Month: July 2025

Complete Guide to Athletic Pubalgia

I’ve seen firsthand how frustrating chronic groin pain can be—whether you’re an elite athlete or just trying to get back to weekend pickup games. Athletic pubalgia (often called a “sports hernia”) is a clinical entity with evolving diagnostic criteria and is sometimes referred to as Gilmore’s groin. This condition affects many athletes across various sports and is really a spectrum of soft-tissue injuries around the pubic bone, not a true hernia at all. The affected area is typically the lower abdomen and groin region. It pops up in both men and women, can masquerade as other conditions (like prostatitis in men or postpartum pelvic pain in women), and thrives on core weakness and compensatory movement patterns.

The good news? With the right blend of manual therapy, movement retraining, pelvic-floor work, and progressive loading, most folks get back to what they love—pain-free.

What Is Athletic Pubalgia?

Athletic pubalgia is a chronic groin-pain syndrome caused by strains or tears of muscles and tendons at their pubic attachments—most often the obliques, rectus abdominis, and adductors, including the adductor longus. The pubic symphysis acts as a pivot point between abdominal and groin muscles at these attachments. The conjoint tendon also plays a significant role in the pathophysiology of this condition.

It’s a “core muscle injury” that leads to pain with twisting, cutting, kicking, or even coughing. Athletic pubalgia is sometimes referred to as sportsman’s hernia and is considered a form of groin disruption. Inguinal pain is a common symptom and may be present alongside lower abdominal and groin pain. Pain may be reproduced during a sit up or resisted sit up, and hip extension can also exacerbate symptoms.

Core Muscle Injury — What That Really Means

It is a more accurate, all-encompassing term that explains the dysfunction at the heart of this condition:

It occurs where deep abdominal and groin muscles anchor to the pelvis—commonly the rectus abdominis and adductor tendons.
Over time, repetitive twisting, kicking, or sprinting stresses the core, creating small tears or imbalances that trigger chronic pain.
This injury often coexists with adductor strains or hip pathology, making accurate diagnosis essential.

Sports Hernia/ Athletic Pubalgia: Understanding the Terminology

Sports Hernia: The term popularized by media and patients to describe groin tissue injury without a true protruding hernia.
Athletic Pubalgia: The preferred medical term reflecting the location (pubis) and mechanism (athletic activity).

Both labels point to the same underlying pathology—and you’ll see both used by clinicians, researchers, and sports-med resources.

How Sports Hernias Occur

Repeated rotations, high-impact stops, and muscle imbalances overload the abdominals and adductors, and these injuries often require sudden changes in direction or forceful movements. As core weakness persists, stress funnels into the pubic attachments and sports hernias occur—silent yet painful injuries. Activities that increase intra-abdominal pressure, such as coughing, sneezing, or heavy lifting, can also trigger symptoms. Sports activity and sporting activity involving repetitive twisting and turning are common causes, especially in professional athletes who are particularly at risk due to the demands of their sport.

Causes and Risk Factors

Athletic pubalgia, commonly referred to as a sports hernia, develops when the soft tissues of the lower abdominal wall and groin area—especially the abdominal muscles and adductor muscles—are subjected to excessive strain. Unlike a true hernia, there’s no visible bulge, but the pain and dysfunction are very real. The root cause is often a weakening or tearing of the abdominal wall near the inguinal canal, where the conjoined tendon and pubic bone serve as critical anchor points for muscle attachments.

Sports hernias occur most frequently in athletes who participate in sports that demand explosive movements, rapid changes in direction, and powerful twisting motions—think soccer, football, ice hockey, and tennis. These activities place repeated stress on the lower abdominal muscles and adductor group, making them vulnerable to injury. Chronic groin pain and lower abdominal pain often develop gradually, but can also be triggered by a single, forceful movement.

Certain anatomical and biomechanical factors can increase the risk. Individuals with femoroacetabular impingement, labral tears, or a history of core muscle injury are more likely to experience groin pain and develop sports hernias. The structure of the inguinal canal, the strength of the conjoined tendon, and the balance between the abdominal wall and adductor muscles all play a role in susceptibility. Understanding these risk factors is key for both prevention and early intervention, helping athletes and active individuals avoid the cycle of chronic pain and repeated groin injury.

Who Is Affected by Athletic Pubalgia?

Male athletes: Often misdiagnosed as inguinal hernia or prostatitis because of overlapping pelvic-floor pain. A thorough review of medical history is essential for accurate diagnosis, especially since symptoms may overlap with other conditions.
Women: Particularly postpartum or high-level athletes with underlying pelvic instability; internal pelvic-floor work is frequently indicated.

