Prostate Recovery MAP

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…..

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

In 1948 Dr Arnold Kegel first reported using a new invention of his, the perineometer, to measure intra-vaginal pressure and proposed a routine of exercises for the female pelvic floor to improve continence and prolapse in his patients (1). Why the female pelvic floor? Because he was an Obs & Gyn specialist. Not many male patients.

Since then, the word ‘Kegels’ has come to refer to any and all exercise programs directed at the pelvic floor, including males. Doing one’s Kegels is the ubiquitous prescription for women post-pregnancy, men post-prostatectomy and all manner of other pelvic presentations.

For all I know, Kegels for the female pelvic floor may still be the most effective exercise strategy. But being a men’s health physio I really have no idea if that is true, or if there is standardised exercise protocol for Kegels which if not followed means Kegels are not being performed. Or is any form of ‘clenching’ down below qualify as ‘Kegeling’.

I used to wonder if exercises targeting the female pelvic floor, designed using a pressure sensitive balloon in a vagina were directly transferable to an anatomically different male pelvic floor where the only aperture for measuring pressure was a little further posterior and had little to do with urinary continence. When I started working with post-prostatectomy men in 2004 I realised I needed a different assessment and teaching strategy to detect recruitment errors and improve performance. The prevailing thought at the time was that you could measure the male pelvic floor using rectal palpation or pressure testing. Turns out that muscle wasn’t much involved in urinary control.

The work of researchers such as Ryan Stafford, Paul Hodges and more have demonstrated that the male pelvic floor is not only structurally different but also recruited differently from the female version when trying to reduce urine leakage. And the men respond differently to verbal cues and biofeedback training when trying to improve their pelvic floor efficiency.

Kegels are for females. Hegels are for males.

I didn’t invent the new exercises, but I did develop methods of teaching them clinically and documented this in my book, ‘Prostate Recovery MAP – Men’s Action Plan’ (2013, Redsok International). While I was developing this program in my clinic, Stafford and Hodges were doing ground breaking research that correlated strongly with my clinical experience and results. Right down to the cueing strategies and recruitment patterns.

Perhaps more importantly is the male perception of Kegel exercises being designed for and used by women for the last 70 years. Imagine coming home with an exercise sheet from the Urologist or the physio and your wife declares, ‘These are Kegels! I did those after the kids were born.’ Or for her prolapse or incontinence. The man now knows he has been given female exercises for his very masculine problem. Having a different name for the program could be as powerful in terms of male compliance as having subtly different exercises. Hegels are bold, structured and male focused exercises designed for the male anatomy and psyche.

If you dispense pelvic floor exercises for men try calling them Hegels. And that’s all you will call them. Never describe them as ‘Kegels for men’, because you immediately destroy the masculine-ownership of the program. Hegels are different. The teaching, execution, training and assessment of Hegels is only for men. They own it. Lead with it – tell them they are about to learn the masculine science of Hegel exercises and deliver the program you feel is the best fit for him depending on his type of incontinence, learning style and trainability. You got this.

More at www.hegels4men.com

1. Kegel, Arnold, The nonsurgical treatment of genital relaxation; use of the perineometer as an aid in restoring anatomic and functional structure. Ann West Med Surg. 1948 May;2(5):213-6.