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Toprak Celenay S, Yardimci FB, Altay H. Pelvic floor muscle strength and dysfunctions in women with pes planus: A case-control study. J Bodyw Mov Ther 2024; 39:38-42. [PMID: 38876655 DOI: 10.1016/j.jbmt.2024.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 12/07/2023] [Accepted: 02/25/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND/AIM Distal extremity misalignment may give rise to pelvic floor dysfunctions (PFDs). This study aimed to compare pelvic floor muscle strength (PFMS) and dysfunctions in women with and without pes planus. MATERIALS AND METHODS Women with (pes planus group, n = 30) and without pes planus (control group, n = 30) were included. The presence of PFDs questioned. Pes planus with the Feiss Line Test, PFMS with the Modified Oxford Scale, and the severity of PFDs with the Pelvic Floor Distress Inventory-20 (PFDI-20), including three subscales (Pelvic Organ Distress Inventory-6 (POPDI-6) for pelvic organ prolapse, Colorectal-Anal Distress Inventory-8 (CRADI-8) for colorecto-anal symptoms, and Urinary Distress Inventory-6 (UDI-6) for urinary symptoms, were assessed. RESULTS It was seen that no difference was found between groups in terms of PFMS (p > 0.05). However, urinary incontinence and anal incontinence were higher in women with pes planus than in women without pes planus (p < 0.05). Only the PFDI-20, CRADI-8, and UDI-6 scores were higher in women with pes planus compared to controls (p < 0.05). There was no difference was found between groups in terms of POPDI-6 scores (p > 0.05). CONCLUSION The PFMS did not change according to the presence of pes planus. However, the prevalence of PFDs and their severity were higher in women with pes planus in comparison to controls. Posture assessments of individuals with PFDs, especially examination of foot posture, and pelvic floor assessments of individuals with posture disorders should be considered.
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Affiliation(s)
- Seyda Toprak Celenay
- Ankara Yildirim Beyazit University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, 06760, Cubuk, Ankara, Turkey.
| | - Fatma Betul Yardimci
- Mardin Artuklu University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, 47000, Artuklu, Mardin, Turkey
| | - Hafize Altay
- Mardin Artuklu University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, 47000, Artuklu, Mardin, Turkey
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Escamilla RF, Thompson IS, Carinci J, MacLean D, MacLean L, Aguinaldo AL. Effects of Ankle Position While Performing One- and Two-Leg Floor Bridging Exercises on Core and Lower Extremity Muscle Recruitment. Bioengineering (Basel) 2024; 11:356. [PMID: 38671779 PMCID: PMC11048684 DOI: 10.3390/bioengineering11040356] [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: 02/03/2024] [Revised: 03/20/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
Given there are no known studies which have examined multiple lower extremity muscles between different ankle positions during bridging activities, the objective was to assess how employing two different ankle positions (PF versus DF) while performing five common bridging exercises (three bipedal and two unipedal) used in rehabilitation and athletic performance affect core and select lower extremity muscle EMG recruitment. Twenty healthy subjects performed a 5 s isometric hold during five two- and one-leg bridge exercises: (1) on right leg with left knee to chest (1LB-LFlex); (2) on right leg with left knee extended (1LB-LExt); (3) standard two-leg bridge (2LB); (4) two-leg bridge with resistance band around knees (2LB-ABD); and (5) two-leg bridge with ball between knees (2LB-ADD). Surface electromyographic (EMG) data were collected using a Noraxon Telemyo Direct Transmission System from fourteen muscles: (1) three superficial quadriceps (VM, VL, and RF); (2) three hip abductors (TFL, GMED, and GMAX); (3) medial hamstrings (ST) and lateral hamstrings (BF); (4) hip adductors (ADD); (5) erector spinae (ES); (6) latissimus dorsi (LATS); (7) upper rectus abdominis (RA); and (8) external oblique (EO) and internal oblique (IO). EMG data were normalized by maximum voluntary isometric contractions (MVICs). A paired t-test (p < 0.01) was used to assess differences in normalized mean EMG activities between DF and PF for each exercise. EMG activities were significantly greater in DF than PF for the (a) VM, VL, and RF during 1LB-LFlex; (b) ADD during 1LB-LFlex, 1LB-LExt; (c) EO during 1LB-LFlex; and (d) IO during 1LB-LFex. In contrast, EMG activities were significantly greater in PF than DF for ST and BF during all five bridge exercises. Bridging with PF (feet flat) was most effective in recruiting the hamstrings, while bridging with DF (feet up) was most effective in recruiting the quadriceps, hip adductors, and internal and external obliques.
