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Skoura A, Billis E, Papanikolaou DT, Xergia S, Tsarbou C, Tsekoura M, Kortianou E, Maroulis I. Diastasis Recti Abdominis Rehabilitation in the Postpartum Period: A Scoping Review of Current Clinical Practice. Int Urogynecol J 2024; 35:491-520. [PMID: 38340172 PMCID: PMC11023973 DOI: 10.1007/s00192-024-05727-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/29/2023] [Indexed: 02/12/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Despite exercise being the standard approach to diastasis recti abdominis (DRA) rehabilitation, there is no consensus on the most effective exercise routine and adjunct modalities for reducing DRA and improving functional parameters. The present study is aimed at investigating evidence for DRA rehabilitation in postpartum women, as well as knowledge gaps and areas for future research. METHODS For this scoping review a systematic search was conducted in MEDLINE, AMED, CINAHL, Embase, ScienceDirect, Scopus, and PEDro up to November 2022. Selection criteria included studies investigating exercise therapy interventions both with and without adjunct modalities for postpartum DRA. Sample characteristics, diagnostic criteria, program design, and outcome measures were recorded. Critical appraisal of clinical trials was performed using PEDro classification. RESULTS Twenty-eight studies were included: 14 clinical trials, 3 case series, and 11 observational studies. DRA exercises that focused on deep and superficial muscles, pelvic floor muscles, respiratory maneuvers, functional exercises, or alternative interventions (yoga, suspension training, hypopressive exercise) and adjunct modalities showed promising results in reducing the inter-recti distance and related dysfunction. However, there was great variability in diagnostic criteria and methods, DRA severity, time post-birth, and exercise program design. CONCLUSIONS Reviewed studies provide valuable insights into exercise therapy, but it is important to recognize their limitations, as variability in diagnostic criteria, sample characteristics, and exercise program design hinder the generalizability of the findings. Further high-quality research is needed to strengthen the evidence in this area and provide reliable recommendations for clinical practice.
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Affiliation(s)
- Anastasia Skoura
- Laboratory of Clinical Physiotherapy and Research, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Building B, Central Campus 26504 Rio, Patras, Achaia, Greece.
| | - Evdokia Billis
- Laboratory of Clinical Physiotherapy and Research, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Building B, Central Campus 26504 Rio, Patras, Achaia, Greece
| | - Dimitra Tania Papanikolaou
- Laboratory of Clinical Physiotherapy and Research, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Building B, Central Campus 26504 Rio, Patras, Achaia, Greece
| | - Sofia Xergia
- Laboratory of Clinical Physiotherapy and Research, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Building B, Central Campus 26504 Rio, Patras, Achaia, Greece
| | - Charis Tsarbou
- Laboratory of Clinical Physiotherapy and Research, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Building B, Central Campus 26504 Rio, Patras, Achaia, Greece
| | - Maria Tsekoura
- Laboratory of Clinical Physiotherapy and Research, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Building B, Central Campus 26504 Rio, Patras, Achaia, Greece
| | - Eleni Kortianou
- Department of Physiotherapy, School of Health Sciences, University of Thessaly, Lamia, Greece
| | - Ioannis Maroulis
- Faculty of Medicine, School of Health Sciences, University of Patras, Rio, Patras, Greece
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Theodorsen NM, Moe-Nilssen R, Bø K, Haukenes I. Effect of exercise on the inter-rectus distance in pregnant women with diastasis recti abdominis: an experimental longitudinal study. Physiotherapy 2023; 121:13-20. [PMID: 37812848 DOI: 10.1016/j.physio.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 04/18/2023] [Accepted: 08/20/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE To investigate the effect of acute contraction of the pelvic floor muscles (PFM) and abdominal exercises on the inter-rectus distance (IRD) compared to resting values, and differences between gestation weeks 27 and 37, in pregnant women with diastasis recti abdominis (DRA). DESIGN Experimental longitudinal design. SETTING Physiotherapy clinic, primary health care. PARTICIPANTS Thirty-eight pregnant women with DRA ≥ 2.8 cm. INTERVENTIONS Two-dimensional ultrasound images of IRD 2 cm above and below the umbilicus were taken at rest and during PFM and abdominal exercises at gestation week 27 and 37. Repeated measures analyses of variance (ANOVAs) with post hoc tests was performed for each exercise for both locations and timepoints. MAIN OUTCOME MEASURES Change in IRD. RESULTS There was a mean increase of the IRD from rest during a PFM contraction (2 mm, 95% CI: 2, 3), drawing-in (4 mm, 95% CI: 3, 5) and a combination of these (5 mm, 95% CI: 4, 6) There was a mean decrease of the IRD from rest during the headlift (-3 mm, 95% CI: -4, -2), the curl-up (-3 mm, 95% CI: -4, -2) and the diagonal curl up (-4 mm, 95% CI: -5, -3). Effect of time from gestation week 27-37 was a mean increase of 8 mm (95% CI: 6, 9). CONCLUSION Pelvic floor and drawing-in exercise increased the IRD, whilst headlift, curl up and diagonal curl up decreased the IRD in pregnant women with DRA at gestation week 27 and 37. CONTRIBUTION OF THE PAPER.
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Affiliation(s)
- Nina-Margrethe Theodorsen
- University of Bergen, Department of Global Public Health and Primary Care, PO Box 7804, 5020 Bergen, Norway.
| | - Rolf Moe-Nilssen
- University of Bergen, Department of Global Public Health and Primary Care, PO Box 7804, 5020 Bergen, Norway
| | - Kari Bø
- Norwegian School of Sport Sciences, Department of Sports Medicine, Postboks 4014 Ullevål stadion, 0806 Oslo, Norway
| | - Inger Haukenes
- University of Bergen, Department of Global Public Health and Primary Care, PO Box 7804, 5020 Bergen, Norway
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Rai A, Sharma N, Jain SK, Lalwani A, Sharma S. Accuracy and Reliability of Different Approaches for the Assessment of Pelvic Floor Muscle Strength: A Systematic Review. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2023; 15:S856-S861. [PMID: 37694079 PMCID: PMC10485409 DOI: 10.4103/jpbs.jpbs_241_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 09/12/2023] Open
Abstract
There had been various methods employed for the evaluation of pelvic floor muscle (PFM) strength. The aim of the study was to do a systemic review of these methods for a better understanding of these techniques and to find the best appropriate method. A systemic review of the literature was done using three databases that included: PubMed, Scopus and Web of Science using the keywords "pelvic floor anatomy" and "functional anatomy of pelvic floor muscles" from 1985 to 2022. All the studies involved were analyzed for the methodologies used by the researcher, advantages, disadvantages, and the conclusion of the study. A total of 1,876 studies were found, out of which only 64 met the criteria of inclusion. In these studies, seven methods were used for the determination of PFM strength. These methods included: clinical palpation, perineometer, electromyography, dynamometer, ultrasonography, magnetic resonance imaging, and vaginal cones. The PFM cannot be calculated accurately using any one measuring technique. There is therefore no "gold standard" approach to PFM assessment. However, combining these methods will result in the best outcomes. According to the literature review, the most often employed procedures were digital palpation, perineometry, and Ultrasonography (USG).
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Affiliation(s)
- Alisha Rai
- Departments of Anatomy, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India
| | - Nidhi Sharma
- Departments of Anatomy, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India
| | - Sanjeev Kumar Jain
- Departments of Anatomy, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India
| | - Astha Lalwani
- Department of Obs and Gynae, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India
| | - Sonika Sharma
- Departments of Anatomy, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India
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Ben Ami N, Feldman R, Dar G. Verbal Instruction for Pelvic Floor Muscle Contraction among Healthy Young Males. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12031. [PMID: 36231333 PMCID: PMC9566287 DOI: 10.3390/ijerph191912031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
Teaching Pelvic Floor Muscle (PFM) contraction is a challenging task for clinicians and patients, as these muscles cannot be directly visualized. Thus, this study's objective is to compare the effectiveness of six verbal instructions for contracting the PFM among young men, as observed with transabdominal ultrasound imaging. Thirty-five male physiotherapy students, mean age 25.9 ± 1.9 years, participated in the study. A 6 MHz 35-mm curved linear array ultrasound transducer (Mindray M5) was placed in the transverse plane, supra-pubically, and angled 15-30° from the vertical plane. During crook lying, participants received six verbal instructions for contracting the PFM, with bladder base displacement and endurance evaluated. Following the instructions, "squeeze your anus", "shorten the penis", and "elevate the scrotum", over 91% of the participants performed a cranial (upward) bladder base displacement. During instruction six, "draw in", which involves breathing, the PFM, and the transversus abdominis, only 25% performed cranial bladder base displacement (p < 0.001), and the endurance was the lowest (p < 0.001). Our findings suggest that several simple verbal instructions can be used for teaching PFM contraction to young males. Moreover, two instructions should be avoided: "draw in" and the general instruction "squeeze your PFM", as they did not produce effective elevation of the bladder base.
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Affiliation(s)
- Noa Ben Ami
- Department of Physiotherapy, Faculty of Health Sciences, Ariel University, Ariel 4077625, Israel
| | - Ron Feldman
- Department of Physiotherapy, Faculty of Health Sciences, Ariel University, Ariel 4077625, Israel
| | - Gali Dar
- Department of Physical Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, Haifa 3498838, Israel
- Ribstein Center for Research and Sports Medicine, Wingate Institute, Netanya 4290200, Israel
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Brandt C, van Vuuren EJ. Postoperative Physiotherapy in Women Undergoing Pelvic Floor Reconstructive Surgery: A Randomized Controlled Clinical Trial. Physiother Can 2022; 74:126-138. [PMID: 37323710 PMCID: PMC10262738 DOI: 10.3138/ptc-2020-0053] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/25/2020] [Accepted: 11/08/2020] [Indexed: 12/01/2023]
Abstract
Purpose: Postoperative physiotherapy in conjunction with pelvic organ prolapse (POP) surgery is still under-investigated and controversial. In this randomized controlled trial, pelvic floor muscle training (PFMT) and abdominal training were compared with a control condition (standard in-hospital treatment). Method: Eighty-one women were randomized to one of three groups. The Prolapse Quality of Life questionnaire, two-dimensional ultrasound, Pelvic Organ Prolapse Quantification System scale, the PERFECT (power, endurance, repetitions, fast contractions, every contraction timed) scheme, electromyography, Sahrmann scale, and pressure biofeedback unit (PBU) were used to measure quality of life (QOL), POP, and pelvic floor and abdominal muscle function. A mixed-model analysis of variance and the Kruskal-Wallis test was used for analysis. Results: Beneficial effects (p < 0.05) were found for the PFMT group - increased power, number of fast contractions, amount of movement, endurance, and Sahrmann and PBU measures - compared with the control group. Abdominal training led to a significant (p < 0.05) increase in bulging and discomfort, number of pelvic floor muscle contractions, and Sahrmann and PBU measures compared with the control condition; both groups showed significantly increased urinary frequency (p < 0.05). Conclusions: Postoperative physiotherapy did not have a beneficial effect on QOL or POP symptoms. PFMT and abdominal training had beneficial effects on pelvic floor muscle function and abdominal muscle measures. Additional abdominal training led to increased symptoms.
