 41-50.

Hewett, T.E., Myer, G.D., Ford, K.R., Heidt, R.S., Colosimo, A.J., McLean, S.G., van den Bogert, A.J., Paterno, M.V., Succop, P., 2005. Biomechanical Measures of Neuromuscular Control and Valgus Loading of the Knee Predict Anterior Cruciate Ligament Injury Risk in Female Athletes: A Prospective Study. Am. J. Sports Med. 33, 492-501. doi:10.1177/0363546504269591

Lotze, M., Moseley, G.L., 2015. Theoretical Considerations for Chronic Pain Rehabilitation. Phys. Ther. 95, 1316-1320. doi:10.2522/ptj.20140581

Scattone Silva, R., Purdam, C.R., Fearon, A.M., Spratford, W.A., Kenneally-Dabrowski, C., Preston, P., Serrão, F.V., Gaida, J.E., 2017. Effects of Altering Trunk Position During Landings on Patellar Tendon Force and Pain. Med. Sci. Sports Exerc. doi:10.1249/MSS.0000000000001369

Tagesson, S., Kvist, J., 2016. Greater fear of re-injury and increased tibial translation in patients who later sustain an ACL graft rupture or a contralateral ACL rupture: a pilot study. J. Sports Sci. 34, 125-132. doi:10.1080/02640414.2015.1035668

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Biomechanics is the science which applies the laws of mechanics to biological movement. This isn't new and has been around since the days of Aristotle. Physiotherapy has had a long-standing affiliation with this concept and is very much seen as an integrated part of the profession - or so it would seem.

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It's a familiar story; a man in his thirties who has let himself go decides he needs to lose some weight and do some exercise. He joins the local 5-a-side football team and lasts only a few weeks before injuring himself. This was me two years ago, and the injury was a ruptured left Achilles tendon.

For me this was quite a shock as there didn't seem to be any warning signs prior to the injury; no pain or swelling in the Achilles, and I was actually starting to feel physically fitter. Unfortunately for me, there was an obvious mismatch between my tissue tolerance and the demands I put on it. Fortunately for me, I never really experienced any significant lasting pain after the initial acute few minutes post injury, and thankfully this remains the case.

It got me thinking - why was this? And why in the following days, weeks, and months, after such a relatively large tissue trauma did I experience very little pain, and why I have not gone on to develop any persistent pain issues? Don't get me wrong, I feel very lucky that I have been pretty much pain free throughout this whole process, but I find it very interesting as to why some people go on to have terrible trouble with chronic / persistent pain and others do not.
Image reference So what? - Why is this relevant, and how big a problem is chronic pain?
Chronic pain is a huge problem, with musculoskeletal conditions being the most frequent cause affecting around 1 in 5 adults in Europe (Monti and Caporali, 2015). A systematic review by Rosenbloom et al., (2013) described persistent pain in more than 28% of patients who had suffered limb trauma as long as 7 years post-injury. Chronic pain can not only have a large impact on the individual but also comes with substantial clinical, social and economic costs. Understanding and potentially predicting certain factors that influence why or why not a person develops persistent pain problems could have huge individual and social consequences.

Throughout this blogging task I hope to delve into this topic further by looking at what pain actually is and what factors influence our pain experience.

More specifically, I am interested in what biological, psychological and social factors helped me avoid chronic pain. By understanding the positive factors that may help reduce the likelihood of developing chronic pain (rather than focusing on negative predictors) we could aim to maximise these elements with our patients and be able to intervene more positively. In his 2005 editorial 'Now for Pink Flags!', Louis Gifford elaborated further on this idea of focusing on the positives and less on the negatives.
(A brief) Introduction to pain
In order to better understand pain, it is important to recognise the multidimensional factors which lead to pain and the current understanding in relation to pain science. Traditionally pain has been viewed as a symptom and a warning sign telling us about an underlying injury or disease. This makes sense with acute pain where it may be viewed as an alarm that serves to protect our physical and mental health by forcing us to change behaviour. At the time of my Achilles injury there was immediate pain which was sufficient to stop me running around and protect me from further damage.

Like with all alarms things can go wrong, which may in part explain why pain may persist without a continuous nociceptive input. With chronic pain there may not always be an underlying injury or disease. Or there might have been initially but the pain persists beyond what we would consider normal healing times.

Modern conceptualisations of pain as explained by Moseley and Butler, (2015) consider pain more as a protector rather than as a marker of tissue state. In chronic pain the link between pain and the actual need to protect the body in some way becomes less obvious and contributions from biopsychosocial factors or other secondary pathologies may start playing a bigger role. How a person perceives the total situation - including nociceptive input, other sensory inputs, social context, previous experiences, expectations, mind-set and so forth -will determine their subsequent output in terms of pain and behaviour (Brodal, 2017).

The diagram below hopefully summarises these points and incorporates bio-psycho-social aspects which I will discuss further in the upcoming blogs.

