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Postural and respiratory functions of the pelvic floor muscles
Abstract
Due to their contribution to modulation of intra-abdominal pressure (IAP) and stiffness of the sacroiliac joints, the pelvic floor muscles (PFM) have been argued to provide a contribution to control of the lumbar spine and pelvis. Furthermore, as IAP is modulated during respiration this is likely to be accompanied by changes in PFM activity.
In order to evaluate the postural and respiratory function of the PFM, recordings of anal and vaginal electromyographic activity (EMG) were made with surface electrodes during single and repetitive arm movements that challenge the stability of the spine. EMG recordings were also made during respiratory tasks: quiet breathing and breathing with increased dead-space to induce hypercapnoea.
EMG activity of the PFM was increased in advance of deltoid muscle activity as a component of the pre-programmed anticipatory postural activity. This activity was independent of the direction of arm movement. During repetitive movements, PFM EMG was tonic with phasic bursts at the frequency of arm movement. This activity was related to the peak acceleration of the arm, and therefore the amplitude of the reactive forces imposed on the spine. Respiratory activity was observed for the anal and vaginal EMG and was primarily expiratory. When subjects moved the arm repetitively while breathing, PFM EMG was primarily modulated in association with arm movement with little respiratory modulation.
This study provides evidence that the PFM contribute to both postural and respiratory functions.
... SUI occurs when PFM contractions fail to withstand the IAP [4]. Therefore, the combined action of the pelvic floor, abdominal wall, and thoracic diaphragm determines the pressure in the abdominal cavity [5]. Dysfunction in any segment affects the PFMs and the thoracic diaphragm [6], impacting surrounding muscles and organs leading to irregular breathing patterns, primarily linked to PFM dysfunction [7]. ...
... The present RCT showed a significant increase in expiratory muscle strength, likely contributing to improved continence status in women with SUI. The present RCT showed a significant improvement in the PFMs, supporting the interconnectedness of abdominal muscles, thoracic diaphragm, and PFM, consistent with previous findings showing increased PFM activity during inhalation [5,24]. Additionally, Zachovajeviene et al. [8] observed improved PFM strength with diaphragmatic training over 6 months. ...
... In fact, The observed improvements in the TUG test may be linked to positive changes in inspiratory muscle strength, leading to positive changes in phasic diaphragmatic contractions [28] and the ability to increase IAP [31]. The PFMs also contribute to postural control, in addition to the thoracic diaphragm [5]. Therefore, we assume that the increase in PFM activity induces an improvement in postural control, confirming the synchronized work between the diaphragm, abdominal muscle, and PFM [4]. ...
Pelvic floor muscles (PFMs) are involved in respiratory mechanisms. Additionally, stress urinary incontinence (SUI) can affect physical function. This randomized controlled trial was aimed at investigating the effects of inspiratory muscle training (IMT) on SUI severity, PFM function, and physical function in Tunisian women with SUI.
Twenty-seven incontinent women were randomly assigned to either the experimental group or the control group. The following parameters were assessed: respiratory muscle strength (RMS; maximal inspiratory and expiratory pressures), SUI severity (Urogenital Distress Inventory-6; Incontinence Impact Questionnaire-7; pad test), PFM function (Modified Oxford Scale, electromyography, and endurance), and physical function (Timed Up & Go test; 6-min walk test; incremental shuttle walking test). IMT was conducted using threshold IMT.
The IMT program significantly reduced the severity of SUI (p < 0.01), improved PFM function (p < 0.001), enhanced physical function (p < 0.01), and increased RMS (p < 0.001).
Inspiratory muscle training could be an effective method for improving pelvic floor disorders and physical function in women with SUI.
... 3 While PFMT is recommended as the gold standard treatment for pelvic floor dysfunctions in the guidelines, it is noteworthy that diaphragmatic breathing exercises are not included despite the role of PFM on breathing function. [4][5][6][7] In healthy women, diaphragm, abdominal muscles and PFM work together in synergy during breathing. [4][5][6][7][8] During inspiration, the diaphragm contracts, the abdominal wall expands slightly, and the PFM relaxes. ...
... [4][5][6][7] In healthy women, diaphragm, abdominal muscles and PFM work together in synergy during breathing. [4][5][6][7][8] During inspiration, the diaphragm contracts, the abdominal wall expands slightly, and the PFM relaxes. During expiration, the abdominal muscles and voluntary PFM contract just before the diaphragm relaxes to return to its resting position. ...
... However, it has been previously emphasized that the synergy between the diaphragm and PFM is important during breathing. [4][5][6][7] To the best of our knowledge, there is no study that investigates the synergy between diaphragm and PFM according to different exercise positions. It is thought that the synergy between the diaphragm and PFM may change in different exercise positions. ...
... Vaginal deliveries, for instance, are associated with a heightened risk due to potential alterations in pelvic floor innervation, injury to the levator ani muscle, and damage to the endopelvic fascia from stretching or tearing. Moreover, vaginal births may lead to reduced mobility of the bladder neck, further exacerbating the risk of SUI [5]. ...
... The concept of the integrated continence system, encompasses deficits in the intrinsic urethral closure system, the urethral support system, and the lumbopelvic stability system [5]. These systems are interconnected through neural and endopelvic fascia connections and thus play a critical role in maintaining urinary continence [5]. ...
... The concept of the integrated continence system, encompasses deficits in the intrinsic urethral closure system, the urethral support system, and the lumbopelvic stability system [5]. These systems are interconnected through neural and endopelvic fascia connections and thus play a critical role in maintaining urinary continence [5]. The lumbopelvic region's control, in turn, relies on the coordination of various muscle groups, including the diaphragm, transversus abdominis, pelvic floor musculature, and lumbar multifidus [5]. ...
Background and objective
Stress urinary incontinence (SUI) is a prevalent condition affecting women of various age groups,
significantly impacting their quality of life. To address this multifaceted issue, a comprehensive approach
that goes beyond traditional pelvic floor exercises is needed. Dynamic neuromuscular stabilization (DNS)
exercises, targeting the integrated spinal stabilization system, offer a promising alternative. Thus, this study
aimed to compare the effectiveness of DNS exercises and Kegel exercises in managing SUI among women.
Methods
This single-blinded, pilot study involved 24 women aged 18-40 years with mild to moderate SUI.
Participants were divided into DNS and Kegel exercise groups. Outcome measures included perineometer
readings, electromyography (EMG) data, and the Urogenital Distress Inventory-6 (UDI-6). Statistical analysis
compared baseline and 12-week data within and between groups, and rank-biserial correlation coefficient
(r) as a measure of effect size in our study was calculated.
Results
At 12 weeks, the DNS group showed significant improvement in pelvic floor muscle strength compared to
Kegel exercises (p = 0.005). Both groups had significantly enhanced pelvic floor muscle strength (p < 0.05). A
significant change occurred for EMG average, EMG peak, and EMG maximum voluntary contraction (MVC) at
12 weeks (average p = 0.005; peak p = 0.001; MVC p = 0.009), with significant improvements in both groups
(p < 0.05). For UDI-6, a significant difference emerged between the two groups at 12 weeks (p < 0.05), with
significant improvements in both groups individually from baseline to 12 weeks (p < 0.05). The effect size "r"
for all variables indicated a medium to large effect size, underscoring the substantial and significant impact
of DNS exercises in managing SUI among women compared to Kegel exercises.
Conclusion
This study suggests that DNS exercises, emphasizing the coordinated activation of the diaphragm,
abdominals, multifidus, and pelvic floor, may provide a more effective approach for managing SUI in women
compared to traditional Kegel exercises.
... Vaginal deliveries, for instance, are associated with a heightened risk due to potential alterations in pelvic floor innervation, injury to the levator ani muscle, and damage to the endopelvic fascia from stretching or tearing. Moreover, vaginal births may lead to reduced mobility of the bladder neck, further exacerbating the risk of SUI [5]. ...
... The concept of the integrated continence system, encompasses deficits in the intrinsic urethral closure system, the urethral support system, and the lumbopelvic stability system [5]. These systems are interconnected through neural and endopelvic fascia connections and thus play a critical role in maintaining urinary continence [5]. ...
... The concept of the integrated continence system, encompasses deficits in the intrinsic urethral closure system, the urethral support system, and the lumbopelvic stability system [5]. These systems are interconnected through neural and endopelvic fascia connections and thus play a critical role in maintaining urinary continence [5]. The lumbopelvic region's control, in turn, relies on the coordination of various muscle groups, including the diaphragm, transversus abdominis, pelvic floor musculature, and lumbar multifidus [5]. ...
Background and objective
Stress urinary incontinence (SUI) is a prevalent condition affecting women of various age groups, significantly impacting their quality of life. To address this multifaceted issue, a comprehensive approach that goes beyond traditional pelvic floor exercises is needed. Dynamic neuromuscular stabilization (DNS) exercises, targeting the integrated spinal stabilization system, offer a promising alternative. Thus, this study aimed to compare the effectiveness of DNS exercises and Kegel exercises in managing SUI among women.
Methods
This single-blinded, pilot study involved 24 women aged 18-40 years with mild to moderate SUI. Participants were divided into DNS and Kegel exercise groups. Outcome measures included perineometer readings, electromyography (EMG) data, and the Urogenital Distress Inventory-6 (UDI-6). Statistical analysis compared baseline and 12-week data within and between groups, and rank-biserial correlation coefficient (r) as a measure of effect size in our study was calculated.
Results
At 12 weeks, the DNS group showed significant improvement in pelvic floor muscle strength compared to Kegel exercises (p = 0.005). Both groups had significantly enhanced pelvic floor muscle strength (p < 0.05). A significant change occurred for EMG average, EMG peak, and EMG maximum voluntary contraction (MVC) at 12 weeks (average p = 0.005; peak p = 0.001; MVC p = 0.009), with significant improvements in both groups (p < 0.05). For UDI-6, a significant difference emerged between the two groups at 12 weeks (p < 0.05), with significant improvements in both groups individually from baseline to 12 weeks (p < 0.05). The effect size "r" for all variables indicated a medium to large effect size, underscoring the substantial and significant impact of DNS exercises in managing SUI among women compared to Kegel exercises.
Conclusion
This study suggests that DNS exercises, emphasizing the coordinated activation of the diaphragm, abdominals, multifidus, and pelvic floor, may provide a more effective approach for managing SUI in women compared to traditional Kegel exercises.
... The pelvic floor muscles contribute to regulation of intra-abdominal pressure (Stafford et al., 2010;Hodges et al., 2007) with contraction. Levator ani forms the base of the abdominal cavity and activity of this muscle (especially the puborectalis component) controls ascent and descent of the abdominal floor and contents (Hodges et al., 2007;Dorey, 2005). ...
... The pelvic floor muscles contribute to regulation of intra-abdominal pressure (Stafford et al., 2010;Hodges et al., 2007) with contraction. Levator ani forms the base of the abdominal cavity and activity of this muscle (especially the puborectalis component) controls ascent and descent of the abdominal floor and contents (Hodges et al., 2007;Dorey, 2005). In contrast, contraction of the striated urethral sphincter, bulbocavernosus, and external anal sphincter muscles constrict the urethra and anus to maintain urinary and faecal continence when intra-abdominal pressure increases (Dorey, 2005). ...
... There has been limited investigation of male pelvic floor muscle function during respiratory tasks. Anal electromyography (EMG) data reported for one male participant showed greater amplitude during expiration (similar to female participants) (Hodges et al., 2007), and data from transperineal ultrasound imaging show displacement of pelvic landmarks during cough including shortening of the striated urethral sphincter and bulbocavernosus muscles, and lengthening of the puborectalis muscle during the expulsive phase (Stafford et al., 2014). Puborectalis lengthening during coughing is likely to reflect an eccentric contraction (as a consequence of increased intra-abdominal pressure) to control the descent of abdominal contents, while contraction of the striated urethral sphincter and bulbocavernosus likely reflects control of urethral pressure to maintain urinary continence. ...
The study aimed to identify whether pelvic floor muscles modulate length with breathing, and if any length changes induced by breathing relate to abdominal cavity displacement and intra-abdominal pressure. To investigate these relationships, displacement of pelvic landmarks that related to pelvic floor muscle length using transperineal ultrasound imaging, breath volume, intra-abdominal pressure, abdominal and ribcage displacement, and abdominal and anal sphincter muscle electromyography were measured during quiet breathing and breathing with increased dead-space in ten healthy men. Pelvic floor muscle landmark displacement modulated with ribcage motion during breathing. This relationship was stronger for: i) motion of the urethrovesical junction (puborectalis muscle length change) than the mid-urethra landmark (striated urethral sphincter muscle length change), and ii) dead-space breathing in standing than dead-space breathing in supine or quiet breathing in standing. In most (but not all) participants, the urethrovesical junction descended during inspiration and elevated during expiration. Striated urethral sphincter length changes during the respiratory cycle was independent of intra-abdominal pressure. In summary, breathing involves pelvic floor muscle length changes and is consistent with the role of these muscles during respiration to aid maintenance of continence, lung ventilation and/or provision of support to the abdominal cavity. Clinicians who train pelvic floor muscles need to be aware that length change of pelvic floor muscles is expected with breathing.