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Affiliation(s)
- Corlia Brandt
- Department of Physiotherapy, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - E.C. Janse van Vuuren
- School of Allied Health Professions, University of the Free State, Bloemfontein, Free State, South Africa
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Validity and Reliability of an Offline Ultrasound Measurement of Bladder Base Displacement in Women. J Clin Med 2022; 11:jcm11092319. [PMID: 35566448 PMCID: PMC9100058 DOI: 10.3390/jcm11092319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/13/2022] [Accepted: 04/19/2022] [Indexed: 02/04/2023] Open
Abstract
The effect of different exercises on the position of pelvic organs in women has not been sufficiently assessed. The objective was to analyze the validity and reliability of a new two-dimensional ultrasound algorithm to measure offline the displacement of the bladder base during abdominal exercises. This algorithm could be a useful method to future studies in determine the most appropriate exercises in sports and in rehabilitative program for the pelvic floor in women. All subjects were tested by transverse transabdominal ultrasound. The measurements were conducted offline using a customized code written in MATLAB (Ecolab) for image-processing, and manually on the ultrasound monitor using electronic calipers. The agreement was assessed with a paired t-test, Pearson’s linear correlation coefficient (r), the Lin’s concordance correlation coefficient (CCC), the intraclass correlation coefficient ICC (A,2) and a Bland–Altman plot. The reliability was confirmed by the interdays intra-rater ICC coefficient. The results were that Ecolab and ultrasound transducer measures did not differ statistically (p = 0.246). Furthermore, both methods showed a very strong relationship, and the Ecolab demonstrated to be a valid and reliable method. We concluded that Ecolab seemed to be a valid and reliable tool to assess the effect of abdominal contractions in the female pelvic floor.
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Foster SN, Spitznagle TM, Tuttle LJ, Lowder JL, Sutcliffe S, Steger-May K, Ghetti C, Wang J, Burlis T, Meister MR, Mueller MJ, Harris-Hayes M. Pelvic Floor Mobility measured by Transperineal Ultrasound Imaging in Women with and without Urgency and Frequency Predominant Lower Urinary Tract Symptoms. JOURNAL OF WOMEN'S HEALTH PHYSICAL THERAPY 2022; 46:100-108. [PMID: 35757164 PMCID: PMC9216208 DOI: 10.1097/jwh.0000000000000224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Women with urgency/frequency predominant lower urinary tract symptoms (UF-LUTS) may have elevated pelvic floor muscle (PFM) position at rest and limited mobility with PFM contraction and bearing down, but this has not been quantified. OBJECTIVES To compare PFM position and mobility using transperineal ultrasound (TPUS) at rest, maximal PFM contraction (perineal elevation), and bearing down (perineal descent) in women with and without UF-LUTS. We hypothesized that women with UF-LUTS would demonstrate elevated resting position and decreased excursion of pelvic landmarks during contraction and bearing down as compared to women without UF-LUTS. STUDY DESIGN Case-control study. METHODS Women with UF-LUTS were matched 1:1 on age, body mass index and vaginal parity to women without UF-LUTS. TPUS videos were obtained during 3 conditions: rest, PFM contraction, and bearing down. Levator plate angle (LPA) and puborectalis length (PR length), were measured for each condition. Paired t-tests or Wilcoxon signed rank tests compared LPA and PR length between cases and controls. RESULTS 21 case-control pairs (42 women): Women with UF-LUTS demonstrated greater LPA at rest (66.8 ± 13.2 degrees vs 54.9 ± 9.8 degrees; P=0.006), and less PR lengthening from rest to bearing down (0.2 ± 3.1 mm vs 2.1 ± 2.9 mm; P=.03). CONCLUSION Women with UF-LUTS demonstrated more elevated (cranioventral) position of the PFM at rest and less PR muscle lengthening with bearing down. These findings highlight the importance of a comprehensive PFM examination and possible treatment for women with UF-LUTS to include PFM position and mobility.
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Affiliation(s)
- Stefanie N Foster
- Program in Physical Therapy, Washington University in St. Louis, St Louis, MO
| | - Theresa M Spitznagle
- Program in Physical Therapy, Washington University in St. Louis, St Louis, MO
- Department Obstetrics and Gynecology, Washington University in St. Louis, St Louis, MO
| | - Lori J Tuttle
- Doctor of Physical Therapy Program, San Diego State University, San Diego, CA
| | - Jerry L Lowder
- Department Obstetrics and Gynecology, Washington University in St. Louis, St Louis, MO
- Division of Female Pelvic Medicine & Reconstructive Surgery, Washington University in St. Louis, St Louis, MO
| | - Siobhan Sutcliffe
- Department of Surgery, Washington University in St. Louis, St Louis, MO
- Department Obstetrics and Gynecology, Washington University in St. Louis, St Louis, MO
| | - Karen Steger-May
- Division of Biostatistics, Washington University in St. Louis, St Louis, MO
| | - Chiara Ghetti
- Department Obstetrics and Gynecology, Washington University in St. Louis, St Louis, MO
- Division of Female Pelvic Medicine & Reconstructive Surgery, Washington University in St. Louis, St Louis, MO
| | - Jinli Wang
- Division of Biostatistics, Washington University in St. Louis, St Louis, MO
| | - Taylor Burlis
- Program in Physical Therapy, Washington University in St. Louis, St Louis, MO
| | - Melanie R Meister
- Department Obstetrics and Gynecology, Washington University in St. Louis, St Louis, MO
- Division of Female Pelvic Medicine & Reconstructive Surgery, Washington University in St. Louis, St Louis, MO
| | - Michael J Mueller
- Program in Physical Therapy, Washington University in St. Louis, St Louis, MO
- Department of Radiology, Washington University in St. Louis, St Louis, MO
| | - Marcie Harris-Hayes
- Program in Physical Therapy, Washington University in St. Louis, St Louis, MO
- Department Orthopedic Surgery, Washington University in St. Louis, St Louis, MO
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Bladder Base Displacement during Abdominal Muscles Contraction and Functional Activities in Primiparous Women Assessed by Transabdominal Ultrasound: A Descriptive Study. J Clin Med 2021; 11:jcm11010025. [PMID: 35011767 PMCID: PMC8745356 DOI: 10.3390/jcm11010025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/18/2021] [Accepted: 12/20/2021] [Indexed: 12/01/2022] Open
Abstract
This study described the response of the bladder base (BB) by transabdominal ultrasound in primiparous women during movements that activate the abdominopelvic cavity musculature and cause variations in intra-abdominal pressure (IAP). A descriptive cross-sectional study was conducted in 64 primiparous women at eight weeks after uncomplicated delivery. BB displacement was measured using a 5-MHz convex transducer in a suprapubic position. Participants were asked to perform the isolated contraction of pelvic floor musculature (PFM) and transverse abdominis (TrA), cough at high lung volume and trunk flexion with and without maximal voluntary contraction of PFM. PFM contraction elevated the BB in all but one participant, whereas TrA contraction caused the BB to ascend in 56% of the women and descend in the rest; their combined contraction rose the BB in 65% of the women although the effect was greater with only PFM contraction (p < 0.01). The BB descended in all participants during coughing and trunk flexion although the descent was inferior with the joint maximal voluntary contraction of PFM (p < 0.01). In conclusion, TrA contraction must be assessed individually in puerperal women since its effect on the BB varies among subjects. During movements increasing IAP, such as coughing or curl-ups, the anticipatory contraction of PFM reduces bladder descent although not sufficiently to counteract bladder displacement.
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Arbieto ERM, Dos Santos KM, da Luz SCT, Da Roza T. Comparison of urinary incontinence, based on pelvic floor and abdominal muscle strength, between nulliparous female athletes and non-athletes: A secondary analysis. Neurourol Urodyn 2021; 40:1140-1146. [PMID: 33998052 DOI: 10.1002/nau.24700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/02/2021] [Accepted: 04/19/2021] [Indexed: 11/08/2022]
Abstract
AIMS To compare the strength of abdominal and pelvic floor muscles (PFM) between nulliparous female athletes (FAs) and non-athletes (FNAs), to determine the frequency of urinary incontinence (UI) in these groups. METHODS This cross-sectional comparative study of nulliparous women included 39 professional FAs, who competed at the district level or above, and 34 FNAs. Participants underwent pelvic floor and abdominal muscle assessments. PFM function and strength were assessed using the modified Oxford scale and a manometer (PERINA 996-2 QUARK). Abdominal muscle function and strength were assessed using a 4-Pro isokinetic dynamometer. The International Consultation on Incontinence Questionnaire-Short Form was used to assess UI symptoms among the athletes, and the International Physical Activity Questionnaire-Short Form was used to establish the level of physical activity among the non-athletes. RESULTS The prevalence of UIs in the FAs was 53.8%, while that for FNAs was 35.3%. There was no association between being an athlete and having UI (p = 0.112). FAs were found to weigh more (p = 0.012) and have increased abdominal muscle strength (p = 0.014) and maximum voluntary PFM contraction as recorded by the manometer (p = 0.035), as well as a decreased PFM contraction endurance time (p = 0.025) than FNAs. CONCLUSION FAs had stronger abdominal muscles and PFM contraction, as assessed by a manometer, but less PFM endurance when compared to FNAs. Despite these differences, the prevalence of UI was similar between groups.