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Affiliation(s)
- Rafael F. Escamilla
- Department of Physical Therapy, California State University, Sacramento, CA 95819, USA;
| | - Irwin S. Thompson
- Department of Physical Therapy, California State University, Sacramento, CA 95819, USA;
| | - Joe Carinci
- UC Davis Sports Medicine & Orthopedics, Sacramento, CA 95817, USA;
| | - Daniel MacLean
- MAC Performance Physical Therapy, Sacramento, CA 95827, USA; (D.M.)
| | - Lisa MacLean
- MAC Performance Physical Therapy, Sacramento, CA 95827, USA; (D.M.)
| | - Arnel L. Aguinaldo
- Department of Kinesiology, Point Loma Nazarene University, San Diego, CA 92106, USA;
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Wang Y, Shi C, Jiao W, Yu W, Shi G, Zheng J. Wearing high heels with an appropriate height is protective for pelvic floor function. Transl Androl Urol 2021; 10:2493-2499. [PMID: 34295735 PMCID: PMC8261421 DOI: 10.21037/tau-21-486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/17/2021] [Indexed: 11/18/2022] Open
Abstract
Background Wearing high-heeled shoes is a common phenomenon among women. However, the association between wearing high heels and pelvic floor function is largely unknown. Our aim was to evaluate the effects of wearing different height shoes on pelvic floor function and to analyze the influencing factors. Methods This was a population-based, cross-sectional study performed in general hospitals with a pelvic floor subspecialty in some cities of China. All participants completed a Urogenital Distress Inventory (UDI-6) questionnaire that consisted of demographic data, information about wearing shoes, and information about pelvic floor function (UDI-6). One-way ANOVA was carried out to compare the differences among 4 groups according to the heel height (<3, 3–5, 5–7, and >7 cm groups). Multivariate logistic regression was performed to identify the factors influencing the effect of wearing 3–5 cm high-heeled shoes on pelvic floor function. Results In total, 1,263 participants finished the questionnaire and full data were collected. The 4 groups were comparable for clinical data, and participants who wore 3–5 cm high-heeled shoes had the lowest UDI-6 scores. Multivariate analysis revealed that the number of hours (≥8 h) wearing high heels per day and the thickness diameter (≥3 cm) of the heel were important factors affecting the protective effect of wearing 3–5 cm high-heeled shoes on pelvic floor function. Conclusions Wearing heeled shoes with a 3–5 cm heel height and ≥3 cm thickness for a long period of time is good for the pelvic floor function of women.
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Affiliation(s)
- Yangyun Wang
- Department of Urology, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Chaoliang Shi
- Department of Urology, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Wei Jiao
- Department of Urology, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Wandong Yu
- Department of Urology, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Guowei Shi
- Department of Urology, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Junhua Zheng
- Department of Urology, Shanghai Renji Hospital, Shanghai, China
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Saltiel F, Miranda-Gazzola APG, Vitória RO, Sampaio RF, Figueiredo EM. Linking Pelvic Floor Muscle Function Terminology to the International Classification of Functioning, Disability and Health. Phys Ther 2020; 100:1659-1680. [PMID: 32201881 DOI: 10.1093/ptj/pzaa044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 02/11/2020] [Indexed: 02/09/2023]
Abstract
OBJECTIVE A previous systematic review on pelvic floor muscle function (PFMF) identified a miscellaneity of terms. The lack of consensual terminology might have come from the complexity of neuromusculoskeletal function itself. This study sought to link the previously identified PFMF terms to the International Classification of Functioning, Disability and Health (ICF) terminology. METHODS In this secondary analysis study, 10 linkage rules were applied to link 196 previously identified PFMF terms to the ICF. Two researchers performed the linking process independently. Disagreements were solved by open dialogue with a third researcher. Percentage agreement was computed for main outcome. RESULTS A total of 184 (93.9%) PFMF terms were subsumed into the following 6 ICF terms: tone, involuntary movement reaction, control, coordination, strength, and endurance. The most frequently investigated PFMF was strength (25.5%), followed by involuntary movement reaction (22.9%), endurance (17.2%), control (14.1%), coordination (9.9%), and tone (4.2%). Only 6.2% PFMF could not be linked to ICF terminology. A wide variation of instruments/methods was used to measure PFMF. Vaginal palpation was the only method employed to measure all 6 PFMF. Percentage agreement between raters was 100%. CONCLUSIONS Linking PFMF terminology to the ICF was feasible and valid. It allowed the identification of the most investigated PFMF and their measuring methods. ICF terminology to describe PFMF should be used since it may improve communication, data gathering, and the advance in scientific knowledge. IMPACT Standardized terminology anchored in a theoretical framework is crucial to data gathering, communication, and dissemination of evidence-based practice. PFMF terminology based on ICF can be used to improve data pooling and communication.
