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Ron NJ, Dolbinski SC, Hodonicky EG, Middlebrook DO, Olmstead SR, Olsen SL, Ron ED, Hollman JH. Associations between running mechanics, functional lower extremity strength, and stress urinary incontinence in parous female runners. JOURNAL OF WOMEN'S & PELVIC HEALTH PHYSICAL THERAPY 2024; 48:147-153. [PMID: 39148952 PMCID: PMC11323885 DOI: 10.1097/jwh.0000000000000302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
Background Women with stress urinary incontinence (SUI) may have altered running mechanics and reduced hip muscle strength compared to women without SUI. Little research has examined running metrics and functional lower extremity strength of parous runners. Objective To determine if stress urinary incontinence (SUI) severity correlates with running metrics and lower extremity muscle strength among parous women. Study Design Cross-sectional observational study of 22 parous participants (mean age 39.8 years, with a mean of 3.4 pregnancies and 8.1 years interval since last delivery). Methods Participants completed the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI), Urinary Distress Inventory (UDI) 6, Colorectal-Anal Distress (CRAD) Inventory 8, and Pelvic Organ Prolapse Distress Inventory (POPDI) 6, Questionnaire for Urinary Incontinence Diagnosis (QUID), and provided demographic, relevant running, and obstetric/gynecologic history information. After a brief warm-up, participants completed 30-second single leg sit to stand tests bilaterally and a standardized 10-minute treadmill run with pod cadence assessment. Pearson-product moment correlation coefficients were calculated (alpha = 0.05). Results Prolonged ground contact times were associated with higher ICIQ-UI SF (r = 0.523, p = 0.015), POPDI-6 (r = 0.694, p < 0.001), and UDI-6 scores (r = 0.577, p = 0.006), while lower cadences were associated with higher POPDI-6 (r = -0.550, p = 0.010) and UDI-6 scores (r = -0.444, p=0.044). Conclusion Parous female runners with more severe SUI and prolapse symptoms demonstrate altered running mechanics characterized by prolonged ground contact times and slower cadences.
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Affiliation(s)
- Nicole J. Ron
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | - Sarah C. Dolbinski
- Program in Physical Therapy, Mayo Clinic School of Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Elizabeth G. Hodonicky
- Program in Physical Therapy, Mayo Clinic School of Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Darby O. Middlebrook
- Program in Physical Therapy, Mayo Clinic School of Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Sally R. Olmstead
- Program in Physical Therapy, Mayo Clinic School of Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Sandra L. Olsen
- Program in Physical Therapy, Mayo Clinic School of Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Eyal D. Ron
- Department of Radiology, Mayo Clinic, Rochester, MN
| | - John H. Hollman
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
- Program in Physical Therapy, Mayo Clinic School of Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, MN
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Muro S, Nimura A, Ibara T, Chikazawa K, Nakazawa M, Akita K. Anatomical basis for contribution of hip joint motion by the obturator internus to defaecation/urinary functions by the levator ani via the obturator fascia. J Anat 2023; 242:657-665. [PMID: 36528838 PMCID: PMC10008353 DOI: 10.1111/joa.13810] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/15/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
The functional association between hip joint motion and defaecation/urinary function has attracted considerable research and clinical attention owing to the potential novel approaches for pelvic floor rehabilitation; however, the anatomical basis remains unclear. This study, therefore, aimed to analyse the anatomical basis of force transmission between the obturator internus, a muscle of the hip joint, and the levator ani, a muscle of the pelvic floor. Twenty-three cadavers were used for macroscopic and histological analyses. The three-dimensional structures of the muscles and fascia were recorded using a high-definition camera and a 3D scanner. The arrangement and attachment of the muscle fibres, tendons and fascia were visualised using histological sections stained with Masson's trichrome. The obturator internus and levator ani were in broad contact through the obturator fascia. The height of their contact area was 24.6 ± 9.1 mm. Histologically, the obturator internus and levator ani shared a large area of the obturator fascia, and the obturator fascia provided the attachment of several muscle layers of the levator ani. The contribution of hip joint motion to defaecation/urinary function can be explained by the broad 'planar' contact between the obturator internus and levator ani. This anatomical feature suggests that movement of the obturator internus creates the foundation for the function of the levator ani and contributes to pelvic floor support through the obturator fascia. This study provides an anatomical basis for the effectiveness of the hip muscles in improving defaecation/urinary function by enabling balanced and proper movements.