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Affiliation(s)
- Eliane Regina Mendoza Arbieto
- Department of Physiotherapy, College of Health and Sport Science, Santa Catarina State University, Florianópolis, Santa Catarina, Brazil
| | - Keyla Mara Dos Santos
- Department of Physiotherapy, Centro Universitário Estácio de Santa Catarina, São José, Santa Catarina, Brazil
| | - Soraia Cristina Tonon da Luz
- Department of Physiotherapy, College of Health and Sport Science, Santa Catarina State University, Florianópolis, Santa Catarina, Brazil
| | - Thuane Da Roza
- Department of Physiotherapy, College of Health and Sport Science, Santa Catarina State University, Florianópolis, Santa Catarina, Brazil
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Martínez-Bustelo S, Ferri-Morales A, Corral-Gómez L, Castillo-García FJ, Castro-Varela V, Jácome MA. Transabdominal ultrasound to assess the displacement of the bladder base during abdominal and pelvic floor contractions in continent parous versus nulliparous women. Int Urogynecol J 2021; 33:2257-2266. [PMID: 33871665 DOI: 10.1007/s00192-021-04756-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 03/03/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The effect of different abdominal contractions on the position of pelvic organs in parous women during postpartum exercises has not been sufficiently assessed. The aim of this study was to evaluate the displacement of the bladder base (BB) during different pelvic floor and abdominal contractions in parous women compared to nulliparous women. We hypothesised that abdominal and perineal contractions will produce a disparate effect on the position of the BB between groups. METHODS Cross-sectional study including a convenience sample of 63 volunteers (35 nulliparous vs. 28 postpartum women). Transabdominal ultrasound was used in mode B to image the displacement of the BB. The protocol included six different pelvic floor and abdominal contractions commonly used in postpartum rehabilitation. RESULTS The BB elevated significantly more in the postpartum group compared to nulliparous women when performing submaximal contraction of pelvic floor and transversus abdominis muscles simultaneously with axial elongation of the back (0.93 ± 0.55 cm in parous women vs. 0.66 ± 0.46 cm in nulliparous women). In contrast, the BB was found to descend significantly during a curl-up contraction in both groups (0.93 ± 0.55 cm in parous women vs. 0.66 ± 0.46 cm in nulliparous women). CONCLUSIONS The overall results of this study showed that perineal and superficial abdominal contractions produced different immediate effects compared to deep abdominal contractions on the displacement of BB in parous and nulliparous women. Further research is required to assess the long-term effects of these contractions.
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Affiliation(s)
- Sandra Martínez-Bustelo
- Faculty of Physiotherapy, Psychosocial Intervention and Functional Rehabilitation Research Group, University of A Coruña, Campus de Oza, CP 15006, A Coruña, Spain
| | - Asunción Ferri-Morales
- Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, Real Fábrica de Armas, CP 45071, Toledo, Spain.
| | - Lis Corral-Gómez
- School of Industrial and Aerospace Engineering, University of Castilla-La Mancha, Real Fábrica de Armas s/n, CP 45071, Toledo, Spain
| | - Fernando J Castillo-García
- School of Industrial and Aerospace Engineering, University of Castilla-La Mancha, Real Fábrica de Armas s/n, CP 45071, Toledo, Spain
| | - Vanessa Castro-Varela
- Midwife Unit. Healthcare center Cesullas. Galician Healthcare Service, A Coruña, Spain
| | - M Amalia Jácome
- Faculty of Science, University of A Coruña. CITIC, Campus de A Zapateira, CP 15071, A Coruña, Spain
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Frawley H, Shelly B, Morin M, Bernard S, Bø K, Digesu GA, Dickinson T, Goonewardene S, McClurg D, Rahnama'i MS, Schizas A, Slieker-Ten Hove M, Takahashi S, Voelkl Guevara J. An International Continence Society (ICS) report on the terminology for pelvic floor muscle assessment. Neurourol Urodyn 2021; 40:1217-1260. [PMID: 33844342 DOI: 10.1002/nau.24658] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The terminology for female and male pelvic floor muscle (PFM) assessment has expanded considerably since the first PFM function and dysfunction standardization of terminology document in 2005. New terms have entered assessment reports, and new investigations to measure PFM function and dysfunction have been developed. An update of this terminology was required to comprehensively document the terms and their definitions, and to describe the assessment method and interpretation of the finding, to standardize assessment procedures and aid diagnostic decision making. METHODS This report combines the input of members of the Standardisation Committee of the International Continence Society (ICS) Working Group 16, with contributions from recognized experts in the field and external referees. A logical, sequential, clinically directed assessment framework was created against which the assessment process was mapped. Within categories and subclassifications, each term was assigned a numeric coding. A transparent process of 12 rounds of full working group and external review was undertaken to exhaustively examine each definition, plus additional extensive internal development, with decision making by collective opinion (consensus). RESULTS A Terminology Report for the symptoms, signs, investigations, and diagnoses associated with PFM function and dysfunction, encompassing 185 separate definitions/descriptors, has been developed. It is clinically based with the most common assessment processes defined. Clarity and user-friendliness have been key aims to make it interpretable by clinicians and researchers of different disciplines. CONCLUSION A consensus-based Terminology Report for assessment of PFM function and dysfunction has been produced to aid clinical practice and be a stimulus for research.
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Affiliation(s)
- Helena Frawley
- School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Beth Shelly
- Beth Shelly Physical Therapy, Moline, Illinois, USA.,Department of Physical Therapy, Saint Ambrose University Davenport, Iowa, USA
| | - Melanie Morin
- School of Rehabilitation Faculty of Medecine and Health Sciences, University of Sherbrooke, Sherbrooke, Québec, Canada
| | - Stéphanie Bernard
- Department of Rehabilitation, Faculté de Médecine, Université Laval, Québec, Quebec, Canada
| | - Kari Bø
- Department of Sports Medicine, Norwegian School of Sports Sciences, Akershus University Hospital, Oslo, Norway.,Department of Obstetrics and Gynecology, Lørenskog, Norway
| | - Giuseppe Alessandro Digesu
- Academic Department of Obstetrics and Gynaecology, St. Mary's Hospital, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Tamara Dickinson
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas, USA
| | | | - Doreen McClurg
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Mohammad S Rahnama'i
- Uniklinik RWTH, University Hospital of Aachen, Aachen, Germany.,Society of Urological Research and Education (SURE), Heerlen, The Netherlands
| | - Alexis Schizas
- Department of Colorectal Surgery, Guy's and St. Thomas NHS Foundation Trust, London, UK
| | - Marijke Slieker-Ten Hove
- Department Gynaecology, University of Erasmus, Rotterdam, The Netherlands.,Pelvic Floor Physiotherapy, ProFundum Instituut, Dordrecht, The Netherlands
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12
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Ikeda M, Mori A. Vaginal palpation versus transabdominal ultrasound in the comprehension of pelvic floor muscle contraction after vaginal delivery: a randomised controlled trial. BMC WOMENS HEALTH 2021; 21:53. [PMID: 33549078 PMCID: PMC7866465 DOI: 10.1186/s12905-021-01203-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 02/01/2021] [Indexed: 11/13/2022]
Abstract
Background Pelvic floor muscles support the pelvic organs and control voiding. The first choice in the repair of pelvic floor function that is damaged during pregnancy and delivery is pelvic floor muscle training, which involves repeated muscle relaxation and contraction. However, as muscle contractions cannot be visualised, it is difficult to assess whether patients understand how to contract them. Therefore, we assessed patients’ comprehension of pelvic floor muscle contraction by comparing two teaching methods, vaginal palpation and transabdominal ultrasound, following vaginal delivery. We hypothesised that vaginal palpation is better than transabdominal ultrasound in this regard. Methods This randomised controlled trial conducted in facilities in Tokyo, Japan between July 2018 and January 2019 included women aged ≥ 20 years at 4–6 weeks after vaginal delivery. The randomisation involved website-based centralised allocation. The primary outcome was a change in bladder base displacement during pelvic floor muscle contraction before and after training, which was measured using transabdominal ultrasound. Participants performed three contractions for 3 s, and the mean value was used for statistical analysis. The secondary outcome was a change in understanding the contraction before and after training, which was measured using a five-point Likert scale questionnaire. Outcomes were analysed using Welch’s t-test. Results Sixty-five participants were randomly allocated to the vaginal palpation group (n = 32) and transabdominal ultrasound group (n = 33). Baseline characteristics were similar between the groups. Changes in bladder base displacement were not significantly different between the groups (p = 0.181). Within-group analyses showed that bladder base displacement was large in both groups after the respective intervention. There were no significant differences in any of the outcomes between the two groups before and after the intervention. Conclusions Vaginal palpation and transabdominal ultrasound might be useful for comprehending pelvic floor muscle contraction after vaginal delivery. Trial registration: UMIN 000032304. Registered 18 April 2018, https://upload.umin.ac.jp/cgi-open-bin/icdr_e/ctr_view.cgi?recptno=R000036820.
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Affiliation(s)
- Mayumi Ikeda
- Graduate Course of Midwifery, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan.
| | - Akiko Mori
- Department of Nursing, Shonan Kamakura University of Medical Sciences School of Nursing, 1195-3 Yamazaki, Kamakura-shi, Kanagawa, Japan
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Da Cuña-Carrera I, Soto-González M, Alonso-Calvete A, González-González Y, Lantarón-Caeiro EM. Immediate effects of different types of abdominal exercises on the inter-rectus distance. ISOKINET EXERC SCI 2021. [DOI: 10.3233/ies-203161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND: The effects of abdominal exercises on the inter-rectus distance are unclear. OBJECTIVE: To compare the inter-rectus distance at rest and during different abdominal exercises: abdominal crunch, abdominal crunch with transversus abdominis pre-activation and hypopressive exercise. METHODS: A transversal experimental study was carried out in 98 healthy adults without diastasis recti abdominis were recruited. Measurements were assessed using ultrasound imaging, and two points were evaluated: just above the umbilicus (U point) and halfway between the U point and the xiphoid (UX point). The inter-rectus distance was measured at rest and during the abdominal exercises. RESULTS: The abdominal crunch with transversus abdominis pre-activation increases the inter-rectus distance in comparison with rest and with abdominal crunch in the U point. CONCLUSION: These results increase the knowledge about the behaviour of the linea alba and inter-rectus distance during abdominal exercises, with practical applications in the rehabilitation of the abdominal wall and low back.
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14
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Khowailed IA, Disney H, Lee H. Gender-specific differences of normative values of pelvic floor muscle function in healthy adults population: an observational analytical study. Women Health 2020; 60:1185-1195. [PMID: 32854597 DOI: 10.1080/03630242.2020.1807449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Females and males differ significantly in gross anatomy and physiology of the pelvic floor muscle, and these differences are commonly discussed in the scientific literature. However, less attention is dedicated to investigating the normative values of pelvic floor muscle (PFM) function between females and males. Our study aims to describe the normal reference values of PFM function in females and males of a healthy adult population using transabdominal ultrasound (TAUS). A total of 200 healthy adults, including 71 males and 129 females consented to participate in this study. Bladder base displacement was measured using a sagittal curved linear array 2-5 MHz transducer over the suprapubic region. The amount of bladder base movement on ultrasound was measured in all subjects from freeze frame ultrasound images and considered as an indicator of PFM function. The average age of subjects was (26.1 ± 2.6 years), (24.4 ± 3.7 BMI). Statistical analysis revealed a significant difference in transabdominal ultrasound measurement for PFM function (p = .00000). The bladder base displacement was significantly greater in males compared to females (0.65 ± 0.42 vs. 0.38 ± 0.35, p <.001, 95% CI:0.16-0.38). The present study provides evidence of a gender-related PFM functional differences creating a baseline for the clinic to establish the normal percentile values of PFM function.