... Due to the dual role of the diaphragm for ventilation and postural control, disruption of ventilation in the form of BPD can lead to a disruption in postural control (Hodges et al., 2007). Activities performed in daily life such as walking, standing, and handling of objects require a degree of postural control to maintain an upright stance. ...
... Unlike previously hypothesised, there were negligible correlations between RTWT and BPD dimensions. Due to the dual role of the diaphragm for ventilation and postural control, it was thought that any disruption to it can lead to disruptions in postural control (Hodges et al., 2007). This could affect a person's ability to execute tasks in the workplace environment thereby limiting full reintegration into the workplace (Haddad et al., 2013).That being said, RTWT and return to work rate does not reflect whether the participants have resumed full functioning in the workplace. ...
... However, Goode et al. suggest that traditional pelvic floor training is suboptimal because some patients are unwilling to undergo it [14]. In recent years, Pilates training has achieved good results in the treatment of patients with urinary incontinence after prostate surgery and can well arouse the enthusiasm of patients, it seems that Pilates training can be used in the conservative treatment of Post-prostatectomy incontinence [15,16]. ...
... Some previous studies have confirmed that Pilates combined with Kegel training can effectively improve urinary control in patients with post-prostatectomy incontinence [24]. By transferring the traditional Kegel training for trunk stability to the Kegel training for trunk instability, the recruitment rate of trunk core muscles can be stimulated by different postural transitions [33], the study conducted by Stafford et al. revealed that the activation of core muscle groups can effectively enhance pelvic floor muscle contraction [34], abdominal muscle activity can improve pelvic floor muscle strength [35], so as to better promote the improvement of pelvic floor muscle strength [15,16]. In trials, Pilates training mostly involved different positions. ...
Background
Urinary incontinence symptoms severely affect older people with different body mass index (BMI).To compare the efficacy of the pelvic floor muscle training (PFMT) in patients with post-prostatectomy incontinence with different BMI.
Methods
Thirty-seven patients with post-prostatectomy incontinence were included. They were divided into group A (BMI ≤ 25,12), group B (26 ≤ BMI ≤ 30,14), and group C (BMI ≥ 31,11) based on difference BMI. Three groups of patients underwent the same Pilates combined with kegel training. Participants were assessed with 1-hour pad test, the number of incontinence episodes, International Consultation on Incontinence Questionnaire and Oxford Grading Scale.
Results
In the 1-hour pad test, the differences before and after training were statistically significant in all three groups of participants. Group A decreased from 81.83 ± 8.79 to 31.08 ± 5.64 g (P < 0.01). Group B decreased from 80.57 ± 8.87 to 35.85 ± 5.66 g (P < 0.01). Group C decreased from 83.55 ± 10.24 to 40.18 ± 7.01 g (P < 0.01). The number of incontinent episodes in group A decreased from 9.33 ± 1.07 to 3.25 ± 0.62 (P < 0.01). Group B decreased from 8.86 ± 1.09 to 3.79 ± 0.80 (P < 0.01). Group C decreased from 9.27 ± 1.10 to 4.09 ± 0.70 (P < 0.01). The correlation between the three groups of participants and the 1-hour pad test, with an R² of 0.51. The correlation between the three groups of participants and the number of urinary incontinence episodes with a R² of 0.43.
Conclusions
Pelvic floor muscle training can affect the recovery of urinary continence in patients with different BMI. Maintaining a lower BMI can be beneficial for improving urinary control.
Trial registration
Date of trial registration: November 27, 2023.
... Durante situações de aumento da pressão intra-abdominal, como em uma tosse, ocorre contração antecipatória desse grupo muscular. Assim, em situações de fadiga e sobrecarga, desencadeado por uma doença respiratória, por exemplo, com inadequada modulação da pressão abdominal, a musculatura pélvica fica mais suscetível a micro-lesões e incoordenação, podendo desencadear o comprometimento da tríade de funções [2]. ...
... Existe uma sinergia mecânica entre o assoalho pélvico, o diafragma respiratório e a musculatura abdominal, de forma que ocorre recrutamento sinérgico da musculatura pélvica durante a inspiração e mais significativamente durante a expiração. Assim, o assoalho pélvico exerce importante papel durante a respiração, sendo solicitado durante situações de maior demanda respiratória, contribuindo para a capacidade respiratória e expiratória máxima, e justificando assim afecções simultâneas de ambos os sistemas em condições patológicas [2,3]. ...
Introdução: Considerando a relação recíproca entre o assoalho pélvico e o diafragma respiratório, a sobrecarga da musculatura pélvica pela tosse e a dispneia e ação viral sobre a bexiga, podemos hipotetizar relação entre a COVID-19 e as disfunções do assoalho pélvico. Objetivo: Investigar a frequência de sintomas urinários em mulheres que foram afetadas pela COVID e se esses sintomas permaneceram após a melhora da infecção e identificar se houve piora de sintomas já previamente existentes nas participantes. Métodos: 88 mulheres entre 18 e 60 anos, que haviam sido infectadas pela COVID-19 responderam ao questionário digital via Google Forms, que buscava identificar a presença ou não de incontinência urinária de esforço e urgência, urgência urinária, noctúria, e outros sintomas do trato urinário, em 4 momentos estabelecidos (antes da pandemia, durante a pandemia, durante o período em que estava infectado pela COVID-19 e após a COVID-19). Para análise estatística foi realizado teste de Kolmogorov-Smirnov seguido do teste de Wilcoxon, considerando significância de p < 0,05. Resultados: A média de idade das 88 participantes foi de 31,9 anos, e dessas 13(14,8%) referiram sintomas de incontinência urinária de esforço antes da COVID, tendo a frequência aumentada para 22(25%) durante a infecção (p < 0,08) e 23(26,1%) após a COVID (p < 0,06). O sintoma de incontinência urinária de urgência foi relatado por 9(10,2%) das participantes antes da COVID e esse sintoma foi descrito por 19(21,5%) durante e 29(33%) após (p < 0,005). A frequência de sensação de urgência sem perda urinária aumentou de 14(15,9%) participantes antes, para 19(21,6%) durante e 29(33%) após a COVID (p < 0,005). A frequência de noctúria aumentou de 36(40,9%) antes para 50 (56,8%) durante (p < 0,05), reduzindo para 48(54,5%) após a COVID (p = 0,07). A frequência urinária também aumentou e 6,02 para 7,56 (p < 0,05) considerando o antes e após a COVID. Conclusão: Ocorreu aumento na frequência da noctúria durante o período de infecção pela COVID e na sensação de urgência e esvaziamento incompleto no período de infecção pela COVID e após COVID. A piora entre as participantes foi nos sintomas de perdas urinárias aos esforços e na sensação de urgência miccional no período de infecção pela COVID e após COVID.
... These muscles are crucial for supporting pelvic organs, maintaining continence, and sexual function (Eickmeyer, 2017). They also play an important role in stabilizing the trunk and the sacroiliac joint, which, if unstable, can lead to the occurrence of CL-BP (Hodges et al., 2007;Lee et al., 2016;Pel et al., 2008). Due to the numerous functions of PFM, they are becoming increasingly important in physiotherapeutic treatment. ...
... Given the importance that literature attributes to the ability to control breathing patterns for both physical (Hodges and Gandevia, 2000;Gilbert, 2003;Hodges et al., 2007) and emotional (Perciavalle et al., 2017;Hopper et al., 2019;Balban et al., 2023) management, this study presents a worrying scenario for young university students. Worries were confirmed by the number of subjects presenting high levels of anxiety in this study. ...
Objective
This study aims to test the hypothesis that breathing can be directly linked to postural stability and psychological health. A protocol enabling the simultaneous analysis of breathing, posture, and emotional levels in university students is presented. This aims to verify the possibility of defining a triangular link and to test the adequacy of various measurement techniques.
Participants and Procedure
Twenty-three subjects (9 females and 14 males), aged between 18 and 23 years, were recruited. The experiment consisted of four conditions, each lasting 3 minutes: Standard quiet standing with open eyes 1), with closed eyes 2), and relaxed quiet standing while attempting deep abdominal breathing with open eyes 3) and with closed eyes 4). These latter two acquisitions were performed after subjects were instructed to maintain a relaxed state.
Main Outcome Measures
All subjects underwent postural and stability analysis in a motion capture laboratory. The presented protocol enabled the extraction of 4 sets of variables: Stabilometric data, based on the displacement of the center of pressure and acceleration, derived respectively from force plate and wearable sensors. Postural variables: angles of each joint of the body were measured using a stereophotogrammetric system, implementing the Helen Hayes protocol. Breathing compartment: optoelectronic plethysmography allowed the measurement of the percentage of use of each chest compartment. Emotional state was evaluated using both psychometric data and physiological signals. A multivariate analysis was proposed.
Results
A holistic protocol was presented and tested. Emotional levels were found to be related to posture and the varied use of breathing compartments. Abdominal breathing proved to be a challenging task for most subjects, especially females, who were unable to control their breathing patterns. In males, the abdominal breathing pattern was associated with increased stability and reduced anxiety.
Conclusion
In conclusion, difficulties in performing deep abdominal breathing were associated with elevated anxiety scores and decreased stability. This depicts a circular self-sustaining relationship that may reduce the quality of life, undermine learning, and contribute to muscular co-contraction and the development of musculoskeletal disorders. The presented protocol can be utilized to quantitatively and holistically assess the healthy and/or pathological condition of subjects.
... Since groups of muscle fibers can be selectively activated during a motor gesture, EMG generates specific spectra associated with the conduction speed of the action potential of the motor unit [10]. EMG has allowed us to discover synergies of the PFMs with the abdominal muscles [11], hip abductor muscles [5], and shoulder flexor/extensor muscles [12,13]. ...
(1) Background: Pelvic-floor-muscle (PFM) activation acts synergistically with multiple muscles while performing functional actions in humans. The purpose of this study was to characterize the activity of the PFMs and gluteus medius (GM) while walking and running in physically active nulliparous females. (2) Methods: The peak and average amplitude of maximal voluntary contractions (MVCs) during 60 s of walking (5 and 7 km/h) and running (9 and 11 km/h) were measured with electromyography of the GM and PFMs in 10 healthy female runners. (3) Results: The activation of both muscles increased (p < 0.001) while walking and running. The MVC of the GM was reached when walking and tripled when running, while the PFMs were activated at half their MVC when running. The global ratio of the GM (75.3%) was predominant over that of the PFMs (24.6%) while static and walking. The ratio reached 9/1 (GM/PFM) while running. (4) Conclusion: The GM and PFMs were active while walking and running. The GM’s MVC tripled at high speeds, while the PFMs reached only half of their maximum contraction.
... It plays a crucial role in urinary and fecal continence, functions directly related to intra-abdominal pressure (IAP). 37,38 These pressure dynamics can be influenced by both automatic mechanisms and voluntary interventions. ...
This study explores the complex role of the diaphragm, traditionally considered essential in respiratory physiology, expanding understanding of its multifunctionality. Beyond respiratory mechanics, the diaphragm contributes to postural stabilization, lumbar support, and regulation of intra-abdominal pressure (IAP). By analyzing the diaphragm's eccentric contraction, we introduce two innovative concepts: "Diaphragm Antagonist Muscles" (DAM) and "Centration". DAM represents an evolution of the abdominal belt concept, integrating the pelvic floor and lower posterior trunk muscles. This muscular synergy is vital for respiratory dynamics and functions such as posture and integrity of the musculoskeletal, pressure, and postural systems. Centration, proposed as a conscious modulation skill of IAP, activates a neurophysiological interaction between the diaphragm, lower posterior trunk muscles, and the pelvic floor, revealing new implications of the diaphragm in sports, health, and kinesiological contexts.
... According to the literature, involuntary pelvic floor muscle (PFM) contractions occur without conscious control or effort, and are considered a normal response preceding increased intra-abdominal pressure (IAP), such as during a cough [1][2][3][4]. However, the literature lacks consensus in regard to the underlying mechanisms involved in involuntary PFM contractions, and has variously characterized them as a reflex [5,6], dynamic response [7], co-activation [8][9][10][11], pre-programmed activation [12], or feed-forward movement [13]. Moreover, scientific research has focused primarily on assessing and establishing outcome measures for evaluating voluntary PFM contractions, whereas involuntary PFM contractions have received significantly less scientific interest. ...
Introduction and Hypothesis
Involuntary pelvic floor muscle (PFM) contractions are thought to occur during an increase in intra-abdominal pressure (IAP). Although no studies have assessed their presence in women with normal pelvic floor (PF) function, existing literature links the absence of involuntary PFM contractions to various PF dysfunctions. This study rectifies this lacuna by evaluating involuntary PFM contractions during IAP in healthy nulliparous women with no PF dysfunction, using visual observation and vaginal palpation. Results were compared with the literature and the IUGA/ICS Terminology Reports.
Methods
Nulliparous ( n =149) women performed three sets of three maximal coughs. Visual observation and vaginal palpation were conducted in the standing and supine positions. The women were not instructed to contract their PFMs. Occurrence rates were calculated for each assessment method and position; differences between positions were analyzed using the Chi-squared test.
