Male Physios in Men’s Health

Historically, in Australia, men’s health physiotherapy evolved from physios practicing women’s health where the common element was the management of incontinence. Unsurprisingly, these practitioners were predominantly female and the idea that the management of male incontinence following prostate cancer surgery was supplied by female physiotherapists. And for the most part they were very proficient.

I recall a meeting of women’s health physiotherapists in Australia where they were debating the merits or otherwise of expanding their group title to include ‘men’s health’ and/or ‘pelvic health’. As one of the very few man delivering men’s health continence and pelvic pain services at the time I was invited to speak and supported the inclusive concept but with the rider that men’s health was more than pelvic health. More men die from cardiovascular disease than incontinence. More people suffer from male mental health issues than do from constipation. The re-titling and a pathway of education was subsequently upheld and the latter is still in development.

Despite this awkward beginning, male physios in Australia and elsewhere have been moving into men’s and pelvic health. I have been delivering education in this area for five years along with colleagues Peter Dornan, Jo Milios and Stuart Baptist. We have educated around 200 physios in Australia under the Mastering the Martians brand, and many participants were male.

I arrived from elite level sports physiotherapy including four Olympic team representations. So did Peter Dornan, an ex-Wallaby physio. Other male physios have applied their musculoskeletal and orthopaedic or neurological skills to men’s health. It is typically a career extension where we take one set of skills and extend them into a new scope of practice.

Men’s Health Physiotherapy is an ideal vehicle for male physios to extend their role into a new market – men who are experiencing muscle dysfunction, pain and disability following a diagnosis of prostate cancer and perhaps treatment as well.

If you are a male physio I strongly recommend you undertake an introductory course with an experienced practitioner to see if it is a good fit for your skills, workplace and career path.

You can start with me in the UK during September 2019 at two Nutting Out Men’s Health Physiotherapy events. Each of these costs only £140 for a one day event.

Glastonbury, Somerset, September 21 2019 – click here for more info or to register

London, St Georges Hospital, Sept 28, 2019 – click here for more info or to register

Prostatitis

Technically this term refers to an inflammation of the prostate gland which causes pain in the pelvis and perhaps on passing urine, obstruction of the urethreal urine flow and voiding problems like frequency, urgency and hesitancy. The inflammation may be due to a bacterial infection in which case it responds well to a course on an appropriate antibiotic medication.

However, most cases labeled as prostatitis are non-bacterial where the man has no signs of a urinary tract infection (fever, positive pathology of a urine sample, smelly urine, etc.). As it turns out, many of these cases are not primarily related to the prostate, and the assumption by medical staff that it is prostatitis may result from substandard evaluation of the patient, a misunderstanding of the term or an assumption that it will sort itself out and the antibiotics won’t do any harm (1). All three of these errors on their own have the potential to cause harm and when applied together the damage and/or delay to access appropriate treatment can be significant for the health and quality of life of the man involved.

Yet since 1999, the expert panels on diagnostic criteria for this condition acknowledged that non-bacterial prostatitis would be more accurately described as ‘chronic pelvic pain syndrome’ (1). A later review further recommended that the use of antibiotics should be withheld until a second culture yielded the same bacterial profile (1).

Chronic pelvic pain in males (as for females) is a complex problem often involving physical, functional, psychological and co-morbiity issues. Everything from a possible history of sexual trauma, chronic bladder/bowel dysfunction, lower back or SIJ injuries, pelvic surgery or recurrent bladder or urinary tract infections.

As such, no one type of practitioner can reliably assess for all the related factors that may be causative or barriers to recovery. Let alone treat them all. So a multidisciplinary approach is considered best practice. Acknowledging there is no gold standard to treamentn Smith (3) reviews 16 treatment options and concludes that a multidisciplinary approach with multi-modal therapy appears to give the best outcome for patients. His list includes physiotherapy for myofascial trigger points.

Every man with a diagnosis of non-bacterial prostatitis is a man with chronic pelvic pain syndrome. The role of pelvic physiotherapists is to include or exclude mechanical, biomechanical and myofascial contributions to his condition and manage them in a reasonable and accountable time frame using objective outcome measures. This may occur while the patient is being treated by other practitioners who may be pursuing a pharmaceutical, nutritional or psychosocial approach.

Physiotherapy evaluation and treatment will include spinal segments from T12 to S4, lumbar and pelvic articulations, the hip joint, deep pelvic and anterior abdominal muscles, neural pathway restrictions and sensitisation, pelvic floor muscle function and myofascial trigger points at the least.

