Gerard Finds Out...
Prior to 18 months ago I wasn’t really sure Men’s Health ( MH) physio courses existed and if they did I would have been quite confident that musculoskeletal physios like myself wouldn’t have been attending ( mainly through our own lack of insight into the specialty) or possibly even know they were running. Two misperceptions I had which are possibly shared by a lot of PTs were that 1. MH Physio related primarily to faecal incontinence and 2. You could only do MH physio if you were a very experienced WH Physio. Meeting Jo Millios in June at WCPT was a turning point as here was a MH Physio clinician doing a PhD in prostatectomy patients. Jo had over 10 years’ experience in MH Physio and had seen several thousand Prostatectomy patients but had never specialised in WH. Perhaps it WAS possible for an MSk Physio to do MH. Bill Taylor then emerged from the ether on Social Media and people who I had immense respect for spoke of Bill in glowing almost mythical tones. What interested me about Bill was that in addition to him being very supportive of events I ran he was the first male pelvic physio I’d heard of. Since then I’ve found another two on social media, Khaled from New York and Antony Lo from Australia.
Approx. 24 of us attended Dr Ruth Jones and Bill Taylor’s Male Pelvic Pain course in Southampton in mid-November 2015. Physios from UK, Ireland, Wales, Cyprus, Iceland, Israel and Scotland attended. There were also 5 male physios who all had an MSk / sports background. Meeting Karl Monaghan was also a first as here was a Sports Therapist who had many years’ experience of treating male pelvic patients. I’m convinced that without the connections made on social media and the work done by Joanne Millios, Bill and Ruth Jones and others on promoting MH Physio none of the male physios would have been there.
During the introduction to the course and the topic of male pelvic dysfunction emphasis was also put on the NIH chronic prostatitis symptom index and how it can be used to determine if there may be an underlying pelvic condition.
http://www.prostatitis.org/symptomindex.html
The morning session was focused on male pelvic anatomy and in particular the pelvic floor musculature but also their connections to the deep hip musculature. Once we got to know each other over a coffee and biscuit we moved into the practical session on rectal examination. Ruth, Bill and Cameron (Angus) were all very skilled at teaching this but what really was a fantastic opportunity was to develop some confidence and skill at this with the help of the brilliant women’s health physios on the course. It was really like having a room full of highly skilled tutors. They were also very patient with those of us who were new to this type of examination. One main reflection on this session was that MSk physios have very good communication, rapport and palpation skills which are transferable to MH Physio. After doing the assessment once it was also interesting how everyone was happy to move around and practice with people at will irrespective of gender, experience or specialism. This is something I hadn’t expected. I have always had immense respect for WH physios and I do feel it’s the most specialised area of practice and working with them so closely was a real honour which was also shared by my other male colleagues.
The section on Pelvic pain looked at Pelvic Girdle pain but had a real focus on Chronic Pelvic Pain. This session was well supported by the evidence on incidence (surprisingly very high in both males and females), reliability and validity of tests, role of rehabilitation for CPP. Ruth and Bill see a lot of complex pelvic pain clients and it was great for them to be able pepper their presentations with real clinical examples. Of particular interest were the sports related hip, groin and pelvic presentations that responded to pelvic floor treatment.
The trigger point practical allowed us an-other opportunity to practice the new skill of rectal examination and to develop this into trigger point examination. All of this was challenging for a novice particularly as we were trying to combine new skills of palpation with a backdrop of our own “sketchy” pelvic floor anatomy. The ability of Ruth and Bill to locate specific internal structures was impressive. Bill’s story of the extensive cadaveric anatomy work he has done on the pelvic cavity highlighted how much training is needed over the years to reach this level.
Day 1 was exhilarating, fascinating but very challenging in a good way. That evening we recorded the MACP Podcast on Men’s Health Physiotherapy which is one of the 1st podcasts on this area of practice.
https://macpweb.org/home/index.php?p=525
Following that we had a fun night socialising in Southampton and finding out what people did both in their own work and outside of work.
Day 2 started early with a session on differential diagnosis in pelvic pain and also identifying red flags. It also prompted some great discussion on the significant role of behavioural, cognitive and emotional factors in CPP. The practical session on the morning of day 2 was one that was familiar to me. Focusing on Lumbar spine, pelvis and SIJ movement dysfunction, pain provocation and motor control came as both reassuring and somewhat surprising. Although I’d previously heard Ruth emphasis the role of MSk skills in treating these patients and conditions it only really hit home when we covered them on the course. Hopefully during this session some of the WH Physios felt that the MSk guys could give something back.
There are few tutors on courses that do “live patient” assessments and it was another real highlight of the course to see Bill assess a male patient with chronic Pelvic symptoms relating to sport and exercise. Seeing the musculoskeletal and pelvic floor components weaved together in both the subjective and objective sections really pulled these areas together. It gave it real clinical context. Day 2 finished with another detailed theory and practical session on male sexual dysfunction. Yet again an area that I knew very little about prior to the course. This also brought Day one’s anatomy session into a real clinical context.
World class tutors in Bill Taylor and Dr Ruth Jones, a wonderful group of international physios and two brilliant but challenging days left me exhilarated , tired but very excited about my future Physiotherapy direction and Men’s Health Physiotherapy. There are few courses that are career shifting but this was definitely one. I’m a big advocate of using Social Media in Physiotherapy and thanks to Sarah Spice on the course we have all been able to stay in touch on Facebook and share what we are doing in Men’s Health and support each other under the reassurance of Bill and Ruth and the other experienced people in the group. I would also strongly recommend the Men’s Health Physiotherapy Group on Facebook that Jo Millios has built. It is a real privilege to read some of the clinical discussions in there from some of the world’s leading MH clinicians.
https://www.facebook.com/groups/1563449207204537/