Symptoms & Diagnosis

Pain: Dull, burning, or sharp ache in lower abdomen/groin that worsens with sprinting, twisting, sit-ups, or coughs. Patients are often experiencing pain that is chronic and worsens with activity.
No visible bulge: Unlike an inguinal hernia, there’s often no outward protrusion.
Diagnostic tools:
Physical examination: A thorough physical examination is crucial, including specific maneuvers to reproduce symptoms, such as resisted adduction and abdominal tests.
MRI: Gold standard for detecting soft-tissue tears or edema (68–98% sensitivity).
Ultrasound: Dynamic but operator-dependent.

Core Weakness & Pathomechanics

We often see a pattern of core instability, compensatory hip movement, and chronic pelvic loading driving symptoms. When the transverse abdominis, obliques, and pelvic floor aren’t firing synchronously, stress funnels into the pubic attachments—resulting in micro-tears and pain.

Conservative (Non-Surgical) Management

Early rest & modalities (ice, NSAIDs) for 7–10 days as part of conservative therapy, which is the first-line approach for most cases.
Phase I (Weeks 1–2): Gentle stretching, manual soft-tissue release, hip mobility.
Phase II (Weeks 3–6): Core-stability drills (planks, dead bugs), isometric adductor holds, pelvic-floor retraining.
Phase III (>6 weeks): Progressive loading, plyometrics, sport-specific drills—only if pain-free.

Outcomes: Up to 80–90% return-to-sport within 3–4 months when following structured rehab. Manual therapy added to exercise speeds return by ~4–5 weeks. While conservative treatment is often effective, some cases may require surgical intervention if symptoms persist.

When Surgery Is Needed

Indications include symptom persistence after 3 months of conservative care and confirmed pubic-wall deficiency on imaging.

Surgical procedures: Options include open repair, laparoscopic surgery (a minimally invasive surgical procedure), and pelvic floor repair techniques. Laparoscopic surgery is often compared to open surgery, with the minimally invasive approach potentially allowing for faster recovery and lower complication rates.
Open vs laparoscopic repair: Both yield >90% return-to-sport; laparoscopic may allow return in 3–5 weeks.
Adductor tenotomy: The adductor longus tendon is often targeted in this procedure, especially if persistent inner-thigh pain remains post-repair.
Conjoint tendon repair: During surgical repair, the conjoint tendon is evaluated and repaired if necessary, as abnormalities or tears can contribute to groin pain.
Surgical outcomes: Key measures include return to sport rates, symptom relief, complication rates, and overall patient satisfaction.
Surgical rehabilitation: A structured rehabilitation program is essential after surgery to restore function and performance, particularly for athletes.

Special Focus: Women & Postpartum

Postpartum pelvic-floor weakness and ligament laxity frequently complicate athletic pubalgia in women. Integrating internal pelvic-floor therapy with core and hip work is key—and outcomes are on par with male cohorts when this holistic approach is used.

Dr. Gvili’s Integrated Rehab Model

First-line care focuses on restoring core-muscle injury through:

Manual therapy and soft tissue release
Core drills: planks, dead bugs, side‑planks
Pelvic‑floor retraining
Hip/adductor strengthening
Neuromuscular retraining and movement pattern correction
Sport-specific progressive loading

Studies show 65–90% of athletes improve within 4–8 weeks. ([turn0search9] [turn0search11])

Phase breakdown:

Weeks 1–2: Rest, ice, NSAIDs
Weeks 3–6: Core and pelvic strengthening
Post‑week 6: Return to sport progression, when pain-free

Outcomes: Conservative care yields up to 90% return-to-sport within 3–4 months; adding manual therapy can quicken recovery by 4–5 weeks.

Prevention and Future Directions

Preventing athletic pubalgia starts with a proactive approach to strengthening and protecting the core and groin area. Regular physical therapy that targets the abdominal muscles, adductor muscles, and hip flexors is essential for building resilience and reducing the risk of sports hernias. Incorporating dynamic stretching, foam rolling, and mobility work into your daily routine can help maintain flexibility and relieve muscle tension, which in turn helps prevent chronic groin pain.

Modifying sports activities to avoid excessive strain—such as limiting sudden changes in direction or high-impact twisting movements—can also lower the risk of injury, especially for those with a history of groin pain or previous core muscle injuries. Early intervention is crucial: advances in diagnostic tools like magnetic resonance imaging (MRI) now allow for more accurate and timely identification of sports hernias, enabling targeted treatment before pain becomes chronic.

Looking ahead, research is focused on refining both surgical and non-surgical treatment options. Minimally invasive surgical procedures and innovative rehabilitation protocols are being developed to improve outcomes and speed up recovery. Personalized rehabilitation plans, tailored to the individual’s specific injury, sport, and goals, are becoming the standard of care, helping athletes return to play safely and reducing the risk of re-injury. By staying informed and proactive, athletes and clinicians can work together to prevent groin pain and ensure long-term health in the groin area.