Results
Rates of occurrence of involuntary PFM contraction were low across both assessments and positions (5–17%). Significant differences were found between standing (5%) and supine (15%) positions for visual observation, but not vaginal palpation (15%, 17% respectively). Occurrence rates also differed compared with the literature and terminology reports.
Conclusions
Contrary to clinical expectations, rates of occurrence of involuntary PFM contraction among our cohort of nulliparous women were extremely low. Digital palpation results showed high agreement with the terminology reports, but only partial agreement was observed for the visual observation results. Our study underscores the need for more research aimed at defining normal involuntary PF functions, a review of our understanding of involuntary PFM contractions, and better standardized guidelines for involuntary PFM assessment methods.
... Some studies report on PFM activity during breathing, forced expiration and generation of intra-abdominal pressure, situations similar to singing [7,8]. Digital palpation, perineometry, surface electromyography (sEMG) and magnetic resonance imaging (MRI) have been used to evaluate muscle activity in studies on breathing and forced expiration. ...
Background
Control of pelvic floor muscles (PFM) is emphasized as important to obtain functional breath support in opera singing, but there is not much research that proves PFM function as part of breath support in classical singing. Transperineal ultrasound is a reliable method for quantification of PFM contraction in urogynecology. Our aim was to establish if transperineal ultrasound can be used for observation of movement of the PFM during singing and to quantify pelvic floor contraction.
Methods
Cross sectional study of 10 professional opera singers examined with transperineal ultrasound in the supine position at rest and contraction, and standing at rest and during singing. Levator hiatal area was measured in a 3D rendered volume. Levator hiatal anteroposterior (AP) diameter and bladder neck distance from symphysis were measured in 2D images.
Results
The AP diameter was shortened from supine rest to contraction (15 mm), standing (6 mm) and singing (9 mm), all p < 0.01. The bladder neck had a non-significant descent of 3 mm during singing. The mean proportional change in AP diameter from rest to contraction was 24.2% (moderate to strong contraction) and from rest to singing was 15% (weak to moderate contraction).
Conclusions
Transperineal ultrasound can be used to examine the PFM during singing. The classically trained singers had good voluntary PFM contraction and moderate contraction during singing. AP diameter was significantly shortened from supine to upright position, with further shortening during singing, confirming that female opera singers contracted their pelvic floor during singing.
... There has been some evidence suggesting that standing involves centrally controlled posturo-respiratory coupling across all joints, from head to foot. Humeral, scapular, diaphragmatic, pelvic and spinal joints demonstrate strong, significant and consistent synchronous automatic interactions, particular in the standing position [13][14][15][16]. This might be a factor contributing to the finding that the standing cough stress test is more reliable and more sensitive than the supine cough stress test [17]. ...
A brief educational intervention focusing on neutral posture during cough, without voluntary pre-contraction of the PFMs, has no clinically significant influence on sEMG peak activity of the PFMs in women with cough-induced UI. However, this intervention can lead to a significant improvement in urinary symptoms and QoL at 6 weeks.
... All studies pointed out the major contribution of superior thorax to the breathing pattern. In trained cyclists, it can be hypothesized that the inferior thorax mechanics have a greater role in intra-abdominal pressure regulation, contributing the most to spinal and pelvic floor stabilization [44,45], respiratory function, and power output [41,45,46]. As a result, we argue that the planning of specific inspiratory muscle training is to be considered to further improve the performance of competitive cyclists, in agreement with [5] who suggested that inspiratory muscle training attenuates the perceptual response to maximal incremental exercise. ...
Thoracoabdominal breathing motion pattern is being considered in sports training because of its contribution, along with other physiological adaptations, to overall performance. We examined whether and how experience with cycling training modifies the thoracoabdominal motion patterns. We utilized optoelectronic plethysmography to monitor ten trained male cyclists and compared them to ten physically active male participants performing breathing maneuvers. Cyclists then participated in a self-paced time trial to explore the similarity between that observed during resting breathing. From the 3D coordinates of 32 markers positioned on each participant’s trunk, we calculated the percentage of contribution of the superior thorax, inferior thorax, and abdomen and the correlation coefficient among these compartments. During the rest maneuvers, the cyclists showed a thoracoabdominal motion pattern characterized by an increased role of the inferior thorax relative to the superior thorax (26.69±5.88%, 34.93±5.03%; p = 0.002, respectively), in contrast to the control group (26.69±5.88%; 25.71±6.04%, p = 0.4, respectively). In addition, the inferior thorax showed higher coordination in phase with the abdomen. Furthermore, the results of the time trial test underscored the same pattern found in cyclists breathing at rest, suggesting that the development of a permanent modification in respiratory mechanics may be associated with cycling practice.
... In healthy subjects however, this "postural disturbance" of respiratory origin does neither cause balance impairment nor falls [14]. Rhythmic contractions of the spinal [14,16] and of pelvic floor muscles [17] limit the postural oscillations linked to breathing by containing the CoP in the support polygon. This reflects a posturo-respiratory coupling (PRC) which is centrally adjusted [11,15]. ...
Alteration of posturo-respiratory coupling (PRC) may precede postural imbalance in patients with chronic respiratory disease. PRC assessment would be appropriate for early detection of respiratory-related postural dysfunction. PRC may be evaluated by respiratory emergence (REm), the proportion of postural oscillations attributed to breathing activity; assessed by motion analysis) as measured from the displacement of the center of pressure (CoP) (measured with a force platform). To propose a simplified method of PRC assessment (using motion capture only), we hypothesized that the REm can appropriately be measured derived from single body segment the postural oscillations of a single body segment rather than whole body postural oscillations. An optoelectronic system recorded the breathing pattern and the postural oscillations of six body segments in 50 healthy participants (22 women), 34 years [26; 48]. The CoP displacements were assessed using a force platform. One-minute recordings were made in standing position in four conditions by varying vision (eyes opened/closed) and jaw position (rest position/dental contact). The Sway Path and Mean Velocity of the CoP and of the representative point of each body segment were recorded. The REm was measured along the major and the minor axis of the 95% confidence ellipse of the CoP position (REm_MajorAxis
CoP
; REm_MinorAxis
CoP
) and of that of each body segment. SwayPath
CoP
and MV
CoP
varied widely across the four conditions (par<0.000001). These changes were related to the visual condition (p<0.000001) while the jaw position had no effect. The REm_MajorAxis
CoP
and the REm_MinorAxis
CoP
changed across conditions (p<0.05); this was related to vision while jaw induced changes only for the REm_MinorAxis
CoP
. The SwayPath, the Mean Velocity and the REm of all body segments were significantly correlated to the CoP, but the highest correlations were observed for the thorax, the pelvis and the shoulder. PRC may be assessed from the postural oscillations of thorax, pelvis and shoulder. This should simplify the evaluation of respiratory-related postural interactions in the clinical environment, by using a single device to simultaneously assess postural oscillations on body segments, and breathing pattern. In addition, this study provides reference data for PRC and its sensory-related modulations on body segments along the postural chain.
... As well as maintaining continence and supporting the pelvic organs, these muscles play an important role in posture, respiration, sexual activity and preparation to undertake an action (e.g. breathing, coughing, and arm, lower extremity and trunk movements) (Nygaard et al. 1996;Ashton-Miller & DeLancey 2007;Hodges et al. 2007;Sapsford et al. 2008;Capson et al. 2011;Talasz et al. 2011;Park & Han 2015;Zhoolideh et al. 2017). These responses are automatic, and human beings go through their lives without consciously activating their PFMs or initiating these muscles for support when talking, singing or swinging a tennis racket, for example. ...
This paper discusses the management of pelvic floor dysfunction (PFD) in an active
female patient. Pelvic health physiotherapy is a relatively new specialty in
some countries, and many healthcare systems only prescribe pelvic floor muscle
(PFM) exercises for the treatment of this condition. The importance of a holistic
approach to the management of PFD in physically active women is addressed. A
biopsychosocial perspective is needed for the assessment and treatment of these
individuals. If this is integrated with an understanding of musculoskeletal dysfunction
and sports medicine, the physiotherapist can improve their female patients’
pelvic health, and individual fitness and sporting performance. “Silent” symptoms
(e.g. incontinence and pelvic heaviness) are a major challenge in the management
of PFD because women can be too embarrassed to discuss these outside the clinic.
The physiotherapist’s role must extend beyond the assessment of the pelvis and the
PFMs, and a variety of skills are required to treat PFD throughout the course of a
woman’s life.
... As a possible explanation for such effectiveness, we know that the Pilates Method comprises exercises that are performed in coordination with breathing, with concomitant recruitment of trunk muscles in various positions (21) . Such exercises are important, since continence (leakage of urine) is associated with the functions of respiratory mechanics and maintenance of intra-abdominal pressure (22) . Thus, when compared to conventional non-specific exercises for the pelvic floor, Pilates can provide greater control of continence. ...
Background: Among the methods used by physiotherapists for strengthening and controlling the pelvic floor muscles, Pilates method can be mentioned. Although recent studies have investigated the effects of the method on urinary incontinence, no recent systematic literature reviews on the subject have been found. Objectives: To conduct a systematic literature review demonstrating the effects of the Pilates method on urinary incontinence.. Methods: A search was conducted in the databases MEDLINE, Scielo, LILACS, and PEDro, supplemented by a manual search. The search terms included the descriptors: urinary incontinence, Pilates method, pelvic floor strengthening, as well as these terms in English. The studies were analyzed by two independent evaluators, with no language or publication date restrictions. The methodological quality of the studies was evaluated using the PEDro scale. Results: Seven articles met the inclusion criteria and were included in this systematic review. Overall, the studies showed that there are significant results in the use of the Pilates method for urinary incontinence and pelvic floor muscle function, as well as improvements in quality of life. However, compared to conventional physiotherapy, the Pilates method is not superior, as both are effective interventions for the treatment of urinary incontinence. Conclusion: Although the Pilates method appears to be an effective intervention for the pelvic floor muscles and, consequently, improves urinary incontinence, this method is not superior to specific conventional physiotherapy targeting this musculature. However, these conclusions are based on only seven studies with low to moderate methodological quality.
... Coactivation of the PFM with other postural muscles in these functional tasks is thought to be mediated via multiple cortical and subcortical regions. (8,12,13) The synergic work of the pelvic floor and diaphram muscle allows to improve the motor activation of muscle less visible on physical examination. According to literature our results suggest that persons with SCI retain some residual innervation of the PFM after injury, possibly via indirect cortical descending pathways. ...
Introduction: One of the most relevant disabilities is caused by spinal cord injury (SCI). Typical causes of spinal cord damage are trauma, disease, or congenital disorders SCI compromises the function of central nervous system.t. The pelvic floor represents the lower closure of the pelvis and it is able to support the pelvic organs. Case Report: acute SCI patient, following intradural-extramedullary spinal neoformation level D6-D9. Rehabilitation approach to pelvic floor included a series of techniques aimed at improving the contractility and tone of the pelvic floor muscles. At the end of 6 sessions patient presented major awareness of bladder emptying through intermittent catheterization and the partial recovery of tactile sensitivity in the wall of the vagina. Conclusions: This paper suggest the possibility for inserting the treatment of the pelvic floor in the neuro-motor rehabilitation program of the complete SCI. The awareness of pelvic floor muscles contraction and bladder functions represent important goals.
... Few papers provided information on body position during the exercises taught by using BFB, which deeply affects intraabdominal pressure (IAB) [31]. None provided full details on respiratory pattern assessment, which also affects IAB [32,33]. Some details about the characteristics of the biofeedback programs are lacking, such as presence and shape of obstacles in the visual programme generated by the computer. ...
BACKGROUND: Postoperative urinary incontinence is the overall result of urethral sphincter incompetence and modifications in urethral length after radical prostatectomy. Findings for preoperative interventions targeted at preventing post-prostatectomy incontinence include preoperative pelvic floor muscle training (PFMT) and biodfeedback (BFB), which can be managed by nurses in many countries and have been used for decades to speed up continence recovery after surgery.
AIM: to determine the effectiveness of preoperative biofeedback (BFB) for post-prostatectomy urinary incontinence compared to pelvic training without BFB, considering the variability between the results of the available studies.
METHODS: A systematic review and meta-analysis was conducted, analyzing the indications provided by the literature regarding preoperative biofeedback for preventing urinary incontinence after open radical prostatectomy, in terms of treatment regimens, timing for beginning the sessions, number of contraction and relaxation exercises, and scheduled work at home. Literature search on Pubmed, CINAHL, Cochrane Library, Web of Science, Scopus, EMBASE, and PEdro.
RESULTS: Despite only three papers being suitable for metanalysis, our results support BFB over written instructions for continence recovery after both 3 and 6 moths from surgery. Implementing progressive programs with many different muscular exercises and including relaxation are the main recommendations.
CONCLUSIONS: Preoperative biofeedback leads to improved urinary continence after 3 and 6 months from radical prostatectomy. Future studies should focus on the characteristics and number of pelvic muscle contractions required during biofeedback in order to maximize effectiveness.