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Affiliation(s)
- Satoru Muro
- Department of Clinical Anatomy, Tokyo Medical and Dental University, Tokyo, Japan
| | - Akimoto Nimura
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takuya Ibara
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kenro Chikazawa
- Department of Obstetrics and Gynecology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Masataka Nakazawa
- Faculty of Health Sciences, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan
| | - Keiichi Akita
- Department of Clinical Anatomy, Tokyo Medical and Dental University, Tokyo, Japan
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Muro S, Akita K. Pelvic floor and perineal muscles: a dynamic coordination between skeletal and smooth muscles on pelvic floor stabilization. Anat Sci Int 2023:10.1007/s12565-023-00717-7. [PMID: 36961619 DOI: 10.1007/s12565-023-00717-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 03/15/2023] [Indexed: 03/25/2023]
Abstract
The purpose of this review is to present our researches on the pelvic outlet muscles, including the pelvic floor and perineal muscles, which are responsible for urinary function, defecation, sexual function, and core stability, and to discuss the insights into the mechanism of pelvic floor stabilization based on the findings. Our studies are conducted using a combination of macroscopic examination, immunohistological analysis, 3D reconstruction, and imaging. Unlike most previous reports, this article describes not only on skeletal muscle but also on smooth muscle structures in the pelvic floor and perineum to encourage new understanding. The skeletal muscles of the pelvic outlet are continuous, which means that they share muscle bundles. They form three muscle slings that pass anterior and posterior to the anal canal, thus serving as the foundation of pelvic floor support. The smooth muscle of the pelvic outlet, in addition to forming the walls of the viscera, also extends in three dimensions. This continuous smooth muscle occupies the central region of the pelvic floor and perineum, thus revising the conventional understanding of the perineal body. At the interface between the levator ani and pelvic viscera, smooth muscle forms characteristic structures that transfer the lifting power of the levator ani to the pelvic viscera. The findings suggest new concepts of pelvic floor stabilization mechanisms, such as dynamic coordination between skeletal and smooth muscles. These two types of muscles possibly coordinate the direction and force of muscle contraction with each other.
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Affiliation(s)
- Satoru Muro
- Department of Clinical Anatomy, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan.
| | - Keiichi Akita
- Department of Clinical Anatomy, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
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Wang Z, Zhu Y, Han D, Huang Q, Maruyama H, Onoda K. Effect of hip external rotator muscle contraction on pelvic floor muscle function and the piriformis. Int Urogynecol J 2021; 33:2833-2839. [PMID: 34842941 DOI: 10.1007/s00192-021-05046-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/01/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS There is a lack of in-depth understanding of the muscles surrounding the pelvic floor muscle (PFM). The study aimed to investigate the functional relationship between PFM and hip external rotator muscles by observing the piriformis muscle thickness and displacement of the bladder base under different contraction conditions of the hip external rotator and/or PFM. We hypothesized that PFM function would be the strongest when the hip external rotator and PFM contracted simultaneously and that during PFM contraction, the piriformis muscle would act as an auxiliary muscle and show coactivation. METHODS The participants included 13 healthy adult women (mean age 23.8 ± 2.8 years). The three contraction conditions were PFM contraction, hip external rotator contraction, and simultaneous contraction of the hip external rotator and PFM. During the tasks, the piriformis muscle thickness and bladder base displacement were measured using ultrasonography and compared among the contraction conditions using one-way analysis of variance. RESULTS Significant differences were noted in bladder base displacement among the three contraction conditions (P < 0.01), with PFM contraction having the highest value. The piriformis muscle thickness showed the greatest increase in simultaneous contraction. CONCLUSIONS In our study, we showed PFM contraction positively influences piriformis contraction, while PFM function operationalized by bladder base displacement was highest during PFM contraction alone.