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Lee K. Investigation of Electromyographic Activity of Pelvic Floor Muscles in Different Body Positions to Prevent Urinary Incontinence. Med Sci Monit 2019; 25:9357-9363. [PMID: 31813929 PMCID: PMC6918805 DOI: 10.12659/msm.920819] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background This study aimed to determine whether trunk stability muscles co-contract with body position as a factor of pelvic floor muscle (PFM) activity. Material/Methods Sixty-one healthy adults without pelvic floor dysfunction were examined for pelvic floor and trunk stability muscle activity in 4 body positions (ankle dorsiflexion and plantar flexion in standing position, and ankle dorsiflexion and plantar flexion in long sitting position). The activities of the PFMs via anal/vaginal probes, internal oblique (IO), multifidus (MF), tibialis anterior, and gastrocnemius muscles were measured by surface electromyography. Three-dimensional motion analysis measured the movement of the pelvis in real time according to the change in body position. Results There was a significant increase in PFM activity from the ankle neutral position while standing for both ankle dorsiflexion and plantar flexion in standing position (p<0.05). In maximal contraction of PFM in the standing position, IO and MF were found to co-activate (p<0.05). Conclusions In standing position, the ankle dorsiflexion and plantar flexion positions activated PFMs, which was found to co-activate with trunk stability muscles. Pelvic floor training programs based on the results of this study may be helpful in patients with incontinence.
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Affiliation(s)
- Kyeongjin Lee
- Department of Physical Therapy, Kyungdong University, Wonju, Gangwon, South Korea
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Kannan P, Fung B, Leung RW, Goonetilleke R, Winser SJ. Association between high-heeled shoes of varied heel height and bladder neck elevation in women: an exploratory study. FOOTWEAR SCIENCE 2019. [DOI: 10.1080/19424280.2019.1588922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Priya Kannan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | | | | | | | - Stanley J. Winser
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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Vitton V, Luciano L, Ortiz S, Baumstarck K, Bouvier M. Can wearing high heels influence anal canal pressure and the severity of fecal incontinence? Int Urogynecol J 2019; 30:2049-2054. [PMID: 30796476 DOI: 10.1007/s00192-019-03902-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 02/05/2019] [Indexed: 12/18/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Wearing high heels may not only produce deleterious effects on the musculoskeletal system and on the general posture, but also on the activity of pelvic floor muscles. However, no data are currently available concerning the link between fecal incontinence and wearing high heels. Our aim was to determine whether wearing high-heeled shoes could influence anal canal pressure values in patients suffering from fecal incontinence. METHODS In this retrospective monocentric study, 338 female patients were included. Clinical data, including the Wexner score, and manometric data were recorded (using 3D high-resolution anorectal manometry). Wearing high heels was defined by the use of high-heeled shoes at least four times a week for 4 consecutive hours with at least 1 year of usage time and heels ≥3 cm. Two sub-groups were defined: "high heels" vs "no high heels." RESULTS The two subgroups were comparable for clinical data, including Wexner score, except for a higher age, menopause and hormone replacement therapy, and urinary incontinence in the group with "high heels." No statistical difference was observed concerning the anal canal pressure. Using analysis by logistic regression, only age was related to a significantly lower resting pressure. CONCLUSIONS In this retrospective cohort of women with fecal incontinence, no clinical or manometric differences were observed between women who wore high heels versus those who did not. Because there is limited knowledge on this potential link and because the pelvic tilt may vary according to age and the habit of walking with high heels, further studies are necessary.
