Posts: 47
Joined: September 19, 2007
From: Vermont
Status: offline
Hi!
A young man was just referred to physical therapy with complaints of a retracting testicle after doing some heavy lifting one month ago. Urgent Care gave him a course of antibiotics (which didn't help), and he's seen a urologist who didn't have any answers and referred him to physical therapy.
If he activates his abdominal muscles his testi retracts and is painful; if he sits for a long time (one hour) his symptoms get worse.
Anyone have any experience with this? I'm at a bit of a loss.
Posts: 1246
Joined: February 27, 2005
Status: offline
My instinct is to doubt the diagnosis. Testicles do of course retract, we even have muscles just for that purpose, but having them be painful when "retracting", sounds like a best guess kind of attempt to me. I would focus on his lower thoracic spine and look for SPB there. The hint is that sitting makes his pain worse and his pain happens to include the perianal area, typical for a T12 referred event.
I don't think that there's anything that PT can help with if his testicle is the problem. I would call the referring Dr.'s office and speak to the Dr. or the medical assistant to see what they had in mind. I really don't think you can do much in this situation except follow up and possibly send him for a second opinion.
< Message edited by CardioFlex Therapy -- May 10, 2018 11:19:12 PM >
Hypertonic pelvic floor? - unable to recruit rectus in isolation of PF? Over recruitment of pelvic floor? Postural? Poor breathing/val salva, poor muscle recruitment with exercise? Nerve related? - I don't know - but worth checking out
Most important thorough evaluation by a advance skilled pelvic floor PT who works and is educated on male PF anatomy/treatments.
They will address breathing, adductor tone, possibly internal rectal work/superficial PF work (extremely high tone?), posture, obturator internus, spermatic cord mobility, possible genital femoral nerve involvement, L1-2, psoas, inguinal ligament ST ligament, spine, coordination of muscles with exercise etc.
The change in s/s with posture + AB contraction of sitting is a cue that this might be musculoskelatil.
Please let the MD and/or patient know that there is hope - lots of weightlifters can start to have issues with their PF and can be helped with the right PT - at the very least rule out pelvic floor dysfunction.
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