Key Takeaways

Athletic pubalgia isn’t a classic hernia—think soft-tissue injury around the pubis.
Core weakness + compensatory patterns underlie most cases.
Conservative rehab (manual therapy + core/pelvic-floor work) helps ~90% recover without surgery.
Surgical repair is highly successful (>90% RTP) when rehab fails.
Tailored pelvic-floor integration is essential for women and postpartum athletes.

Ready to tackle that stubborn groin pain? Dr. Adam Gvili at Pelvis NYC is here to collaborate—feel free to refer your toughest athletic pubalgia cases or reach out for a case discussion!

Can UroLift Cause Erectile Dysfunction? Your Guide to Better Understanding

A Physical Therapist’s Take on BPH Treatment, Sexual Function & Recovery

Can UroLift Cause Erectile Dysfunction?

Let’s tackle this right out of the gate—can Urolift cause erectile dysfunction?- the short answer is no. The UroLift System is designed to relieve urinary symptoms caused by BPH (Benign Prostatic Hyperplasia) without affecting erectile function. Clinical studies show that UroLift does not cause new, sustained erectile dysfunction, setting it apart from other BPH treatments.

As a pelvic health PT, I work with men post-procedure and see firsthand that erectile dysfunction (ED) after UroLift is rare and typically unrelated to the procedure itself.

But does that mean it never affects your performance? Not exactly.

While the mechanical side of erections remains safe, some men report temporary issues due to:

Pelvic floor tension
Anxiety
Post-op inflammation
Pre-existing sexual health concerns

Most of this is manageable with pelvic rehab, relaxation techniques, and time. Importantly, UroLift is not associated with new sexual dysfunction, and the treatment effect on sexual function is minimal compared to other BPH therapies like TURP or laser, which have higher rates of sexual side effects.

What You Should Know About Erectile Dysfunction

ED is complex—it’s not just about the penis; it’s about nerves, blood flow, pelvic floor muscles, emotions, and overall health.

From my clinical perspective, men who experience ED post-UroLift often:

Already had mild ED
Are dealing with stress, performance anxiety, or prostate-related tension
Experience tight pelvic muscles that interfere with function

The good news? Physical therapy can help. We work on improving blood flow, relaxing the pelvic floor, and restoring confidence.

Understanding BPH Treatment and Sexual Health

BPH affects about 50% of men over age 50, and the number one symptom is disrupted urination—urgency, frequency, dribbling, or incomplete emptying.

Unfortunately, many treatments for BPH have a dark side: they can mess with your sex life.

Common BPH treatments and their sexual side effects:

Treatment	Invasive?	Risk of ED?	Risk of Retrograde Ejaculation?
TURP	Yes	Moderate	High
Laser therapy	Yes	Moderate	Moderate
Medications (alpha-blockers, 5-ARIs)	No	Possible	Low–Moderate
UroLift	No	Very Low	Very Low ✅

Therapies such as TURP, laser, and even medication are associated with a higher risk of sexual side effects, including erectile and ejaculatory dysfunction, compared to UroLift®. UroLift® stands out as a minimally invasive alternative to traditional surgical options, with clinical data showing it does not cause new or lasting ejaculatory dysfunction.

Why Sexual Function Matters in BPH Treatment

It’s not just about urination—it’s about feeling like yourself again.

As a therapist, I’ve seen men recover their urinary confidence but still feel “off” because of unexpected sexual challenges. That’s why sexual function should always be part of the conversation around BPH treatment options.

UroLift shines here because it:

Preserves erectile function
Maintains ejaculation
Doesn’t involve hormones or cutting tissue
Allows for quicker recovery compared to invasive procedures
Helps patients avoid major surgery and is a safer alternative to most traditional surgical options

Exploring BPH Treatment Options (The Balanced View)

Before committing to a treatment, it’s wise to understand your options. It’s important to consider other BPH treatment options, such as medications, minimally invasive procedures, and traditional surgeries, to find what best fits your needs.

Medications
Medications are often the first line of therapy for BPH. BPH medications, such as alpha-blockers and 5-alpha-reductase inhibitors, can help relieve symptoms by relaxing the muscles of the prostate and bladder or by shrinking the prostate. However, some patients may experience side effects or may not achieve sufficient relief with medication alone.

Ultimately, the best approach is chosen after you and your doctor decide together based on your symptoms and preferences.

✅ Lifestyle + Watchful Waiting

Mild symptoms? Start here. Diet, hydration, bladder training, and pelvic floor therapy can help.