... Further, 89.1% agreed that CSE involves training the body's posture through complex and dynamic movements. Several studies have also proved that the core muscles aid in stabilizing the lumbar spine and postural maintenance (Hides et al., 1996;Hodges et al., 2007;Kibler et al., 2006). Szczygieł et al. demonstrated that four weeks of core deep muscle training helps to improve posture, particularly trunk postural control in the sagittal plane (Szczygieł et al., 2018). ...
The current study intended to determine recreational runners' knowledge, attitude, and practices toward CSE to prevent LBP. Materials and Methods: A cross-sectional study design was adopted. Two hundred fifty-seven recreational runners were chosen using a simple random sampling approach and administered with a semi-structured questionnaire to evaluate their KAP toward CSE. Data analysis was carried out using SPSS 28.0. Results: The correct response to the knowledge-related items in the questionnaire was from 65% to 91%. Precisely, 91.4% of study participants understood CSE. Furthermore, most participants showed a positive attitude toward CSE, considering that it is essential for running (79%), improving fitness (76%), reducing the risk of injuries (71%), and boosting their appearance (54%). Most participants (>85%) performed CSE for recommended frequency and duration to strengthen their core muscles and prevent LBP. The recreational runners had good practice toward CSE. Conclusion: Recreational runners possess adequate knowledge, a positive attitude, and good practice toward CSE. This study suggested that motivational strategies and awareness programs can be conducted to improve recreational runners' KAP toward CSE preventing LBP.
Although anxiety is a common psychological condition, its symptoms are related to a cardiopulmonary strain which can cause palpitation, dyspnea, dizziness, and syncope. Severe anxiety can be disabling and lead to cardiac events such as those seen in Takotsubo cardiomyopathy. Since torso stiffness is a stress response to unpredictable situations or unexpected outcomes, studying the biomechanics behind it may provide a better understanding of the pathophysiology of anxiety on circulation, especially on venous impedance. Any degree of torso stiffness related to anxiety would limit venous return, which in turn drops cardiac output because the heart can pump only what it receives. Various methods and habits used to relieve stress seem to reduce torso stiffness. Humans are large obligatory bipedal upright primates and thus need to use the torso carefully for smooth upright activities with an accurate prediction. The upright nature of human activity itself seems to contribute to anxiety due to the needed torso stiffness using the very unstable spine. Proper planning of actions with an accurate prediction of outcomes of self and non-self would be critical to achieving motor control and ventilation in bipedal activities. Many conditions linked to prediction errors are likely to cause various degrees of torso stiffness due to incomplete learning and unsatisfactory execution of actions, which will ultimately contribute to anxiety. Modifying environmental factors to improve predictability seems to be an important step in treating anxiety. The benefit of playful aerobic activity and proper breathing on anxiety may be from the modulation of torso stiffness and enhancement of central circulation resulting in prevention of the negative effect on the cardiopulmonary system.
The pelvic floor is responsible for controlling important functions such as urination, evacuation or continence of urine and feces, acting as a sphincter. All these functions are performed in a voluntary manner, in a harmony between the systems of suspension and sustentation.
The suspension is performed by the smooth musculature and connective tissue, being: anterior bundles (pubocervical ligament), lateral bundles (Mackenrodt’s or cardinal ligaments) and posterior bundles (uterosacral ligaments, which connect the uterus to the sacrum, taking the structures upwards and backwards). The pelvic diaphragm presents dynamic functionality in the pelvic floor and divides the perineum from the pelvic cavity. It consists of the coccygeal (or ischiococcygeal) muscle and the levator ani muscles (pubococcygeal, pubovaginal, puborectal and iliococcygeal).
The urogenital diaphragm, in turn, is responsible for the static functionality of the pelvic floor, composed of the bulbocavernosus, ischiocavernosus, transverse perineal muscles (superficial and deep) and the external sphincteral muscle.
Background:
Limited chest expansion and asymmetry in the respiratory muscles after a stroke lead to poor ventilation and reduced physical performance.
Objectives:
To determine the effect of chest expansion resistance exercise and respiratory muscle stretching on respiratory function and gait endurance in patients with stroke.
Methods:
Thirty stroke patients were randomly assigned to a chest expansion resistance group (CERG), a respiratory muscle stretching group (RMSG), and a control group (CG). CERG and RMSG received chest expansion resistance and respiratory muscle stretching, respectively, 3 times a week for 8 weeks. Respiratory function, respiratory muscle strength, and gait endurance were measured before and after the intervention period.
Results:
The experimental groups, CERG and RMSG, showed significant improvements in respiratory function variables (p < .05). For respiratory muscle strength variables, maximal inspiratory pressure (MIP) in the CERG and maximal expiratory pressure (MEP) in the RMSG showed significant changes compared to the CG (p < .05). Both CERG and RMSG also showed significant improvements in the 6MWT compared to the CG (p < .05).
Conclusion:
Chest expansion resistance exercise would be a more effective method, while both chest expansion resistance exercise and respiratory muscle stretching are helpful in improving respiratory function and gait endurance.
Objective:
Levator ani muscles undergo significant stretching and micro-trauma at childbirth. The goal was to assess the neuromuscular integrity of this muscle group by means of magnetomyography and correlate with Brink score - a commonly used digital assessment of pelvic floor muscle strength.
Methods:
Non-invasive magnetomyography (MMG) data was collected on 22 pregnant women during rest and voluntary contraction of the pelvic-floor muscles (Kegels). The mean amplitude and power spectral density (PSD) of the Kegels were correlated to Brink pressure score.
Results:
The Brink’s scores demonstrated medium correlations (≥0.3) with MMG amplitude and PSD with the average Kegel of medium intensity and rest. Data showed that the “resting state” of the pelvic floor is, in actuality, quite dynamic and may have implications for pelvic floor disorder propensity postpartum.
Conclusion:
These results confirm the ability of non-invasive magnetomyography to reliably capture pelvic floor contraction as these signals correlate with clinical measure.
PURPOSE This study investigated the differences in plantar pressure distribution when using three breathing techniques during heel raises.METHODS The subjects were 29 professional dancers aged 20 to 30 years with more than 10 years of experience. Pressure distribution according to breathing method during heel raise was measured for 10 seconds while controlling the raise speed and gaze. The three breathing techniques were randomly ordered. Peak pressure, contact area and time, displacement, and absolute velocity of the center of pressure trajectory were measured using Emed®-le from Novel GMBH. Plantar pressure was analyzed by dividing it into a total of 12 areas (masks): five toes, five metatarsals, the midfoot, and the hindfoot.RESULTS Using the teeth occlusion breathing technique, the peak pressure on the first metatarsal was significantly reduced, the contact time of the second metatarsal was significantly longer, and the displacement of the center of pressure trajectory was significantly shorter. Additionally, during the phase of the forefoot retainer, the velocity of the center of pressure trajectory was significantly reduced.CONCLUSIONS The teeth occlusion technique reduces peak pressure, increases contact time and area, and decreases the displacement and velocity of the center of pressure trajectory, demonstrating an efficient method for maintaining balance in ballet movements. This technique can potentially enhance stability and prevent injuries in ballet dancers.
Pelvic floor dysfunction is a common problem in women and has a negative impact on their quality of life. The aim of this review was to provide a general overview of the current state of technology used to assess pelvic floor functionality. It also provides literature research of the physiological and anatomical factors that correlate with pelvic floor health. This systematic review was conducted according to the PRISMA guidelines. The PubMed, ScienceDirect, Cochrane Library, and IEEE databases were searched for publications on sensor technology for the assessment of pelvic floor functionality. Anatomical and physiological parameters were identified through a manual search. In the systematic review, 114 publications were included. Twelve different sensor technologies were identified. Information on the obtained parameters, sensor position, test activities, and subject characteristics was prepared in tabular form from each publication. A total of 16 anatomical and physiological parameters influencing pelvic floor health were identified in 17 published studies and ranked for their statistical significance. Taken together, this review could serve as a basis for the development of novel sensors which could allow for quantifiable prevention and diagnosis, as well as particularized documentation of rehabilitation processes related to pelvic floor dysfunctions.
Objective
The study aimed to investigate treatment options for older women with pelvic organ prolapse (POP) and postoperative outcomes based on their long‐term care (LTC) status.
Methods
We used the medical and LTC insurance claims databases of Tochigi Prefecture in Japan, covering 2014 to 2019. We included women 65 years and older with POP and evaluated their care status and treatment, excluding women with an observation period <6 months. Among women with a postsurgical interval ≥6 months, we compared care level changes and deaths within 6 months and complications within 1 month postoperatively between those with and without LTC using Fisher exact test.
Results
We identified 3406 eligible women. Of the 447 women with LTC and 2959 women without LTC, 16 (3.6%) and 415 (14.0%), respectively, underwent surgery. Among 393 women with a postsurgical interval ≥6 months, 19 (4.8%) required LTC at surgery. Two of the 19 women with LTC (10.5%) and eight of 374 women without LTC (2.1%) experienced worsening care–needs level. No deaths were recorded. Urinary tract infection (UTI) was significantly more frequent in women with LTC than in women without LTC (36.8% vs 8.6%). Other complications were rare in both groups.
Conclusion
The proportion of patients who underwent surgery for POP was lower in women with LTC than in women without LTC. Postoperative UTI was common and 11% had a worsening care–needs level postoperatively, whereas other complications were infrequent. Further detailed studies would contribute to providing optimal treatment to enhance patients' quality of life.
Surface electromyography is commonly applied to measure the electrophysiological activity of the neuromuscular system. However, there is no consensus regarding the best protocol to assess pelvic floor muscles.
A scoping literature review was carried out in six databases, using MeSH descriptors. It included studies with electromyographic assessment in adult women presenting or not with pelvic floor dysfunction. The results were presented in categories to contribute to the development of a protocol considering the most used parameters for non-invasive assessment of myoelectric activity of pelvic floor muscles.
A total of 1,074 articles were identified, and 146 studies were selected for analysis. The intravaginal probe was used in 80.8% of the studies, the bipolar sensor with metallic plates placed on both sides of the vagina was the most frequent (71.3%), with a reference electrode positioned on the anterior superior iliac spine (33.5%). The supine position with hip and knee flexed (45.2%) was the most frequent position used. Of the studies, 44.5% normalized the data by maximum voluntary contraction (MVC) whereas 44.5% performed an average of 3 MVCs.
The most frequently used protocol for the pelvic floor is the bipolar intracavitary probe with metal plates positioned at 3–9 o’clock and introduced distally to the vaginal introitus with the volunteer in the supine position and the hip and knee flexed with the reference placed on the anterior–superior iliac spine.
Background: Evaluating and improving the movement ability and functional fitness of teenagers in sports is one of the methods of injury prevention. The aim of the study was to investigate the effect of a 6-week breathing control exercise on some functional performance factors of female student athletes. Research method: As a statistical sample, 42 teenage female athletes from Mashhad, aged 15 to 16, took part in this quasi-experimental study with a pre and post-test design. They were randomly divided into two experimental groups (21 individuals) and control groups (21 individuals). Six sessions of dynamic neuromuscular stability motor control training were administered to participants in the experimental group over six weeks. The Y test, the Davis test, the trunk flexor muscular endurance test, and the vertical jump were used to assess the dynamic control variables of posture, upper limb agility and stability, explosive power, and trunk flexor muscular endurance, respectively. The pre-test and post-test measures were completed in the same conditions. After confirming the normality of the data, SPSS statistical software was used to analyze repeated measures using analysis of variance (P<0.05). Results: The results showed that breathing control exercises on dynamic posture test (P<0.05), the endurance of trunk flexors (P<0.05), agility and stability of upper limbs (P<0.05), and vertical jump (P<0.05) of teenage sports girls had a significant effect. Conclusion: The findings indicate improvements in all research variables in the experimental group. Therefore, these exercises can be beneficial for participants in enhancing their performance in specialized functional movements, including sports skills, during periods of motor development.
Background
Pelvic floor muscle training (PFMT) is widely used for pelvic floor muscle (PFM) weakness in women; however, it has no prolonged effects.
Objective
To evaluate the effect of Transcranial Direct Current Stimulation (tDCS) associated with PFMT on PFM contraction, sexual function and quality of life (QoL) in healthy women.
Study Design
32 nulliparous women, aged 22.7 ± 0.42 years, were randomized into two groups: G1 (active tDCS combined with PFMT) and G2 (sham tDCS combined with PFMT). The treatment was performed three times a week for 4 weeks, totaling 12 sessions. PFM function was assessed using the PERFECT scheme (P = power, E = endurance, R = repetitions, F = rapid contractions, ECT = each timed contraction) and the perineometer (cmH 2 O). Sexual function was assessed by The Female Sexual Function Index, and QoL by the SF‐36 questionnaire. These assessments were performed before and after the 12nd treatment session and after 30‐day follow‐up.
Results
There was a significant increase ( p = 0.037) in the power of G2 compared to G1; repetitions and fast contraction increased in the G1 group, and the resistance increased in both groups, however, without statistical difference between the groups. ECT increased in the G1 group ( p = 0.0).
Conclusion
Active tDCS combined with PFMT did not potentiate the effect of the PFMT to increase the PFM function, QoL, and sexual function in healthy women. However, adjunctive tDCS to PFMT improved the time of contractions, maintaining it during follow‐up.