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Affiliation(s)
- Iman Akef Khowailed
- Department of Physical Therapy, College of Rehabilitative Sciences, University of St Augustine for Health Sciences , San Marcos, California, USA
| | - Heather Disney
- Department of Physical Therapy, College of Rehabilitative Sciences, University of St Augustine for Health Sciences , San Marcos, California, USA
| | - Haneul Lee
- Department of Physical Therapy, Gachon University , Incheon, Korea
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15
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Gluppe SB, Engh ME, Bø K. Immediate Effect of Abdominal and Pelvic Floor Muscle Exercises on Interrecti Distance in Women With Diastasis Recti Abdominis Who Were Parous. Phys Ther 2020; 100:1372-1383. [PMID: 32302393 DOI: 10.1093/ptj/pzaa070] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 02/29/2020] [Indexed: 02/09/2023]
Abstract
OBJECTIVE There is a lack of consensus on which abdominal or pelvic floor muscle (PFM) exercises to recommend for the treatment of diastasis recti abdominis (DRA). The objective of this study was to investigate the immediate effect of abdominal and PFM exercises on interrecti distance (IRD) in women with DRA who are parous. METHODS In this cross-sectional study, 38 women who were parous, with a mean age of 36.2 years (SD = 5.2), diagnosed with DRA participated. IRD was assessed with 2-dimensional real-time ultrasonography during rest and during 8 randomly ordered different exercises. A paired t test was used to compare the IRD at rest with the IRD recorded during each exercise as well as the differences between exercises. Means with 95% CI are reported. RESULTS Head lift and twisted curl-up exercises significantly decreased the IRD both above and below the umbilicus. Above the umbilicus, the mean IRD difference from rest during head lift was 10 mm (95% CI = 7 to 13.2), whereas during twisted curl-up it was 9.4 mm (95% CI = 6.3 to 12.5). Below the umbilicus, the corresponding values were 6.1 mm (95% CI = 3.2 to 8.9) and 3.5 mm (95% CI = 0.5 to 6.4), respectively, but PFM contraction, maximal in-drawing, and PFM contraction + maximal in-drawing increased the IRD (mean difference = -2.8 mm [95% CI = -5.2 to 0.5], -4.7 mm [95% CI = -7.2 to -2.1], and - 5.0 mm [95% CI = -7.9 to -2.1], respectively). CONCLUSIONS Head lift and twisted curl-up exercises decreased the IRD both above and below the umbilicus, whereas maximal in-drawing and PFM contraction exercises only increased the IRD below the umbilicus. A randomized controlled trial is needed to investigate whether head lift and twisted curl-up exercises are effective in permanently narrowing the IRD. IMPACT To date there is scant scientific knowledge of which exercises to recommend in the treatment of DRA. In-drawing and PFM contraction leads to an acute increase in IRD, while head lift and twisted curl-up leads to an acute decrease in IRD in postpartum women. There is a need for high-quality randomized controlled trials to investigate if there is a long-term reduction in IRD by doing these exercises over time. The acute IRD increase and decrease during the different exercises is also present in a sample of women with larger separations.
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Affiliation(s)
- Sandra B Gluppe
- Department of Sports Medicine, Norwegian School of Sport Sciences, Sognsveien 220 Oslo 0806, Norway
| | - Marie Ellström Engh
- Department of Obstetrics and Gynaecology, Akershus University Hospital, Lørenskog, Norway; and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kari Bø
- Department of Sport Medicine, Norwegian University of Sport and Physical Education, Oslo, Norway
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16
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Navarro-Brazález B, Prieto-Gómez V, Prieto-Merino D, Sánchez-Sánchez B, McLean L, Torres-Lacomba M. Effectiveness of Hypopressive Exercises in Women with Pelvic Floor Dysfunction: A Randomised Controlled Trial. J Clin Med 2020; 9:E1149. [PMID: 32316686 PMCID: PMC7230910 DOI: 10.3390/jcm9041149] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/03/2020] [Accepted: 04/15/2020] [Indexed: 02/02/2023] Open
Abstract
Hypopressive exercises have emerged as a conservative treatment option for pelvic floor dysfunction (PFD). The aim of this study was to compare the effects of an eight-week hypopressive exercise program to those of an individualized pelvic floor muscle (PFM) training (PFMT) program, and to a combination of both immediately after treatment and at follow-up assessments at 3, 6 and 12 months later. The study was a prospective, single-centre, assessor-blinded, randomised controlled trial. Ninety-four women with PFD were assigned to PFMT (n = 32), hypopressive exercises (n = 31) or both (n = 31). All programs included the same educational component, and instruction about lifestyle interventions and the knack manoeuvre. Primary outcomes were the Pelvic Floor Distress Inventory Short Form (PFDI-20); the Pelvic Floor Impact Questionnaire Short Form (PFIQ-7); PFM strength (manometry and dynamometry) and pelvic floor basal tone (dynamometry). There were no statistically significant differences between groups at baseline, nor after the intervention. Overall, women reduced their symptoms (24.41-30.5 on the PFDI-20); improved their quality of life (14.78-21.49 on the PFIQ-7), improved their PFM strength (8.61-9.32 cmH2O on manometry; 106.2-247.7 g on dynamometry), and increased their pelvic floor basal tone (1.8-22.9 g on dynamometry). These data suggest that individual PFMT, hypopressive exercises and a combination of both interventions significantly reduce PFD symptoms, enhance quality of life, and improve PFM strength and basal tone in women with PFD, both in the short and longer term.
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Affiliation(s)
- Beatriz Navarro-Brazález
- Physiotherapy in Women’s Health (FPSM) Research Group. Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28805 Madrid, Spain; (B.N.-B.); (V.P.-G.); (D.P.-M.); (M.T.-L.)
| | - Virginia Prieto-Gómez
- Physiotherapy in Women’s Health (FPSM) Research Group. Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28805 Madrid, Spain; (B.N.-B.); (V.P.-G.); (D.P.-M.); (M.T.-L.)
| | - David Prieto-Merino
- Physiotherapy in Women’s Health (FPSM) Research Group. Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28805 Madrid, Spain; (B.N.-B.); (V.P.-G.); (D.P.-M.); (M.T.-L.)
- Applied statistical methods in Medical Research Group, Catholic University of Murcia (UCAM), 30107 Murcia, Spain
| | - Beatriz Sánchez-Sánchez
- Physiotherapy in Women’s Health (FPSM) Research Group. Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28805 Madrid, Spain; (B.N.-B.); (V.P.-G.); (D.P.-M.); (M.T.-L.)
| | - Linda McLean
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1H 8M5, Canada;
| | - María Torres-Lacomba
- Physiotherapy in Women’s Health (FPSM) Research Group. Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28805 Madrid, Spain; (B.N.-B.); (V.P.-G.); (D.P.-M.); (M.T.-L.)
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17
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Navarro Brazález B, Sánchez Sánchez B, Prieto Gómez V, De La Villa Polo P, McLean L, Torres Lacomba M. Pelvic floor and abdominal muscle responses during hypopressive exercises in women with pelvic floor dysfunction. Neurourol Urodyn 2020; 39:793-803. [PMID: 31985114 DOI: 10.1002/nau.24284] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 01/10/2020] [Indexed: 11/09/2022]
Abstract
AIM To measure the neuromuscular activation of the pelvic floor and abdominal muscles concurrently with vaginal closure forces induced during a hypopressive exercise (HE) and to identify the contribution of the HEs sequences (posture and maneuver) in the muscle's activation. METHODS A cross-sectional study design was employed. Sixty-six women who had participated in a physical therapy program focused on HEs were recruited. Pelvic floor muscle (PFM) activation was measured using surface electromyography (sEMG) in supine and in the orthostatic position, and vaginal closure force was measured through vaginal dynamometry in supine. Activation of the abdominal, gluteal, and hip adductor muscles was measured using sEMG. Maximum effort voluntary contractions (MVCs) of the PFMs and reference contractions of the abdominal and hip muscles were acquired for normalization purposes. A HE was then performed in a supine position with one leg raised, then in an orthostatic position. RESULTS During the supine HE, the peak PFM sEMG amplitude was 74.4% to 86.5% (49.6%-109.6%) of MVC, the peak vaginal closure force was between 51.2% and 55.7% (95.5%-382.9%) of MVC, and the muscles of the lateral abdominal wall were activated between 25.4% and 35.3% of the reference contraction. During the orthostatic HE, PFM activation was 61.4% (40.1%-105.6%) of MVC, and the lateral abdominal wall muscles contracted at 22.8% of the reference activation level. CONCLUSIONS The PFMs, abdominal, gluteal, and adductor muscles are activated during the performance of a HE. The activation level of the PFMs and abdominal muscles is likely insufficient to result in strength gains; however, they could have an endurance effect.
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Affiliation(s)
- Beatriz Navarro Brazález
- Department of Physical Therapy, Faculty of Medicine and Health Sciences, Physical Therapy in Women's Health Research Group, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Beatriz Sánchez Sánchez
- Department of Physical Therapy, Faculty of Medicine and Health Sciences, Physical Therapy in Women's Health Research Group, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Virginia Prieto Gómez
- Department of Physical Therapy, Faculty of Medicine and Health Sciences, Physical Therapy in Women's Health Research Group, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Pedro De La Villa Polo
- Department of Systems Biology, Faculty of Medicine and Health Sciences, Physical Therapy in Women's Health Research Group, University of Alcalá, Alcalá de Henares, Spain
| | - Linda McLean
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - María Torres Lacomba
- Department of Physical Therapy, Faculty of Medicine and Health Sciences, Physical Therapy in Women's Health Research Group, University of Alcalá, Alcalá de Henares, Madrid, Spain
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18
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Abstract
More women participate in sports than ever before and the proportion of women athletes at the Olympic Games is nearly 50%. The pelvic floor in women may be the only area of the body where the positive effect of physical activity has been questioned. The aim of this narrative review is to present two widely held opposing hypotheses on the effect of general exercise on the pelvic floor and to discuss the evidence for each. Hypothesis 1: by strengthening the pelvic floor muscles (PFM) and decreasing the levator hiatus, exercise decreases the risk of urinary incontinence, anal incontinence and pelvic organ prolapse, but negatively affects the ease and safety of childbirth. Hypothesis 2: by overloading and stretching the PFM, exercise not only increases the risk of these disorders, but also makes labor and childbirth easier, as the PFM do not obstruct the exit of the fetus. Key findings of this review endorse aspects of both hypotheses. Exercising women generally have similar or stronger PFM strength and larger levator ani muscles than non-exercising women, but this does not seem to have a greater risk of obstructed labor or childbirth. Additionally, women that specifically train their PFM while pregnant are not more likely to have outcomes associated with obstructed labor. Mild-to-moderate physical activity, such as walking, decreases the risk of urinary incontinence but female athletes are about three times more likely to have urinary incontinence compared to controls. There is some evidence that strenuous exercise may cause and worsen pelvic organ prolapse, but data are inconsistent. Both intra-abdominal pressure associated with exercise and PFM strength vary between activities and between women; thus the threshold for optimal or negative effects on the pelvic floor almost certainly differs from person to person. Our review highlights many knowledge gaps that need to be understood to understand the full effects of strenuous and non-strenuous activities on pelvic floor health.