  1. Potts, J.M., 2015 Male pelvic pain syndrome: escaping the snare of prostatocentric thinking. Curr Bladder Dysfunt Rep 10:75-80.
  2. Barampwslo A, Mandeville A, Edwards S, Brook S, Cambitzi J, Cohen M. 2013. Male chronic pelvic pain syndrome and the role of interdisciplinary pain management. World J Urol 31:779-784
  3. Smith C, 2016. Male chronic pelvic pain: an update. Ind J of Urol 32:34-39

Coffee, Vitamin D & PCa

Two new pieces of research have confirmed the information contained in The Prostate Playbook. The danger of publishing health advice is that more recent research might not support the advice given. When it does support my book, however, I am really chuffed. Two research projects published in the International Journal of Epidemiology have confirmed that coffee consumption is not linked to prostate cancer (2019), and circulating levels of Vitamin D are likewise not linked to the incidence of prostate cancer (2018).

So my advice in the book remains current and once again supported by published research.

Body Fat & Fatal Prostate Cancers

New research published in the Journal of Cancer suggests that where body fat is deposited is more critical than how much in regards advanced and fatal prostate cancer.

Men who deposit fat in their thighs and around their abdominal organs (visceral fat) were more at risk than those who deposited fat elsewhere in their bodies, or (better still) did not have much fat at all. Leaner men, those with a lower body mass index (BMI) were more at risk of advanced prostate cancer if their small excess fat was visceral in an otherwise lean body.

Body fat is stored energy. The body will use it to fuel activity, exercise and training when the easily accessible blood sugar is used up. You see where I am going with this.

To reduce your risk of prostate cancer you should reduce your stored fat, especially around your organs. Your waist measurement (girth) is a reliable indicator of this and if you can get it below 95cm that would be brilliant. Or if that seems to big a step, start with trying to reduce it by 5 or 10 cm as every bit helps.

How to lose it? Here we go again – smaller food portions, replace red meat with white meat or fish, don’t snack between meals except on fruit, avoid sugary foods and drinks, yada, yada, yada.

You already know this but maybe haven’t been sufficiently motivated by fear, vanity or desperation to make changes. So here we go, if you don’t want to die from prostate cancer and suffer the nasty side-effects of treatment (impotence and incontinence) AND you would like to look slimmer AND you would like to have more energy, sleep better and have lower blood pressure – lose your GUT FAT over the next 6 months. Be strong.

Brain Smarts

There is plenty of research on how what you eat can influence your cognitive function and perhaps stave off brain decline such as dementia and Alzheimer’s disease. Wondrously, they are similar to the prostate saving strategies in The Prostate Playbook –

  • Reduced added sugar, including artificial sweeteners
  • Focus on ‘good’ fats: olive oil, avocado, nuts, omega-3 fatty acids from fish
  • Anti-inflammatory spices: turmeric, cinnamon, thyme,
  • Ensure good quality sleep – manage apnoea, adequate time and comfort
  • Exercise – aerobic and resistance but it should not be stressful in its own right
  • Avoid environmental toxins – pesticides, heavy metals, arsenic
  • Socialise – engaging with others face-to-face if possible

Source: The Food Sleuth, Melinda Hemmelgarn, Investigative Nutritionist, Columbia, MO.

Book Launch Event Sunshine Coast

Click here for a video highlight reel of this event – Craig speaking about the new book and why it is important for all men.

Saturday June 8, 2019 from 2pm. I will be at the fabulous Harry Hartog Book Store in the Sunshine Plaza at Maroochydore. A short talk about men’s health then you will have the opportunity to purchase my new book (or my previous one – The Prostate Recovery MAP) and I will sign it for you.

Come along if you can, buy whatever books take your fancy in the store (or not) and let’s get a big crowd to show that men’s health is important and generates interest.

Nutting Out Men’s Health – Perth & Adelaide

As part of A/Prof. Craig Allingham’s national book launch tour there are two events coming up in early May 2019

Perth – Monday May 6, Leederville Sporting Club, 7pm – 9pm
This is a two hour event comprising an entertaining and informative presentation from Craig on Men’s Health, followed by a guided tour of his new book The Prostate Playbook.

Adelaide – Wednesday May 8, Duke of Brunswick Hotel, 207 Gilbert Street, Adelaide, 7pm – 9pm
Same gig, different city. Click on the second image for the Adelaide registration.

Click above for Perth event

Handing over this book to a man

It is a common observation that men are not always receptive when health advice is being dispensed. The information may be coming from a public health campaign (no smoking, don’t text and drive) or from his doctor (lose weight, reduce alcohol consumption) but this makes little difference.

Be careful how you hand it over

If you have purchased The Prostate Playbook for a man in your life (spouse, partner, brother, son, father, postman) it is really important how you present the book to him if you want him to actually read it then take some of the actions to reduce his prostate cancer risk.

