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A dynamic MRI video of the lower abdominal musculature (anterior view) during forced expiration. The top red arrows point cranially and are at the level of the thoracic diaphragm. The bottom red arrow points to the pelvic floor. The video demonstrates the parallel phase-locked movement of the thoracic diaphragm and the pelvic floor. Video used with permission from the University of Innsbruck, Innsbruck, Austria. (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)

A dynamic MRI video of the lower abdominal musculature (anterior view) during forced expiration. The top red arrows point cranially and are at the level of the thoracic diaphragm. The bottom red arrow points to the pelvic floor. The video demonstrates the parallel phase-locked movement of the thoracic diaphragm and the pelvic floor. Video used with permission from the University of Innsbruck, Innsbruck, Austria. (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)

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Article
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Objective: To conduct an interdisciplinary literature review on the function of the pelvic floor musculature during respiration and its role in phonation, particularly singing. Study design: This is a literature review. Methods: A literature review was conducted using three electronic databases: PubMed, Scopus, and Google Scholar. An index sea...

Citations

... As the patient inhales deeply the lower ribs expand laterally, the chest stays still while the abdomen expands, causing the dome-shaped diaphragm to descend and flatten (Vostatek et al., 2013). As the diaphragm descends caudally so does the pelvic floor muscles (Emerich Gordon and Reed, 2020). In SCT the patients are made aware of the co-work between respiration and the pelvic floor muscles; on inhalation the pelvic floor muscles relax and on exhalation these muscles contract. ...
Article
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Somatocognitive therapy is a multimodal physiotherapy treatment developed in the early 2000s to alleviate the burden of long-standing chronic pelvic pain. In recent years, somatocognitive therapy has been further developed to treat women with provoked vestibulodynia. This prevalent gynecological pain condition is a subgroup of chronic pelvic pain and the most common form of vulvodynia. Provoked vestibulodynia is a neglected multifactorial pain condition of unknown cause, adversely affecting women's sexual life, relation to their partners and their psychological health. Pain is located at the vulvar vestibule and is provoked by touch or pressure such as sexual intercourse. In the management of sexual pain, somatocognitive therapy combines bodily exploration, pain education, cognitive coping strategies and structured homework to improve sexual function and reduce pain. To support these processes, developing a sound therapeutic alliance with the patient is essential. The aim of this article is to provide a conceptual model for managing provoked vestibulodynia with somatocognitive therapy, including a theoretical rational for this treatment. We base our conceptual model on the biopsychosocial model, i.e., considering the complex interplay of biomedical, emotional/cognitive, psychosexual and interpersonal factors in provoked vestibulodynia management. In addition, implications for practice and a detailed description of somatocognitive therapy for provoked vestibulodynia will be provided, to allow replication in clinical practice and in clinical trials.
... However, pelvic floor recruitment might provide a unique stimulus to entrain the cardiovascular system beyond the general effects of muscle activation, especially when combined with RB. Precisely, the pelvic muscles and their intentional control, respectively, have recently been explored as a tool to optimize respiration, which we suggest could even enhance the resonance effects observed during 0.1 Hz breathing (Gordon & Reed, 2020). For example, by modulating intra-abdominal pressure in a functional manner, voluntary pelvic floor activation during the inspiratory phase could affect venous return, ultimately boosting baroreflex stimulation (Kitano et al., 1999;Russo et al., 2017;Takata et al., 1990;Takata & Robotham, 1992). ...
... However, as briefly mentioned earlier, we hypothesize that PRB could exert its effects directly acting on cardiac-pulmonary functioning. For example, it has been shown that the pelvic floor plays an important, though to date largely neglected role in respiration and that voluntary pelvic muscle activation could further enhance breathing capacity (Gordon & Reed, 2020). Specifically, intentional pelvic floor recruitment has been shown to increase maximum voluntary ventilation, which might be attributed to strengthened activation of the diaphragm Park & Han, 2015). ...