✅ Medications

Options like tamsulosin or finasteride, which are examples of BPH medications, are common but can cause dizziness, low libido, or ED in some men.

✅ Surgical Interventions

TURP: Effective but carries sexual side effects
Laser therapy: Less invasive than TURP but still risky
Prostatic urethral lift (UroLift): A minimally invasive treatment performed as an outpatient procedure, office-based, and sex-sparing

What Is the Prostatic Urethral Lift (UroLift System)?

The UroLift System deploys permanent implants made from standard surgical implantable materials to lift and hold prostate tissue away from the urethra. Think of it like opening curtains to let urine flow freely again.

Why Patients Love It:

Patients typically experience a quick recovery, minimal side effects, and preservation of sexual function after UroLift, making it a preferred choice for many.

No hospital stay
No cutting
No catheter (in most cases)
Sexual function stays intact
Quick return to work and life

For men who are sexually active and concerned about side effects, UroLift is often the first-line option I recommend in collaboration with their urologist.

Minimally Invasive with Solid Clinical Data

UroLift is FDA-approved and backed by some of the most robust clinical data in the BPH space. Clinical studies have demonstrated the effectiveness of UroLift as a minimally invasive treatment for treating BPH, providing evidence-based support for its safety and efficacy.

Key Stats from Clinical Trials:

5-year data shows durable symptom relief
Patients report symptom relief after UroLift treatment
No new cases of ED reported in trials
High patient satisfaction
Improved urinary flow and quality of life

If you’re into data (and who isn’t when it’s your body), here’s what one of the leading studies showed:

“Erectile and ejaculatory function were preserved in 100% of sexually active men treated with UroLift.” — Journal of Sexual Medicine, 2019

How This Treatment Affects Daily Life

The goal of any BPH procedure shouldn’t just be symptom relief—it should be a return to normal life, including:

Better sleep (less nighttime peeing)
More confidence in social settings
Renewed sexual energy
Less anxiety about “accidents”

After UroLift, the most common side effects include urinary discomfort, pelvic pain, burning with urination, and blood in the urine. Most symptoms are mild to moderate and typically resolve within a few weeks. Symptoms related to the procedure are temporary, and most patients have their symptoms resolved within a short period.

Most of my patients report feeling lighter, more in control, and more themselves within weeks of UroLift.

And when they pair it with pelvic physical therapy? The results are even better.

What to Expect During UroLift Treatment

If you’re considering the UroLift System, you’ll be glad to know it’s a minimally invasive procedure designed with your comfort and convenience in mind. The entire treatment usually takes less than an hour, and it’s performed right in your urologist’s office or an ambulatory surgery center.

Here’s how it works: Using the UroLift delivery device, your doctor will deploy tiny, permanent implants that gently lift and hold the enlarged prostate tissue away from your urethra. This relieves the obstruction caused by benign prostatic hyperplasia (BPH) and allows urine to flow more freely—no cutting or removal of prostate tissue required.

The procedure can be done under local or general anesthesia, depending on your needs and your doctor’s recommendation. Most patients experience only minimal discomfort, and you’ll typically be able to go home the same day—often without the need for a catheter. Many patients experience symptom relief within just a few weeks after the procedure, and you can expect to get back to your normal routine quickly.

For men looking for a straightforward, effective way to address BPH symptoms and enlarged prostate tissue, UroLift offers a path to symptom relief with minimal downtime and a fast return to daily life.

Finding the Right Healthcare Provider for UroLift

Selecting the right healthcare provider is a crucial step in your journey to relief from BPH symptoms. The UroLift System consists of a specialized delivery device and permanent implants, and it’s important to choose a urologist who is experienced in performing this minimally invasive procedure.

Start by asking your primary care physician for a referral or searching online for urologists in your area who offer the UroLift System treatment. Look for providers who have a track record of success with the procedure and who can clearly explain how the UroLift System works to relieve obstruction caused by enlarged prostate tissue.

A knowledgeable provider will answer all your questions about benign prostatic hyperplasia, the UroLift System, and what to expect before, during, and after treatment. By partnering with an experienced urologist, you’ll be setting yourself up for the best possible outcome—achieving symptom relief and getting back to your life with confidence.

The Role and Importance of Physical Therapy in the Question: Can Urolift Cause Erectile Dysfunction?

As a pelvic health physical therapist, I’ve seen how targeted rehab can make a huge difference post-UroLift.
PT addresses pelvic floor tension, improves circulation, reduces anxiety, and promotes healthy muscle coordination. We also help men regain confidence and sexual function after BPH treatments. Personalized therapy programs can accelerate recovery, reduce post-operative discomfort, and improve outcomes for both urinary and sexual health.