All patients with neuromusculoskeletal conditions managed by a physical therapist (PT) could have pelvic floor (PF) dysfunction contributing to their condition. Yet many PTs do not include assessment and management of the PF and pelvic floor muscles (PFMs) in their practice. While complex primary disorders of the PF, including continence and sexual function, are appropriately managed by pelvic health specialists, these specialists are few in numbers and availability across the country. This leaves patients with secondary PF involvement, specifically related to PF roles of stability and respiration, undermanaged. Lack of assessment of PFM contributions to respiration and stability leaves a practice gap for PTs and patient care across populations and settings. Clinicians, educators, and administrators are invited to join together to solve this practice gap. The purpose of this article is a call to action for PTs across all practice settings to address the PF functional roles in stability and respiration critical for neuromuscular function in our patients (see the Supplemental Digital Content Video Abstract, available at: http://links.lww.com/JWHPT/A114).
Introduction: Functional Movement Screening (FMS) is a battery used for injury prediction, identifying asymmetry
and weak connections in basic functional movement patterns. The muscles assessed in FMS are also
respiratory muscles. Therefore, FMS scores were thought to be related to respiratory muscle strength. The aim of
our study was to examine the relationship between Functional Movement Screen and respiratory muscles
strength in professional football players and sedentary individuals.
Methods: The study included 23 male professional football players (mean age: 25 ± 6.22 years) and 22 sedantery
healthy volunteers (mean age: 24.54 ± 2.75 years). Functional Movement Screen tests were applied by the
certified researcher. Respiratory muscle strength measurement were measured with an additional mouth
apparatus attached to the portable spirometer ‘Pony FX Desktop Spirometry’ device.
Results: Trunk stability push-up (p = 0.01; r = 0.490), rotational stability (p = 0.025; r = 0,519), and Functional
Movement Screen total score (p = 0.02; r = 0.568) with maximum expiratory pressure were moderately positive
correlated in professional football players. In the sedantery group, Functional Movement Screen sub-parameters
were not correlated respiratory muscle strength (p > 0.05).
Discussion: The higher Functional Movement Screen total score in professional football players and their skills in
functional movements that require trunk and core stabilization increase expiratory muscle strength were found
compared to sedentary individuals.
Conclusion: Increase of expiratory muscle strength may be useful in the treatment program when the aim was to
Improving functional movement patterns, trunk and core stabilization.
Die Atmung wirkt sich auf die motorische Kontrolle und die Haltungsstabilität aus. Erklärt werden im folgenden Artikel der Begriff des Atemmusters und die Auswirkung des dysfunktionalen Atemmusters Mundatmungssyndrom auf die Haltung. Diese Haltungsanpassung wird mit ihren Auswirkungen auf die Atemmuskeln beschrieben. Um dieses Krankheitsbild besser zu verstehen, wird auf ihre pathologische Emotionsregulierung eingegangen. Zuletzt wird ein osteopathischer Therapieansatz vorgestellt.
Bewegung und Sport während und nach der Schwangerschaft sind wichtig. Auch das Training der Beckenboden- und Bauchmuskulatur gehört dazu, denn es hilft, Risiken für den Beckenboden durch Schwangerschaft und Geburt reduzieren. Sah man früher vor allem in einem Training der Beckenbodenmuskulatur Nachteile für den Geburtsvorgang, weiß man heute, dass die Vorteile überwiegen. Dieser Artikel bietet ein Update und erklärt, wie sich die Bauchmuskeln bei einer Rektusdiastase effektiv trainieren lassen.
Humans use their voice concurrently with upper limb movements, known as hand gestures. Recently it has been shown that fluctuations in intensity and the tone of the human voice synchronizes with upper limb movement (including gesticulation). In this research direct evidence is provided that the voice changes with arm movements because it interacts with whole-body muscle activity (measured through surface EMG and postural measurements). We show that certain muscles (e.g., pectoralis major) that are associated with posture and upper limb movement are especially likely to interact with the voice. Adding wrist weights to increase the mass of the moving upper limb segment led to increased coupling between movement and voice. These results show that the voice co-patterns with whole-body kinetics relating to force, rather than kinematics, invoking several implications how the voice is biomechanically modeled, how it should be simulated, and importantly how the human voice must have evolved in relation to the whole-body motor system. We concluded that the human voice is animated by the kinetics of the whole body.
Patients with chronic functional constipation have some problems such as weakness of pelvic floor muscles, and a lack of coordination of pelvic floor and abdominal muscles has been seen. The goal of this study was to investigate the lumbar proprioception and the core muscle recruitment pattern.
The study type is a cross-sectional case–control study. There were 30 participants (case, n = 15, and control, n = 15). Electromyography of the core muscles was recorded while the subjects were getting up from the chair accompanied by lifting a weight, to check the pattern of muscle recruitment. Moreover, the lumbar proprioception was evaluated by an isokinetic device in both groups. The study was analyzed using independent t test and Mann–Whitney U test, and a nonparametric Friedman test was performed followed by Bonferroni pairwise comparison.
The comparison of muscle activity delay between the two groups showed that there was a significant difference between the two groups regarding the abdominal muscles, anal sphincter, and erector spinae (p < 0.05). However, there was no significant difference in the rectus femoris and gluteal muscles between the two groups (p > 0.05). Moreover, the proprioception of the lumbar region showed a significant difference (p < 0.05) between the two groups.
The results of this study demonstrated that the lumbar proprioception sense was reduced in the case group. This result can be justified, based on the problems in constipation (lack of coordination of muscles, weakness of pelvic floor muscles). The coordination of core muscles changed in patients with chronic functional constipation during a functional task.
Background. It has been suggested that pelvic floor dysfunction may contribute to
the development of chronic non-specific low back pain (LBP). However, there is
limited evidence of the impact of pelvic floor muscle training (PFMT) on clinical
outcomes such as pain or disability in the conservative management of LBP.
Objective. The aim of this study was to investigate the effectiveness of PFMT in
contrast to conventional treatment by comparing the disability and pain scores of
patients with non-specific LBP.
Methods. Thirty-seven participants with chronic non-specific
LBP were recruited. They were randomly assigned to: a control group (n = 11) who received routine physiotherapy treatment and regular exercises; or one of two intervention groups who received either routine physiotherapy treatment and PFMT alone (n = 12), or routine physiotherapy treatment and PFMT focusing on transversus abdominis muscle coactivation (n = 14). The clinical characteristics of the participants were measured using the Oswestry Disability Index and the Numerical Pain Rating Scale.
Results. Pain intensity and functional disability were significantly decreased in the
control group (P < 0.05) and the two intervention groups (P < 0.05). There was no
significant difference between the groups after treatment.
Conclusion. Pelvic floor muscle training focusing on transversus abdominis muscle
coactivation could be included in the conservative management of patients with
non-specific LBP after reviewing their pelvic health history and performing a clinical
assessment of their pelvic floor.
Bowel dysfunction is a common consequence of neurological diseases and has a major impact on the dignity and quality of life of patients. Evidence on neurogenic bowel is focused on spinal cord injury and multiple sclerosis; few studies have focused on patients with acquired brain injury (ABI). Neurogenic bowel dysfunction is related to a lifelong condition derived from central neurological disease, which further increases disability and social deprivation. The manifestations of neurogenic bowel dysfunction include fecal incontinence and constipation. Almost two out of three patients with central nervous system disorder have bowel impairment. This scoping review aims to comprehend the extent and type of evidence on bowel dysfunction after ABI and present conservative treatment. For this scoping review, the PCC (population, concept, and context) framework was used: patients with ABI and bowel dysfunction; evaluation and treatment; and intensive/extensive rehabilitation path. Ten full-text articles were included in the review. Oral laxatives are the most common treatment. The Functional Independence Measure (FIM) subscale is the most common scale used to assess neurogenic bowel disease (60%), followed by the Rome II and III criteria, and the colon transit time is used to test for constipation; however, no instrumental methods have been used for incontinence. An overlapping between incontinence and constipation, SCI and ABI increase difficulties to manage NBD. The need for a consensus between the rehabilitative and gastroenterological societies on the diagnosis and medical care of NBD.
Systematic review registration
Open Science Framework on August 16, 2022 https://doi.org/10.17605/OSF.IO/NEQMA.
Introduction
There is little evidence regarding the effect of trunk‐stabilizing muscles training on the improvement of stress urinary incontinence (SUI) symptoms.
Objective
To investigate the effect of trunk‐stabilizing muscles training on trans‐abdominal ultrasonography (TAUS) and clinical urological indices, and on the quality of life (QoL) in women with SUI.
Design
Randomized controlled trial.
Setting
A university hospital.
Participants
Forty‐six women with SUI, aged 20‐55 years, were randomly assigned to experimental (n =23) and control group (n =23).
Interventions
The experimental group performed trunk stabilization exercises according to the Sapsford protocol, while the control group performed pelvic floor muscle (PFM) exercises for eight weeks.
Main outcome measures
The primary outcome measure was bladder base displacement (BBD), assessed by TAUS during PFM contraction (PFMC), Valsalva, and abdominal curl. The secondary outcome measures were PFM strength, the severity of urinary incontinence (UI), voiding diary, and QOL, assessed by the Modified Oxford Grading System, the severity index, frequency chart, and lower urinary tract symptoms‐QOL questionnaire respectively. All variables were assessed at baseline and after 8‐weeks of interventions.
Results
The interaction of group and time wasn't significant for BBD during PFMC ( p =0.98), Valsalva ( p= 0.28) , abdominal curl (p =0.34), and secondary variables ( p >0.05). The main effect of time was significant in both groups for BBD during PFMC, PFM strength, the severity of UI, voiding diary, and QoL ( p <0.001), with effect size (d) of 0.30, 0.80, 2.05, 1.07, 1.03 in the control; and 0.49, 0.52, 1.75, 0.66, 0.88 in the experimental group respectively. The main effect of the group wasn't significant for BBD during PFMC ( p =0.68), Valsalva ( p= 0.22) , abdominal curl (p =0.53), and secondary variables ( p >0.05).
Conclusions
Trunk‐stabilizing muscles training and PFM exercise are equally effective in the improvement of PFM function, UI symptoms, and QOL in women with SUI. Both methods can be used interchangeably by physical therapists.
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Havacılık, otomotiv ve beyaz eşya gibi sektörlerde delik delme talaşlı ve talaşsız imalatın büyük çoğunluğunu oluşturur. Bu sektörlerde kullanılan metal aksamların üretilmesi esnasında yüzlerce delik delinmektedir. Özellikle ocak gibi ev eşyalarının metal parçalarında 1-5 mm gibi küçük çaplarda zımbalar kullanılarak delik elde edilmektedir. Yüksek üretim adetleri ve üretim proseslerinde karşılaşılan problemler sebebi ile bu zımbalar aşınmaktadır. Seri üretim esnasında aşınan zımbalar delinen deliklerde çapaklanmaya, ölçüsel farklılıklara ve üretim duruşlarına sebebiyet vermektedir. Bu sebeplerden dolayı delik delme ve kesme zımbalarının dayanımlarının arttırılması amacı ile tavlama, normalleştirme, su verme, temperleme, tavlama, yaşlandırma, karbürleme, nitrürleme ve kriyojenik işlem gibi uygulamalar yapılmaktadır. Bu yöntemlerden kriyojenik işlem ile kesme zımbalarının mikroyapısının iyileştiği, homojen karbür dağılımı ve ince taneli martensit yapıya dönüşmesi sayesinde sertlik, tokluk, aşınma direnci gibi birçok özelliklerinin iyileştiği bilinmektedir. Bu çalışmada ankastre ocakların metal parçalarının delinmesinde kullanılan Ø3 mm zımbalara 36 saat kriyojenik işlem ve 500 °C temperleme parametrelerinde kriyojenik işlem uygulanarak sertlik değişimleri incelenmiştir. Kriyojenik işlem uygulanan ve referans olarak işlemsiz seçilen üçer adet zımbanın makro, mikro analizleri sonrası sertlik ölçümleri yapıldıktan sonra kriyojenik işlemli zımbaların mekanik özelliklerinin iyileştiği tespit edilmiştir. Sertlik ölçüm sonuçlarına göre kriyojenik işlem görmüş zımbaların ortalama sertlik değerleri 774 HV0.3 ‘dan 801 HV0.3 değerine yükselerek % 3.37 artmıştır. Delik elde etmek için kullanılan zımbalara uygulanan kriyojenik işlemin malzeme mikro yapısını olumlu etkilediği ve seri üretimde zımba hasarlarının azaltılmasında avantaj sağlayacağı düşünülmektedir.