... First, young and healthy individuals (as in the present sample) are likely to exhibit stronger effects than health compromised and/or older populations. For example, pelvic floor strength as well as the degree of its activation could moderate its effects on diaphragmatic function as well as on generating pressure modulations (Gordon & Reed, 2020). Therefore, as pelvic floor functionality seems to decline with age as well as in individuals suffering from anxiety and depression, weaker acute effects might be observed in these populations (Trowbridge et al., 2007;Vrijens et al., 2017;Wente & Dolan, 2018). ...
Article
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Resonance breathing (RB) has been shown to benefit health and performance within clinical and non-clinical populations. This is attributed to its baroreflex stimulating effect and the concomitant increase in cardiac vagal activity (CVA). Hence, developing methods that strengthen the CVA boosting effect of RB could improve its clinical effectiveness. Therefore, we assessed whether supplementing RB with coherent pelvic floor activation (PRB), which has been shown to entrain the baroreflex, yields stronger CVA than standard RB. N = 32 participants performed 5-min of RB and PRB, which requires to recruit the pelvic floor during the complete inspiratory phase and release it at the initiation of the expiration. CVA was indexed via heart rate variability using RMSSD and LF-HRV. PRB induced significantly larger RMSSD (d = 1.04) and LF-HRV (d = 0.75, ps < .001) as compared to RB. Results indicate that PRB induced an additional boost in CVA relative to RB in healthy individuals. However, subsequent studies are warranted to evaluate whether these first findings can be replicated in individuals with compromised health, including a more comprehensive psychophysiological assessment to potentially elucidate the origin of the observed effects. Importantly, longitudinal studies need to address whether PRB translates to better treatment outcomes.
... Quiet breathing occurs largely independent of conscious perception [31] by means of continuous phase-locked activity of the autonomously innervated deep trunk muscles with an always-open glottis to allow airflow into and out of the lungs. However, in situations with higher sympathetic activity, throughout strenuous efforts or aerobic activities, in the course of protective reflexes, such as sneezing and coughing, or during other activities that require adaptation of the breathing, such as laughing, speaking, or singing, respiration becomes stronger [31,[39][40][41][42]. To ensure the body's increased demands for oxygen, the magnitude of both inspiratory and expiratory movements of the thoracic diaphragm increase [13,30,31,35,36]. ...
... The superficial abdominal muscles act powerfully on the ribs to reduce the thoracic and abdominal dimensions [7,30,39] (Figure 2). The somatic nervous system control allows them to influence the amount and pressure of expelled air in different variations [16,37,39,40]. ...
... The superficial abdominal muscles act powerfully on the ribs to reduce the thoracic and abdominal dimensions [7,30,39] (Figure 2). The somatic nervous system control allows them to influence the amount and pressure of expelled air in different variations [16,37,39,40]. Humans can consciously activate and contract these muscles independently [31], not only in support of expiration, but also during inspiratory phases of breathing, in fact, opposing the activity of the deep trunk muscles. ...
Article
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Background: The current scientific literature is inconsistent regarding the potential beneficial or deleterious effects of high-intensity physical activities on the pelvic floor (PF) in women. So far, it has not been established with certainty whether disparate breathing mechanisms may exert short- or long-term influence on the PF function in this context, although based on the established physiological interrelationship of breathing with PF activation, this seems plausible. Objective: To propose a basic concept of the influence of different breathing patterns on the PF during strenuous physical efforts. Methodical approaches: Review of the recent literature, basic knowledge of classical western medicine regarding the principles of muscle physiology and the biomechanics of breathing, additional schematic illustrations, and magnetic resonance imaging (MRI) data corroborate the proposed concept and exemplify the consequences of strenuous efforts on the PF in relation to respective breathing phases. Conclusion: The pelvic floor muscles (PFMs) physiologically act as expiratory muscles in synergy with the anterolateral abdominal muscles, contracting during expiration and relaxing during inspiration. Obviously, a strenuous physical effort requires an expiratory motor synergy with the PFM and abdominal muscles in a co-contracted status to train the PFM and protect the PF against high intra-abdominal pressure (IAP). Holding breath in an inspiratory pattern during exertion stresses the PF because the high IAP impinges on the relaxed, hence insufficiently protected, PFMs. It seems conceivable that such disadvantageous breathing, if performed regularly and repeatedly, may ultimately cause PF dysfunction. At any rate, future research needs to take into account the respective breathing cycles during measurements and interventions addressing PFM function.
