Effect of combined actions of hip adduction/abduction on the force generation and maintenance of pelvic floor muscles in healthy women

A novel multifaceted physical therapy approach for stress incontinence secondary to prostatectomy: Randomized controlled trial

METHOD

40 men with stress urinary incontinence (SUI) secondary to radical prostatectomy were randomly assigned to two groups (control = 20, treatment = 20). The treatment group received a novel multifaceted approach (including interferential therapy, a combination of exercise therapy approaches, and manual therapy) and the control group received sham electrotherapy. Both groups received 12 sessions of treatment in one month. Outcome measures include SF12 form to assess the quality of life and bladder diary to assess incontinence parameters including urination amount, fluid intake, urinary frequency, and incontinence frequency.

RESULT

treatment group shows significant improvement in comparison with the control group in quality of life (control group from 29.6 ± 4.5 to 31.0 ± 4.9 and the treatment group from 30.6 ± 4.4 to 42.2 ± 2.4, P = 0.003), urinary frequency (control group from 10.1 ± 2.0 to 9.2 ± 1.8 and treatment group from 9.7 ± 1.91 to 7.1 ± 1.1, P = 0.038), and incontinence frequency (control group from 7.0 ± 2.2 to 6.4 ± 2.0 and treatment group from 7.8 ± 2.4 to 1.2 ± 1.1, P = 0.003). Also, urination amount (control group from 1621.50 ± 403.7 to 1507.2 ± 402.3 and treatment group from 1638.3 ± 356.1 to 1360.55 ± 360.9, P = 0.503) and fluid intake (control group from 2024.0 ± 595.5 to 1865.2 ± 596.5 and treatment group from 2184.4 ± 484.5 to 1724.2 ± 596.6, P = 0.987) showed no significant difference between the two groups after the treatment sessions.

CONCLUSION

the multifaceted approach presented here, consists of electrotherapy (interferential therapy), exercise therapy, and manual therapy that can improve incontinence and quality of life in patients with stress incontinence secondary to prostatectomy. To determine the long-term efficacy of this approach, studies with long-term evaluation are required.

Viability of ex-vivo myography as a diagnostic tool for rectus abdominis muscle electrical activity collected at Cesarean section within a diamater cohort study

Background

Ex-vivo myography enables the assessment of muscle electrical activity response. This study explored the viability of determining the physiological responses in muscles without tendon, as rectus abdominis muscle (RAM), through ex-vivo myography to assess its potential as a diagnostic tool.

Results

All tested RAM samples (five different samples) show patterns of electrical activity. A positive response was observed in 100% of the programmed stimulation. RAM 3 showed greater weight (0.47 g), length (1.66 cm), and width (0.77 cm) compared to RAM 1, RAM 2, RAM 4 and RAM 5 with more sustained electrical activity over time, a higher percentage of fatigue was analyzed at half the time of the electrical activity. The order of electrical activity (Mn) was RAM 3 > RAM 5 > RAM 1 > RAM 4 > RAM 2. No electrical activity was recorded in the Sham group.

Conclusions

This study shows that it is feasible to assess the physiological responses of striated muscle without tendon as RAM, obtained at C-section, under ex vivo myography. These results could be recorded, properly analyzed, and demonstrated its potential as a diagnostic tool for rectus abdominis muscle electrical activity.

Effect of hip external rotator muscle contraction on pelvic floor muscle function and the piriformis

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.

Does imagining interrupting the flow of urine really elicit contractions of the pelvic floor muscles in stress-incontinent postpartum women?

Objectives:

This study evaluated if imagining interrupting the flow of urine really elicits contractions of the pelvic floor muscles (PFM) in stress-incontinent postpartum women.

Methods:

A total of 21 postpartum women with recent vaginal deliveries performed four trials of Kegel’s exercises, each prompted by a different contraction technique. PFM activities were measured with a surface electromyography via a vaginal electrode. Inferential statistics of repeated-measures one-way analysis of variance with Bonferroni post hoc analysis were performed to compare the effective recruitment of the PFMs across the four trials.