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Affiliation(s)
- Veronique Vitton
- Service de Gastroentérologie, CHU Nord, Aix-Marseille Université, Marseille, France
| | - Laure Luciano
- Department of Gastroenterology, Instruction Hospital of French Army Laveran, Marseille, France. .,Department of Gastroenterology, French Military Hospital Laveran, 13384, Marseille Cedex, France.
| | - Sandra Ortiz
- Service de Gastroentérologie, CHU Nord, Aix-Marseille Université, Marseille, France
| | - Karine Baumstarck
- EA3279 Self-perceived Health Assessment Research Unit, University Hospital, Aix-Marseille Université, APHM, Marseille, France
| | - Michel Bouvier
- Service de Gastroentérologie, CHU Nord, Aix-Marseille Université, Marseille, France
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Lee K. Activation of Pelvic Floor Muscle During Ankle Posture Change on the Basis of a Three-Dimensional Motion Analysis System. Med Sci Monit 2018; 24:7223-7230. [PMID: 30301876 PMCID: PMC6192454 DOI: 10.12659/msm.912689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Weak pelvic floor muscles (PFMs) is an important cause of stress urinary incontinence. Effective strengthening of PFMs is very helpful in improving lower urinary tract disease. The purpose of this study was to determine the activation of PFMs in accordance with movement of the pelvis and ankle. MATERIAL AND METHODS Fifty healthy adults who underwent PFM contraction in ankle posture change (dorsiflexion, neutral, and plantar flexion) while standing were simultaneously measured using electromyography and motion capture systems. Muscle activity at the tibialis anterior and gastrocnemius muscles was measured by surface electromyography electrodes and PFMs was measured using anal/vaginal probe. Motion analysis was captured by 3-dimensional motion trajectories of the retro-reflective markers. RESULTS At the ankle dorsiflexion, pelvic tilted anteriorly and PFMs were activated, but there was no pelvic movement in ankle plantar flexion. Significantly greater PFM activities were seen in ankle dorsiflexion. CONCLUSIONS PFM exercises performed in active ankle dorsiflexion positions while standing may increase the effectiveness of these exercises. For an effective pelvic floor enhancement in patients with weak PFMs, we recommend a dorsiflexion of the ankle in the standing position.
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Affiliation(s)
- Kyeongjin Lee
- Department of Physical Therapy, Kyungdong University, Gangwon, South Korea
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9
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Saltiel F, Miranda-Gazzola APG, Vitória RO, Figueiredo EM. Terminology of Pelvic Floor Muscle Function in Women With and Without Urinary Incontinence: A Systematic Review. Phys Ther 2018; 98:876-890. [PMID: 30010919 DOI: 10.1093/ptj/pzy084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 04/08/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND Pelvic floor muscle function (PFMF) is a target of the physical therapist intervention for women with urinary incontinence (UI). However, possible variations in PFMF terminology might hamper communication among researchers and health care professionals in Women's Health. OBJECTIVE The objective of this study was to investigate the terminology of PFMF regarding clear terms, conceptual definitions, and operational definitions. DATA SOURCES Data sources include PUBMED, CINAHL, LILACS, and SCIELO. STUDY SELECTION Observational studies investigating any PFMF in women with or without UI, published in English, Spanish, or Portuguese from 2005 through 2017, were considered. DATA EXTRACTION The risk of bias was assessed by a questionnaire on the quality of observational studies. Data on terminology were extracted as terms, conceptual definitions, and operational definitions of PFMF and were synthesized according to key words, key ideas, and key operationalization, respectively. Consistencies and variations were identified for the most frequently investigated PFMF. DATA SYNTHESIS Sixty-four studies were included, and a low risk of bias was identified. All studies presented terms and operational definitions of PFMF, but only 29.7% presented conceptual definitions of those terms. One hundred ninety-six different terms referred to PFMF. According to similarities in terminology, 161 PFMF terms could be grouped under 26 terms; the other 35 were left ungrouped. Therefore, a total of 61 different PFMF terms were identified in the literature. LIMITATIONS A limitation in the study was that only observational studies were included. CONCLUSIONS A large variation in PFMF terminology was identified, precluding data gathering and meta-analysis. The lack of use of standardized terminology delays the progress of scientific knowledge and evidence-based practice dissemination. Efforts toward creating a collaborative, consensual terminology based on a sound framework are necessary.