... The following mechanism has been proposed for the pathophysiological role of breathing in stroke-hemiplegia causes an asymmetry in the body, which leads to inefficient movements, with a direct or indirect impact on the activation of respiratory muscles, ultimately affecting the respiratory cycle [14]. Muscles such as the diaphragm, transverse abdominis, and pelvic floor perform local stabilization, with dual roles in breathing and trunk stabilization [15][16][17]. When stroke adversely affects the activation of those muscles, trunk stabilization is impacted [18,19], which affects the muscles related to breathing [20,21]. ...
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Patients with stroke may experience a certain degree of cognitive decline during the period of recovery, and a considerable number of such patients have been reported to show permanent cognitive damage. Therefore, the period of recovery and rehabilitation following stroke is critical for rapid cognitive functional improvements. As dysfunctional breathing has been reported as one of the factors affecting the quality of life post stroke, a number of studies have focused on the need for improving the breathing function in these patients. Numerous breathing exercises have been reported to enhance the respiratory, pulmonary, cognitive, and psychological functions. However, scientific evidence on the underlying mechanisms by which these exercises improve cognitive function is scattered at best. Therefore, it has been difficult to establish a protocol of breathing exercises for patients with stroke. In this review, we summarize the psychological, vascular, sleep-related, and biochemical factors influencing cognition in patients and highlight the need for breathing exercises based on existing studies. Breathing exercises are expected to contribute to improvements in cognitive function in stroke based on a diverse array of supporting evidence. With relevant follow-up studies, a protocol of breathing exercises can be developed for improving the cognitive function in patients with stroke.
... The role of the PFMs with respect to respiration was not included explicitly in the report of the Pelvic Floor Clinical Assessment Group of the International Continence Society in 2005 [6], nor in more recent guidelines on this topic [22]. Meanwhile, evidence has become sufficiently strong to acknowledge and emphasise the complex synergies of the PFMs in connection with breathing and coughing manoeuvres [10][11][12][13][14][15][16][26][27][28][29][30]. ...
Article
Background Reduced pelvic floor muscle (PFM) contraction strength is a common condition in elderly female patients with urinary incontinence (UI). However, little data exist to demonstrate the importance of appropriate PFM activation during exhaling and coughing. Objectives To analyse breathing and coughing patterns in elderly female inpatients with UI, and to assess PFM activation patterns during exhalation and coughing. Design Retrospective chart data analysis. Patients and methods Data from 177 elderly female inpatients with UI were analysed to determine voluntary PFM contraction strength, as well as PFM activation and displacement of the pelvic floor (PF) and abdominal wall during forced exhalation and coughing. Clinical data were obtained by means of inspection and digital palpation in the course of a routine clinical UI assessment. Data collected were correlated with age, body mass index and number of childbirths, and categorised by predominant UI symptoms, history of previous hysterectomy and history of PFM training. Results Independent of voluntary PFM contraction strength, nearly all patients (n = 168) demonstrated bulging of the abdominal wall and PF during forced exhalation and coughing instead of contracting the PFMs and consequently lifting the PF, which would be in accordance with physiological breathing synergies. None of the nine women who reflexively contracted the PFM physiologically in accordance with an expiratory breathing pattern complained of symptoms of stress UI alone. Conclusion A high percentage of elderly females with UI do not activate their PFMs appropriately during forced exhalation and coughing, possibly contributing to or exacerbating UI.
... No canto, particularmente, o controle da respiração varia conforme a altura, ressonância, extensão e duração da frase musical. A habilidade de regular a expiração fornece ao cantor a competência para sustentar uma nota musical (Silva & Luna, 2009;Gordon & Reed, 2020). Cantar em maiores níveis de pressão sonora (NPS) exige adequada capacidade respiratória. ...