Rehab with Pelvic Floor Therapy After UroLift

Recovery doesn’t end once the UroLift procedure is over — rehab is where your body integrates the change. That’s why pelvic floor therapy is so valuable in the post-op phase.

I work with men to retrain muscles that may have been compensating for years of straining or dysfunction. After UroLift, some patients develop tightness, guarding, or overactive muscles as their body adjusts to the improved urinary flow. Addressing this early leads to better long-term outcomes.

What does rehab look like?

Typical post-UroLift pelvic floor rehab may include:

Pelvic floor relaxation and retraining exercises
Manual therapy for the lower back, hips, and perineum
Breathwork and core coordination drills
Education on bladder habits, voiding posture, and fluid timing

Many men are surprised by how much PT can enhance their confidence—not just physically, but sexually and emotionally too. Think of it as the final step in reclaiming your comfort, control, and quality of life after BPH treatment.

Final Thoughts on Can Urolift Cause Erectile Dysfunction

If you’re on the fence about UroLift, here’s my take:

If you want to fix your flow and keep your mojo, it’s one of the best options out there.

But don’t go it alone.

Discomfort varies greatly between individuals, but the procedure typically helps minimize discomfort for most patients.

Talk to your urologist. Talk to a pelvic therapist. Support your recovery, mentally and physically, and you’ll be back to peak performance in no time.Ready to take the next step? Visit Pelvis NYC to schedule a consultation with a specialist who understands your body and your goals.

Pelvic Wall Therapy: A Physical Therapist’s Complete Guide to Healing

Pelvic wall therapy, more commonly referred to as pelvic floor physical therapy (PFPT), is gaining traction as a transformative approach to managing a wide range of pelvic health issues. Despite the growing attention, confusion still exists about what pelvic wall therapy entails, who it’s for, and why it’s a first-line treatment backed by research and medical professionals alike.

As a Doctor of Physical Therapy specializing in pelvic health, I’ve seen the profound impact that this form of therapy can have. This guide will walk you through everything you need to know about pelvic wall therapy.

What Is Pelvic Floor Therapy?

Pelvic floor therapy is a subset of physical therapy that focuses on treating conditions caused by dysfunction of the pelvic floor muscles. The pelvic floor consists of muscles and connective tissue that support the bladder, uterus (or prostate), rectum, and other pelvic organs. These muscles and connective tissue form a hammock-like structure that supports vital internal organs and is attached to the pubic bone and the pelvis, providing stability to the pelvic region.

In women, the pelvic floor also supports the vagina, along with other reproductive organs. Whether the muscles are too weak (hypotonic), too tight (hypertonic), or poorly coordinated, therapy can help retrain them. Dysfunction can involve muscle weakness or muscle spasms, leading to pelvic floor disorder and a range of pelvic floor disorders. These conditions can affect sexual function, and in men, may contribute to erectile dysfunction. This process improves function and alleviates common but often misunderstood.

Pelvic Floor Physical Therapy: How It Works

When people think of pelvic floor physical therapy, Kegels are often the first thing that comes to mind. While Kegels (pelvic floor contractions) can be beneficial for some patients, they are far from a one-size-fits-all solution, and in many cases, they’re not even appropriate, especially for those with pelvic floor overactivity or pain.

Pelvic floor physical therapy is a specialized therapy offering a range of treatment options tailored to each patient. This comprehensive, individualized approach goes far beyond simple exercises. An individualized plan is created based on a thorough assessment to relieve symptoms and reduce pain. The therapy addresses the full complexity of pelvic floor dysfunction by targeting muscular imbalances, nervous system regulation, postural alignment, and behavioral habits that contribute to symptoms. Treatment may include exercise to strengthen pelvic floor muscles, target specific muscles, and train for activities such as heavy lifting. Here’s what that approach often includes:

Internal and External Assessments

During the first appointment, therapists evaluate pelvic floor muscles through both external (abdomen, hips, back) and internal (vaginal or rectal) exams, and an internal exam may be performed as part of the assessment to check muscle tone, strength, and coordination. This helps identify tightness, weakness, prolapse, or scar tissue that may be contributing to symptoms.

Based on assessment findings and patient comfort, both internal and external therapy options are considered to create a comprehensive treatment plan.

Manual Therapy

Hands-on techniques—like myofascial release, trigger point therapy, and scar tissue mobilization—are used to relieve pain, improve circulation, and restore normal muscle function. These may be applied internally or externally. External therapy, including joint mobilization, may be used to address issues in the sacroiliac joint and other areas to improve mobility and support pelvic health.