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Affiliation(s)
- Fernanda Saltiel
- Rehabilitation Sciences Program, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Women's Health Specialist, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Elyonara M Figueiredo
- Physical Therapy Department, Rehabilitation Sciences Program, Universidade Federal de Minas Gerais, Av. Antonio Carolos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901 Brazil
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Kannan P, Winser S, Goonetilleke R, Cheing G. Ankle positions potentially facilitating greater maximal contraction of pelvic floor muscles: a systematic review and meta-analysis. Disabil Rehabil 2018; 41:2483-2491. [PMID: 29733699 DOI: 10.1080/09638288.2018.1468934] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objectives: To evaluate the effect of ankle positions on pelvic floor muscles in women. Methods: Multiple databases were searched from inception-July 2017. Study quality was rated using the grading of recommendations, assessment, development, and evaluation system and the "threats to validity tool". Results: Four studies were eligible for inclusion. Meta-analysis revealed significantly greater resting activity of pelvic floor muscles in neutral ankle position (-1.36 (95% CI -2.30, -0.42) p = 0.004) and induced 15° dorsiflexion (-1.65 (95% CI -2.49, -0.81) p = 0.0001) compared to induced 15° plantar flexion. Significantly greater maximal voluntary contraction of pelvic floor was found in dorsiflexion compared to plantar flexion (-2.28 (95% CI -3.96, -0.60) p = 0.008). Meta-analyses revealed no significant differences between the neutral ankle position and 15° dorsiflexion for either resting activity (0.30 (95% CI -0.75, 1.35) p = 0.57) or maximal voluntary contraction (0.97 (95% CI -0.77, 2.72) p = 0.27). Conclusion: Pelvic floor muscle-training for women with urinary incontinence could be performed in standing with ankles in a neutral position or dorsiflexion to facilitate greater maximal pelvic floor muscle contraction. As urethral support requires resting contraction of pelvic floor muscles, decreased resting activity in plantar flexion identified in the meta-analysis indicates that high-heel wearers with urinary incontinence might potentially experience more leakage during exertion in a standing position. Implications for rehabilitation Pooled analyses revealed that maximal voluntary contraction of pelvic floor muscle is greater in induced ankle dorsiflexion than induced plantar flexion. As pelvic floor muscle strengthening involves achieving a greater maximal voluntary contraction, pelvic floor muscle training for women with stress urinary incontinence could be performed in standing either with ankles in a neutral position or dorsiflexion. Decreased resting activity in plantar flexion identified in the meta-analysis indicates that high-heel wearers with stress urinary incontinence might potentially experience more leakage during exertion in a standing position. Women with stress urinary incontinence should be advised to wear flat shoes instead of high-heels and should be cautioned about body posture and ankle positions assumed during exercise and daily activities.
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Affiliation(s)
- Priya Kannan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University , Hung Hom , Hong Kong
| | - Stanley Winser
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University , Hung Hom , Hong Kong
| | - Ravindra Goonetilleke
- Human Performance Laboratory, Department of Industrial Engineering and Logistics Management, The Hong Kong University of Science and Technology , Kowloon , Hong Kong
| | - Gladys Cheing
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University , Hung Hom , Hong Kong
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Krzysztoszek K, Truszczyńska-Baszak A. Physical therapy in stress urinary incontinence among women – a review of the literature and a suggested treatment protocol. REHABILITACJA MEDYCZNA 2018. [DOI: 10.5604/01.3001.0011.8078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Stress urinary incontinence is an increasingly common problem among women. The disorder affects every third woman, regardless of age. To make treatment of these women more effective, the therapeutic treatment path should be regulated. Important elements are cooperation between specialists, prevention and conservative treatment. This paper is a systematic review of current literature concerning physiotherapy in the treatment of stress urinary incontinence in women.
Aim of the study: The main aim of the study was to develop a physiotherapy protocol for this particular group of patients.