... O apoio respiratório é definido como a sensação das ações musculares relacionadas ao diafragma, musculatura abdominal e intercostal, com adequado fluxo aéreo, alívio das tensões cervicais e correção postural (Pinho, 2003;Gava Júnior, Ferreira, & Silva, 2010;Gordon & Reed, 2020). Estudo envolvendo profissionais da voz relacionou o apoio respiratório ao alívio das tensões laríngeas e à maior coordenação pneumofonoarticulatória (Gava Júnior et al., 2010). ...
... Neste contexto, o músculo TA, com a orientação horizontal de suas fibras, é o principal gerador da pressão intra-abdominal, além de estabilizador profundo da coluna na sustentação pélvica. É um músculo fundamental para a manutenção da coluna de ar na expiração, favorecendo a constância da pressão aérea subglótica (Siqueira et al., 2014, Research, Society and Development, v. 9, n. 10, e4389108580, 2020(CC BY 4.0) | ISSN 2525 13 Gordon & Reed, 2020). A pressão aérea subglótica exerce papel importante no controle do NPS durante a fonação (Gordon & Reed, 2020). ...
Article
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Abstract Objective: to investigate the effect of an intensive physical therapy training of the core strength on respiratory and aerodynamic vocal measurements of popular professional singers. Methods: Randomized clinical trial. Sample composed of popular professional singers, eight in the control group and eight in the study group, who underwent the physiotherapeutic protocol. The measurements of maximum phonation time, sound pressure level and dynamic extension were under the responsibility of Speech Therapy professionals and the measurements of forced vital capacity, activation of the transverse abdomen muscle, and maximum respiratory pressures were under the responsibility of Physiotherapy professionals. The results were compared in the pre and post intensive physical therapy training. Results: In the treated group, there was a significant improvement in forced vital capacity, sound pressure level, activation of the transverse abdomen muscle, and maximum phonation time of /e/ voiceless. Conclusion: The intensive physical therapy training of the core strength caused an improvement in respiratory and aerodynamic vocal measurements of popular professional singers.
... The pelvic floor and abdominals are included within these accessory muscles because when they co-contract more forcefully than in quiet breathing, they create a cranially directed increase in intra-abdominal pressure that assists with diaphragm elevation. 3,4 ...
Background: Much of the research and clinical commentary on COVID-19 have been focused on respiratory function. Pelvic floor therapists understand that both respiratory dysfunction and hospitalization can have an impact on pelvic floor function. This clinical commentary provides context as to how the long-term effects of COVID-19 could affect the pelvic floor as well as some generalized treatment considerations. Discussion: The respiratory diaphragm has an impact on the ability of the pelvic floor to contract and relax in a manner that will allow for both continence and elimination. COVID-19 survivors often have disability in this muscle of respiration that can lead to implications for both overactive and underactive pelvic floor. Commonly, this population is hospitalized for long periods of time, which can have long-term consequences on both bladder and bowel functioning including, but not limited to, incontinence, urinary retention, and constipation. Pelvic floor therapists must be prepared to adjust both their evaluation and treatment methods in consideration of this novel treatment population. Conclusions: Because of the pervasive nature of this virus, pelvic floor physical therapists should be a part of the rehabilitation team treating these patients once they have become medically stable.Video abstract with sound available at http://links.lww.com/JWHPT/A36.
... Speece (2001) and other scientific writings now point out four diaphragms of the body. Most of the literature agrees with Gordon & Reed (2018) who talk about four diaphragms that are mainly known in osteopathic medicine: the cranial diaphragm, the cervical diaphragm, the thoracic diaphragm, and the pelvic diaphragm. Bordoni & Zanier (2015) assert that there are five diaphragms: the diaphragm muscle, the pelvic floor, the floor of the mouth, the thoracic outlet, and the tentorium of the cerebellum. ...