Biofeedback

This technology uses special sensors attached to the body to monitor the activity of specific pelvic floor muscles. The results are displayed in real time on a computer screen, giving patients immediate feedback on how their pelvic floor muscles are functioning. This helps them learn how to properly contract and relax these muscles. It’s particularly effective for retraining coordination and improving control.

Neuromuscular Reeducation

Therapists help retrain how the pelvic floor works with the core, diaphragm, and posture. This often involves movement-based exercises that integrate breathing, lifting, and stability training for better overall control.

Tailored Pelvic Floor Exercises

Rather than one-size-fits-all Kegels, therapists prescribe tailored pelvic floor exercises that may include Kegel exercises and relaxation techniques, depending on whether the muscles are tight, weak, or poorly coordinated. These can include strengthening, relaxation, or endurance work depending on your goals.

Behavioral Coaching

Simple lifestyle changes—like improving posture, toilet habits, or breathing patterns—can have a major impact. Therapists guide patients on daily routines that reduce strain on the pelvic floor and support healing.

Collaborative Care

When needed, pelvic health therapists work alongside urologists, gynecologists, and other specialists to ensure comprehensive care, especially for complex conditions like interstitial cystitis or chronic pelvic pain.

Recognizing the Symptoms of Pelvic Floor Dysfunction

Many people live with pelvic floor dysfunction without even realizing it. Symptoms can vary based on whether the muscles are too tight or too weak. Common symptoms include:

Urinary incontinence (leakage during sneezing, laughing, or running)
Overactive bladder (frequent, urgent need to urinate)
Pelvic organ prolapse (a sensation of bulging or heaviness)
Chronic pelvic pain
Pain during intercourse or gynecological exams
Constipation or straining during bowel movements
Low back, hip, or tailbone pain with no clear orthopedic cause

If you’re experiencing one or more of these symptoms, pelvic wall therapy may help relieve symptoms and improve your quality of life.

Why Physical Therapy Is the First Line of Treatment

For those experiencing pelvic floor issues, physical therapy is often recommended before surgical or pharmaceutical interventions. Physical therapists play a crucial role in providing expert care, assessing each patient’s needs, and guiding them through a range of treatment options tailored to their condition. It’s a low-risk, high-reward strategy that’s supported by extensive research.

A 2024 review published in Frontiers in Global Women’s Health highlighted that pelvic floor physical therapy is significantly effective in treating pelvic floor dysfunction—including urinary incontinence, pelvic pain, and sexual dysfunction—without adverse side effects.

Unlike medications that mask symptoms, physical therapy addresses the root cause: the muscle imbalance or coordination dysfunction at the heart of the issue.

How We Treat Pelvic Floor Dysfunction in Clinical Practice

As a pelvic health physical therapist, I assess not only the pelvic muscles themselves, but also the surrounding structures that influence function. Each patient receives an individualized plan based on their specific pelvic floor disorder, taking into account their medical history, examination findings, and personal goals. Treatment plans typically include:

Manual therapy for trigger points and soft tissue tension
Postural correction and diaphragmatic breathing
Pelvic floor exercises that focus on both strength and relaxation, addressing muscle weakness as well as tightness
Scar tissue mobilization (postpartum or post-surgical)
Biofeedback and electrical stimulation as needed
Internal therapy for appropriate cases, when the patient is comfortable
Education on bladder and bowel behavior modification

Each treatment plan is customized. For example, some patients need to learn how to relax the pelvic muscles—not tighten them—especially those with chronic pain or interstitial cystitis.

Pelvic Floor Exercises: More Than Just Kegels

Pelvic floor exercises are foundational in therapy, but they must be done correctly and under the right circumstances. Not everyone should do Kegels. For individuals with overactive (tight) pelvic muscles, relaxation exercises and down-training are more appropriate.

Examples of common exercises include:

Slow and fast Kegels (for strengthening, when appropriate)
Deep core and gluteal activation
Bridge and squat progressions
Child’s pose breathing and pelvic drop stretches

Your therapist will evaluate your baseline and recommend exercises that meet your body’s specific needs.

Managing Chronic Pelvic Pain and Interstitial Cystitis with Therapy

Interstitial cystitis (IC), also known as painful bladder syndrome, is a chronic condition characterized by bladder pressure, pain, and frequent urination. While the exact cause is unknown, pelvic floor dysfunction is a common underlying factor, and IC is considered one of several pelvic floor disorders that can be addressed with therapy.

Research shows that physical therapy focusing on myofascial release and trigger point therapy can significantly reduce symptoms in people with IC. Internal therapy, such as internal vaginal or rectal release techniques, is often included in the treatment plan—alongside behavior changes and bladder retraining. The goal of therapy is to relieve symptoms and reduce pain, improving overall quality of life.

Patients with IC often respond best to a multidisciplinary approach involving PT, dietary changes, and pain psychology.