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Affiliation(s)
- Zimin Wang
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yuetong Zhu
- Graduate School of Health and Welfare Sciences, International University of Health and Welfare, 2600-1 Kitakanemaru, Otawara-shi, Tochigi, 324-8501, Japan.
| | - Dan Han
- Graduate School of Health and Welfare Sciences, International University of Health and Welfare, 2600-1 Kitakanemaru, Otawara-shi, Tochigi, 324-8501, Japan.,Physical Therapy Department, China Rehabilitation Research Center, Beijing, China
| | - Qiuchen Huang
- Physical Therapy Department, China Rehabilitation Research Center, Beijing, China
| | - Hitoshi Maruyama
- Graduate School of Health and Welfare Sciences, International University of Health and Welfare, 2600-1 Kitakanemaru, Otawara-shi, Tochigi, 324-8501, Japan
| | - Ko Onoda
- Graduate School of Health and Welfare Sciences, International University of Health and Welfare, 2600-1 Kitakanemaru, Otawara-shi, Tochigi, 324-8501, Japan
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Hip and Pelvic Floor Muscle Strength in Women with and without Urgency and Frequency Predominant Lower Urinary Tract Symptoms. ACTA ACUST UNITED AC 2021; 45:126-134. [PMID: 34366727 DOI: 10.1097/jwh.0000000000000209] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Urgency and frequency are common lower urinary tract symptoms (UF-LUTS) in women. There is limited evidence to guide physical therapist-led treatment. Objectives To compare hip and pelvic floor muscle strength between women with and without UF-LUTS. We hypothesized women with UF-LUTS would demonstrate 1) diminished hip external rotator and abductor strength and 2) equivalent pelvic floor strength and diminished endurance compared to controls. Study Design A matched case-control study. Methods Women with UF-LUTS (cases) and controls were matched on age, body mass index (BMI), vaginal parity. Examiner measured participants' 1) hip external rotator and abductor strength via dynamometry (maximum voluntary effort against fixed resistance) and 2) pelvic floor muscle strength (peak squeeze pressure) and endurance (squeeze pressure over a 10 second hold) via vaginal manometry. Values compared between cases and controls with paired-sample t-tests (hip) or Wilcoxon signed rank tests (pelvic floor). Results 21 pairs (42 women): Hip external rotation (67.0 ± 19.0 N vs 83.6 ± 21.5 N; P=0.005) and hip abduction strength (163.1 ± 48.1 N vs 190.1 ± 53.1 N; P=0.04) were significantly lower in cases than controls. There was no significant difference in pelvic floor strength (36.8 ± 19.9 cmH20 vs 41.8 ± 21.0 cmH20; P=0.40) or endurance (234.0 ± 149.6 cmH20*seconds vs 273.4 ± 149.1 cmH20*seconds; P=0.24). Conclusion Women with UF-LUTS had weaker hip external rotator and abductor muscles, but similar pelvic floor strength and endurance compared to controls. Hip strength may be important to assess in patients with UF-LUTS, further research is needed.
