About

Daniel Kirages, PT, DPT, OCS, FAAOMPT, is a Professor of Clinical Physical Therapy at the University of Southern California's Division of Biokinesiology and Physical Therapy. His clinical practice involves caring for diverse patients with orthopedic and pelvic health disorders. In the academic setting, he serves as the course director for integrated patient management clinical skills in the third year of the Doctor of Physical Therapy curriculum, for both residential and hybrid pathways. Dr. Kirages is a board-certified orthopedic clinical specialist and a fellow of the American Academy of Orthopedic Manual Physical Therapists, actively involved in advanced professional education through teaching and clinical mentorship within USC's orthopedic physical therapy residency and spine physical therapy fellowship. His research focuses on pelvic health, and he contributes to continuing education courses and lectures nationally and internationally. Additionally, he serves on the nominating committee for the APTA Academy of Pelvic Health Physical Therapy. His educational background includes a fellowship in Orthopedic Manual Therapy from Kaiser Permanente Los Angeles, a Doctor of Physical Therapy degree from USC, and a Bachelor of Science in Exercise Science from USC.

Research topics

• Physical therapy
• Surgery
• Internal medicine
• Medicine
• Physical medicine and rehabilitation
• Urology

Selected publications

• Impaired Ability to Relax Pelvic Floor Muscles in Men With Chronic Prostatitis/Chronic Pelvic Pain Syndrome

  Physical Therapy · 2022 · 17 citations

  • Medicine
  • Physical therapy
  • Urology

  OBJECTIVE: Excessive pelvic floor muscle activity has been suggested as a source of pain in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Our objective was to determine whether men with CP/CPPS have changes in neural drive that impair their ability to relax pelvic floor muscles. METHODS: We recruited 90 men (42 with CP/CPPS and 48 in the control group [without a history of pelvic pain]). All completed the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI). We quantified the ability to relax by comparing resting pelvic floor muscle activity under 2 conditions: a "rest-only" condition, in which participants were instructed to simply relax, and a "rest-between-contraction" condition, in which participants were instructed to rest for several seconds between voluntary pelvic floor muscle contractions. We used multivariate mixed-effects models to examine differences between the groups (men with CP/CPPS and men in the control group) as well as the effect of 6 symptoms captured by the NIH-CPSI: pain related to location (perineum, testicles, penis, suprapubic region) and activity (urination, ejaculation). RESULTS: Men with CP/CPPS were significantly different from men in the control group; men with CP/CPPS had higher resting activity in the rest-between-contraction condition than in the rest-only condition, whereas men in the control group had similar resting activities in both conditions. This effect was strongest in men who reported ejaculation-related pain, which was 70% of the CP/CPPS group. CONCLUSION: Men without a history of pelvic pain were able to relax their pelvic floor muscles back to baseline after performing voluntary pelvic floor muscle contractions. In contrast, men with CP/CPPS, particularly those with ejaculation-related pain, had an impaired ability to relax their pelvic floor muscles. IMPACT: This study may support the investigation of more personalized physical therapist approaches for CP/CPPS that enhance the ability to relax pelvic floor muscles as a mechanism for pain reduction.

  PublisherOA PDFDOI

• Incontinence after Prostate Treatment: AUA/SUFU Guideline

  The Journal of Urology · 2019-05-06 · 269 citations

  articleOpen access

  PURPOSE: Urinary incontinence after prostate treatment (IPT) is one of the few urologic diseases that is iatrogenic, and, therefore, predictable and perhaps preventable. Evaluation of the incontinent patient, risk factors for IPT, the assessment of the patient prior to intervention, and a stepwise approach to management are covered in this guideline. Algorithms for patient evaluation, surgical management, and device failure are also provided. MATERIALS AND METHODS: , 2017 using Ovid, MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Databases of Systematic Reviews. Additional references through 12/31/2018 were identified. RESULTS: This guideline was developed by a multi-disciplinary panel to inform clinicians on the proper assessment of patients with IPT and the safe and effective management of the condition in both surgical and non-surgical contexts. Statements guiding the clinician on proper management of device failure are also included. CONCLUSION: Most patients who undergo radical prostatectomy (RP), and some patients who undergo radiation therapy (RT) or surgery for benign prostatic hyperplasia (BPH), will experience IPT. Although non-surgical options, such as pelvic floor muscle exercises (PFME), can hasten continence recovery, patients who remain incontinent at one-year post-procedure, or have severe incontinence at six months, may elect to undergo surgical treatment (e.g. artificial urinary sphincter). Prior to IPT surgery, the risks, benefits, alternatives, and additional likely procedures should be discussed with the patient.