When Should You Start Pelvic Floor Therapy?

Early intervention is ideal. However, it’s never too late to seek help. You should consider seeing a pelvic health physical therapist if you:

Experience urinary or bowel leakage
Have pelvic pressure or notice a bulge
Feel pain with sex or during pelvic exams
Suffer from chronic pelvic or lower back pain
Are recovering from childbirth, abdominal surgery, or pelvic trauma

Postpartum recovery is especially critical. Studies show that initiating pelvic floor therapy within the first 6–12 weeks postpartum can prevent long-term issues such as prolapse, diastasis recti, and bladder dysfunction.

What Does a Pelvic Therapy Session Look Like?

A typical pelvic floor physical therapy session may include:

Review of symptoms and daily habits
Reassessment of posture, breathing, and muscle tone
Guided pelvic floor exercises or manual therapy, including internal and external therapy as appropriate
Education on self-care tools (perineal massage, dilators, postural changes)
Progress tracking and goal-setting

Therapy is typically done once per week for 6 to 10 weeks, depending on your condition and response to treatment.

Conclusion: Take the First Step Toward Pelvic Health

Pelvic wall therapy is a safe, effective, evidence-based path to healing pelvic floor dysfunction. Whether you’re a new mom, recovering from surgery, or managing chronic pain or interstitial cystitis, pelvic floor physical therapy offers real hope without relying on medications or surgery.

As a PT, I’ve seen how profoundly this therapy can change lives. Don’t wait for symptoms to worsen. With tailored guidance, pelvic floor rehabilitation can restore function, reduce pain, and help you reclaim control over your body.

Ready to take the first step? Visit Pelvis NYC to schedule an evaluation with a specialized pelvic health therapist and start your journey to recovery.

Varicocele: What Guys Should Know About This “Silent” Issue

Most men don’t want to talk about their balls, especially if something feels weird or off down there. But if you’ve ever felt a strange heaviness, dull ache, or swelling in your scrotum, you might be dealing with something called a varicocele.

It’s more common than you’d think. About 1 in 7 men will get one, and for guys dealing with fertility issues, that number jumps to nearly 1 in 2.

So let’s break it down—what varicoceles are, why they matter, what you can do about them, and how physical therapy (yep, really) can be part of the solution.

The Male Reproductive System

Before we go deeper, let’s quickly break down how the male reproductive system works—and why something like a varicocele can quietly throw the whole thing off.

The main parts of the male reproductive system include the testicles, which are responsible for making sperm and testosterone; the epididymis, where sperm mature; and the vas deferens, which transports sperm during ejaculation. Supporting glands like the seminal vesicles and prostate add fluid that makes up semen, helping sperm survive their journey.

All of this needs to work in sync. But here’s the catch: sperm production is extremely sensitive, especially to heat, pressure, and blood flow. That’s why your testicles hang outside the body in the first place: to stay a few degrees cooler than your core temperature.

So when something like a varicocele causes enlarged veins and increased heat around the testicles, it can throw off that delicate balance. The result? Poor sperm health.

That’s where a semen analysis comes in.

If you’re trying to conceive and it’s taking longer than expected (usually six to twelve months), doctors often order this test to get a read on:

Sperm count – how many sperm are in your semen
Motility – how well your sperm swim
Morphology – how normal they look in size and shape
Volume and consistency of the semen itself

If any of those numbers are off, a varicocele is one of the first things a urologist will look for—because it’s such a common, correctable cause of male infertility.

So… What Is a Varicocele?

A varicocele is a varicose vein—but in your scrotum, not your legs. The veins that carry blood away from your testicles get enlarged and twisted, usually on the left side, thanks to how our plumbing is built.

You might feel:

A weird dragging sensation in your groin
A dull ache after standing or working out
Swelling or even a “bag of worms” feel (yeah, it’s as weird as it sounds)
Or maybe… nothing at all

And that’s what makes varicoceles so tricky. Some guys don’t notice anything until they and their partner start trying for a baby, and suddenly, a semen analysis throws up red flags.

Varicocele Symptoms: What to Watch For

Not all varicoceles cause noticeable pain or discomfort, which is why many men don’t even realize they have one until a fertility issue arises. But when symptoms do show up, they can include a dull, aching pain or a sense of heaviness in the scrotum. Some men notice a visible or palpable lump, often described as feeling like a “bag of worms” (strange but accurate), and swelling or asymmetry in the testicles, most commonly on the left side. Discomfort may become more noticeable after standing for long periods, lifting weights, or during physical activity.

In many cases, the first clue comes during a fertility workup, when a doctor orders a semen analysis and finds issues like low sperm count or abnormal motility. That’s often when the varicocele diagnosis comes into focus, turning what seemed like a minor issue into a much more pressing concern.

