Endurance sports like running and triathlons demand exceptional physical and mental resilience. But for women, there’s an additional layer to performance and wellbeing that often goes overlooked: hormonal health. As a pelvic health physiotherapist, I frequently see active women who are doing “everything right” with their training—yet struggling with fatigue, injuries, pelvic floor symptoms, or disrupted menstrual cycles. Often, the missing piece is understanding how endurance training interacts with the body’s hormonal system.

The Hormonal System: More Than Just Periods

Hormones regulate everything from energy levels and metabolism to bone density, recovery, mood, and pelvic floor function.

• Oestrogen – supports bone health, muscle repair, and tissue elasticity (including the pelvic floor)

• Progesterone – influences temperature regulation, breathing, and recovery

• Cortisol – the stress hormone, elevated with intense or prolonged training

• Leptin & insulin – regulate energy availability and metabolic function

When training load, nutrition, and recovery are well balanced, these systems work in harmony. When they’re not, disruption can occur.

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Thoracic Outlet Syndrome (TOS) is a group of conditions caused by compression of neurovascular structures as they travel from the neck to the upper limb. Due to its complex anatomy and symptom overlap with cervical spine and shoulder disorders, TOS is frequently underdiagnosed or misdiagnosed (Hooper et al., 2010). Physiotherapists play a vital role in the conservative management of this condition.

What Is Thoracic Outlet Syndrome?

TOS occurs when the brachial plexus, subclavian artery, or subclavian vein becomes compressed within the thoracic outlet—an anatomical region bordered by the first rib, clavicle, and surrounding musculature (Sanders et al., 2007). Compression most commonly occurs at the interscalene triangle, costoclavicular space, or beneath the pectoralis minor tendon.

Types of Thoracic Outlet Syndrome

Neurogenic TOS (nTOS)

Neurogenic TOS accounts for approximately 70–90% of all TOS cases and involves compression of the brachial plexus (Povlsen et al., 2014). Common symptoms include neck and shoulder pain, paraesthesia in the arm or hand, and upper limb weakness, often exacerbated by overhead activities.

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Back pain is one of the most common reasons people walk into a physiotherapy clinic. For many, it’s frustrating, persistent, and often linked to everyday tasks like sitting, lifting, or working long hours at a desk.

One question we’re asked all the time is:

“Will Pilates help my back pain?”

From a physiotherapist’s perspective, and supported by a growing body of research, the answer is often yes. Pilates can be an effective, low-impact, evidence-based tool for rebuilding strength, improving movement, and reducing the risk of recurring back pain.

Here’s why.

1. Pilates targets deep stabilising muscles of the spine

One of the key elements of Pilates is training the deep core muscles:

• Transversus abdominis

• Multifidus

• Diaphragm

• Pelvic floor

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Flexibility and mobility are often used interchangeably, but they represent distinct components of musculoskeletal health. Both are essential for functional movement, injury prevention, and performance. This blog explores their definitions, benefits, limitations, and evidence-based strategies for improvement.

What is Flexibility?

Flexibility is the ability of a muscle or muscle group to lengthen passively through a range ofmotion.

Primary Influences:

• Muscle length

• Connective tissue elasticity

• Neural factors (muscle spindle sensitivity)

Example: Touching your toes demonstrates hamstring flexibility.

Benefits of Flexibility

• Reduces risk of muscle strain injuries

• Improves posture and alignment

• Enhances relaxation and reduces muscle tension

• Supports joint health by reducing compressive forces

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Understanding a complex and often misunderstood condition

Complex Regional Pain Syndrome (CRPS) is a chronic pain condition that can be confusing, overwhelming, and frustrating for those living with it. It’s often misunderstood - even by people experiencing it - because the pain and symptoms can seem out of proportion to what initially caused them.

This blog aims to explain what CRPS is, why it happens, and how physiotherapy can play a meaningful role in recovery and long-term management.

 

What Is CRPS?

CRPS is a chronic pain condition that most commonly affects a person’s arm or leg. It often develops after an injury, fracture, surgery, or trauma - but in some cases, it can occur without a clear trigger.

A key feature of CRPS is that the pain and symptoms are out of proportion to the original injury. That doesn’t mean the pain isn’t real - it means the nervous system is behaving differently.

CRPS can affect people of all ages and activity levels, and its presentation can vary significantly from person to person.

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Becoming a parent is a huge physical and emotional transition, and breastfeeding often becomes a major focus in those early weeks. What many people don’t realise is that breastfeeding doesn’t just affect the upper body — it can influence the pelvic floor, too. Understanding this connection can help new mums feel more supported, more informed, and more confident in their recovery.

Why Breastfeeding Affects the Pelvic Floor

1. Hormones play a big role

During breastfeeding, the body produces higher levels of prolactin and oxytocin, and lower levels of oestrogen. That drop in oestrogen can lead to:

• Vaginal dryness

• Increased sensitivity or discomfort

• A feeling of pelvic heaviness

These hormonal changes are completely normal, but they can make pelvic floor symptoms more noticeable.

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Ankle fractures are common injuries seen across both sporting and general populations, with the Weber classification being one of the most widely used systems to describe fibular fractures in relation to the ankle syndesmosis (Weber, 1972). Understanding the type of Weber fracture is crucial for physiotherapists, as it directly influences management, rehabilitation timelines and long-term outcomes.

Weber Classification Overview

The Weber system categorises fractures based on their position relative to the distal tibiofibular syndesmosis. Weber Afractures occur below the level of the syndesmosis and are typically stable, often associated with a supination–adduction mechanism (Lauge-Hansen, 1950). Weber B fractures occur at the level of the syndesmosis and may be stable or unstable depending on ligament involvement. These are the most common type seen clinically (Michelson, 2003). Weber C fractures occur above the syndesmosis and are usually unstable, often associated with syndesmotic disruption and medial injury.

Fracture stability rather than fracture position alone ultimately determines whether surgical intervention is required. Stable Weber A and selected Weber B fractures are often managed conservatively, whereas Weber C fractures almost always require operative fixation (Michelson, 2003).

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Remaining independent at home is a priority for many people as they age or recover from illness or injury. The ability to move confidently, manage daily tasks, and stay engaged in meaningful activities plays a major role in quality of life. Home physiotherapy supports this by helping individuals maintain mobility, build strength, reduce falls risk, and regain confidence within their own environment.

Whether someone is recovering from a hospital stay, surgery, managing a long-term condition, or noticing a gradual decline in balance and endurance, physiotherapy delivered in the home can be a highly effective and accessible form of rehabilitation.

Who can benefit from home physiotherapy?

Home-based physiotherapy can benefit a wide range of people. Older adults who feel less steady on their feet often use home physio to improve balance and prevent falls. It is also commonly used by individuals recovering after a fall, surgery, or hospital admission, where mobility and confidence may have declined. People living with chronic conditions such as arthritis, osteoporosis, neurological conditions, heart disease, or lung disease often benefit from tailored exercise programs delivered at home. Those experiencing ongoing fatigue, deconditioning, or reduced physical capacity may also benefit, particularly when attending clinic appointments is difficult due to mobility, transport, or safety concerns. In all cases, the underlying goal is thesame: to support safe movement and long-term independence at home.

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