  PublisherOA PDFDOI

• Pelvic Floor Rehabilitation for Orthotopic Diversion

  2017-01-01 · 2 citations

  book-chapterSenior author
  PublisherDOI

• Pelvic Floor Muscle Rehabilitation to Improve Sexual Function in Geriatric Men

  Topics in Geriatric Rehabilitation · 2016-07-01 · 4 citations

  article1st authorCorresponding

  Background: There is a growing population of geriatric men experiencing sexual health concerns. These issues may stem from surgical interventions of the prostate gland, age-related changes affecting erectile dysfunction, or other concerns. Objectives: To illuminate the male sexual dysfunctions lessened via pelvic floor muscle rehabilitation and proper education to assist clinicians in achieving positive patient outcomes. Methods: The literature was reviewed from 1996 to 2015 using PubMed. Results: Effective conservative care strategies exist for appropriate patients via pelvic floor muscle therapy, manual therapy, education regarding cardiovascular health, and triage to psychological and sexual counseling. Conclusion: Efficacy is present for this population, but some conditions are more effectively treated conservatively than others.

  PublisherDOI

• Pelvic Osteomyelitis Presenting as Groin and Medial Thigh Pain: A Resident's Case Problem

  Journal of Orthopaedic and Sports Physical Therapy · 2015-01-10 · 8 citations

  article

  STUDY DESIGN: Resident's case problem. BACKGROUND: Groin pain represents a diagnostic challenge and requires a diagnostic process that rules out life-threatening illness or disease processes. Osteomyelitis is a potential fatal disease process that requires accurate diagnosis and medical management. Osteomyelitis presents a problem for the outpatient physical therapist, as the described physical findings for the diagnosis of osteomyelitis are nonspecific. DIAGNOSIS: A 67-year-old man with groin and bilateral medial thigh pain was referred for physical therapy care to address right adductor weakness and generalized deconditioning. He had undergone extensive treatment for bladder cancer, with a recent radical cystoprostatectomy and cutaneous urinary diversion with an Indiana pouch. Postsurgical magnetic resonance imaging indicated normal findings, and the patient was currently being managed by an orthopaedic surgeon, who diagnosed the patient as having obturator nerve palsy. The physical therapist's examination produced findings inconsistent with this diagnosis. Subsequently, nuclear medicine studies revealed pubic symphysitis/osteomyelitis with secondary myositis, predominantly affecting the right adductor muscles. DISCUSSION: Osteomyelitis represents a difficult problem for the outpatient physical therapist. Careful consideration of red-flag symptoms and inconclusive physical testing indicate the need for further medical work-up. In this case, appropriate medical management led to improvement in patient function, highlighting the need for early diagnosis. LEVEL OF EVIDENCE: Differential diagnosis, level 4.

  PublisherDOI

• Altered resting state neuromotor connectivity in men with chronic prostatitis/chronic pelvic pain syndrome: A MAPP

  NeuroImage Clinical · 2015-01-01 · 78 citations

  articleOpen access

  Brain network activity associated with altered motor control in individuals with chronic pain is not well understood. Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is a debilitating condition in which previous studies have revealed altered resting pelvic floor muscle activity in men with CP/CPPS compared to healthy controls. We hypothesized that the brain networks controlling pelvic floor muscles would also show altered resting state function in men with CP/CPPS. Here we describe the results of the first test of this hypothesis focusing on the motor cortical regions, termed pelvic-motor, that can directly activate pelvic floor muscles. A group of men with CP/CPPS (N = 28), as well as group of age-matched healthy male controls (N = 27), had resting state functional magnetic resonance imaging scans as part of the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network study. Brain maps of the functional connectivity of pelvic-motor were compared between groups. A significant group difference was observed in the functional connectivity between pelvic-motor and the right posterior insula. The effect size of this group difference was among the largest effect sizes in functional connectivity between all pairs of 165 anatomically-defined subregions of the brain. Interestingly, many of the atlas region pairs with large effect sizes also involved other subregions of the insular cortices. We conclude that functional connectivity between motor cortex and the posterior insula may be among the most important markers of altered brain function in men with CP/CPPS, and may represent changes in the integration of viscerosensory and motor processing.