Material and methods: The following databases: Pubmed, Google Scholar, Cochrane Library, Scopus were searched using the following keywords: stress urinary incontinence therapy/ physiotherapy/manual therapy, pelvic floor muscle training/ diagnostic/ investigation, pelvic floor dysfunction, diaphragm. The information available on the websites of the Polish Urogynecological Association, Przegląd Urologiczny (Urological Review) and the UroConti Association was also used.
Results: On the basis of the collected literature, the Polish medical care system for patients with stress urinary incontinence
in Poland was presented, the effectiveness of physiotherapeutic methods was determined and elements of therapy worthy of
further attention were marked. On the basis of the collected information, a physiotherapeutic protocol was proposed in stress
urinary incontinence.
Conclusions: 1. Physiotherapy as a form of treatment of stress urinary incontinence should always constitute a part of the therapeutic process. Used as the first in some cases, it helps avoid surgical intervention. It can also reduce the risk of complications after surgical intervention. 2. The therapeutic treatment path should also include diagnostics and physiotherapeutic treatment. 3. In the treatment of a patient with stress urinary incontinence, the following elements should be taken into account: body posture, breathing method, patient’s habits, pelvic floor muscle work. 4. For physiotherapy in stress urinary incontinence to be more accessible and widespread, it should be refunded. 5. Physiotherapy in stress urinary incontinence requires further systematic research.
Article received: 04.01.2018; Accepted: 15.04.2018
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Affiliation(s)
- Katarzyna Krzysztoszek
- Studia doktoranckie, Wydział Wychowania Fizycznego, Akademia Wychowania Fizycznego im. Józefa Piłsudskiego w Warszawie / Doctoral studies, Department of Physical Education, Józef Piłsudski University of Physical Education in Warsaw, Poland
| | - Aleksandra Truszczyńska-Baszak
- Katedra Fizjoterapii, Wydział Rehabilitacji, Akademia Wychowania Fizycznego im. Józefa Piłsudskiego w Warszawie / Faculty of Rehabilitation, Józef Piłsudski University of Physical Education in Warsaw, Poland
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Ribeiro AM, Mateus-Vasconcelos ECL, Silva TDD, Brito LGDO, Oliveira HFD. Functional assessment of the pelvic floor muscles by electromyography: is there a normalization in data analysis? A systematic review. FISIOTERAPIA E PESQUISA 2018. [DOI: 10.1590/1809-2950/16559525012018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
ABSTRACT This study aims to evaluate the method of analysis of electromyographic data considering the functional assessment of pelvic floor muscles (PFM). We have included in our search strategy the following databases: Medline, PubMed, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, PEDro, and IBECS, considering articles published in the last ten years (2004-2014). The identified articles were independently examined by two evaluators, according to these inclusion criteria: (1) population: female adults; (2) PFM assessment by electromyography (EMG) with vaginal/anal probe; and (3) description of how electromyographic data analysis is performed. The Newcastle-Ottawa Scale (NOS) was used to assess the risk of bias. We identified 508 articles, of which 23 were included in the review. The data showed differences between the collection protocols, and a significant number of studies did not normalize the electromyographic data. Physiotherapists are among the clinicians who most frequently use EMG to evaluate the function and dysfunction of the neuromuscular system. Although some previous studies have provided an overview to guide the evaluator in the assessment, few succeeding studies followed their recommendations.
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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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Halski T, Słupska L, Dymarek R, Bartnicki J, Halska U, Król A, Paprocka-Borowicz M, Dembowski J, Zdrojowy R, Ptaszkowski K. Evaluation of bioelectrical activity of pelvic floor muscles and synergistic muscles depending on orientation of pelvis in menopausal women with symptoms of stress urinary incontinence: a preliminary observational study. BIOMED RESEARCH INTERNATIONAL 2014; 2014:274938. [PMID: 24701567 PMCID: PMC3950402 DOI: 10.1155/2014/274938] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 01/05/2014] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Evaluation of resting and functional bioelectrical activity of the pelvic floor muscles (PFM) and the synergistic muscles, depending on the orientation of the pelvis, in anterior (P1) and posterior (P2) pelvic tilt. DESIGN Preliminary, prospective observational study. SETTING Department and Clinic of Urology, University Hospital in Wroclaw, Poland. PARTICIPANTS Thirty-two menopausal and postmenopausal women with stress urinary incontinence were recruited. Based on inclusion and exclusion criteria, sixteen women aged 55 to 70 years were enrolled in the study. PRIMARY OUTCOME MEASURES Evaluation of resting and functional bioelectrical activity of the pelvic floor muscles by electromyography (sEMG) and vaginal probe. SECONDARY OUTCOME MEASURES Evaluation of activity of the synergistic muscles by sEMG and surface electrodes. RESULTS No significant differences between orientations P1 and P2 were found in functional and resting sEMG activity of the PFM. During resting and functional PFM activity, higher electrical activity in P2 than in P1 has been recorded in some of the synergistic muscles. CONCLUSIONS This preliminary study does not provide initial evidence that pelvic tilt influences PFM activation. Although different activity of synergistic muscles occurs in various orientations of the pelvic tilt, it does not have to affect the sEMG activity of the PFM.
