By now, you know the drill. Chiropractors rarely claim to treat conditions. Instead, we focus on checking and adjusting subluxations, knowing that in doing so, we are allowing the body to do what it does best – self-heal, self-regulate and function optimally. Naturally, that can lead to all sorts of plausible changes in symptoms, and that is as individual as the person under care.
Recently, the Asia Pacific Chiropractic Journal ran a men’s health special, and we thought it was high time to follow suit and run a blog series on chiropractic care and men’s health. Welcome to part one: a quick look at recent case report data on presentations related to male reproductive health.
As a case series by Apalvik (2023) points out, testicular discomfort in males is “relatively common, and can be of great concern to those to experience it, especially when no cause can be found.” [1] Orchialgia is the technical term used to describe testicular pain experienced in any of the scrotal contents (such as the testicle, epididymis, vas deferens and spermatic cord). While it may be a result of trauma to the area, it could also be because of infection, lesions, scarring or changes following surgery. Pain in the testes may also be felt as a result of dysfunction outside of the scrotum, such as pelvic floor issues, inguinal hernia, aortic aneurysms, blood flow issues, and nerve entrapment.
Research has revealed that up to 50% of chronic pain in this region is from an unknown origin [2]. It has been postulated that lumbosacral problems may be a potentially overlooked cause of orchialgia in men. [2] As it has rarely been described in literature, there is no accepted treatment guide for clinicians to evaluate or manage chronic orchialgia. While there is no current randomised controlled trial pertaining to chiropractic care and male reproductive health, recent case reports have shown the resolution of related symptoms while under chiropractic care. It goes without saying that we can’t make big claims based on case report data alone, but it is interesting to drop the breadcrumbs close together and see that such studies may indeed be worthwhile.
Alpavik, who authored a case series, in which three adult males presented with chronic and intermittent testicular pain and were cared for using subluxation-based chiropractic (specifically the Gonstead technique), points out that the potential neurological impacts of subluxation are vast and varied, and may impact pelvic and vertebral column joint dysfunction. [1] This, feasibly, may manifest in issues pertaining to the male reproductive system and, of course, pain.
So what then does the case report data say? Let’s start with testicular pain.
In a recent case series, three males, aged 34, 35 and 53 presented for care with a variety of symptoms (such as headaches or lower back pain). Only one of the patients presented for testicular pain alone [2]. Two of the three presented with no swelling, while the third presented with significant swelling. In all three cases, subluxations were detected using static and motion palpation as well as instrumentation, and all three had subluxations in the Sacral spine (as well as the lumbar spine in two of the three cases). Testicular pain and swelling resolved concomitant with chiropractic care in all three cases.
Another case report covered the progress of a sports coach who complained of constant low back pain associated with episodic right testicular pain for nearly a decade. As a professional fencing competitor, the patient participated in weightlifting, swimming, and hiking in the previous 14 years. [2] Following a back-packing trip 7 years ago, his back pain worsened with radiating right testicular pain. Pain would occur when squat lifting, butterfly stroke swimming, or coughing. Symptoms had worsened in the last 2 months, accompanied by radiating pain down the right leg, which he had not experienced before. He then sought chiropractic care.
Following urological consultation, trauma and direct testicular pathologies were ruled out. An MRI performed 2 years prior to presentation revealed degenerative spondylitis of the lumbar spine. The patient had tried oral medications, sports physiotherapy, and acupuncture with little relief or long-term improvement. His symptoms were impacting the physical, emotional, sexual, and social aspects of his life quite considerably, and he was unable to coach fencing.
Upon presentation to a chiropractic clinic, examination revealed that his testicles were descended bilaterally and normal in size, and consistency, with unrestricted movement within the scrotal sac. Active range of motion of the spine was normal. Low back soreness could be induced by passive lumbar extension and right lateral lumbar flexion. Palpation indicated tenderness in the lower lumbar and sacral spine, and MRI data showed changes at multiple levels including a right L4 nerve impingement. Therefore, chronic testicular pain was likely caused by lumbar disc herniation.
The patient received lumbar manipulation over 6 consecutive days to release intersegmental restriction, along with therapeutic ultrasound to provide deep heating to soft tissues, following which the patient’s pain complaints were substantially reduced. Care continued, and after an additional period of 8 weeks, with one session per week, the patient’s low back pain, testicular pain, and radiating leg pain were all fully resolved.
In this case, the patient’s Oswestry Disability Index score decreased from 50% to 0% (meaning no limitation) and the World Health Organisation Quality of Life score had improved from 70% to 98% (100% indicating the highest possible well-being).
This case report was followed by another by the same chiropractor, in which testicular pain was linked to disc herniation and resolved under chiropractic care. This time, injury and significant pain including severe lower back pain radiating into the buttocks and legs was treated using chiropractic adjustments and traction from T12 right through to L5 as indicated by palpation and imaging.
These cases alone create an interesting look at what may happen when subluxation is reduced, thus allowing optimal nerve function to return. However, other case reports emerging have indicated that where there is pathology, inflammation or trauma, chiropractic care may still have a role. More research is required to confirm this and to explain the mechanisms behind the effect, but still, the cases prove interesting enough to warrant such research.