... Other non-academic literature discusses six, eight and even twelve diaphragms. Not all studies completely agree with the names or the number of diaphragms but all mention the synchronous motion of all diaphragms of the body (Johnson, 1991) and their control of moving fluid through the body during breathing (Gordon & Reed, 2018). This is a very interesting fact. ...
... Interestingly, Peper & Cohen (2017) indicate that if one is feeling afraid, anterolateral abdominal muscles and pelvic floor muscles contract to protect the body. During expiration, pelvic floor muscles and anterolateral abdominal muscles tighten, go upward/in and push the digestive organs upward right before the thoracic diaphragm relaxes and relocates IAP from the abdomen to the thorax (Bolster et al., 2000;Talasz et al., 2011;Tahan et al., 2014;Gordon & Reed, 2018). Being aware of the pelvis's behaviour helps singing teachers to visualise and correctly address respiration. ...
Research
I am currently rewriting/updating this research study. This independent study will examine the literature on the function of the pelvic floor muscles during respiration, its connection to the whole body and its role in singing. Particularly, I will focus on all diaphragms within the body and the role, function and anatomy of the pelvic floor, pelvic muscles and the pelvic diaphragm. I will also assess the link between the pelvis and the primary diaphragm. This study will examine the impact of the pelvis in respiration and in singing, and compare and analyse recent research.
Article
Communication is defined as the phenomenon found specifically in animal species. It was however refined and modified only by the human species. Language and speech are two basic areas that fall under the umbrella of communication. With these processes also comes the impending danger of abnormal speech and language, leading to the development of their disorders. Objectives: Reporting the frequency changes in the voice of patients who are positive of covid-19. Methods: Application of cross-section study type of retrospective nature was steered. Details were extracted from 2 trust hospitals of Lahore, UOL Teaching Hospital and Arif Memorial Hospital. Convenient based sample accumulation technique was applied for data assembly from subjects. The Voice Handicap Index (VHI) , was used for the evaluation of patient perceived voice changes. Results: Data of 379 patients of Covid-19 infection was compiled. Shaky and weak voice, unclear voice and change in voice observed at the end of the day were all highlighted as voice changes in subjects. Out of 379, 263 experience shaky and weak voice to some extent which meant 69.4% of the participants experienced this. 241 out of 379 experienced problems with voice clarity and complained about not being able to speak clearly, meaning 63.6% faced this issue. 242 experienced change of voice over the passage of time in entire day, indicating 63.9% experienced this. Conclusion: Weak voice or having a shaky voice, having voice that was not clear enough to be understood by others, and feeling a change is voice quality over the day were considered as pointers of voice change. collecting and analyzing the data, the investigation concluded that voice changes were observed in individuals during Covid-19 infection.
Article
Objective To investigate the feasibility and preliminary effects of Pilates exercises in primigravida women. Design Single-blind randomized controlled feasibility trial. Setting Community Pilates classes. Participants Low-risk pregnant women. Interventions Pregnant women were randomly assigned to Pilates® exercises (experimental) group for 6 consecutive weeks or usual antenatal care, the control group. Main outcomes The primary outcome was feasibility of Pilates classes. Secondary outcomes included quality of life, pain, and mobility. Results 21 women were recruited to the trial. Eleven were randomly allocated to the experimental group and 10 to the control group. Retention of participants was excellent for the Pilates group (100%) compared to 70% in the control group. There were no adverse events. The Pilates group showed greater gains in quality of life on the SF-12 from the pre-test (M = 81.0, SD = 11.8) to the post-test (M = 83.3, SD = 8.52) compared to the control group (pre-test M = 69.78, SD = 15.9) (post-test M = 68.1, SD = 16.05) (Wald Chi-Square = 5.597, p = 0.018). Although the duration of labour was shorter in the Pilates group (Mdn = 215, IQR: 279 min) than usual care (Mdn = 458.5, IQR: 305 min), the difference was not statistically significant. There were no significant differences between groups for pain, mobility, abdominal separation, urinary continence, analgesia or the mode of birth. Conclusions Modified Pilates appears feasible and safe for low-risk pregnant women.