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originally published: September, 2016

birmingham health physiotherapy
A Week in Men’s Health Physiotherapy

What Type of Men’s Health Patients did I see this Week?

My clinical work covers 3 clinics based in Birmingham, Harborne Physiotherapy, Southampton with Dr Ruth Jones (http://www.cerianlife.com) & Hertfordshire at the new One Stop Doctors Clinic (http://www.onestopdoctors.co.uk).

What Type of Men’s Health Patients did I see this week? 
A mid 20’s competetive crossfit athlete who’s training was being limited by rectal and perineal pain. Gentleman 6 weeks post radical robot assisted radical prostatectomy who was depressed anxious with low mood as he was wearing 8 pads a day and felt lost. An aircraft pilot who was now returning to flying for the 1st time in years following resolution of his pelvic pain having been seen by my very esteemed colleague. Asking him how he was when he originally attended he said ” Could barely get out of bed, presumed I’d never work again at anything, would def never fly again” . He now cycyles, skies and looks superfit, healthy and enjoying life. Company exec with flare of of his penile pain due to intense period of heavy office hours,commuting and stress. He’s had it before is informed about his pelvic floor and is confident Physiotherapy will help. Young ( early 30’s) male who has had a minor urology procedure but has developed pain on ejaculation/ masturbation , weak erection (worrying for him) and pain on sitting. Rugby player with pubic pain but some bowel/ urinary symptoms. He’s had excellent hip/ groin rehab but still breaks down and had read on the web that the urinary/ bowel may be related. 

What do I do clinically? 
I am very lucky to work alongside Dr Ruth Jones one day a week and have learnt a lot from seeing her with patients and her seeing me with patients. It is both an honour and a challenge treating people she has previously seen. What stands out is the effect she has had on their lives

In Men’s health I do a lot of patient questioning, examination and use some questiinaires that Ruth has recommended. Ask a lot of questions about erectile function, sexual health, urinary function, bowel health , previous investigations and what the patient understands or is concerned about. 

There are lots of musculoskeletal assessment techniques used focusing on spine, hip, pelvis , muscle lenght and control etc. SIJ pain provocation techniques . Palpation is similar to an MSk patient but different with the focus on reproducing penile, perineal , rectal symptoms spinally. Lots of soft tissue palpation especially Rec Abd / obliques looking for refered pain. 
Pelvic floor exam consists of using Transperineal Ultrasound imaging looking at anorectal angle and movement of this during pelvic floor contraction. The pelvic floor is also examined rectally for tone, strength and referred pain. The mythology and confusion around the pelvic floor has dissapeared for me and Ruth’s advice ” that’s it’s only a muscle” has helped in addition to lots of reading and doing some cadeveric anatomy. 

Men’s Health Treatment
It depends on what the problem is. Lots and lots of patient education using the pelvis model, Ruth’s website resources and Prostate UK site. Lots of spinal work and exercise, some have pelvic floor strengthening using ultrasound imaging and the pelvic pain patients have internal work done to decrease their PF activity/pain. This is done rectally with a digit or more commonly an EZ Magic treatment wand. Headspace, meditation, breathing,yoga, general exercise all play a big part also. Patient self management is the most important aspect as in Ruth’s words ‘ we treat to redundancy ” . With the elite sports patients a big part is linking with their physio and keeping them in the loop.

Men’s health can be difficult to develop in private practice as no one seems to know much about it. My marketing consists of seeing what my friends from the Pelvic pain Facebook group are doing and we all share good and not so good ideas. We share material . This weeks marketing has been spent on a big mailshot and trying to work out how Adrian Wagstaff (my good friend) has such a high google ranking for Men’s Health. 😄 My Google + page is also being revamped.

Big week for training as Joanne Millios is over from Australia and I am running and attending her Prostate Course for Physios in Dublin & Birmingham. I will also be attending Jo’s ISCP talk on male sexual health in Dublin. Also looking forward to spending time in Dublin with Grainne who has a very progressive and growing pelvic clinic in N Ireland and Maeve Whelan who is an internationally known Pelvic health clinician,author and tutor. 

Start of a new term in Coventry University and hoping to get started on my study looking at pelvic floor function in elite level male weight lifters.

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