Return to Running After Manual Therapy for Chronic 16-year Cremaster Muscle Strain: A Case Study

Abstract

BACKGROUND: Cremaster Muscle Strain (CMS) is an uncommon condition characterized by persistent testicular pain without clinical guidelines for conservative care. This case demonstrated how an applied anatomical analysis influenced the framework of care after which the patient had reduced pain and returned to running. CASE PRESENTATION: The 32-year-old man had 16-years of unremitting CMS that began during high school cross country training. His 5-8/10 intensity pain, aggravated by sexual or physical activity, limited his ability to sit for work >30 minutes or run. Manual therapy to mobilize anatomic structures potentially affecting cremaster muscle function was followed by graded return to running. OUTCOME AND FOLLOW-UP: After 5 sessions, pain intensity had decreased to 0.5/10 at worst, hip flexibility and strength impairments had resolved, and he had returned to running without increased pain. His Chronic Prostatitis Symptom Index score improved from 19/45 to 8/45. DISCUSSION: Anatomical analysis and the organized care framework led to sequenced treatment starting with body structures affecting the cremaster including mobilization of spinal and peripheral joints, and myofascial structures; followed by exercise and neuromotor training. Despite his condition’s chronicity, treatment culminated in return-to-running. This case informs the differential diagnosis of lumbo-pelvic-hip problems because concurrent CMS may be under-reported.