A male cyclist came to us with erectile dysfunction and pelvic pain. He was being treated elsewhere with manual therapy, with no signs of improvement.
The therapist who had been treating the patient was using internal manual therapy to address tight pelvic floor muscles, when in fact the muscle tension was a symptom secondary to the actual mechanism of injury.
After a thorough health history and clinical exam, we used diagnostic ultrasonography to visualize the structures of the patient’s pelvis. We discovered that the pudendal nerve had been injured by repetitive trauma related to the patient’s cycling activity.
To promote healing of the injured nerve, we applied nano-energy focused shockwaves along the course of the pudendal nerve where it comes in contact with the bicycle seat.
After just seven shockwave sessions once a week, our patient showed a 90% improvement in his erectile dysfunction.
Contrary to current treatment trends, not all pelvic pain and dysfunction is related to pelvic muscle tension. Unless there is a specific mechanism of injury, nearly all pelvic issues are multifactorial. Most physical therapists address pelvic pain from inside the pelvic floor, when in fact pelvic pain is most often secondary to other issues that originate above or below the pelvic floor.
Pelvic pain often arises from dysfunctional breathing, spinal instability, hip dysfunction, foot problems, fascia dysfunction, autonomic dysregulation, nerve entrapment and other issues that have been ongoing, and eventually spread to the pelvic floor. Prior to treating tight pelvic floor muscles, practitioners should seek to diagnose other issues that eventually lead to pelvic pain, and address them.
Lee, K. C. J., et al. “Extracorporeal Shockwave Therapy of the Perineum for male patients with chronic pelvic pain syndrome: A Pilot Study.” Prostate International (2023).
https://www.sciencedirect.com/science/article/pii/S2287888223000582
Dr. Lev Kalika is a world-recognized expert in musculoskeletal ultrasonography, with 20+ years of clinical experience in advanced rehabilitative medicine. In addition to operating his clinical practice in Manhattan, he regularly publishes peer-reviewed research on ultrasound-guided therapies and procedures.
Dr. Kalika is an esteemed member of the International Society for Medical Shockwave Treatment ((SMST), and the only clinician in New York certified by the ISMST to perform extracorporeal shockwave therapy. He is also an active member of the American Institute of Ultrasound in Medicine (AIUM), and has developed his own unique approach to dynamic functional and fascial ultrasonography.