This case study presents the successful treatment of a 30-year-old male patient with a left-sided varicocoele of several years’ duration by means of spinal postural adjustment, with the additional benefit of PixelFlux guided physical training.
The treatment was successful.
He followed the principle of midline congestion, which states that increased lumbar lordosis is the cause of midline and left-sided organ congestion. The objective was to reduce the venous pressure in the left testicle by increasing the venous outflow from the left renal vein. The left testicular vein is in communication with the left renal vein. An increase in pressure within the left renal vein results in the stagnation or reflux of blood towards the left testis.
As compression of the left renal vein is a consequence of an increasing lordotic curvature of the spine, the physical treatment of testicular congestion is aimed at reducing lumbar lordosis through physical exercise and attention to posture in daily life.

After several months of training, he noticed a significant reduction in the size of the varicocele on his left side.
We used the PixelFlux method to measure the effect of different postures on the perfusion of the left kidney. The objective was to identify specific postures that would most effectively reduce testicular congestion. PixelFlux is an effective technique for measuring the parenchymal perfusion of the kidney. It is capable of detecting even minor changes resulting from hemodynamic effects caused by alterations in posture and spinal alignment. The findings highlight the vital importance of trunk orientation in space and the degree of lordotic curvature of the lumbar spine.

All postures of the trunk are less favourable than a supine horizontal posture – this has been demonstrated. Gravitation occurs along the axis of the trunk when the person is in an erect posture, whether standing or sitting. Gravitation pulls down the blood towards the lowest locations in the body. In terms of the extremities, this is the feet. In terms of the trunk, this is the external genitalia. Therefore, congestion of the testicle, the deepest-lying structure of the male trunk while standing or sitting, is an inevitable consequence.
When lying horizontally with the hips extended, a degree of lordosis is produced. Flexing the hips further reduces this.

We conducted PixelFlux measurements of renal perfusion in the left kidney in comparison to the right, utilising this degree of lumbar lordotic curvature as a point of departure, with the objective of determining the extent of obstruction of the venous return from the testicle. We therefore measured renal parenchymal perfusion, which is influenced by the incoming pressure from the renal artery and the venous counterpressure from the left renal vein.
An increase in venous pressure inevitably leads to a reduction in arterial influx, which in turn results in a decrease in parenchyma perfusion of the kidney.
The reduction in left renal parenchymal perfusion is therefore a clear indicator of the increasing counterpressure in the left renal vein, which subsequently affects the left testicular vein and the left testicle itself.

The data irrefutably show a decline in left renal perfusion when subjects are in a horizontal position (100% represents the baseline) compared to when they are in an erect seated position with crossed legs (81%), in a standing position with a reduced lordosis (72%), or in a slouched standing position with a reduced lordosis and a forward bend under the assumption that the increasing kyphosis of the thoracic spine mihht exert a flattening force onto the lumbar spine (50%), while standing with increased lordosis (44%) represents the intuitively chosen body posture if no attention is directed to the realignment of the spine.
The flexion of the hip joints has a clear effect on the degree of lumbar lordosis through two different mechanisms.
First, hip flexion stretches the psoas muscle, which exerts a ventral pull on the cranial anchorage of the lumbar vertebrae. This results in an increase in lumbar lordosis.
Secondly, stretching the hip joints beyond 45° causes an anterior tilt (in the supine position) or a ventral tilt (in the standing or sitting position) due to the inhibiting effect of the iliofemoral ligament. This tilt inclines the sacral bone. The lumbar spine then needs to bend more dorsally to compensate for this tilt in order to maintain a vertical position with the head on top of the line of gravity.

The flexion of the hip joints as a function of the psoas muscle has a peculiar effect on the degree of lumbar lordosis through two different mechanisms.
The first mechanism is straightforward: when the hip joint is extended, the psoas muscle is stretched, exerting a ventral pulling force on the cranial anchorage at the lateral processes of the lumbar vertebrae. This results in increased lumbar lordosis.
Secondly, stretching the hip joints beyond 45° causes an anterior tilt (in the supine position) or a ventral tilt (in the standing or sitting position) due to the inhibiting effect of the iliofemoral ligament.

This is why sitting with the hips flexed by crossing the legs is beneficial and the most favourable vertical posture for men with varicocoele.
The best standing posture is to stand upright, reducing lumbar lordosis by voluntarily contracting the back muscles.
There is no further beneficial effect from slouching the thoracic spine. It can therefore be stated that the supposed flattening effect of the increased kyphosis of the thoracic spine on the lumbar spine is not confirmed.
It is a fact that the relaxed “normal” everyday standing posture with relaxed back muscles and thus increased lordosis reduces the renal perfusion of the left kidney by 46% compared to the best standing posture! It is crucial to be aware of your posture in everyday situations.

The effect of lumbar lordosis on renal blood flow is significant, spanning a wide range from 100 to 15%.
PixelFlux measurements therefore enable the creation of customised training programmes with the clear aim of reducing testicular congestion, which has positive effects on pain, fertility and vitality.