Paediatric Care for Undescended Testicles
Another notable case report emerging in the latest batch is that of paediatric Cryptorchidism – a failure of testicular descent. While it occurs in approximately 10% of births, it usually spontaneously reduces. The prevalence at one year old is only 2-3%. In the general population, the prevalence is thought to be only 0.4-0.5%. [4] It is still unclear why this occurs, and if the condition hasn’t resolved after a sufficient observation period, a surgical intervention called an “orchidopexy” is often recommended to bring the testes down into their normal position inside the scrotum.
The first case relates to a seven-year-old male who presented to a chiropractic clinic with abdominal pain that had been “on and off” for a period of two years. [4] His parents had taken him to a general practitioner several times, but no abnormalities had been detected. Notably, his medical history revealed that his right kidney had been removed at ten months old. He had also suffered from an umbilical hernia that failed to self-correct over time.
His examination revealed an abnormal gait (walking movement) which involved a left leg swing and left foot flare described as “extreme” on external rotation. An abdominal and pelvic ultrasound revealed compaction (or cryptorchidism) of the left testis that was present in the mid-inguinal canal rather than the scrotum. Imaging also revealed an increased (hyperlordotic) lumbar curve and a large bowel impaction. Parents then confirmed that the child only had a bowel movement every 3-4 days.
A course of chiropractic care commenced in which the patient was cared for using the Gonstead technique, and additional homecare recommendations were provided to address postural concerns and to encourage activation and strengthening of the abdominal muscles. This case report was published after just three sessions of chiropractic care, after which the left testis had begun to descend into, and remain in the scrotum. While it still at times remained retracted, at the time of publication, significant improvements had been noted, and it was now possible that the child would not require surgical intervention.
Levator Ani Syndrome Resolution
Yet another case report detailed the resolution of Levator Ani Syndrome concomitant with chiropractic care. [5] Levator Ani syndrome is caused by spasms of the levator ani muscle. It presents as a dull ache in and around the anus and higher in the rectum. This is often accompanied by the feel of fullness in the rectum and a burning sensation. Pain may also be felt in the low pelvis or perineum. While it is important to screen and exclude more threatening pathologies, such as bowel cancer, this may mean Levator Ani may go overlooked as a cause of pain and discomfort.
In the recent case report, a 67-year-old man presented with persistent rectal pain, fullness, and dull lower back pain. The pain kept him up at night, and he was unable to sleep for longer than 2 hours together. This had been going on for 3 months. He had recently been seen by a gastroenterologist and had an inguinal hernia repair by a general surgeon. When he presented for care, he had the results from a bone scan, MRI, CT, and various recent blood tests, all of which demonstrated no pathology or obvious reason for his symptoms.
He had already tried physiotherapy and acupuncture but received little or no relief. A full orthopaedic and neurological examination revealed the following notable findings: patient shows slight tenderness at the lower aspect of the sacrum (S3) and the sacrococcygeal joint.
MRI findings painted a clearer picture, revealing sclerotic lesions at S1, T1, T2, T8, and L2. Active sclerotic metastases were excluded as a cause, and the chiropractor found sacral segmental posteriority subluxation and associated ligament strain.
After only two appointments the patient reported significant relief from rectal pain. Unfortunately (and unrelated), the patient experienced a few falls while under chiropractic care which prompted additional visits, 9 visits, with adjustments given at 4 of these visits over roughly 6 weeks. One month after these sessions, the patient was reviewed and found to have remained pain-free and reported all his original symptoms had resolved.
What does this mean?
While we will be bringing you more information about men’s health and chiropractic in the coming weeks, it should be noted that these case reports present common symptoms that men may not speak to their chiropractors about. We know that when we check and adjust subluxations, the brain and body can do amazing things in terms of resolving complex symptoms – even symptoms that may not have been the main reason for a person’s presentation for chiropractic care in the first place.
It is encouraging to see individuals getting results for testicular pain and related symptoms. It certainly presents a strong case for further research, and a strong case for involving the chiropractor in discussions about all health problems, not just the ones relating to your back.
REFERENCES:
- Apalvik. A Chiropractic management of chronic testicular pain and discomfort: A case series. Asia-Pac Chiropr J. 2023;3.4. URL apcj.net/Papers-Issue-3-4/#ApalvikChronicTesticularPain
- Chu ECP, Wong AYL. Chronic Orchialgia stemming from Lumbar Disc Herniation: A case report and brief review. Asia-Pac Chiropr J. 2023;3.4. URL apcj.net/Papers-Issue-3-4/#ChuWongOrchialgia
- Chu ECP. Taming of the testicular pain complicating lumbar disc herniation with spinal manipulation: A case report. Asia-Pac Chiropr J. 2023;3.4. URL apcj.net/Papers-Issue-3-4/#ChuTamingTesticularPain
- Lourie S. Undescended testicle: A case report. Asia-Pac Chiropr J. 2023;3.4. URL apcj.net/Papers-Issue-3-4/#LourieCryptorchidism
McNamara C. Gonstead approach to the chiropractic management of Levator Ani syndrome. Asia-Pac Chiropr J. 2023;3.4. URL apcj.net/Papers-Issue-3-4/#McNamaraLevatorAni