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Affiliation(s)
- Kari Bø
- Department of Sports Medicine, Norwegian School of Sport Sciences, PB 4014, Ullevål Stadion, 0806, Oslo, Norway.
- Akershus University Hospital, Lørenskog, Norway.
| | - Ingrid Elisabeth Nygaard
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, USA
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19
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Effect of pelvic floor and transversus abdominis muscle contraction on inter-rectus distance in postpartum women: a cross-sectional experimental study. Physiotherapy 2019; 105:315-320. [DOI: 10.1016/j.physio.2018.08.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 08/19/2018] [Indexed: 11/21/2022]
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20
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Nieuwhof-Leppink AJ, Schroeder RPJ, van de Putte EM, de Jong TPVM, Schappin R. Daytime urinary incontinence in children and adolescents. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 3:492-501. [DOI: 10.1016/s2352-4642(19)30113-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/21/2019] [Accepted: 03/06/2019] [Indexed: 01/21/2023]
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21
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Ptaszkowski K, Zdrojowy R, Ptaszkowska L, Bartnicki J, Taradaj J, Paprocka-Borowicz M. Electromyographic evaluation of synergist muscles of the pelvic floor muscle depending on the pelvis setting in menopausal women: A prospective observational study. Gait Posture 2019; 71:170-176. [PMID: 31075659 DOI: 10.1016/j.gaitpost.2019.04.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 03/24/2019] [Accepted: 04/24/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pelvic floor muscle (PFM) training is recommended to increase their strength and endurance. Muscles which act synergistically with PFM are taken into consideration in the therapeutic management of weakened PFM. RESEARCH QUESTION how does electromyography activity of the synergists muscle to PFM change concerning pelvis position and does the greater bioelectric activity of synergist muscles affect PFM function? METHODS A prospective, observational study evaluating the surface electromyography (sEMG) activity of selected synergist muscles of the PFM depending on the orientation of the pelvis. One hundred thirty-one menopausal women registered for the study were screened for inclusion and exclusion criteria, and by the results, eighty-two participants were enrolled for measurements. The comparisons of results between the values obtained in different positions of the pelvis (anterior pelvic tilt - P1, posterior pelvic tilt - P2 and neutral pelvic tilt - P3) were performed using Kruskal-Wallis test. A multivariate linear regression analysis was used to assess relationships between the bioelectrical activity of PFM and activity of all tested muscles - rectus abdominis (RA), gluteus maximus (GM), and adductor magnus (AM). RESULTS Higher RA, GM, AM bioelectrical activity was observed in the P2 as compared to P3 (during resting and functional PFM activity)(p < 0.05). Multivariate linear regression did not find the association between the bioelectrical activity of PFM and the activity of all synergist muscles in each position. SIGNIFICANCE sEMG activity of selected muscles acting synergistically with PFM differ depending on the pelvis position and is the highest in the posterior pelvic tilt. Greater activity of the synergists, resulting from the pelvic position, does not affect the myoelectric activity of PFM. It seems that muscles that act synergistically with PFM may not play such a significant role in the therapeutic management of PFM.
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Affiliation(s)
- Kuba Ptaszkowski
- Department of Clinical Biomechanics and Physiotherapy in Motor System Disorders, Faculty of Health Science, Wroclaw Medical University, Grunwaldzka 2, 50-355 Wroclaw, Poland.
| | - Romuald Zdrojowy
- Department and Clinic of Urology, Faculty of Postgraduate Medical Training, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland.
| | - Lucyna Ptaszkowska
- Department of Physiotherapy, Opole Medical School, Katowicka 68, 45-060 Opole, Poland.
| | - Janusz Bartnicki
- Department of Obstetrics, Faculty of Health Science, Wroclaw Medical University, K. Bartla 5, 51-618 Wroclaw, Poland; Department of Gynecology and Obstetrics, Hospital Maerkisch Oderland, Proetzeler Chaussee 5, Germany.
| | - Jakub Taradaj
- Department of Physiotherapy Basics, Academy of Physical Education in Katowice, Mikolowska Street 72, Building B, 40-065 Katowice, Poland; College of Rehabilitation Sciences, University of Manitoba, McDermot Avenue, R106 - 771 Winnipeg, Canada.
| | - Malgorzata Paprocka-Borowicz
- Department of Clinical Biomechanics and Physiotherapy in Motor System Disorders, Faculty of Health Science, Wroclaw Medical University, Grunwaldzka 2, 50-355 Wroclaw, Poland.
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Werner LA, Dayan M. Diastasis Recti Abdominis-diagnosis, Risk Factors, Effect on Musculoskeletal Function, Framework for Treatment and Implications for the Pelvic Floor. CURRENT WOMENS HEALTH REVIEWS 2019. [DOI: 10.2174/1573404814666180222152952] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:Diastasis Recti Abdominis (DRA) can occur during pregnancy and postpartum. It is defined as an increase of the inter-recti distance (IRD) beyond normal values. The diagnosis of DRA is inconsistent within the literature and varies depending on measurement instrument and activity during measurement (rest versus active curl-up). DRA is characterized by the stretching of linea alba (LA) and contributes to a protrusion of the anterior abdominal wall due to increased laxity in the myofascial system that supports abdominal viscera. DRA has been postulated to affect lumbopelvic support and function due to laxity of the LA and altered angle of muscle insertion, but recent studies have not confirmed this. Risk factors for the development of DRA have been investigated in pregnancy to 12-months postpartum.Objective:Rehabilitation for DRA has been traditionally focused on reducing the IRD, but recent research has proposed that a sole focus on closing the DRA is suboptimal.Results:It is important alongside the rehabilitation of the abdominal wall that there is the consideration of the pelvic floor (PF). In healthy individuals, with the activation of the transversus abdominis, there is a sub-maximal co-contraction of the PF muscles. This co-contraction can be lost or altered in women with urinary incontinence. An increase in intra-abdominal pressure without simultaneous co-contraction of the PF may cause caudal displacement of the PF.Conclusion:The aim of this review is to bring the reader up to date on the evidence on DRA and to propose a rehabilitation framework for the whole abdominal wall in DRA with consideration of the impact on the PF.
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Affiliation(s)
- Laura Anne Werner
- Shelbourne Physiotherapy 100B-3200 Shelbourne V8P 5G8, Victoria, BC, Canada
| | - Marcy Dayan
- Dayan Physiotherapy and Pelvic Floor Clinic 909-750 W Broadway V5Z 1H8 Vancouver, BC, Canada
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23
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Madokoro S, Miaki H. Relationship between transversus abdominis muscle thickness and urinary incontinence in females at 2 months postpartum. J Phys Ther Sci 2019; 31:108-111. [PMID: 30774216 PMCID: PMC6348182 DOI: 10.1589/jpts.31.108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 10/24/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Urinary incontinence is a frequent postpartum complication. Thus, this study aimed to examine the associations of transversus abdominis muscle thicknesses at rest and during an abdominal drawing-in maneuver with urinary incontinence in females at 2 months postpartum. [Participants and Methods] The participants included 18 females at 2 months postpartum with or without urinary incontinence, and 10 nulliparous females as controls. Transversus abdominis thickness was measured at rest and during the abdominal drawing-in maneuver using diagnostic ultrasonography. The Japanese version of the International Consultation on Incontinence Questionnaire-Short Form was used to evaluate urinary incontinence. [Results] Females at 2 months postpartum were divided into groups with and without urinary incontinence according to questionnaire scores. The muscle thickness during the abdominal drawing-in maneuver contraction was significantly lower in those with urinary incontinence than in those without urinary incontinence and controls. [Conclusion] The results showed significantly reduced transversus abdominis thickness during contraction, which suggested reduced transversus abdominis strength in females with postpartum urinary incontinence. Thus, promoting synergistic contraction of the inner unit, including the transversus abdominis, in exercise therapy may be more effective for postpartum urinary incontinence.