Before the recommended method, let me review what not to do –
– Never give him this book in front of his mates (unless you have a copy for each of them).
– Never gushingly gift him any book exclaiming this will solve his problem (he has no problem and, if he did, solving problems is his job).
– Never infer that the book will restore his manliness. It never left.
– Never suggest that he doesn’t already know everything that is in the book.
– Try very hard not to keep asking him if he has read it yet, or if there is anything he didn’t understand.

Now for the Professor Allingham system of getting a man to read The Prostate Playbook you have purchased for him –

  • Leave it lying somewhere in the house where he will find it on his own (self-discovery).
  • When he finds it, wait for him to mention the book in conversation. Don’t press him.
  • If the book never seems to move, don’t panic. This doesn’t mean he isn’t reading it. He won’t reveal his interest until he is well into it. And it may be the only item he ever put back where he found it in his effort to mask his pursuit of information that he didn’t realise he needed.
  • Be patient. This will be your challenge as he won’t acknowledge the book until he has found value with it.
  • If he believes the book was his idea and he just found it, don’t argue. You have won.

These guidelines are most applicable for cross-gender referral where a female is presenting the book to a man. A man will just tell his mate to read the book and better still, buy the book. This is because he has the advantage of extra-knowledge and men just love to share that.

Women & Prostate Cancer

The effect of prostate cancer is usually indirect where a male partner, father, brother, son or friend is diagnosed with the disease. Depending on the closeness and nature of the link with the man, a woman may be caught up in the anxiety, fear, decision making confusion, treatment recovery and long-term side effects.

However some women can have a direct link to prostate cancer following gender re-assignment surgery. Men who transition to female undergo a complex surgical procedure to reconstruct their pelvic appearance and function. Generally the prostate gland is left in place as removing it adds further complexity and risk of complications. Hormone manipulation to increase feminization may reduce prostate gland size and activity but it still has the potential to develop a tumor.

If this occurs, the woman has the same challenges of deciding on what treatment (if any) and how to cope with any subsequent side-effects.

The Prostate Playbook is written for men, however if a women with a prostate gland can overlook the constant male pronoun and male references she will find valuable information to reduce her chances of developing a prostate cancer or of an existing low-risk cancer progressing to the point of needing treatment.

For those women who have outsourced prostate care to their male partner, The Prostate Playbook is a valuable tool to understand and support the life changes necessary to help prolong his life. Given that most health books are purchased by women, she may even be the catalyst for his action by presenting him with The Prostate Playbook at the one time in his life that he might actually accept some advice. Check out the blog post on how to introduce the book to a man in a way that he is most likely to read it.

Putting the ‘Active’ in Active Surveillance

Many men are receiving a diagnosis of prostate cancer that is rated as low-risk or low-volume in terms of it’s likely progression or threat. Almost 50% of the new diagnoses this year in Australia will fall into this category, that’s around 8,000 men who may be offered the choice of deferring treatment by their Urologist.

Surveillance is only half the story….

During the period of deferring treatment the Urologist will recommend regular testing of key prostate disease markers such as Prostate Specific Antigen (PSA), Gleason Score (aggression rating) or imaging of the prostate to detect changes in cancer volume. This is the surveillance component of a management program called Active Surveillance.

These men are initially very relieved to discover that their cancer does not demand immediate surgery, radiation or hormone treatment due to its advanced state or aggressive nature. They leave the Urology office and resume life, work and relationships without the prospect of facing the side-effects of treatment, namely incontinence and erectile dysfunction.

However they often become uneasy when they realise they are now living with an active cancer in their prostate and nobody is recommending treatment (except perhaps for his spouse or children). He may become anxious about the cancer and fret about his future and constantly worry that not treating may not be the best option, despite the evidence from the pathology reports and recommendations from his Urologist. He may feel dis-empowered.

He needs to invest in the Active part of the treatment plan. He needs to educate himself about his prostate gland, cancer and what he can do for himself to slow the progression of any cancer and undermine its development so he never needs treatment. But the Urologist didn’t provide any resources for ‘non-treatment’, just reams of information on incontinence and erectile dysfunction and depression associated with interventional procedures such as surgery, radiation or androgen deprivation therapy (ADT).

Yet there is a huge amount of research and experience demonstrating that men can reduce the progression and development of a low-grade prostate cancer through lifestyle decisions, reducing their stress, physical training and smarter eating habits. The Prostate Playbook is a strategic guide for men and their support team to take some control of their outcome and take action to sabotage their prostate cancer. For these men, the goal is to frustrate the surveillance through smart plays everyday to stay well.

The Prostate Playbook is to be published in May 2019. It will be available in Australia and New Zealand bookstores from June or you can purchase it online after May 15 at this website.