How Does Varicocele Affect Fertility?

Here’s where it gets serious. Varicoceles can mess with your male reproductive system in a few important ways:

Raises testicle temperature → Sperm don’t develop properly in heat
Reduces oxygen and blood flow → Leads to oxidative stress, damaging sperm DNA
Impaired hormone regulation → May lower testosterone over time

📊 Studies show that varicoceles are present in 40% of men with abnormal semen parameters, and treating them can improve both sperm quality and pregnancy rates.

How Is a Varicocele Diagnosed?

Doctors typically diagnose a varicocele during a physical exam or scrotal ultrasound. You may be asked to stand and perform a Valsalva maneuver (basically bearing down) so they can check for vein enlargement.

It’s often graded from Grade 1 (small) to Grade 3 (large), and those grades help determine the need for medical treatment.

Varicocele Treatment Options: What Can You Do?

Not every varicocele needs to be treated. But if you’re in pain, your semen quality is poor, or you’re trying to conceive without luck, here’s what you can consider:

Watchful Waiting

If your varicocele is small and symptom-free, doctors may suggest monitoring it regularly, especially if you’re not trying to have kids right now.

Medical Treatment: Varicocele Surgery

If you’re dealing with pain or fertility problems, varicocele surgery (aka varicocelectomy) is often recommended. It involves tying off the enlarged veins to restore normal blood flow.

There are a few surgical techniques:

Microsurgical varicocelectomy – highest success, lowest risk
Laparoscopic surgery
Percutaneous embolization – a minimally invasive option using a catheter

According to the American Urological Association, surgery improves semen quality in 60–80% of men and boosts natural pregnancy rates in many couples.

How Can Physical Therapy Help Varicocele?

This is where things get interesting. Most men are never told that pelvic physical therapy can support recovery and manage symptoms, sometimes even before considering surgery.

1. Pain Management

Chronic testicular or pelvic pain isn’t always about the veins. Sometimes, it’s due to muscle tension, nerve entrapment, or poor posture.

A men’s health PT can release tension in the:

Pelvic floor
Hip flexors
Lower back and core

These techniques relieve pressure and improve blood flow.

2. Post-Surgical Recovery

After varicocele repair, PT helps you:

Regain core strength
Reduce scar tissue adhesions
Return to pain-free sex, sports, and workouts

🧠 Fact: About 30–50% of men with varicocele-related pain continue to feel discomfort even after surgery (AUA Guidelines, 2021). Physical therapy can address muscular and nerve-based causes that surgery doesn’t fix.

3. Pelvic Floor Rehabilitation

Pelvic floor dysfunction in men can mimic varicocele pain, worsen congestion, and impair urinary/sexual function.

Men’s health PTs use techniques like:

Biofeedback
Internal release (yes, men have pelvic floors too!)
Diaphragmatic breathing to improve circulation

4. Lifestyle Support

PTs can guide you in:

Movements that improve venous return
Anti-inflammatory routines (breathing, stretching)
Advice on compression, lifting techniques, and posture

What the Research Says

2018 Review (Andrologia): Varicocele-related pain is often neuromuscular, not purely vascular. Conservative therapies like PT should be part of the care plan.
2021 Study (Urology Journal): Men undergoing PT after varicocelectomy reported faster pain relief and improved daily function.
Pelvic PT Research (Hodges, 2020): The pelvic floor is central to venous and lymphatic return, a key factor in varicocele symptom management.

When Should You See a PT?

You should consider seeing a pelvic health PT if:

You’ve had surgery but still have discomfort
You’re dealing with testicular or groin pain that doesn’t seem to improve
You want to explore non-surgical options before going under the knife
You’ve noticed that posture, movement, or stress makes symptoms worse

There’s Help—You Just Have to Ask

A varicocele isn’t the end of the world—but it’s also not something to brush off. Whether it’s causing pain, fertility issues, or just messing with your peace of mind, you deserve answers and real solutions.

Between surgical treatment, lifestyle changes, and physical therapy, there are more options than you think. The key is getting the right diagnosis and building a team that helps you move forward—without shame, fear, or guesswork.

Ready to Take the Next Step?

If you’re dealing with testicular pain, fertility struggles, or just want answers about your body, you don’t have to navigate it alone. At Pelvis NYC, we specialize in male pelvic health, offering personalized, expert-led care that supports your recovery, improves blood flow, and helps you feel like yourself again.

Whether you’re preparing for varicocele treatment, recovering from surgery, or exploring non-invasive options, our team is here to help you move forward confidently and pain-free.👉 Book a private consultation today at Pelvis NYC and take control of your health, your fertility, and your future.