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Gerard Greene – Male Athletic Pelvic Health – Injury Rehab Network

The first Injury Rehab Network event of 2024 with BASRaT featured a presentation from Gerard Greene, Men’s Health Physiotherapist. The online event took place on the evening of 15th January with 290 sports rehabilitation practitioners in attendance.

Gerard discussed male athletic pelvic health. The recording is available to watch here

Gerard Greene

Gerard Greene, Physiotherapist

Gerard is a graduate of Trinity College in Dublin and an experienced Men’s health physio and is based in the UK. He works clinically in male pelvic pain, pelvic floor rehab post prostate surgery, hard flaccid syndrome, younger erectile dysfunction, pelvic floor dysfunction in sport and focused shockwave in pelvic health. He has established 2 Men’s health physio clinics in the UK (London & Birmingham) and has experience in developing the role and service of Men’s health Physiotherapy.

He has produced a popular Male pelvic pain webinar for the APTA Pelvic Health Academy and delivered a pre-con course at the APTA CSM 2020 conference in Denver with his good friend and colleague Dr Jo Milios. He also presented at IFOMPT Asia in Tokyo in September 2020 and taught in Washington DC in 2019 & 2023.

He presented at WCPT 2017 in Cape Town on Men’s health and was invited to teach the 1st Men’s Health course in South Africa with Dr Jo Milios (South African Physiotherapy Society). He has delivered Male pelvic health courses/ conferences for the Japanese Physical Therapy Association and delivered one of the 1st practical Men’s health physiotherapy courses in the Middle East (Dubai). He has also taught men’s health courses in the UK & Ireland. He is a passionate advocate for more physiotherapists to get involved in Male pelvic health.

He is also an Assistant Professor of Physiotherapy in Coventry University, UK. He is also proud to be a #tutorwhotreats.

Cyclist close up

Male athletic pelvic health

Mr Greene’s presentation considered:

  • What are the typical male sporting patients and conditions seen in a busy male pelvic health physiotherapy clinic?
  • The role of the male pelvic floor and pudendal nerve in male sporting conditions.
  • What is male athletic pelvic pain, and how do you pick it up in a sporting male?
  • Cycling-related pelvic pain.
  • What urinary, bowel and erectile symptoms are common, and how do we ask those questions?
  • What does the assessment of these patients look like?
  • How they are treated and managed.
  • Myth busting around athletic male pelvic health.

Introduction

Gerard started his presentation with advice for men to keep an eye on their special friend as he’s a good indicator of your general health.

Gerard works in his clinics at London and Birmingham Men’s Health Physiotherapy and is an Assistant Professor of Physiotherapy at Coventry University. The team at Gerard’s clinics are specialist pelvic health physios, offering a range of services, including the treatment of sporty people.

Gerard described health problems associated with male pelvic health, including:

  • Pain
  • Leakage
  • Sex issues
  • Penis issues

Patients are encouraged to keep a bladder diary and a bowel diary to monitor any changes.

Gerard considered how pelvic health issues can be harder to discuss and share.

Pelvic Health and Sport

Gerard described how pelvic health issues in athletes/ sporty men are often linked to sexual activity and ejaculation. This may include groin pain, ejaculation pain and urinary frequency. Typical patients include weekend warriors, CrossFit, cyclists, football players and participants from many other sports.

Gerard presented case studies of a CrossFit athlete, cyclist, football player and weightlifter. These case studies featured a range of pelvic health problems/ injuries and demonstrated the impact that sports/ MSK injuries can have on pelvic health and how pelvic health problems may impact sports participation and performance.

Pelvic Floor Anatomy

Gerard discussed the pelvic floor anatomy, including muscles and the Pudendal Nerve, which has a rectal branch and perineal branch.

Pelvis Model

Does my patient have male pelvic pain?

Gerard discussed the features and symptoms associated with male pelvic pain, including:

  • Clinical features are pelvic pain and urinary tract symptoms.
  • Symptoms in the perineum, rectum, penis, pubic, abdomen, and scrotum.
  • Sexual health.
  • Erectile dysfunction.
  • Pain on sex.
  • Often aggravated by lots of abdominal work and strengthening.
  • Sitting can be a big aggravating factor.

Gerard recommends the NIH Male Pelvic Health Pain Questionnaires as an ice breaker to initially assess the patient. Gerard’s advice for clinical assessment is to start with symptoms and progress to urinary, bowel, and sexual health.

This method of assessment is usually a huge relief to patients when they are finally asked about their problems. It becomes normal for practitioners to ask these questions and reassure patients.

Pelvic Floor

Gerard described how pelvic floor pain/ issues can be linked to possible over-activity and/ or hypersensitivity. There may also be a secondary lack of slow and fast twitch-coordinated recruitment.

Gerard considered how pelvic floor dysfunction is linked to overactivity with a strong mind-body connection. Therefore, the treatment/ rehabilitation that Gerard provides has an emphasis on relaxation.

Assessment, treatment, and management

A combined approach is required for the assessment, treatment and management of male pelvic pain, and Gerard described how this includes:

  • Pelvic Health
  • Musculoskeletal
  • Education
  • Exercise

Most patients have usually been screened a lot prior to an appointment with Gerard, so other and potentially more serious problems can usually be ruled out.

Gerard discussed the external assessment of the pelvic floor with consideration of slow vs. fast twitch fibres, breathing and pain. Imaging is also used with ultrasound, providing a dynamic tool for assessment of the pelvic floor.

Internal assessment may also be required in some cases, and Gerard discusses this in detail with patients so they are well-informed and comfortable.

Gerard described how treatment is often focused on pelvic floor relaxation, with breath work forming an important part of treatment. Internal treatment may include the use of an EZ Magic to assist with exercises.

Q&A

Gerard kindly answered questions put forward by practitioners who attended the session. Please see the presentation recording for Gerard’s insights to the questions.

Presentation Recording

The recording of Gerard’s presentation is available to watch here

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