Results:

PFM activities significantly varied across the four trials ( p<0.001), with ‘imagination of interrupting urine flow’ eliciting the least muscular activity (25.40±10.98) and ‘abdominal bracing with hip adduction’ elicited the highest activity (49.67±11.33).

Conclusion:

Findings showed that utilizing many contraction techniques during Kegel’s education is more effective compared to educating patients with one contraction technique.

Level of Evidence:

Level 2.

Electromyographic characteristics of pelvic floor muscles in women with stress urinary incontinence following sEMG-assisted biofeedback training and Pilates exercises

The aim of this study was to compare the effect of pelvic floor muscle training with surface electromyographic (sEMG) biofeedback (BF group) and Pilates exercises (P group) on the bioelectrical activity of pelvic floor muscles in women with stress urinary incontinence. The other aim aim was to compare changes in voiding diaries and scores on quality of life questionnaire against baseline values and between the groups. Women in the BF group (n = 18) participated in pelvic floor muscle training with sEMG biofeedback; the P group (n = 13) participated in basic level Pilates workouts. Both protocols were continued for eight weeks. Voiding diary, quality of life and electromyographic characteristics of the pelvic floor muscles were assessed at the three-time points: at baseline, after eight weeks’ training, and at month six post-training. The sEMG activity of the pelvic floor muscles was tested during five trials in two positions. There was no marked improvement in bioelectrical activity of the pelvic floor muscles during contraction following training with sEMG biofeedback or Pilates exercises. Following eight weeks of sEMG biofeedback training, a decrease was noted in resting bioelectrical activity of pelvic floor muscles and during relaxation after sustained contraction but only in supine-lying. No such effect was observed in the Pilates group. In the BF group, the number of incontinence episodes after end of treatment (timpepoints: 1vs. 2) and at six month follow-up (timpepoints: 1vs. 3) decreased by 68.5% and 89.3%, respectively. The respective values in the P group were 78.6%, and 86.4%. The intergroup differences did not reach the level of statistical significance. As regards the quality of life, the questionnaire demonstrated that Pilates exercises had significantly better effects compared to biofeedback training both at the end of the eight-week exercise program and (p = 0.003) and at six month follow-up (p = 0.0009). The International Consultation on Incontinence Questionnaire—Short Form (ICIQ- SF) showed comparable efficacy of Pilates exercises and training with sEMG biofeedback. Intragroup improvements in micturition frequency, incontinence (leakage) episodes, and nocturia frequency were comparable. Alleviation of urinary incontinence symptoms was comparable in both groups, whereas the improvement in the quality of life was more notable in the Pilates group. The obtained results failed to demonstrate the superiority of any of the two methods regarding the bioelectrical activity of pelvic floor muscles in patients with stress urinary incontinence.

Validity and reliability of evaluating hip abductor strength using different normalization methods in a functional electromechanical device

The hip abductor muscles are vitally important for pelvis stability, and common strength deficits can negatively affect functionality. The muscle strength can be measured using different dynamometers and be evaluated in three positions (side-lying, standing, and supine). Obtained strength data can be expressed in different ways, with data normalization providing more objective and comparable results. The aim of this study was to establish the validity and reliability of three protocols in evaluating the isometric strength of the hip abductor muscles. A new functional electromechanical dynamometer assessed strength in three positions, with findings subjected to three data normalization methods. In two identical sessions, the hip abductor strengths of 29 subjects were recorded in the side-lying, standing, and supine positions. Peak force was recorded in absolute terms and normalized against body mass, fat-free mass, and an allometric technique. The peak force recorded in the side-lying position was 30% and 27% higher than in the standing and supine positions, respectively, independent of data normalization methodology. High inter-protocol correlations were found (r: 0.72 to 0.98, p ≤ 0.001). The supine position with allometric data normalization had the highest test-retest reliability (0.94 intraclass correlation coefficient and 5.64% coefficient of variation). In contrast, the side-lying position with body mass data normalization had a 0.66 intraclass correlation coefficient and 9.8% coefficient of variation. In conclusion, the functional electromechanical dynamometer is a valid device for measuring isometric strength in the hip abductor muscles. The three assessed positions are reliable, although the supine position with allometric data normalization provided the best results.