Image reference - How dangerous is this really? - as described by (Moseley, 2007)
In the next blog I will aim to explore some of the biological factors that may have helped me stay clear of chronic pain (so far). Thanks for reading, comments are more than welcome. Gav References
Brodal, P., 2017. A neurobiologist's attempt to understand persistent pain. Scand. J. Pain 15, 140-147. doi:10.1016/j.sjpain.2017.03.001

Gifford, L. S., 2005 Editorial: Now for Pink Flags! PPA News 22: 3-4

Monti, S., Caporali, R., 2015. Chronic pain: the burden of disease and treatment innovations. Reumatismo 67, 35-44. doi:10.4081/reumatismo.2015.840

Moseley, G.L., Butler, D.S., 2015. Fifteen Years of Explaining Pain: The Past, Present, and Future. J. Pain Off. J. Am. Pain Soc. 16, 807-813. doi:10.1016/j.jpain.2015.05.005

Moseley, L., 2007. Reconceptualising pain according to modern pain science. Phys. Ther. Rev. 12, 169-178. doi:10.1179/108331907X223010

Rosenbloom, B.N., Khan, S., McCartney, C., Katz, J., 2013. Systematic review of persistent pain and psychological outcomes following traumatic musculoskeletal injury. J. Pain Res. 6, 39-51. doi:10.2147/JPR.S38878

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It's a familiar story; a man in his thirties who has let himself go decides he needs to lose some weight and do some exercise. He joins the local 5-a-side football team and lasts only a few weeks before injuring himself. This was me two years ago, and the injury was a ruptured left Achilles tendon.

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THE MANAGEMENT - HOW WE CAN 'HEAL' My previous blogs discussed the role of communication during the patient interview and examination. Last time I wrote about things... Read more "COMMUNICATION: THE POWER TO HARM AND HEAL (part 4)" THE MANAGEMENT - WORDS THAT HARM My previous blogs talked about the role of communication during the interview and patient examination.

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HI Everyone, I want to use this medium to appreciate you all for taking out time to read my blog and for your comments. 808 views so far, YAYYYYYYYY!!! This has indeed been encouraging. Do keep them coming please. Thank you once again. DORCAS KYELA YUSUF

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In my first blog, I will talk about urinary incontinence following pregnancy which is one of the most common problems among women. My motivation for selecting this topic is that I believe the issue of urinary incontinence has not been as fully recognized as its frequency and crucial effects upon women's daily life requires. This article aims to raise awareness about incontinence in pregnancy and wishes to see these issues be discussed more openly.

It is widely regarded that medical conditions following childbirth can prompt difficult situations for women. According to Balik et al's study (2014), the prevalence of urinary incontinence has been recorded at 58% during pregnancy. Also, it has been showed by Macarthur et al. (2015) that the frequency of persistent urinary incontinence is 24% in 6 years following childbirth. Although the existence of incontinence is really common, women are likely to ignore its importance and consider the situation as a natural result of the birthing process. They generally do not seek professional support to help them in alleviating symptoms even if they have severe problems (Brown et al. 2014). Incontinence is also seen to affect women's confidence toward social interactions due to their fear of smelling and being wet (Adaji et al. 2010).

Incontinence has three different types; they include urge incontinence (bladder dysfunction), stress incontinence (sphincter dysfunction), and mixed incontinence (both sphincter and bladder dysfunction). All urinary incontinence types can be seen either alone or together during pregnancy or afterward childbirth. Pregnancy causes a variety of physiological, anatomical and hormonal changes in the body. Physiological weight gaining leads to increased pressure on the pelvic floor and bladder (Balik et al. 2014). Indeed, fetal head compression or direct trauma can also affect pudendal nerves and muscles during the pregnancy process (Donnelly et al 1998, Logan 2005). Hence, the pelvic floor is often damaged after childbirth and it can result in urinary incontinence problems. Moreover, vaginal delivery, age, prolonged labor, previous incontinence, maternal age, pre-pregnancy BMI and baby weight can be included in other risk factors for urinary incontinence (Balik et al. 2014).

All these conditions not only decrease the quality of women's lives but also affect the psychological situation of mothers and their babies. Unfortunately, there exists a tendency to keep these issues secret, which can then become dangerous due to possible related development of more severe urinary health problems. However, I believe we should not become victim to the embarrassment this condition can cause, as urinary incontinence is as normal as any other health problem. In fact, as with all treatable health conditions, the earlier patient contacts a professional about suspected symptoms of this issue, the easier the condition is to be nullified. Yet, even when the urinary condition has worsened, showing escalated symptoms, there are always a variety of available treatment methods.

In the next part, I will explain these methods and give recommendations, aiming to improve the awareness of this condition's treatability. If you enjoyed reading this post, please leave a comment!

References

Adaji, Shittu, O., Bature, S., Nasir, S. and Olatanji, O. (2010) "Suffering in Silence: Pregnant Women's Experience of Urinary Incontinence in Zaria, Nigeria". European Journal Of Obstetrics & Gynecology And Reproductive Biology 150 (1), 19-23

BALIK, G., GUVEN, E., TEKIN, Y., SENTURK, S., KAGITCI, M., USTUNER, I., METE URAL, U. and SAHIN, F. (2014) "Lower Urinary Tract Symptoms And Urinary Incontinence During Pregnancy". LUTS: Lower Urinary Tract Symptoms 8 (2), 120-124

Brown, S., Gartland, D., Perlen, S., McDonald, E. and MacArthur, C. (2014) "Consultation About Urinary And Faecal Incontinence in The Year After Childbirth: A Cohort Study". BJOG: An International Journal Of Obstetrics & Gynaecology 122 (7), 954-962

Logan, K. (2005) "Incontinence And The Effects Of Childbirth On The Pelvic Floor". British Journal Of Midwifery 13 (6), 374-377

MacArthur, C., Wilson, D., Herbison, P., Lancashire, R., Hagen, S., Toozs-Hobson, P., Dean, N. and Glazener, C. (2015) "Urinary Incontinence Persisting After Childbirth: Extent, Delivery History, And Effects in A 12-Year Longitudinal Cohort Study". BJOG: An International Journal Of Obstetrics & Gynaecology 123 (6), 1022-1029

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In my first blog, I will talk about urinary incontinence following pregnancy which is one of the most common problems among women. My motivation for selecting this topic is that I believe the issue of urinary incontinence has not been as fully recognized as its frequency and crucial effects upon women's daily life requires.