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Affiliation(s)
- Sachiko Madokoro
- Division of Health Sciences, Graduate School of Medical Science, Kanazawa University: 5-11-80 Kodatsuno, Kanazawa, lshikawa 920-0942, Japan
| | - Hiroichi Miaki
- Division of Health Sciences, Graduate School of Medical Science, Kanazawa University: 5-11-80 Kodatsuno, Kanazawa, lshikawa 920-0942, Japan
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24
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Ben Ami N, Dar G. What is the most effective verbal instruction for correctly contracting the pelvic floor muscles? Neurourol Urodyn 2018; 37:2904-2910. [DOI: 10.1002/nau.23810] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 08/05/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Noa Ben Ami
- Faculty of Health Sciences; Department of Physiotherapy; Ariel University; Ariel Israel
| | - Gali Dar
- Faculty of Social Welfare and Health Studies, Department of Physiotherapy; Haifa University; Haifa Israel
- Ribstein Center for Research and Sports Medicine; Wingate Institute; Netanya Israel
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Panicker JN, Anding R, Arlandis S, Blok B, Dorrepaal C, Harding C, Marcelissen T, Rademakers K, Abrams P, Apostolidis A. Do we understand voiding dysfunction in women? Current understanding and future perspectives: ICI-RS 2017. Neurourol Urodyn 2018; 37:S75-S85. [DOI: 10.1002/nau.23709] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/05/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Jalesh N. Panicker
- Department of Uro-Neurology; The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology; Queen Square London United Kingdom
| | - Ralf Anding
- Neurourology; Department of Urology and Pediatric Urology; University Hospital Bonn; Bonn Germany
| | - Salvador Arlandis
- Department of Urology; Hospital Universitario y Politécnico La Fe; Valencia Spain
| | - Bertil Blok
- Department of Urology; Erasmus Medical Center; Rotterdam The Netherlands
| | | | - Chris Harding
- Department of Urology; Freeman Hospital; Newcastle Upon-Tyne United Kingdom
| | - Tom Marcelissen
- Department of Urology; Maastricht University Medical Centre; Maastricht The Netherlands
| | - Kevin Rademakers
- Department of Urology; Maastricht University Medical Centre; Maastricht The Netherlands
| | - Paul Abrams
- Department of Urology; University of Bristol; Bristol United Kingdom
- Department of Teaching and Research, Bristol Urological Institute; International Consultation on Urological Diseases; Bristol United Kingdom
| | - Apostolos Apostolidis
- 2nd Department of Urology; Aristotle University of Thessaloniki; Thessaloniki Greece
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Kubota A, Sakuraba K, Araki K, Ishizuka T, Nakaniida A, Suzuki Y. Effects of a facilitating device on pelvic floor muscle contraction during breathing exercises. J Phys Ther Sci 2018; 30:1468-1472. [PMID: 30568336 PMCID: PMC6279704 DOI: 10.1589/jpts.30.1468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 09/17/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to clarify the effects and to verify the efficacy of various breathing exercises performed while sitting on a small foam roller on the contraction of pelvic floor muscles in males. [Participants and Methods] This study, involving 10 healthy males (age 19.9 ± 1.6 years), had a crossover design and involved two conditions: sitting at rest for 10 min (CON condition) and sitting on a small foam roller placed on a chair while performing seven breathing exercises (EXE condition). Movement of the posterior side of the bladder was examined in both conditions using ultrasonic imaging. Pelvic floor muscle contraction was evaluated based on the movement distance. [Results] No significant difference was found in any parameter for CON conditions. The distance of bladder posterior side movement was 5.58 ± 2.51 mm (pre), 13.66 ± 5.16 mm (post), and 9.59 ± 3.67 mm (post-1 month) for EXE conditions. Subjective evaluation also demonstrated that the feeling of contraction was stronger immediately after the experiment. [Conclusion] Results demonstrated that various breathing exercises, performed while sitting on a small foam roller, enhanced the voluntary contraction of pelvic floor muscles in males. Efficacy was demonstrated, at least in young males.
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Affiliation(s)
- Atsushi Kubota
- Sports Medicine, School of Health and Sports Science, Graduate School of Health and Sports Science, Juntendo University: 1-1 Hiragagakuendai, Inzai, Chiba 270-1695, Japan
| | - Keishoku Sakuraba
- Department of Sports Medicine, Graduate School of Health and Sports Science, Juntendo University, Japan
| | - Kazutaka Araki
- School of Health Professions, Texas Tech University Health Sciences Center, USA
| | | | - Atsuko Nakaniida
- Sports Medicine, School of Health and Sports Science, Graduate School of Health and Sports Science, Juntendo University: 1-1 Hiragagakuendai, Inzai, Chiba 270-1695, Japan
| | - Yoshio Suzuki
- Sports Nutrition and Biochemistry, Graduate School of Health and Sports Science, Juntendo University School of Health and Sports Science, Japan
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Martín-Rodríguez S, Bø K. Is abdominal hypopressive technique effective in the prevention and treatment of pelvic floor dysfunction? Marketing or evidence from high-quality clinical trials? Br J Sports Med 2017; 53:135-136. [PMID: 29038216 DOI: 10.1136/bjsports-2017-098046] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Saúl Martín-Rodríguez
- Colegio Oficial de Licenciados en Educación Física de Canarias (COLEF), Las Palmas de Gran Canaria, Gran Canaria, Spain
| | - Kari Bø
- Department of Sports Medicine, Norwegian School of Sport Science, Oslo, Norway
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Navarro Brazález B, Torres Lacomba M, Arranz Martín B, Sánchez Méndez O. Respuesta muscular durante un ejercicio hipopresivo tras tratamiento de fisioterapia pelviperineal: valoración con ecografía transabdominal. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.ft.2017.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Martins LA, Santos KMD, Dorcínio MBA, Alves JO, Roza TD, Luz SCTD. A PERDA DE URINA É INFLUENCIADA PELA MODALIDADE ESPORTIVA OU PELA CARGA DE TREINO? UMA REVISÃO SISTEMÁTICA. REV BRAS MED ESPORTE 2017. [DOI: 10.1590/1517-869220172301163216] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Atualmente, diversos estudos relatam incontinência urinária (IU) entre mulheres jovens nulíparas e fisicamente ativas. Contudo, alguns investigam a prevalência da IU de acordo com as modalidades esportivas, enquanto outros investigam a carga de treino. A finalidade do presente estudo foi verificar se a modalidade esportiva é mais determinante na prevalência de IU do que a carga de treino entre mulheres jovens nulíparas. Para esta revisão sistemática, três revisores independentes realizaram uma busca de publicações originais nas bases de dados PubMed, LILACS e SciELO, entre 1994 e 2015. Foram utilizadas como estratégia de busca as palavras-chave: urinary incontinence AND (physical activity OR women OR nulliparous OR athletes), registradas na MeSH e no DeCS. Foram incluídos apenas estudos originais publicados nas línguas português, inglês e espanhol, que verificaram a IU em mulheres nulíparas, atletas ou praticantes de atividade física. Foram selecionados 873 estudos, mas somente dez artigos satisfizeram os critérios de inclusão e exclusão. Todos os artigos foram do tipo transversal, dos quais quatro relacionaram a IU com as modalidades esportivas, cinco verificaram a carga de treino com a perda de urina e um estudo verificou ambos os aspectos. Foi encontrada uma alta taxa de prevalência de IU entre atletas. Parece haver evidência de que as atividades que exigem salto, aterrissagem longa e corrida são as mais propensas a provocar perda de urina. Além disso, a maior carga de treino parece estar associada com a quantidade de urina perdida. Esta revisão evidencia as altas taxas de IU em praticantes de grandes cargas de treinamento associadas a esportes com salto, especialmente entre atletas. Contudo, ainda não há resposta para qual fator esportivo é mais determinante para a perda de urina entre mulheres nulíparas.
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Affiliation(s)
| | | | | | | | - Thuane da Roza
- Universidade do Estado de Santa Catarina (UDESC), Brazil; Universidade do Porto, Portugal
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Halski T, Ptaszkowski K, Słupska L, Dymarek R, Paprocka-Borowicz M. Relationship between lower limb position and pelvic floor muscle surface electromyography activity in menopausal women: a prospective observational study. Clin Interv Aging 2017; 12:75-83. [PMID: 28115836 PMCID: PMC5221554 DOI: 10.2147/cia.s121467] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives In physiotherapeutic practice, special attention is being given to the reciprocal anatomical, physiological, and biomechanical relationship of the pelvis and the structures connected to it. However, the scientific literature shows mainly the theoretical information about their mutual connections. The lack of information about these relations from a practical aspect coupled with the paucity of scientific papers on the impact of posture changes on the pelvic floor led the authors to conduct this study. The primary aim of this study was to compare the resting and functional bioelectrical activities of pelvic floor muscles (PFMs) depending on three different positions of the lower limbs (positions A, B, and C) in the supine position. Materials and methods This was a prospective observational study evaluating resting and functional activities of the PFM depending on the position of the lower limbs. The study was carried out at the Department and Clinic of Urology, University Hospital in Wroclaw, Poland and the target group were women in the menopausal period. Bioelectrical activity of PFM was recorded using a surface electromyographic instrument in the supine position. Results of the values obtained in A, B, and C positions were compared using a one-way analysis of variance. Results In position A, the average resting surface electromyography (sEMG) activity of PFM was 6.9±2.6 µV; in position B, the result was 6.9±2.5 µV and in position C, the resting sEMG activity was 5.7±1.8 µV (P=0.0102). The results of the functional bioelectrical activity of PFM were as follows: position A – 20.3±11.8 µV, position B – 19.9±10.6 µV, and position C – 25.3±10.9 µV (P=0.0104). Conclusion The results showed that in the supine position, the PFM achieved the lowest resting activity and the highest functional activity. Therefore, the supine position can be recommended for the diagnosis and therapy of weakened PFM.
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Affiliation(s)
- Tomasz Halski
- Department of Physiotherapy, Opole Medical School, Opole
| | - Kuba Ptaszkowski
- Department of Clinical Biomechanics and Physiotherapy in Motor System Disorders
| | - Lucyna Słupska
- Department of Physiotherapy, Opole Medical School, Opole
| | - Robert Dymarek
- Department of Nervous System Diseases, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
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Ferla L, Darski C, Paiva LL, Sbruzzi G, Vieira A. Synergism between abdominal and pelvic floor muscles in healthy women: a systematic review of observational studies. FISIOTERAPIA EM MOVIMENTO 2016. [DOI: 10.1590/0103-5150.029.002.ao19] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: The training of the pelvic floor muscles is widely used for treating pelvic floor dysfunctions, like urinary incontinence. During the training, abdominal contractions are avoided; however several studies support the use of the synergy between these muscle groups. Objective: Carrying out a systematic review of studies that seek to identify the presence of synergy between the muscles of the abdomen and the pelvic floor and its functionality in women without pelvic floor dysfunction. Methodology: To conduct the review, we have followed the recommendations proposed by the Cochrane Collaboration for systematic reviews. The literature search included the databases SCIELO, PEDro, MEDLINE, Cochrane CENTRAL and EMBASE, and manual research, the starting date of the databases until August 2013. We included cross observational studies with healthy women who were assessed to find the presence of synergy between the abdominal muscles and the pelvic floor. Results: We included 10 articles and they all showed the existence of synergy between the abdominal and pelvic floor muscles in healthy women in the supine, sitting and standing positions. Conclusion: Thus, we can conclude that there is synergy between the muscles of the abdomen and the pelvic floor in healthy women. Better understanding the behavior of these muscles and synergy may favor the development of strategies for the prevention and treatment of disorders of the female pelvic floor muscles.
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Affiliation(s)
- Lia Ferla
- Universidade Federal do Rio Grande do Sul, Brazil
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Jung H, Jung S, Joo S, Song C. Comparison of changes in the mobility of the pelvic floor muscle on during the abdominal drawing-in maneuver, maximal expiration, and pelvic floor muscle maximal contraction. J Phys Ther Sci 2016; 28:467-72. [PMID: 27065532 PMCID: PMC4792992 DOI: 10.1589/jpts.28.467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 10/31/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to compare changes in the mobility of the pelvic
floor muscle during the abdominal drawing-in maneuver, maximal expiration, and pelvic
floor muscle maximal contraction. [Subjects] Thirty healthy adults participated in this
study (15 men and 15 women). [Methods] All participants performed a bridge exercise and
abdominal curl-up during the abdominal drawing-in maneuver, maximal expiration, and pelvic
floor muscle maximal contraction. Pelvic floor mobility was evaluated as the distance from
the bladder base using ultrasound. [Results] According to exercise method, bridge exercise
and abdominal curl-ups led to significantly different pelvic floor mobility. The pelvic
floor muscle was elevated during the abdominal drawing-in maneuver and descended during
maximal expiration. Finally, pelvic floor muscle mobility was greater during abdominal
curl-up than during the bridge exercise. [Conclusion] According to these results, the
abdominal drawing-in maneuver induced pelvic floor muscle contraction, and pelvic floor
muscle contraction was greater during the abdominal curl-up than during the bridge
exercise.