Beyaz eşya sektöründe yüksek üretim adedine sahip fırın ve ocaklar büyük oranda metal parçalardan oluşurlar. Özellikle dış kasa ve dayanım gerektiren parçaların bir çoğu metal malzemelerden imal edilmektedir. Bu parçaların kullanım yerlerine montaj edilebilmesi veya diğer ekipmanların bu parçalara sabitlenebilmesi için üzerlerine delik oluşturmak gerekir. Seri üretime uygunluk ve ölçüsel hassasiyet söz konusu olduğu için delik delme işlemleri hidrolik veya eksantrik preslerde sac ve metal kalıplar kullanılarak yapılmaktadır. Delme kalıplarında kullanılan delik delme zımbalarının ısı ve sürtünmeye karşı dirençli, sarma ve soğuk kaynak gibi etkilere karşı dayanıklı olması istenir. Bu sebeple delik delme zımbaları olarak sinterli karbür, toz metal ve titanyum nitrür kaplamalı gibi çeşitler tercih edilmektedir. Bu çalışmada ise 1.3343 HSS malzemeden imal edilen titanyum nitrür kaplı zımbalara 36 saat kriyojenik işlem ve 200 °C temperleme parametrelerinde kriyojenik işlem uygulanmıştır. Deneylerde kullanılan zımbaların kriyojenik işlem öncesi ve sonrası SEM, EDS analizleri yapılarak mikro ve makro görüntüleri elde edilmiştir. Ayrıca her bir zımbanın sertlik değerleri ölçülerek aritmetik ortalamalar tespit edilmiştir. Yapılan ölçümler neticesinde kriyojenik işlem görmüş zımbaların ortalama sertlik değerleri 774 HV0.3 ‘dan 792 HV0.3 değerine yükselerek % 2.32 artmıştır. Bu artışın mikroyapıda kalan ve yumuşak faz olan östenitin, sert faz olan martenzite dönüşmesinden kaynaklandığı düşünülmektedir. Ayrıca kriyojenik işlem ve temperleme uygulanması sonrası malzeme mikroyapısında ikincil sert karbür yapılarının çökelmesinin ortalama sertlik değerlerini arttırdığı düşünülmektedir.
The diaphragm is an essential respiratory muscle that accounts for 70% of the inspiratory function during stable breathing. Diaphragm weakness leads to decreased thoracic mobility due to inspiratory assist muscles overuse. It is closely related to respiratory dysfunction. This study aims to define the effect of TECAR therapy using Winback on diaphragm movement and chest mobility in adults with limited chest mobility. Thirty-six young adults with limited chest mobility were selected as participants in this study. TECAR therapy was applied to the participant’s diaphragm for 15[Formula: see text]min. Ultrasound measured each group’s diaphragm movement, and a tape measure was used to measure chest mobility. A paired t-test analyzed each group’s diaphragm movement and chest mobility change, and an independent t-test analyzed the difference in the amount of change between groups. The value was set to 0.05. As a result, after the intervention, diaphragm movement (unit: cm) significantly increased from [Formula: see text] to [Formula: see text] ([Formula: see text]). Upper chest movement (unit: cm) significantly increased from [Formula: see text]-[Formula: see text], middle chest movement (unit: cm) increased from [Formula: see text]-[Formula: see text], and lower chest movement (unit: cm) increased from [Formula: see text]-[Formula: see text] ([Formula: see text]). The results provide innovative clinical evidence that TECAR therapy significantly affected diaphragm movement and chest mobility improvement in young adults with limited chest mobility.
Introduction and hypothesis:
This study aimed to evaluate the relationship between pelvic floor muscle (PFM) strength and low back pain (LBP) in women with and without non-specific low back pain (NSLBP) with similar demographic and physical characteristics.
Methods:
The study included 40 women (35.73±6.74 years) with NSLBP (with LBP group) and 32 women (34.59±5.93) without LBP (without LBP group). PFM strength with a perineometer, pain intensity with a Visual Analog Scale (VAS), quality of life with the Short Form-36 (SF-36), and perceptions of LBP and related disability with the Rolland Morris Disability Questionnaire (RMDQ) were evaluated.
Results:
There was no difference between the groups in terms of age, BMI, number of births (0, 1, and 2 births) and mode of delivery (vaginal/cesarean section) (p>0.05). There was a statistical difference between the groups in all parameters except SF-36 Emotional Role Limitation subscale (p<0.05). We found PFM strength an independent predictor of the RMDQ score, and RMDQ and VAS scores as independent predictors of SF-36 physical and mental components (p<0.05).
Conclusions:
Decreased PFM strength in women causes non-specific mechanical low back pain and disability independent of age, BMI, and the number and type of delivery. Decreased PFM strength is a predictor of disability. Disability and pain are also independent predictors of decreased quality of life. PFM measurement should be prioritized when evaluating women with NSLBP. PFM strength may be a determinant of LBP.
Resumo Introdução A incontinência urinária é definida como qualquer perda involuntária de urina. Um desequilíbrio na transmissão de forças entre bexiga e uretra, associado a um suporte deficitário dos músculos do assoalho pélvico, contribui para uma alteração no equilíbrio de mulheres. Objetivo Comparar o equilíbrio entre mu-lheres continentes e incontinentes. Métodos Trata-se de um estudo transversal, com 13 mulheres divididas em incontinentes (idade: 41,50 ± 9,13 anos) e continentes (idade: 35,29 ± 4,99 anos). A avaliação do equilíbrio foi realizada na plataforma de força associada à eletromi-ografia: em pé, com olhos abertos (BI_OA); em pé, com olhos fechados (BI_OF); em pé sobre uma espuma, com olhos abertos (ESP_OA) e fechados (ESP_OF); e em pé com apoio unipodal, com olhos abertos (UNI_OA). A análise estatística foi iniciada após a reamostragem dos dados originais pela técnica Bootstrap, com valor de α fixado em 5% (p < 0,05). Resultados Na avaliação do equilíbrio BI_OA, não foram encontradas diferenças significativas entre os grupos. No BI_OF, as mulheres incontinentes apresentaram maior deslocamento no eixo anteroposterior (p < 0,001), enquanto as continen-tes, no médio-lateral (p = 0,008). Na tarefa ESP_OA, as incontinentes apresentaram maior deslocamento em ambos os eixos COP_X (p = 0,003) e COP_Y (p = 0,001); já na ESP_OF, as continentes apresentaram maior deslocamento no COP_X (p < 0,001). Na tarefa UNI_OA, observou-se maior deslocamento anteroposterior entre as incontinentes (p = 0,008). Conclusão Mulheres continentes apresentaram maiores deslocamentos no eixo médio-lateral nas tarefas de olhos fechados, enquanto as incontinentes, no eixo anteroposterior nas tarefas BI_OF, ESP_OA, UNI_OA.
Unexpected ventral and dorsal perturbations and expected, self-induced ventral perturbations were delivered to the trunk by suddenly loading a vest strapped to the torso. Six male subjects were measured for intra-abdominal pressure (IAP) and intra-muscular electromyography of the transversus abdominis (TrA), obliquus internus abdominis (OI), obliquus externus abdominis (OE) and rectus abdominis (RA) muscles. Erector spinae (ES) activity was recorded using surface electromyography. Displacements of the trunk and head were registered using a video-based system. Unexpected ventral loading produced activity in TrA, OI, OE and RA, and an IAP increase well in advance of activity from ES. Expected ventral loading produced pre-activation of all muscles and an increased IAP prior to the perturbation. The TrA was always the first muscle active in both the unexpected and self-loading conditions. Of the two ventral loading conditions, forward displacement of the trunk was significantly reduced during the self-loading. Unexpected dorsal loading produced coincident activation of TrA, OI, OE, RA and ES. These results indicate a response of the trunk muscles to sudden expected and unexpected ventral loadings other than the anticipated immediate extensor torque production through ES activation. It is suggested that the increase in IAP is a mechanism designed to improve the stability of the trunk through a stiffening of the whole segment.
To assess associations between various medical conditions and drug treatments and reports of urinary incontinence.
Secondary analysis of responses to the second wave of the National Population Health Survey (NPHS). Odds ratios were calculated using survey-weighted multiple logistic regression; confidence intervals were calculated using bootstrap methods.
Canadian households in all 10 provinces, as assessed by Statistics Canada's NPHS.
From among respondents to the NPHS, the 54,920 people aged 30 years or older.
Responses to the question "Do you have urinary incontinence diagnosed by a health professional?" and analysis of variables related to medical conditions and medications.
Urinary incontinence was associated with strokes, arthritis, and back problems in both sexes. Odds ratios for incontinence were elevated among men and women who reported having asthma. Narcotics and diuretics were strongly associated with incontinence in both sexes. Psychoactive medications were associated with incontinence in women; antidepressants were associated with incontinence in men.
Physicians should consider the possibility that patients with common conditions, such as arthritis, back problems, or respiratory conditions associated with coughing, might also have urinary incontinence. Physicians should also be aware that urinary incontinence might be a side effect of therapies and make relevant inquiries. Medications associated with incontinence could be changed.
Pelvic floor muscle exercises prescribed for the treatment of incontinence commonly emphasize concurrent relaxation of the abdominal muscles. The purpose of this study was to investigate the interaction between individual muscles of the abdominal wall and the pelvic floor using surface and intramuscular electromyography, and the effect of their action on intra-abdominal pressure. Four subjects were tested in the supine and standing positions. The results indicated that the transversus abdominis (TA) and the obliquus internus (OI) were recruited during all pelvic floor muscle contractions. It was not possible for these subjects to contract the pelvic floor effectively while maintaining relaxation of the deep abdominal muscles. A mean intra-abdominal pressure rise of 10 mmHg (supine) was recorded during a maximum pelvic floor muscle contraction. These results suggest that advice to keep the abdominal wall relaxed when performing pelvic floor exercises is inappropriate and may adversely affect the performance of such exercises.
It is unclear whether contraction of the external anal sphincter (EAS) following a voluntary cough is an integral component of the cough response itself, or a reflex response to the abdominal and pelvic floor dynamics induced by the cough. Clinical experience suggests a reflex origin for this response.
To compare motor latencies for intercostal, abdominal, and EAS muscle contraction after transcranial magnetic stimulation with those following voluntary coughing and sniffing.
A needle electrode inserted into the EAS measured responses, which were confirmed by tonic electromyographic recording. Direct motor latencies from the cerebral cortex to the intercostal, rectus abdominis and EAS muscles were obtained using transcranial magnetic stimulation. Sniff and cough induced responses were also recorded in these muscles.
The results suggest that EAS responses following a voluntary cough or sniff represent a polysynaptic reflex.
As the cough induced anal reflex response is consistent and easily elicited, its use in clinical neurological examination is appropriate.
The response of the abdominal muscles to voluntary contraction of the pelvic floor (PF) muscles was investigated in women with no history of symptoms of stress urinary incontinence to determine whether there is co-activation of the muscles surrounding the abdominal cavity during exercises for the PF muscles. Electromyographic (EMG) activity of each of the abdominal muscles was recorded with fine-wire electrodes in seven parous females. Subjects contracted the PF muscles maximally in three lumbar spine positions while lying supine. In all subjects, the EMG activity of the abdominal muscles was increased above the baseline level during contractions of the PF muscles in at least one of the spinal positions. The amplitude of the increase in EMG activity of obliquus externus abdominis was greatest when the spine was positioned in flexion and the increase in activity of transversus abdominis was greater than that of rectus abdominis and obliquus externus abdominis when the spine was positioned in extension. In an additional pilot experiment, EMG recordings were made from the pubococcygeus and the abdominal muscles with fine-wire electrodes in two subjects during the performance of three different sub-maximal isometric abdominal muscle maneuvers. Both subjects showed an increase in EMG activity of the pubococcygeus with each abdominal muscle contraction. The results of these experiments indicate that abdominal muscle activity is a normal response to PF exercise in subjects with no symptoms of PF muscle dysfunction and provide preliminary evidence that specific abdominal exercises activate the PF muscles. Neurourol. Urodynam. 20:31–42, 2001. © 2001 Wiley-Liss, Inc.
Phasic activity in the human back muscle erector spinae (ES) was studied during repetitive hand movements. The hand movements were elicited voluntarily by the subject or induced passively by the experimenter through a servomotor or through cyclical electrical stimulation of muscles acting about the wrist. The aim of the study was to determine whether the rhythmical activation of ES was of supraspinal, intersegmental or segmental origin.
When voluntary rhythmical hand movements were performed as fast as possible, cyclical ES EMG bursts occurred at the same frequency. This frequency was significantly higher than that reached when the task was to contract the back muscles as rapidly as possible. This suggests that the ES activity during the fast hand movements was not generated by direct commands descending to the ES muscles from the motor area of the cerebral cortex responsible for voluntary back muscle activation.
During imposed rhythmical hand movements, ES EMG bursts remained entrained to the hand movements, even when movement frequencies far exceeded those attainable voluntarily either for the hand or the back. This showed that ES EMG responses could be evoked by the hand movements even when these were not generated by descending neural commands. Two alternative mechanisms of ES activation were considered: (a) propriospinal transmission of afferent input entering the spinal cord from the upper extremity; (b) afferent input from ES and other trunk muscles, responding to local oscillations transmitted mechanically from the hand to the lower back.
Activation of ES via proprioceptive signals from the forearm was unlikely since (a) simultaneous electrical stimulation of wrist extensor and wrist flexor muscles did not result in repetitive ES EMG bursting; (b) cyclical vibration of the wrist extensors did not evoke ES EMG bursting; (c) when the forearm was constrained and the hand was moved passively, the lower trunk accelerations and cyclical ES EMG both occurred at a harmonic of the hand movement frequency.