  PublisherDOI

• 2031387 Cadaveric Validation and In-Vivo Measurement Reliability of a Novel Liner-Array Transperineal Sonographic Evaluation of Male Pelvic Floor Structures

  Ultrasound in Medicine & Biology · 2015-02-16

  articleOpen access
  PublisherOA PDFDOI

• Cortical Activation Associated with Muscle Synergies of the Human Male Pelvic Floor

  Journal of Neuroscience · 2014-10-08 · 59 citations

  articleOpen access

  Human pelvic floor muscles have been shown to operate synergistically with a wide variety of muscles, which has been suggested to be an important contributor to continence and pelvic stability during functional tasks. However, the neural mechanism of pelvic floor muscle synergies remains unknown. Here, we test the hypothesis that activation in motor cortical regions associated with pelvic floor activation are part of the neural substrate for such synergies. We first use electromyographic recordings to extend previous findings and demonstrate that pelvic floor muscles activate synergistically during voluntary activation of gluteal muscles, but not during voluntary activation of finger muscles. We then show, using functional magnetic resonance imaging (fMRI), that a region of the medial wall of the precentral gyrus consistently activates during both voluntary pelvic floor muscle activation and voluntary gluteal activation, but not during voluntary finger activation. We finally confirm, using transcranial magnetic stimulation, that the fMRI-identified medial wall region is likely to generate pelvic floor muscle activation. Thus, muscle synergies of the human male pelvic floor appear to involve activation of motor cortical areas associated with pelvic floor control.

  PublisherOA PDFDOI

• Reliability of Superficial Male Pelvic Floor Structural Measurements Using Linear-Array Transperineal Sonography

  Ultrasound in Medicine & Biology · 2014-11-25 · 5 citations

  articleOpen access
  PublisherOA PDFDOI

• The Role of Pelvic Floor Exercises on Post-Prostatectomy Incontinence

  The Journal of Urology · 2003-07-01 · 212 citations

  article

  PURPOSE: Post-radical prostatectomy incontinence occurs in 0.5% to 87% of patients. This condition may be attributable to intrinsic sphincteric deficiency, and/or detrusor abnormalities. Previous studies of pelvic floor exercise (PFE) for improving post-prostatectomy incontinence have shown mixed results. We determined whether preoperative and early postoperative biofeedback enhanced PFE with a dedicated physical therapist would improve the early return of urinary incontinence. MATERIALS AND METHODS: A total of 38 consecutive patients undergoing radical prostatectomy from November 1998 to June 1999 were randomly assigned to a control or a treatment group. The treatment group of 19 patients was referred to physical therapy and underwent PFE sessions before and after surgery. Patients were also given instructions to continue PFE at home twice daily after surgery. The control group of 19 men underwent surgery without formal PFE instructions. All patients completed postoperative urinary incontinence questionnaires at 6, 12, 16, 20, 28 and 52 weeks. Incontinence was measured by the number of pads used with 0 or 1 daily defined as continence. RESULTS: Overall 66% of the patients were continent at 16 weeks. A greater fraction of the treatment group regained urinary continence earlier compared with the control group at 12 weeks (p <0.05). Three control and 2 treatment group patients had severe incontinence (greater than 3 pads daily) at 16 and 52 weeks. Of all patients 82% regained continence by 52 weeks. CONCLUSIONS: PFE therapy instituted prior to radical prostatectomy aids in the earlier achievement of urinary incontinence. However, PFE has limited benefit in patients with severe urinary incontinence 16 weeks after surgery. There is a minimal long-term benefit of PFE training since continence rates at 1 year were similar in the 2 groups.

  PublisherDOI

Frequent coauthors

• Moheb S. Yani

  University of California, Los Angeles

  5 shared

• Jason J. Kutch

  University of Southern California

  5 shared

• Manku Rana

  4 shared

• Skulpan Asavasopon

  University of Southern California

  2 shared

• Eileen V. Johnson

  University of Southern California

  2 shared

• Susan M. Sigward

  2 shared

• G Deutsch

  Seattle Children's Hospital

  2 shared

• Timothy J. Ness

  University of Alabama at Birmingham

  2 shared

Labs

• Health Equity LabPI

Education

• Other, Physical Therapy

  University of Southern California

• B.S., Physical Therapy

  University of Southern California

Awards & honors

• Fellow of the American Academy of Orthopedic Manual Physical…
• Orthopedic Manual Therapy Fellowship, Kaiser Permanente Los…