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Affiliation(s)
- Tomasz Halski
- Department of Physiotherapy, Public Higher Medical Professional School in Opole, Katowicka 68, 45-060 Opole, Poland
| | - Lucyna Słupska
- Department of Clinical Biomechanics and Physiotherapy in Motor System Disorders, Faculty of Health Science, Wroclaw Medical University, Grunwaldzka 2, 50-355 Wroclaw, Poland
| | - Robert Dymarek
- Department of Nervous System Diseases, Faculty of Health Science, Wroclaw Medical University, K. Bartla 5, 51-618 Wroclaw, Poland
| | - Janusz Bartnicki
- Department of Obstetrics, Faculty of Health Science, Wroclaw Medical University, K. Bartla 5, 51-618 Wroclaw, Poland
- Department of Obstetrics and Gynecology, Health Center Bitterfeld/Wolfen gGmbH, Friedrich-Ludwig-Jahn-Straße 2, 06749 Bitterfeld-Wolfen, Germany
| | - Urszula Halska
- Department of Physiotherapy, Public Higher Medical Professional School in Opole, Katowicka 68, 45-060 Opole, Poland
| | - Agata Król
- Department of Physiotherapy Basics, Academy of Physical Education in Katowice, Mikolowska 72, 40-065 Katowice, Poland
| | - Małgorzata 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
| | - Janusz Dembowski
- Department and Clinic of Urology, Faculty of Postgraduate Medical Training, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Romuald Zdrojowy
- Department and Clinic of Urology, Faculty of Postgraduate Medical Training, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Kuba Ptaszkowski
- Department of Obstetrics, Faculty of Health Science, Wroclaw Medical University, K. Bartla 5, 51-618 Wroclaw, Poland
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Stav K, Leibovici D, Yoram SI, Ronny O, Zisman A. Self-induced plantar-flexion objectively reduces wave amplitude of detrusor overactivity and subjectively improve urinary urgency: a pilot study. Neurourol Urodyn 2013; 33:1247-50. [PMID: 24115037 DOI: 10.1002/nau.22493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 08/20/2013] [Indexed: 11/09/2022]
Abstract
AIMS To estimate the effect of plantar-flexion on the wave amplitude of involuntary detrusor contraction and the severity of urinary urgency during filling cystometry in patients with detrusor overactivity (DO). METHODS Twenty-two consecutive patients with DO were enrolled. During urodynamics, the mean peak detrusor pressures of each contraction were documented and compared. At the beginning of the 2nd or 3rd wave, patients were asked to perform continuous plantar-flexion by pushing their tiptoes against the floor. Following each wave, patients were asked to grade the severity of the urgency by a visual analogue scale (VAS). RESULTS The mean peak detrusor pressure without plantar-flexion was 58 cmH2 O (95% CI: 46.3-69.7) compared to 31 cmH2 O (95% CI: 23.1-38.9) with plantar-flexion (P < 0.001). All patients reported a reduced degree of urgency during plantar-flexion reflected in a significant reduction in mean VAS score from 9.3 (95% CI: 9-9.5) to 4.7 (95% CI: 3.9-5.4; P < 0.0001). CONCLUSIONS Self-performed plantar-flexion maneuver might reduce the severity of urinary urgency and the magnitude of overactive detrusor contractions, which may have a role in the conservative therapy of detrusor overactivity.
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Affiliation(s)
- Kobi Stav
- Neurourology Division, Department of Urology, Assaf Harofeh Medical Center, Beer Yaakov, Zerifin, Tel Aviv, Israel; Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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