Prostate Playbook

To acknowledge the 2020 concurrence of Men’s Health Week and National Continence Week I was asked by Fiona Rogers of Pelvic Floor Exercise to have a casual chat about men’s health, how I got there, what I am doing and (at the end) to reveal a surprising and unknown fact about myself.

The conversation was recorded and is now available on Fiona’s You Tube channel. To view the 30 minute fig-side chat (we don’t do fires here on the Sunshine Coast in Australia so we did it by a fig) simply click on the link below.

And remember to go the distance to discover my surprise reveal…..

Not much else to say really. I made this video for my training clients who are all blokes and over the age of 60. The pandemic has closed our gym spaces and it is vital for their muscle mass, mental health, bone mass and functional strength to stay as strong as possible. These six exercises include variations for current ability and key teaching points for safe execution. Like all physical training programs they only work if you do them. Regularly. Add them to your walking or cycling program.

Click Here to see the video.

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

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

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.

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.

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.

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.