We conclude that the repetitive ES EMG bursting during hand movements was probably due to a local segmental reflex rather than to descending commands. Remote mechanical oscillations of the trunk caused by hand movements evidently elicited proprioceptive reflexes in ES that presumably contributed to trunk stabilization.
This study validates surface EMG as a measure of pelvic muscle and abdominal activity by showing its high correlation to internal pressure data. Using standardized scores, between-subjects correlation of perineal EMG and intravaginal pressure was r= .75, and the correlation of abdominal EMG and intra-abdominal pressure was r= .72. Discriminant validity was also demonstrated by showing low correlation between standardized abdominal and perineal EMG measurements (r= .10). A repeated measures multivariate analysis of variance demonstrated that visual and auditory biofeedback of EMG during pelvic floor contractions increases intravaginal pressure when compared with trials without biofeedback. Potential benefits of fabric electrodes include reduced invasiveness and risk and the ease with which patients can utilize this technology for home practice.
The abdominal pressure response following repetitive electrical stimulation of the central end of the pelvic nerve (pelvicoabdominal reflex) was studied in anesthetized cats. This reflex response comprises simultaneous tonic contractions of the muscles of the abdominal wall and the diaphragm. Successive transections of the brain stem showed the center of this reflex to lie in the lower medulla. The reflex is provoked by activation of the A gamma-delta afferent fibers of the pelvic nerve. The centripetal paths enter the spinal cord through the S1 and S2 dorsal roots. They undergo an extensive crossing in the segments below L4. From there forwards there is no crossing, the major component ascending in the contralateral lateral funiculus and the minor one in the ipsilateral funiculus. The site of paths shifts ventrally from the dorsal portion to the mid-portion of the lateral funiculus as the fibers ascend from the sacral to the cervical segments. The descending paths of the reflex from the medulla are situated in the ventral and ventrolateral funiculi bilaterally at the higher cervical segments. The reflex activity is facilitated by lesion of the superficial layer of the dorsolateral funiculus, especially at the higher cervical segments. This suggests that a tonic inhibitory path for the pelvioabdominal reflex lies in the dorsolateral funiculus of the spinal cord.
The co‐ordination between respiratory and postural functions of the diaphragm was investigated during repetitive upper limb movement. It was hypothesised that diaphragm activity would occur either tonically or phasically in association with the forces from each movement and that this activity would combine with phasic respiratory activity.
Movements of the upper limb and ribcage were measured while standing subjects performed repetitive upper limb movements ‘as fast as possible’. Electromyographic (EMG) recordings of the costal diaphragm were made using intramuscular electrodes in four subjects. Surface electrodes were placed over the deltoid and erector spinae muscles.
In contrast to standing at rest, diaphragm activity was present throughout expiration at 78 ± 17% (mean ± s.d.) of its peak inspiratory magnitude during repeated upper limb movement.
Bursts of deltoid and erector spinae EMG activity occurred at the limb movement frequency (≈2.9 Hz). Although the majority of diaphragm EMG power was at the respiratory frequency (≈0.4 Hz), a peak was also present at the movement frequency. This finding was corroborated by averaged EMG activity triggered from upper limb movement. In addition, diaphragm EMG activity was coherent with ribcage motion at the respiratory frequency and with upper limb movement at the movement frequency.
The diaphragm response was similar when movement was performed while sitting. In addition, when subjects moved with increasing frequency the peak upper limb acceleration correlated with diaphragm EMG amplitude. These findings support the argument that diaphragm contraction is related to trunk control.
The results indicate that activity of human phrenic motoneurones is organised such that it contributes to both posture and respiration during a task which repetitively challenges trunk posture.
Evaluation of trunk movements, trunk muscle activation, intra-abdominal pressure and displacement of centres of pressure and mass was undertaken to determine whether trunk orientation is a controlled variable prior to and during rapid bilateral movement of the upper limbs. Standing subjects performed rapid bilateral symmetrical upper limb movements in three directions (flexion, abduction and extension). The results indicated a small (0.4-3.3 degrees) but consistent initial angular displacement between the segments of the trunk in a direction opposite to that produced by the reactive moments resulting from limb movement. Phasic activation of superficial trunk muscles was consistent with this pattern of preparatory motion and with the direction of motion of the centre of mass. In contrast, activation of the deep abdominal muscles was independent of the direction of limb motion, suggesting a non-direction specific contribution to spinal stability. The results support the opinion that feedforward postural responses result in trunk movements, and that orientation of the trunk and centre of mass are both controlled variables in relation to rapid limb movements.
The electromyographic patterns of the external urethral sphincter, the anal sphincter, and the levator ani during cystometries have been analyzed. Synchronized activity changes occur during abdominal straining. Muscle fatigue is very pronounced. Activity may be less synchronized during bladder filling and micturition, even in normal cystometries. In neurogenic diseases, true dyssynergia between the striated muscles may be observed.
With a curved array real-time ultrasound scanning machine and the probe placed sagitally onto the vulva, symphysis, bladder, urethra and the pelvic floor can be visualized in one frame. With this technique we studied 10 women with stress incontinence and 10 control women. In both groups active contraction of the pelvic floor resulted in a similar elevation of the urethrovesical junction (UVJ). During Valsalva maneuver an equal descent of the UVJ was found in patients and controls. During coughing a significant descent of the UVJ only occurred in the patient group. This suggests that women with stress incontinence are capable of operating the pelvic floor muscles but do not use them adequately during a cough.
It has been suggested that the muscles of the anterolateral abdominal wall increase the stability of the lumbar region of the vertebral column by tensing the thoracolumbar fascia and by raising intra-abdominal pressure. In this report these new mechanisms are reviewed and their contribution to vertebral stability assessed. The thoracolumbar fascia consists of two principal layers of dense fibrous tissue that attach the abdominal muscles to the vertebral column. Each of these layers was dissected in fresh and fixed material and samples chosen for light and scanning electron microscopy to study the arrangement of the component fibers. Computed axial tomography in volunteers showed the changes in spatial organization that occur during flexion of the back and during the Valsalva maneuver. The fascia was then tensed experimentally in isolated unfixed motion segments. The results suggested that the stabilizing action of the thoracolumbar fascia is less than had been thought previously but was consistent with calculations based on the more accurate structural and mechanical information that had been derived from the current study. Abdominal muscle contraction was simulated in whole cadavers in both the flexed and lateral bending positions to compare the stabilizing effect of the thoracolumbar fascia and intra-abdominal pressure mechanisms. These definitive experiments showed that the resistance to bending in the sagittal plane offered by the abdominal muscles acting through fascial tension was of a similar magnitude to that offered by a raised intra-abdominal pressure, both being relatively small in the fully flexed position. The stabilizing influence of the middle layer of the thoracolumbar fascia in lateral bending was clearly demonstrated and warrants further study in vivo.
The intra-abdominal pressure (IAP) has been regarded as important for stabilization and relief of the lumbar spine when exposed to heavy loads, such as when lifting. Previous trials, however, have failed to increase the IAP by abdominal muscle training. Twenty healthy subjects, 20 low-back patients and 10 weight-lifters, were tested with various breathing techniques in order to elucidate the causal factors of the IAP rise during lifting and the effects respiration. Those with high IAP and low IAP as well as those with great variations in IAP underwent an extended program. The intra-abdominal and intrathoracic pressures and the EMG of the oblique abdominal, the erector spinae and--in some cases--the puborectalis muscles, were recorded. The transdiaphragmatic pressure was calculated both during lifting and during the Mueller manoeuvre. The IAP rise during lifting seems to be correlated to a good coordination between the muscles surrounding the abdominal cavity. Of these, the diaphragm seems to be the most important for the IAP level. Closure of the glottis seems to help the diaphragm to maintain the IAP rise, otherwise the respiration type seems to be less important for the IAP during lifting.
The present research concerns anticipatory postural adjustments (APA), with the purpose of determining whether they are preprogrammed and of specifying their biomechanical finality. The experimental situation allowed us to distinguish between the voluntary movement itself (an upper limb elevation) and the postural adjustments associated with it. To this aim, the upper limb kinematics, evaluated from an accelerometer fixed at wrist level, were compared to the whole body dynamics, recorded by means of a force platform. Movements, executed in series of five, were studied according to three conditions: bilateral flexions (BF) and unilateral flexions (UF), with (IUF) and without (OUF) an additional inertia, of the stretched upper limb(s). Six right handed adults were tested twice. Results showed that the ground reaction resultant forces as well as the ground reaction resultant moment about the vertical axis presented reproducible variations before and after the onset of upper limb acceleration. The biomechanical organization of APA corresponded, for the three experimental conditions, to an upward and forward acceleration of the body center of gravity, and also, for UF, to a resultant moment directed towards the contralateral side. The duration of APA varied with the characteristics of the forthcoming voluntary movement, increasing significantly from BF to OUF and from OUF to IUF. It is concluded that APA correspond to dynamic phenomena which are centrally preprogrammed. The inertia forces associated with APA may, when the time comes, balance the inertia forces due to the movement of the mobile limb therefore counteracting the disturbance to postural equilibrium.(ABSTRACT TRUNCATED AT 250 WORDS)
The nucleus of Onuf (ON) in mammals contains motoneurons innervating the pelvic floor muscles including the external urethral and anal sphincters. Recently, direct pathways from the dorsolateral pons to the ON, probably involved in supraspinal micturition control, have been reported (Holstege et al., 1986). Since the pelvic floor muscles are involved not only in micturition but also in various other functions (e.g., coughing, vomiting, defaecation, parturition), an attempt has been made to establish whether, in the cat, there exist other direct brainstem pathways to the ON motoneurons. Our results indicate that specific projections to the ON are derived from 3 different areas: (1) the ipsilateral paraventricular hypothalamic nucleus; (2) the ipsilateral caudal pontine lateral reticular formation; and (3) the contralateral caudal nucleus retroambiguus. More diffuse projections (to all motoneuronal cell groups in the spinal cord including the ON) are derived from (1) neurons in the area of the nucleus subcoeruleus in the dorsolateral pontine reticular formation, (2) the nucleus raphe pallidus, and (3) the ventral part of the medullary medial reticular formation. Possible functional implications of these pathways are discussed.
Specimens from the human male and female external urethral sphincter and the periurethral levator ani muscle have been examined using histochemical and electron microscopic techniques.
In both sexes the external sphincter consists of a single population of type I (slow twitch) fibres with a mean diameter of 1 7.47±0.7 μm in the absence of muscle spindles. In contrast, the periurethral levator ani possesses muscle spindles and the constituent fibres form a heterogeneous population of type I and type II (fast twitch) fibres, with mean diameters of 45.5±0.8 μm and 59.5±3.4 μm respectively.
These findings indicate that the external urethral sphincter is functionally adapted to maintain tone over prolonged periods and may be of considerable importance in producing active urethral closure during continence. The anatomical location and fibre characteristics of the levator ani muscle suggest that these fibres actively assist in urethral closure, particularly during events which cause elevation of intra‐abdominal pressure.
In view of the differences in fibre characteristics between the external urethral sphincter and the levator ani, EMG activity recorded from a single site in the levator ani may not be representative of the functional status either of other levator ani muscle fibres or of the external urethral sphincter.
We localized the temporal and spatial distribution of pressures in the urethra to identify their contribution to continence. With the data obtained we resolved the timing between the passively transmitted and actively generated urethral pressures. Data were obtained from 11 healthy female volunteers, with a mean age of 22 years. Simultaneous measurements of bladder and urethral pressures were taken from subjects during the Valsalva maneuver and coughing, and then holding with the subject in the supine, standing and sitting positions. The ratio of urethral to bladder pressure increase and the latency between these pressure increases were analyzed. A biphasic pressure distribution results from coughing with subjects in all positions. The first phase occurs at the normalized distance of 10 to 15 per cent from the bladder neck, where the ratio of urethral to bladder pressure increase is 0.8. The second phase occurs at 60 to 70 per cent of the urethral length and has a 1.5 to 1.7 ratio of urethral to bladder pressure increase, indicating the presence of pressure magnification. Simultaneous latency measurements indicate that the pressure increase in the urethra precedes that of the bladder by 240 plus or minus 30 msec. in the region that exhibits maximum pressure magnification. These results indicate that a fast-acting contraction occurs in the distal third of the urethra, which contributes reflexly to the compressive forces of the proximal urethra, thereby preventing urine loss during stress.
In this study we developed a probe for surface EMG investigation of the circumvaginal muscle function in women with various forms of urinary incontinence. 69 women were investigated, 20 healthy volunteers, 25 patients with stress incontinence, 11 with urge incontinence and 13 with a mixed type of incontinence. We found that the circumvaginal surface EMG activity at short lasting (2 sec) maximum contraction was significant lower in patients with incontinence compared to healthy volunteers. We also found that the ability to hold a maximum contraction during one minute was significant reduced in all the patient groups compared to controls. The results suggest that patients with stress, urge or mixed incontinence all seem to have a defective function of the circumvaginal musculature. A common aetiology for stress, urge and mixed incontinence seems to be a reasonable working hypothesis for future investigations.