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Affiliation(s)
- Halim Jung
- Department of Physical Therapy, Sahmyook University, Republic of Korea
| | - Sangwoo Jung
- Department of Physical Therapy, Sahmyook University, Republic of Korea
| | - Sunghee Joo
- Department of Physical Therapy, Sahmyook University, Republic of Korea
| | - Changho Song
- Department of Physical Therapy, Sahmyook University, Republic of Korea
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Ptaszkowski K, Paprocka-Borowicz M, Słupska L, Bartnicki J, Dymarek R, Rosińczuk J, Heimrath J, Dembowski J, Zdrojowy R. Assessment of bioelectrical activity of synergistic muscles during pelvic floor muscles activation in postmenopausal women with and without stress urinary incontinence: a preliminary observational study. Clin Interv Aging 2015; 10:1521-8. [PMID: 26445533 PMCID: PMC4590414 DOI: 10.2147/cia.s89852] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Muscles such as adductor magnus (AM), gluteus maximus (GM), rectus abdominis (RA), and abdominal external and internal oblique muscles are considered to play an important role in the treatment of stress urinary incontinence (SUI), and the relationship between contraction of these muscles and pelvic floor muscles (PFM) has been established in previous studies. Synergistic muscle activation intensifies a woman's ability to contract the PFM. In some cases, even for continent women, it is not possible to fully contract their PFM without involving the synergistic muscles. The primary aim of this study was to assess the surface electromyographic activity of synergistic muscles to PFM (SPFM) during resting and functional PFM activation in postmenopausal women with and without SUI. MATERIALS AND METHODS This study was a preliminary, prospective, cross-sectional observational study and included volunteers and patients who visited the Department and Clinic of Urology, University Hospital in Wroclaw, Poland. Forty-two patients participated in the study and were screened for eligibility criteria. Thirty participants satisfied the criteria and were categorized into two groups: women with SUI (n=16) and continent women (n=14). The bioelectrical activity of PFM and SPFM (AM, RA, GM) was recorded with a surface electromyographic instrument in a standing position during resting and functional PFM activity. RESULTS Bioelectrical activity of RA was significantly higher in the incontinent group than in the continent group. These results concern the RA activity during resting and functional PFM activity. The results for other muscles showed no significant difference in bioelectrical activity between groups. CONCLUSION In women with SUI, during the isolated activation of PFM, an increased synergistic activity of RA muscle was observed; however, this activity was not observed in asymptomatic women. This may indicate the important accessory contribution of these muscles in the mechanism of continence.
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Affiliation(s)
- Kuba Ptaszkowski
- Department of Obstetrics, Wroclaw Medical University, Wroclaw, Poland
| | - Małgorzata Paprocka-Borowicz
- Department of Clinical Biomechanics and Physiotherapy in Motor System Disorders, Wroclaw Medical University, Wroclaw, Poland
| | - Lucyna Słupska
- Department of Clinical Biomechanics and Physiotherapy in Motor System Disorders, Wroclaw Medical University, Wroclaw, Poland
| | - Janusz Bartnicki
- Department of Obstetrics, Wroclaw Medical University, Wroclaw, Poland ; Department of Obstetrics and Gynecology, Health Center Bitterfeld/Wolfen gGmbH, Bitterfeld-Wolfen, Germany
| | - Robert Dymarek
- Department of Nervous System Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Joanna Rosińczuk
- Department of Nervous System Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Jerzy Heimrath
- Department of Gynaecology and Obstetrics, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
| | - Janusz Dembowski
- Department and Clinic of Urology, Faculty of Postgraduate Medical Training, Wroclaw Medical University, Wroclaw, Poland
| | - Romuald Zdrojowy
- Department and Clinic of Urology, Faculty of Postgraduate Medical Training, Wroclaw Medical University, Wroclaw, Poland
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Bø K, Herbert RD. There is not yet strong evidence that exercise regimens other than pelvic floor muscle training can reduce stress urinary incontinence in women: a systematic review. J Physiother 2013; 59:159-68. [PMID: 23896331 DOI: 10.1016/s1836-9553(13)70180-2] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
QUESTION What evidence is there for alternative exercises to specific pelvic floor muscle training for treatment of stress urinary incontinence in women? DESIGN A systematic review was conducted with searches of PubMed and PEDro to January 2013. The quality of randomised trials was evaluated using the PEDro scale. Each type of exercise was classified as being in a Development Phase, Testing Phase, or Refinement and Dissemination Phase. PARTICIPANTS Women with stress or mixed urinary incontinence with predominantly stress urinary incontinence. INTERVENTION Exercise regimens other than pelvic floor muscle training. OUTCOME MEASURES The primary outcome was urinary leakage. RESULTS Seven randomised controlled trials were found: three on abdominal training, two on the Paula method, and two on Pilates exercise. The methodological quality score ranged between 4 and 8 with a mean of 5.7. There was no convincing evidence for the effect of these exercise regimens so they remain in the Testing Phase. Because no randomised trials were found for posture correction, breathing exercise, yoga, Tai Chi, and general fitness training, these were classified as being in the Development Phase. CONCLUSION There is not yet strong evidence that alternative exercise regimens can reduce urinary leakage in women with stress urinary incontinence. Alternative exercise regimens should not yet be recommended for use in clinical practice for women with stress urinary incontinence.
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Affiliation(s)
- Kari Bø
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.
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35
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The effect of abdominal and pelvic floor muscle activation patterns on urethral pressure. World J Urol 2012. [DOI: 10.1007/s00345-012-0995-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
Since its founding in Montreal, Canada in 1974, the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) has been providing orthopaedic and manual therapists from around the world with the highest-quality learning opportunities through a conference held every 4 years. In 2012, IFOMPT is partnering with The International Private Practitioners Association (IPPA) to host this prestigious event in Quebec City, Canada. As more than 51% of the Canadian Physiotherapy Association membership is working in private practice, this adds even greater value to this quadrennial event. This conference emulates best-evidence practice in the marriage of research and clinical excellence by pulling together some of the best and brightest hands and minds in orthopaedic physiotherapy. Through a call for proposals that equally emphasized research, clinical excellence, and the knowledge translation link between the two, the IFOMPT mandate of clinical and academic excellence has been kept at the forefront of this year's conference. Included in this supplement are the IFOMPT 2012 keynote addresses, schedule, and abstracts.
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Stafford RE, Ashton-Miller JA, Constantinou CE, Hodges PW. Novel insight into the dynamics of male pelvic floor contractions through transperineal ultrasound imaging. J Urol 2012; 188:1224-30. [PMID: 22902016 DOI: 10.1016/j.juro.2012.06.028] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Indexed: 11/16/2022]
Abstract
PURPOSE Transperineal ultrasound imaging enables the minimally invasive assessment of pelvic floor muscle function. Although commonly used in women, the approach has rarely been reported in men. This approach has advantages because the midsagittal view visualizes a bony landmark and the entire urethral length. This allows investigation of the displacement of multiple points along the urethra and the unique mechanical actions of multiple muscles that could influence continence. We used a new transperineal ultrasound technique to compare the relative displacement of urethrovesical junction, anorectal junction and distal urethra during voluntary pelvic floor muscle contractions in continent men. MATERIALS AND METHODS We performed measurement and comparison of urethral displacement at specific urethral regions in 10 continent men (age range 28 to 41 years). Measures made on 2-dimensional midsagittal plane ultrasound images included the displacements of specific points along the urethra. Anatomical considerations suggest that these are caused by contraction of the levator ani, striated urethral sphincter and bulbocavernosus muscles. Pearson's correlation coefficient was used to investigate the relationship between displacements of pairs of points. RESULTS Data show individual variation in displacement of the distal urethra (striated urethral sphincter contraction) and urethrovesical junction (levator ani contraction). A strong inverse linear relationship (0.723) between displacements of these points indicates 2 alternative strategies of urethral movement. CONCLUSIONS Transperineal ultrasound imaging allows the simultaneous investigation of multiple pelvic floor muscles by measuring urethral displacement. The data provide evidence of different but coordinated strategies of urethral displacement in men.
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Affiliation(s)
- Ryan E Stafford
- Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, the University of Queensland, Brisbane, Australia
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Sapsford RR, Hodges PW. The effect of abdominal and pelvic floor muscle activation on urine flow in women. Int Urogynecol J 2012; 23:1225-30. [PMID: 22278713 DOI: 10.1007/s00192-011-1654-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 12/24/2011] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Interruption of urine flow during micturition has been used as an assessment of ability to voluntarily contract the pelvic floor muscles (PFM). However, the PFM are also activated during specific abdominal manoeuvres. This study aimed to assess the effect of similar abdominal manoeuvres on urine flow and compare this with the effect of PFM contraction. METHODS Eight healthy women, of mixed parity, contracted the abdominal muscles and the PFM during urine flow on separate occasions. Differences in urine flow were compared using paired t tests. RESULTS All participants were able to interrupt the urine stream using both muscle activation patterns. There was no difference in the time taken to interrupt urine flow (p = 0.78) between the two patterns. CONCLUSIONS These data provide evidence that specific abdominal muscle manoeuvres influence urethral closure in continent women, and this is probably mediated by concurrent activation of PFM during the abdominal task.
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Affiliation(s)
- Ruth R Sapsford
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia 4072.
