Celebrate Muliebrity with Michelle Lyons

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

Hello & Welcome to the Podcast!
In today's episode, I'm joined by Orla O'Doherty @thecliniccoach for a chat about using coaching skills for behaviour change, especially around physical activity in postpartum women
Orla shared her journey, including insights from her masters training in behaviour change and health coaching, explaining key frameworks such as COM-B (Capability, Opportunity, Motivation, Behaviour) and emphasising the importance of helping the people we work with identify their own goals, rather than prescriptively telling them what to do.
We discussed practical strategies including goal setting, habit formation, motivation maintenance and the challenge of implementing these in clinical practice.
We highlight how coaching skills can liberate the clinician's role from being a fixer to supporting the person's self-efficacy, noting that this approach not only helps the people we are working with, but also reduces frustration for healthcare providers, while making clinical work more effective and sustainable.
Some of the topics we covered:
Behaviour change in health coaching
Health coaching on Postpartum care
Effective goal setting discussions
Behavioural goals in patient care
Motivation vs Willpower
Patient resistance in physio strategies
Trust, compassion and how to deal with challenges
and much more!
Orla is doing great work on changing how we can help move from the old model of healthcare professionals acting as mechanics to fix people, but rather empowering them with self efficacy toolboxes - she offers coursework on all of this so make sure you're following her on instagram
Want to learn more about a bio psychosocial approach to Perinatal Pelvic Rehab? I designed my new online course to cover all of this and more, from preconception ,through pregnancy and into postpartum and beyond. Full of up to date evidence and 'how to' strategies, from PGP to DRAM and R2R!
all of the info on this and all of my other online courses can be found at CelebrateMuliebrity.com
Until next time, Onwards & Upwards, Mx
#celebratemuliebrity

New Podcast Alert ‼️
Welcome to today’s episode, in conversation with Dr Juliet McGrattan, all about menopause & running
🏃‍♀️ 🏃‍♀️ 🏃‍♀️
We chatted about her new book "The Runner's Guide to Menopause," which provides practical advice for runners navigating menopause.
In today’s episode, we discussed some of the key challenges menopausal runners face, including the importance of strength training despite common reluctance, nutrition and fueling strategies, and the impact of menopause on bladder function and pelvic health.
Juliet explained how behavior change and motivation are the main barriers to exercise, and emphasised the need for women to be given permission to adjust programming as needed during menopause. We covered topics like energy management, the controversy around running fasted, and the critical importance of proper sports bra fitting for running efficiency. The conversation highlighted how menopause can present opportunities for women to prioritise self-care and make different lifestyle choices while maintaining their running identity.
We also explored how health benefits become more significant motivators for women around midlife and menopause, particularly regarding muscle preservation and preventing sarcopenia.
We talked about the challenges of energy management during menopausal running, including the risk of relative energy deficiency syndrome (REDs) and bone stress injuries. Juliet noted that many menopausal women find traditional weight management approaches less effective, leading to potential energy deficiency, while I expressed concern about anterior hip or groin pain in menopausal runners potentially indicating bone health issues (if you’re thinking ’hip flexor problem’ make sure it’s not a neck of femur problem - go back and have a listen to the podcast episode I did about this with Benoy Mathew!)
Juliet’s book ‘The Runner’s Guide to Menopause’ is a great resource to support runners through this transition and keep them running before, during and after menopause!
🏃‍♀️ 🏃‍♀️ 🏃‍♀️
And if you’d like to take a deeper dive into supporting women going through menopause, I think my online course, Flourish! The Menopausal Toolbox covers all the things you need know (plus access to Hysterectomy: Prehab to Rehab is included for free) All of my online courses are available at CelebrateMuliebrity.com 🥳💝 #celebratemuliebrity

Hello & welcome to today's episode where we're talking about a new paper looking at menstrual health in female rowing - I'm in conversation with lead author, Dr Ciara Everard, who is an assistant professor at Trinity College Dublin's physiotherapy programme
In our chat, we discussed her recent research paper focusing on menstrual health in female rowers, from Ireland & the US, highlighting how sociocultural and gendered norms influence how female athletes experience and manage their menstrual cycles. The research, involving ex-international rowers, explored menstrual cycle pain and symptoms but found that gendered norms in the male-dominated sport played a significant role in the findings. Ciara explained that female rowers often feel illegitimized within the rowing culture, as they are perceived as weaker than their male counterparts.
Key findings included that 70% of respondents experienced irregular cycles, 80% reported menstrual symptoms affecting performance, and 70% had fears about leakage, though only 50% discussed these issues with their coaches.
The conversation highlighted that while some athletes showed interest in tracking their cycles, there was a gap between existing knowledge in the wider literature and implementation in sub-elite contexts.
Ciara & I discussed findings from a research paper on female athletes, highlighting issues around education and misinformation regarding menstrual health. We noted that harmful discourses, such as the "slim-to-win" ideology where missing periods is valorized, still prevail among younger athletes.
We also talked about the silencing of symptoms related to conditions like endometriosis and PCOS, which can delay athletes from seeking help due to fear of being perceived as weaker or affecting their selection for teams.
Despite increased awareness, athletes still face issues related to fueling and period-related pain.
There's a huge need for continuous conversations and education at all levels of sport, including the importance of sharing personal stories to help athletes relate to the information. Our discussion also touched on the variability of menstrual experiences and the challenges in diagnosing conditions like endometriosis, stressing the need for more qualitative research and open dialogue about these issues (which is of course why I created this podcast!)
“I feel like I’m marinating in the boat... and it just makes me feel gross”: a sociocultural exploration of female rowers' experiences of the menstrual cycle'' https://bmjopensem.bmj.com/content/bmjosem/12/1/e003004.full.pdf
Want to learn more about Menstrual Health - understanding the MC, tracking it, applying menstrual knowledge to female athlete health AND get access to the course ‘Pelvic Health for the Young Female Athlete for FREE?! Then check out my online course, The Menstrual Detective (and all of my other online courses) at CelebrateMuliebrity.com
Until next time, Onwards & Upwards! Mx