“Lift your nuts to your guts.”

Musculoskeletal physiotherapist Jo Milios regularly uses this frank yet effective sentence when teaching her male clients about how to perform pelvic floor muscle training.

“Academically speaking, I should be asking them to shorten their penis because that’s the description that research came up with as being the best descriptor, but I learnt men don’t like to think of their penis as getting smaller,” she says.

“With ‘nuts to guts’, they kind of pause for a second, have a chuckle and then do it. Whereas, if I say ‘shorten your penis’ - they look at me with alarm, like they don’t want to go there.

“The language that you use really needs to be quite down to earth, and men tend to appreciate less medicalisation of everything.”

Jo’s approach may sound funny but the reality is men’s health is no laughing matter. While there’s been a rise in awareness, early detection and focus on treating women’s health in the past few decades, men’s health has largely been left by the wayside.

Jo, just one of a handful of practitioners specialising in men’s health physiotherapy in Australia, says men’s health is about 20 years behind women’s health.

The Perth physiotherapist, who runs Complete Physiotherapy and Men’s Health with her husband Dean, also a physiotherapist, says the statistics show one in seven men are diagnosed with prostate cancer in Australia while one in nine women are diagnosed with breast cancer.

On average, Australian men die 4.3 years earlier than women, while figures reveal almost 60 per cent of men are overweight or obese and almost 50 per cent of men don’t exercise regularly.

But, if prostate cancer is caught early, 94 per cent of men can expect to live to five years and 92 per cent to 10 years.

“We’ve got a rising occurrence of prostate cancer detection and excellent treatment options, so that we can usually cure a person of their cancer, but there are side effects with treatment," Jo says.

“Undergoing a radical prostatectomy may impact on the quality of life for men - as they usually, instantaneously, have urinary incontinence and erectile dysfunction, and none of them really want to deal with that.

“So you’ve got about 22,000 cases being diagnosed a year in Australia and over one million around the world, so there’s a lot of it occurring and a lot of work to be done in catching up, providing them with the resources they need to get through the treatment.”

A physiotherapist of 23 years, Jo found herself gravitating towards men’s health after working with her brother, urologist Dr David Sofield, and realising there was a gaping hole in physiotherapy services for men battling prostate cancer.

Soon inundated with male clients, Jo linked up with the Prostate Cancer Foundation of Australia, established a not-for-profit community exercise program, PROST! Exercise 4 Prostate Cancer Inc, has run men’s health workshops overseas and in Australia, and is now undertaking a PhD at the University of Western Australia’s School of Sport Science, Exercise and Health.

Since specialising in men’s health, Jo has treated more than 2000 prostatectomy patients, 500 chronic pelvic pain patients, and hundreds of men with erectile dysfunction.

“It astounded me. I just kept seeing man after man after man sitting in front of me, really quite shaken up, with no understanding of where to go to get help,” she says.

“I very quickly had a couple of thousand patients under my belt because no-one else was really specialising in this area of physiotherapy.

“It’s all been a huge learning curve for me as well - I didn’t anticipate that my career would divert to this but I just saw an urgent need.”

Jo, a member of the Australian Physiotherapy Association’s newly named Women’s, Men’s and Pelvic Health Group (formerly known as the Continence and Women’s Health Group) in recognition of the emerging men’s health field of physiotherapy, says it’s vital physiotherapists play a greater role in embracing men’s health.

“There’s a lot of other professions that can’t really deal with it so well and we are the experts of muscle and exercise training but we just haven’t done very well with focusing on the male needs in the past,” she says.

“What I really want to do is try and get more physiotherapists, especially male physiotherapists, to think about opening their minds to making each opportunity with a male patient an opportunity to address men’s health in general,” she says.

“We need to do something about shortening that life span gap and getting men a bit more comfortable about being proactive about preventative health.”

Jo says physiotherapists should ask male patients, particularly from the age of 40 and over, about their bladder, bowel or sexual function, as well as their heart function.

“You can ask - do you have any concerns with your physical performance? It might be that they have started to notice that they’re getting a bit breathless with exercise and that can be an indicator that they’ve got some cardiovascular problems,” she says.

“Then you can ask deeper questions, especially if they present with low back problems, like - have you noticed your erectile function or your morning erections aren’t quite happening as they were? That’s important, because there’s a really strong link between heart health and erectile function health.

“Quite often if a man has narrowing in his heart arteries he will have reduced erectile blood flow - there’s about a three year gap between when he’s noticed his erections haven’t been working so well and him having the onset of a cardiac event.”

Jo also wants every physiotherapist who treats male patients to learn how to instruct men in performing exercises to properly train their pelvic floor.

“The pelvic floor can be too tight, which can cause pain, or too weak, which can cause incontinence, so sometimes strengthening the pelvic floor can flare a patient, whereas relaxing the pelvic floor may be the best option,” she says.

“It would be great if every physiotherapist had the understanding that the pelvic floor is an important part of a male body - men should know where it is, what it feels like, and what’s normal.”

Jo, who will speak on men’s health at a symposium as part of the World Confederation for Physical Therapy Congress being held in South Africa in July, says men’s health is an incredibly rewarding field to work in.

It’s also an area, where there’s no room for embarrassment.

“Men are usually quite appreciative of you giving them the tools to fix themselves. Men just want direction, they are very easy to work with, and usually like a sense of humour thrown in to help them along the way,” Jo says.

“We are physiotherapists so we deal in physical health. We should try not to be embarrassed to ask the questions about total physical health - and that includes the pelvic area.”

* US physical therapist Holly Herman will deliver a two-day APA course on Male Health, Wellness and Sexual Function, in Sydney, from April 28-29.