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Hay-Smith EJC, Herderschee R, Dumoulin C, Herbison GP. Comparisons of approaches to pelvic floor muscle training for urinary incontinence in women. Cochrane Database Syst Rev 2011:CD009508. [PMID: 22161451 DOI: 10.1002/14651858.cd009508] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Pelvic floor muscle training is the most commonly recommended physical therapy treatment for women with stress urinary incontinence. It is also sometimes recommended for mixed and, less commonly, urge urinary incontinence. The supervision and content of pelvic floor muscle training programmes are highly variable, and some programmes use additional strategies in an effort to increase adherence or training effects. OBJECTIVES To compare the effects of different approaches to pelvic floor muscle training for women with urinary incontinence. SEARCH METHODS We searched the Cochrane Incontinence Group Specialised Trials Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and CINAHL, and handsearching of journals and conference proceedings (searched 17 May 2011), and the reference lists of relevant articles. SELECTION CRITERIA Randomised trials or quasi-randomised trials in women with stress, urge or mixed urinary incontinence (based on symptoms, signs or urodynamics). One arm of the study included pelvic floor muscle training. Another arm was an alternative approach to pelvic floor muscle training, such as a different way of teaching, supervising or performing pelvic floor muscle training. DATA COLLECTION AND ANALYSIS We independently assessed trials for eligibility and methodological quality. We extracted then cross-checked data. We resolved disagreements by discussion. We processed data as described in the Cochrane Handbook for Systematic Reviews of Interventions (version 5.2.2). We subgrouped trials by intervention. MAIN RESULTS We screened 574 records for eligibility and included 21 trials in the review. The 21 trials randomised 1490 women and addressed 11 comparisons. These were: differences in training supervision (amount, individual versus group), in approach (one versus another, the effect of an additional component) and the exercise training (type of contraction, frequency of training). In women with stress urinary incontinence, 10% of those who received weekly or twice-weekly group supervision in addition to individual appointments with the therapist did not report improvement post-treatment compared to 43% of the group who had individual appointments only (risk ratio (RR) for no improvement 0.29, 95% confidence interval (CI) 0.15 to 0.55, four trials). Looking at this another way, 90% of those who had combined group and individual supervision reported improvement versus 57% of women receiving individual supervision only. While women receiving the combination of frequent group supervision and individual supervision of pelvic floor muscle training were more likely to report improvement, the confidence interval was wide, and more than half of the 'control' group (the women who did not get the additional weekly or twice-weekly group supervision) reported improvement. This finding, of subjective improvement in both active treatment groups, with more improvement reported by those receiving more health professional contact, was consistent throughout the review.We feel there are several reasons why caution is needed when interpreting the results of the review: there were few data in any comparison; a number of trials were confounded by comparing two arms with multiple differences in the approaches to pelvic floor muscle training; there was a likelihood of a relationship between attention and reporting of more improvement in women who were not blind to treatment allocation; some trials chose interventions that were unlikely to have a muscle training effect; and some trials did not adequately describe their intervention. AUTHORS' CONCLUSIONS This review found that the existing evidence was insufficient to make any strong recommendations about the best approach to pelvic floor muscle training. We suggest that women are offered reasonably frequent appointments during the training period, because the few data consistently showed that women receiving regular (e.g. weekly) supervision were more likely to report improvement than women doing pelvic floor muscle training with little or no supervision.
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Affiliation(s)
- E Jean C Hay-Smith
- Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand
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40
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Stüpp L, Resende APM, Petricelli CD, Nakamura MU, Alexandre SM, Zanetti MRD. Pelvic floor muscle and transversus abdominis activation in abdominal hypopressive technique through surface electromyography. Neurourol Urodyn 2011; 30:1518-21. [PMID: 21826719 DOI: 10.1002/nau.21151] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 04/14/2011] [Indexed: 11/09/2022]
Abstract
AIMS The abdominal hypopressive technique (AHT) is performed mainly via transversus abdominis (TrA) activation and has been indicated for pelvic floor muscle (PFM) disorders. In some European countries, this technique has become widely used. This study aimed to investigate PFM and TrA activation during the AHT through surface electromyography. METHODS Thirty-four nulliparous physical therapists in good general health were asked to participate in the trial. To ascertain a correct PFM contraction, each of the participants was assessed by inspection and digital palpation. Ability to contract the TrA was assessed by surface electromyography and AHT training was given before analysis. TrA and PFM activity was recorded using surface electromyography. RESULTS The mean age of the volunteers was 28.1 (±6.0) years and the mean body mass index was 23.7 (±3.3) kg/m(2) . More than half of the volunteers were physically active (61.3%) and regularly performed PFM training (52.9%) but not TrA exercises (58.8%). Although the AHT activates the PFM when compared to resting tone (P < 0.001), this method is significantly less effective than PFM alone (P < 0.001). Additionally, the combination of the two techniques (AHT + PFM) was similarly effective as isolated PFM contraction (P = 0.586). Although the AHT activated the TrA significantly more than did PFM alone (P = 0.002), the addition of PFM contraction to the AHT significantly increased the amount of TrA activation (P < 0.001). CONCLUSIONS Based on our results, the AHT is less effective than PFM contraction alone, and adding PFM contraction to AHT also improves the TrA contraction.
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Affiliation(s)
- Liliana Stüpp
- Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil.
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Nelson P, Apte G, Justiz R, Brismeé JM, Dedrick G, Sizer PS. Chronic Female Pelvic Pain-Part 2: Differential Diagnosis and Management. Pain Pract 2011; 12:111-41. [DOI: 10.1111/j.1533-2500.2011.00492.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Arab AM, Behbahani RB, Lorestani L, Azari A. Correlation of digital palpation and transabdominal ultrasound for assessment of pelvic floor muscle contraction. J Man Manip Ther 2011; 17:e75-9. [PMID: 20046616 DOI: 10.1179/jmt.2009.17.3.75e] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Pelvic floor muscle (PFM) dysfunction has been commonly associated with urinary disorders and lumbo-pelvic pain. Transabdominal (TA) ultrasound is currently used by physical therapists to assess PFM function. Controversy exists regarding the correlation between TA ultrasound measurement and vaginal palpation for assessment of PFM contraction, and this relationship has not yet been examined concurrently during the same contraction. The purpose of this study was to determine the correlation of digital palpation and TA ultrasound to assess PFM contraction when recorded 1) simultaneous to digital palpation during one contraction and 2) following digital palpation testing in another contraction. A descriptive correlational design was used to describe the relationship between variables. A total of 19 women (both asymptomatic women and those with incontinence or lumbo-pelvic pain) participated in the study. The modified Oxford scale was used to grade PFM contraction in digital palpation testing. The amount of bladder base movement on ultrasound was measured and considered as an indicator of PFM activity. Two trials were performed for TA ultrasound measurement: 1) simultaneous to digital palpation during one contraction, and 2) following digital palpation testing in another contraction. Spearman's correlation coefficient was used for analysis. There was a significant correlation between digital palpation and TA ultrasound for PFM assessment when measured simultaneously in one contraction (rho=0.62, p=0.01) and separately in a different contraction (rho=0.52, p=0.02), with a stronger correlation found in simultaneous testing. In conclusion, digital palpation and TA ultrasound measurement are significantly correlated and measure comparable parameters in evaluation of PFM contraction.
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Nahon I, Waddington G, Adams R, Dorey G. Assessing muscle function of the male pelvic floor using real time ultrasound. Neurourol Urodyn 2011; 30:1329-32. [PMID: 21563212 DOI: 10.1002/nau.21069] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 12/22/2010] [Accepted: 01/06/2011] [Indexed: 11/10/2022]
Affiliation(s)
- Irmina Nahon
- Faculty of Health, University of Canberra, Canberra, Australia.
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Korelo RIG, Kosiba CR, Grecco L, Matos RA. Influência do fortalecimento abdominal na função perineal, associado ou não à orientação de contração do assoalho pélvico, em nulíparas. FISIOTERAPIA EM MOVIMENTO 2011. [DOI: 10.1590/s0103-51502011000100009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Verificar se o fortalecimento abdominal promove influência na musculatura do assoalho pélvico feminino. MATERIAIS E MÉTODOS: Caracterizou-se como um ensaio clínico, realizado com 21 nulíparas, com idade média de 21,7 anos, divididas por conveniência em dois grupos: A (n = 10) - com orientação de contração perineal simultânea à contração abdominal e B (n = 11) - sem orientação de contração perineal. As participantes foram submetidas à avaliação ginecológica e abdominal pré e pós-intervenção por meio de: avaliação funcional do assoalho pélvico (AFA), cones vaginais, perineometria, teste de flexão anterior de tronco, descida de membros inferiores, força de oblíquos e endurance abdominal. O protocolo de fortalecimento abdominal continha três exercícios distintos, associados ou não à contração perineal, com três séries de dez repetições e repouso de 60 segundos, três vezes por semana, em um período de seis semanas. Para a análise estatística foi aplicado o teste t de Student e ANOVA. RESULTADOS: A comparação entre os valores iniciais e finais demonstrou diferenças significativas entre os dois grupos na avaliação do períneo, somente no teste com cones (p = 0,00) e na perineometria (resistência/pressão) (p = 0,03), indicando piora das variáveis no grupo B. Já na avaliação abdominal, o grupo A apresentou resultado significativo em três testes (descida de membros inferiores: p = 0,03, endurance: p = 0,03 e endurance modificado: p = 0,00) comparando-se a somente um do grupo B (endurance: p = 0,01). CONCLUSÕES: Sugere-se que a associação de exercícios de fortalecimento abdominal com o perineal pode potencializar o ganho de força e a função desses grupos musculares, e a falta dessa associação pode prejudicar a funcionalidade do assoalho pélvico.
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Bø K, Bratland-Sanda S, Sundgot-Borgen J. Urinary incontinence among group fitness instructors including yoga and pilates teachers. Neurourol Urodyn 2011; 30:370-3. [DOI: 10.1002/nau.21006] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 08/31/2010] [Indexed: 11/08/2022]
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Bø K, Hilde G, Stær-Jensen J, Brækken IH. Can the Paula method facilitate co-contraction of the pelvic floor muscles? A 4D ultrasound study. Int Urogynecol J 2010; 22:671-6. [DOI: 10.1007/s00192-010-1317-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 10/31/2010] [Indexed: 11/28/2022]
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Evaluation of pelvic floor function by transabdominal ultrasound in postpartum women. J Med Ultrason (2001) 2010; 37:187-93. [DOI: 10.1007/s10396-010-0271-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Accepted: 05/18/2010] [Indexed: 10/19/2022]
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Assessment of pelvic floor muscle function in women with and without low back pain using transabdominal ultrasound. ACTA ACUST UNITED AC 2010; 15:235-9. [DOI: 10.1016/j.math.2009.12.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2008] [Revised: 10/25/2009] [Accepted: 12/14/2009] [Indexed: 11/17/2022]
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Hung HC, Hsiao SM, Chih SY, Lin HH, Tsauo JY. An alternative intervention for urinary incontinence: Retraining diaphragmatic, deep abdominal and pelvic floor muscle coordinated function. ACTA ACUST UNITED AC 2010; 15:273-9. [DOI: 10.1016/j.math.2010.01.008] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Revised: 01/13/2010] [Accepted: 01/21/2010] [Indexed: 11/16/2022]
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