JP - Testicular Pain
Name, picture and some elements in the case are fictional to protect the anonymity of the patient.
When Jean-Phillipe came to see me, he looked defeated. "I can’t play hockey anymore because of this f**king pain in my ball".
Jean-Phillipe is a 21-year-old college hockey player. Hockey has always been Jean-Phillippe’s great love. He was barely 5 years old when his dad first put him on the ice. And he’s never looked back since. The rush he felt playing the game was unparalleled. The seemingly impossible wins, the heartbreaking defeats, the cheering from parents and friends, the early morning, and late-night practices, he wouldn’t trade it for anything else in the world. But just like that, at the young age of 21, because of testicular pain, his reality was shattered. No more hockey.
Before he had testicular pain, Jean-Phillipe trained 2-3 times a week with his team. He was in excellent physical shape. But then it happened. Six months before his initial consultation, he felt a sharp pain in his left groin after a hockey practice. Having played hockey all these years, Jean-Phillippe was used to injuries: pulled muscles, muscle contusions, bloody nose, and even some broken bones. You name it and he probably had it. At the time, after his hockey practice, he thought he just pulled his groin muscles, and that the pain would disappear after a few days of rest. He was used to these kinds of injuries you know, so he rested and iced the painful area and paid no mind to it. However, after a couple days, things started getting worse. And by worse it was a lot worse. What was initially a groin pain, became a couple days later, a testicular pain. The pain went down to his left testicle. He went to the emergency, and the doctor ruled out testicular torsion, inguinal hernia, and other pathologies. This marked the beginning of many visits to different health professionals. His hopes were high. He thought that with all these professionals on his case, there was bound to be someone who had the answer to his problem. Yet, he was left empty handed. It was akin to having a bad episode of blue balls that never went away and there’s was nothing he could do about it. He felt powerless.
Jean-Phillipe described the next six months as living hell. His left testicle was so sensitive that he couldn’t tolerate wearing tight underwear or pants. In class, he had difficulty focusing because the pain was always there; the only tolerable position for him was to spread a bit his legs while sitting in class. But that wasn’t even the worse. What affected him the most was that he couldn’t play hockey anymore. In fact, he stopped hockey, training, jogging, and all other physical activities. He also couldn’t have sex because his left testicle was so painful and went numb with back-and-forth motions. And as if this wasn’t enough, sometimes his pain would spread to his upper thigh. He had seen a few medical doctors and worked with two pelvic floor physical therapists. But he didn’t see much improvement. He was entering a state of despair. And slowly, he started losing confidence in physiotherapy and the medical system.
Fast forward a couple weeks after getting his initial consultation, Jean-Phillippe’s problem was completely resolved. Looking back, Jean-Phillippe would’ve never guessed that his testicular pain was in fact referred from his back. He’d never considered the relationship between his back pain and the pain in his left testicle. The fact is, none of the previous physiotherapists he worked with have examined and treated his back.
By using the IPC framework and going through it with Jean-Phillipe, it became clear to him what was the main source and driver of his left testicular pain. Jean-Phillipe being a left-handed shooter had started noticing pain on the left side of his middle back since the beginning of the season but didn’t really pay attention to it. He didn’t know that there existed nerves in his back that innervated his testicles, so to him it was a big surprise when he learned about which structures the nerves in the thoracolumbar area innervated. What was fascinating to him was that during the examination, his testicular pain changed and improved rapidly with the loading of thoracolumbar spine. It turned out that the root cause of his pain was his thoracolumbar spine, which referred pain down to his testicle through the genitofemoral nerve. By targeting the root cause of his pain, it did not take long for us to abolish his pain, and he returned to hockey practice within a month.
As physical therapists, when treating men with pelvic pain, finding the main driver of the pain is the most important. Otherwise, our intervention might be limited in effectiveness or simply not effective at all. The Four Horsemen of Pelvic Pain Masterclass discusses how to differentiate a pain source between the pelvis and the spine and shows a bit the pain patterns that exist for testicular and perineal pain.