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Tuttle LJ, Autry T, Kemp C, Lassaga-Bishop M, Mettenleiter M, Shetter H, Zukowski J. Hip exercises improve intravaginal squeeze pressure in older women. Physiother Theory Pract 2019; 36:1340-1347. [PMID: 30704364 DOI: 10.1080/09593985.2019.1571142] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Pelvic Floor Muscle Training (PFMT), an accepted treatment for incontinence and pelvic floor dysfunction, has good evidence, though it is unknown if adjunct therapies can be useful. Strengthening the obturator internus (OI), along with other hip external rotator muscles, may help strengthen the pelvic floor muscles (PFM) through fascial attachment. We hypothesized that strengthening the hip external rotators will improve intravaginal squeeze pressure in older women.Methods: A total of 25 women (with or without pelvic floor dysfunction) greater than 55 years of age participated in monitored and home exercise sessions three times a week for 12 weeks. The exercises included concentric, isometric, and eccentric training of hip external rotators, without instruction to include PFM contraction. A physical therapist performed the assessments of each participant: Pelvic Floor Distress Inventory-20 (PFDI-20), a manual pelvic assessment, hip strength testing using a hand-held dynamometer and maximum intravaginal squeeze pressure using the PeritronTM PFM manometer (correct PFM contraction was confirmed visually and with palpation). Comparison was made to data obtained in a previous study in young women. Data were analyzed using paired t-tests and mixed model ANOVA.Results: Average intravaginal squeeze pressure increased from 21.47 ± 2.55 to 29.1 ± 3.15 cm H2O p < 0.0001. Hip external rotation strength increased in the right hip from 12.75 ± 0.46 to 15.42 ± 0.63 lbs p = 0.0009 and the left hip from 11.43 ± 0.43 to 15.61 ± 0.69 lbs p < 0.0001. The PFDI-20 scores decreased from 56.88 ± 10.76 to 40.62 ± 10.63, p > 0.05. Compared to a previous study in young women, both hip external rotation strength and intravaginal squeeze pressure increased with no significant difference between groups.Conclusion: Hip external rotation exercises may be effective as an indirect form of PFM exercise.
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Affiliation(s)
- Lori J Tuttle
- Doctor of Physical Therapy Program, San Diego State University , San Diego, CA, USA
| | - Taylor Autry
- Doctor of Physical Therapy Program, San Diego State University , San Diego, CA, USA
| | - Caitlin Kemp
- Doctor of Physical Therapy Program, San Diego State University , San Diego, CA, USA
| | | | | | - Haley Shetter
- Doctor of Physical Therapy Program, San Diego State University , San Diego, CA, USA
| | - Janelle Zukowski
- Doctor of Physical Therapy Program, San Diego State University , San Diego, CA, USA
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Age-related alterations in female obturator internus muscle. Int Urogynecol J 2016; 28:729-734. [PMID: 27704154 DOI: 10.1007/s00192-016-3167-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 09/20/2016] [Indexed: 12/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic floor muscle rehabilitation is a widely utilized, but often challenging therapy for pelvic floor disorders, which are prevalent in older women. Regimens involving the use of appendicular muscles, such as the obturator internus (OI), have been developed for strengthening of the levator ani muscle (LAM). However, changes that lead to potential dysfunction of these alternative targets in older women are not well known. We hypothesized that aging negatively impacts OI architecture, the main determinant of muscle function, and intramuscular extracellular matrix (ECM), paralleling age-related alterations in LAM. METHODS OI and LAM were procured from three groups of female cadaveric donors (five per group): younger (20 - 40 years), middle-aged (41 - 60 years), and older (≥60 years). Architectural predictors of the excursional (fiber length, L f), force-generating (physiological cross-sectional area, PCSA) and sarcomere length (L s) capacity of the muscles, and ECM collagen content (measure of fibrosis) were determined using validated methods. The data were analyzed using one-way ANOVA and Tukey's post-hoc test with a significance level of 0.05, and linear regression. RESULTS The mean ages of the donors in the three groups were 31.2 ± 2.3 years, 47.6 ± 1.2 years, and 74.6 ± 4.2 years (P < 0.005). The groups did not differ with respect to parity or body mass index (P > 0.5). OI L f and L s were not affected by aging. Age >60 years was associated with a substantial decrease in OI PCSA and increased collagen content (P < 0.05). Reductions in OI and LAM force-generating capacities with age were highly correlated (r 2 = 0.9). CONCLUSIONS Our findings of age-related decreases in predicted OI force production and fibrosis suggest that these alterations should be taken into consideration, when designing pelvic floor fitness programs for older women.
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