Beyond Bikini Medicine: Why Women's Health PT Is Full-Body PT

There’s little question that women and people assigned female at birth (AFAB) need specialized care for musculoskeletal issues that impact their breast and pelvic health — the anatomical and functional differences between the sexes are obvious to everyone, with or without a medical degree.

But what about MSK care for the rest of the body? In large part, our current medical system continues to take an outdated, “bikini medicine” approach to musculoskeletal care, in which all female body parts not covered by a bikini are effectively treated like smaller male body parts.

This approach persists despite a large body of research that consistently shows that women have a disproportionately higher risk for developing MSK disorders, endure greater impact from pain and MSK dysfunction, and are disproportionately dismissed and ignored when reporting symptoms and health concerns.

When we refer women to physical therapists who take a unisex approach to care, we're denying their unique medical needs and leaving them at a huge disadvantage when it comes to understanding and feeling good in their bodies.

The more equitable model: providing all individuals with evidence-based, sex-specific care, at every stage of life.

The Scope and Impact of MSK Disorders

MSK disorders are consistently found to be the leading cause of disability and reduced quality of life, making them a significant public health issue that impacts millions of people worldwide. According to the United States Bone and Joint Initiative (USBJI) MSK disorders impact over 1 in every 2 people in the U.S.

Musculoskeletal or MSK disorders describe a wide range of conditions or injuries that affect the:

• Muscles
• Tendons
• Nerves
• Joints
• Cartilage
• Spinal discs

These include well-known conditions like:

• Rheumatoid arthritis
• Osteoarthritis
• Low back pain
• Neck pain
• Gout

They also include everything from fibromyalgia and “worn-out” knees to work- and sports-related injuries.

MSK disorders can cause inflammation, stiffness, and significant pain. They often limit your mobility, disrupt sleep, and interfere with daily activities and societal participation. These conditions can be acute or chronic and vary in severity from mild discomfort to debilitating pain.

MSK Disorders Hit Women Harder

Numerous studies have shown that MSK disorders disproportionately affect women — and the disparity only increases with age.

A literature review of 57 different studies on upper extremity MSK disorders found that women generally have a higher prevalence of these conditions and higher odds of developing carpal tunnel syndrome compared to men. A more recent research review found neck pain, chronic low back pain, osteoarthritis, and rheumatoid arthritis (RA) affected a larger percentage of women compared to men. Additionally, when present, women’s pain symptoms tend to be more persistent and often coexist with other MSK comorbidities than those of men.

In the context of MSK injuries among athletes, one study found that 9.7% of female athletes experienced stress factors compared to 6.5% of male athletes. This same study showed that women are more at risk for ligamentous injury compared to men, particularly when participating in sports.

When looking at the broader picture of MSK disorders, the differences become even more apparent. A large systematic analysis conducted as part of the Global Burden of Disease (GBD) Study 2021 found that MSK disorders are 47% more common in females than males globally, with prevalence increasing with age and peaking in the 65 to 69 year age group.

Women's Pain and Unique Needs Are Frequently Ignored

Despite the higher prevalence and impact of musculoskeletal pain in women, and research showing that women experience pain and respond to analgesics differently than men, their pain continues to be dismissed or underestimated by healthcare providers. This dismissal can be attributed to a variety of factors, including sex and gender biases in medical research and practice.

Historically, medical research has been riddled with bias, focusing primarily on male subjects and even underreporting sex differences when they are found. Without evidence from the research to show otherwise, this dismissal of women’s pain, suffering, and MSK differences can result in treatment options that are delayed, ineffective, or simply inappropriate — causing more harm than good.

Unfortunately, these oversights have perpetuated the bikini medicine approach, where only reproductive health differences are acknowledged, while other important physiological differences are ignored.

It's Time to Move Beyond Bikini Medicine in MSK Care

It’s clear that the outdated bikini medicine model fails to address the full spectrum of MSK needs that differ between men and women. This fact needs to be acknowledged by all healthcare professionals, researchers, and policymakers so that we can adopt a more comprehensive approach to MSK care that considers the unique needs of women and all people AFAB. By doing so, we can take steps in the right direction towards everyone receiving the appropriate care and attention they deserve.

Stay tuned for the next blog in this 3-part series, as we dive deeper into the hormonal, anatomical, and physical differences that dictate sex-specific MSK care for women.