The aim of the present study was to describe co-activity patterns of the striated urethral wall muscle and the pelvic floor muscles (PFM) during contraction of outer pelvic muscles. Six healthy nulliparous physical education students, mean age 19.5 years (19-21) participated in the study. Concentric needle EMG and a Dantec amplifier were used for registrations. EMG activity was continuously recorded with the participants lying in a supine position. EMG was recorded during relaxation, contraction of the PFM, valsalva maneuver, coughing, hip adductor contraction, gluteal muscle contraction, backward tilting of the pelvis, and sit-ups. The procedure was performed with the needle in the striated muscle of the anterior wall of the urethra and then repeated with the needle set lateral to the urethra in the PFM. The results showed that the striated urethral wall muscle was contracted synergistically during PFM, hip adductor, and gluteal muscle contraction, but not during abdominal contraction. Both hip adduction, gluteal muscle, and abdominal muscle contraction gave synergistic contraction of the PFM. Thus the urethral wall striated muscle and the PFM react differently during abdominal contraction.
To introduce neurophysiological methods to search for damage to neuromuscular structures involved in sustaining continence in women who experienced stress urinary incontinence during pregnancy and/or after delivery.
Eight stress urinary incontinent parous women (mean of 2.75 vaginal deliveries [range 2-4] median age 45.3 years [range 31-60]) were examined using simultaneous electromyogram recordings of the left and right pubococcygeus muscle via wire electrodes. Comparisons were made with 10 nulliparous continent women (median age 27.2 years [range 22-32]).
Individual muscle activation patterns in stress urinary incontinent parous women were in principle similar to those observed in the continent nulliparous women, with two significant exceptions: (i) voluntary 'squeeze' showed significant differences in the holding time between the parous stress urinary incontinent patients and the nulliparous continent controls, with an empty bladder (49.0 s versus 193.9 s median value) and a full bladder (39.2 s versus 198.4 s); (ii) asymmetrical and uncoordinated levator activation patterns were demonstrated in four of eight parous stress incontinent women, i.e. inhibition of motor unit firing on coughing (n = 3) and dissociated recruitment of motor units during voluntary and reflex activation (n = 1).
Childbirth appeared to induce both quantitative and qualitative changes in the pelvic floor which jeopardized the continence mechanism. Sphincter weakness appeared to result not only from the loss of motor units but also from altered activation patterns in the remaining units: shorter activation periods, lack of response or paradoxical inhibition. Kinesiological EMG recordings revealed behavioural abnormalities which appeared relevant for planning treatment.
Because the structure of the spine is inherently unstable, muscle activation is essential for the maintenance of trunk posture and intervertebral control when the limbs are moved. To investigate how the central nervous system deals with this situation the temporal components of the response of the muscles of the trunk were evaluated during rapid limb movement performed in response to a visual stimulus. Fine-wire electromyography (EMG) electrodes were inserted into transversus abdominis (TrA), obliquus internus abdominis (OI) and obliquus externus abdominis (OE) of 15 subjects under the guidance of real-time ultrasound imaging. Surface electrodes were placed over rectus abdominis (RA), lumbar multifidus (MF) and the three parts of deltoid. In a standing position, ten repetitions of shoulder flexion, abduction and extension were performed by the subjects as fast as possible in response to a visual stimulus. The onset of TrA EMG occurred in advance of deltoid irrespective of the movement direction. The time to onset of EMG activity of OI, OE, RA and MF varied with the movement direction, being activated earliest when the prime action of the muscle opposed the reactive forces associated with the specific limb movement. It is postulated that the non-direction-specific contraction of TrA may be related to the control of trunk stability independent of the requirement for direction-specific control of the centre of gravity in relation to the base of support.
1. Phasic activity in the human back muscle erector spinae (ES) was studied during repetitive hand movements. The hand movements were elicited voluntarily by the subject or induced passively by the experimenter through a servomotor or through cyclical electrical stimulation of muscles acting about the wrist. The aim of the study was to determine whether the rhythmical activation of ES was of supraspinal, intersegmental or segmental origin. 2. When voluntary rhythmical hand movements were performed as fast as possible, cyclical ES EMG bursts occurred at the same frequency. This frequency was significantly higher than that reached when the task was to contract the back muscles as rapidly as possible. This suggests that the ES activity during the fast hand movements was not generated by direct commands descending to the ES muscles from the motor area of the cerebral cortex responsible for voluntary back muscle activation. 3. During imposed rhythmical hand movements, ES EMG bursts remained entrained to the hand movements, even when movement frequencies far exceeded those attainable voluntarily either for the hand or the back. This showed that ES EMG responses could be evoked by the hand movements even when these were not generated by descending neural commands. Two alternative mechanisms of ES activation were considered: (a) propriospinal transmission of afferent input entering the spinal cord from the upper extremity; (b) afferent input from ES and other trunk muscles, responding to local oscillations transmitted mechanically from the hand to the lower back. 4. Activation of ES via proprioceptive signals from the forearm was unlikely since (a) simultaneous electrical stimulation of wrist extensor and wrist flexor muscles did not result in repetitive ES EMG bursting; (b) cyclical vibration of the wrist extensors did not evoke ES EMG bursting; (c) when the forearm was constrained and the hand was moved passively, the lower trunk accelerations and cyclical ES EMG both occurred at a harmonic of the hand movement frequency. 5. We conclude that the repetitive ES EMG bursting during hand movements was probably due to a local segmental reflex rather than to descending commands. Remote mechanical oscillations of the trunk caused by hand movements evidently elicited proprioceptive reflexes in ES that presumably contributed to trunk stabilization.
The response of the diaphragm to the postural perturbation produced by rapid flexion of the shoulder to a visual stimulus was evaluated in standing subjects. Gastric, oesophageal and transdiaphragmatic pressures were measured together with intramuscular and oesophageal recordings of electromyographic activity (EMG) in the diaphragm. To assess the mechanics of contraction of the diaphragm, dynamic changes in the length of the diaphragm were measured with ultrasonography.
With rapid flexion of the shoulder in response to a visual stimulus, EMG activity in the costal and crural diaphragm occurred about 20 ms prior to the onset of deltoid EMG. This anticipatory contraction occurred irrespective of the phase of respiration in which arm movement began. The onset of diaphragm EMG coincided with that of transverses abdominis.
Gastric and transdiaphragmatic pressures increased in association with the rapid arm flexion by 13.8 ± 1.9 (mean ± s.e.m. ) and 13.5 ± 1.8 cmH 2 O, respectively. The increases occurred 49 ± 4 ms after the onset of diaphragm EMG, but preceded the onset of movement of the limb by 63 ± 7 ms.
Ultrasonographic measurements revealed that the costal diaphragm shortened and then lengthened progressively during the increase in transdiaphragmatic pressure.
This study provides definitive evidence that the human diaphragm is involved in the control of postural stability during sudden voluntary movement of the limbs.
We tested the null hypothesis that vesical neck descent is the same during a cough and during a Valsalva maneuver. We also tested the secondary null hypothesis that differences in vesical neck mobility would be independent of parity and continence status.
Three groups were included: 17 nulliparous continent (31.3 +/- 5.6; range 22-42 years), 18 primiparous continent (30.4 +/- 4.3; 24-43), and 23 primiparous stress-incontinent (31.9 +/- 3.9; 25-38) women. Measures of vesical neck position at rest and during displacement were obtained by ultrasound. Abdominal pressures were recorded simultaneously using an intravaginal microtransducer catheter. To control for differing abdominal pressures, the stiffness of the vesical neck support was calculated by dividing the pressure exerted during a particular effort by the urethral descent during that effort.
The primiparous stress-incontinent women displayed similar vesical neck mobility during a cough effort and during a Valsalva maneuver (13.8 mm compared with 14.8 mm; P =.49). The nulliparous continent women (8.2 mm compared with 12.4 mm; P =. 001) and the primiparous continent women (9.9 mm compared with 14.5 mm; P =.002) displayed less mobility during a cough than during a Valsalva maneuver despite greater abdominal pressure during cough. The nulliparas displayed greater pelvic floor stiffness during a cough compared with the continent and incontinent primiparas (22.7, 15.5, 12.2 cm H(2)O/mm, respectively; P =.001).
There are quantifiable differences in vesical neck mobility during a cough and Valsalva maneuver in continent women. This difference is lost in the primiparous stress-incontinent women.
Needle electromyography (EMG) remains the 'gold standard' for the assessment of external anal sphincter innervation. It is, however, an invasive and poorly tolerated technique. In this study a quantitative form of surface electromyography was compared with needle EMG of the external anal sphincter.
Invasive needle EMG to assess mean fibre density and neuromuscular jitter was compared directly with quantitative surface EMG in 37 patients with faecal incontinence and 12 age-matched controls.
There was a significant positive correlation between mean fibre density on needle EMG and maximum turns rate on surface EMG (rs = 0.48 (95 per cent confidence interval 0.28-0.76), P = 0.003). Furthermore, surface EMG was able to discriminate between patients with normal neuromuscular jitter and those with increased jitter, a measure of progressive denervation and reinnervation, on the basis of reduced rectified mean surface signal (P = 0.02, Fisher's exact test).
Quantitative surface EMG may potentially replace invasive needle EMG as the investigation of choice in the assessment of anal sphincter electrophysiology.
In humans, when the stability of the trunk is challenged in a controlled manner by repetitive movement of a limb, activity of the diaphragm becomes tonic but is also modulated at the frequency of limb movement. In addition, the tonic activity is modulated by respiration. This study investigated the mechanical output of these components of diaphragm activity. Recordings were made of costal diaphragm, abdominal, and erector spinae muscle electromyographic activity; intra-abdominal, intrathoracic, and transdiaphragmatic pressures; and motion of the rib cage, abdomen, and arm. During limb movement the diaphragm and transversus abdominis were tonically active with added phasic modulation at the frequencies of both respiration and limb movement. Activity of the other trunk muscles was not modulated by respiration. Intra-abdominal pressure was increased during the period of limb movement in proportion to the reactive forces from the movement. These results show that coactivation of the diaphragm and abdominal muscles causes a sustained increase in intra-abdominal pressure, whereas inspiration and expiration are controlled by opposing activity of the diaphragm and abdominal muscles to vary the shape of the pressurized abdominal cavity.
The response of the abdominal muscles to voluntary contraction of the pelvic floor (PF) muscles was investigated in women with no history of symptoms of stress urinary incontinence to determine whether there is co-activation of the muscles surrounding the abdominal cavity during exercises for the PF muscles. Electromyographic (EMG) activity of each of the abdominal muscles was recorded with fine-wire electrodes in seven parous females. Subjects contracted the PF muscles maximally in three lumbar spine positions while lying supine. In all subjects, the EMG activity of the abdominal muscles was increased above the baseline level during contractions of the PF muscles in at least one of the spinal positions. The amplitude of the increase in EMG activity of obliquus externus abdominis was greatest when the spine was positioned in flexion and the increase in activity of transversus abdominis was greater than that of rectus abdominis and obliquus externus abdominis when the spine was positioned in extension. In an additional pilot experiment, EMG recordings were made from the pubococcygeus and the abdominal muscles with fine-wire electrodes in two subjects during the performance of three different sub-maximal isometric abdominal muscle maneuvers. Both subjects showed an increase in EMG activity of the pubococcygeus with each abdominal muscle contraction. The results of these experiments indicate that abdominal muscle activity is a normal response to PF exercise in subjects with no symptoms of PF muscle dysfunction and provide preliminary evidence that specific abdominal exercises activate the PF muscles.
The aim of the study was to evaluate whether four different techniques were able to correctly measure pelvic floor muscle strength only. Sixteen volunteers performed a set of muscle contractions using the pelvic floor muscles (PFM) only, the abdominal muscles with and without PFM, gluteal muscles with and without PFM, adductor muscles with and without PFM and Valsalva maneuver with and without PFM. Pelvic floor muscle strength was evaluated by digital palpation, intravaginal EMG, pressure perineometry and perineal ultrasound. A 'non-pelvic muscle induced' reading was defined as a significant increase even though the pelvic floor muscles were not contracted. Results were as follows: isolated abdominal muscle contraction: non-pelvic muscle induced readings in 3/8 women with EMG and in 3/8 with pressure perineometry; isolated gluteal muscle contraction: non-pelvic muscle induced readings in 1/2 women with EMG perineometry; isolated adductor muscle contraction: non-pelvic muscle induced readings in 6/11 women with EMG perineometry and in 2/11 women with pressure perineometry; Valsalva maneuver: non-pelvic muscle induced readings in 4/9 women with EMG perineometry and 9/9 women with pressure perineometry. It was concluded that EMG and pressure perineometry do not selectively depict pelvic floor muscle activity.
The aim of this study was to describe normal characteristics of spontaneous and voluntary pelvic muscle function in nulliparous healthy continent women and to assess the reaction of the pelvic floor to stress and fatigue. Ten nulliparous volunteers were recruited. Pelvic muscle strength was evaluated by palpation and perineal ultrasound. Kinesiological EMG and perineal ultrasound were performed to test for possible fatigue and to assess bladder neck mobility during coughing with a pre-contraction of the pelvic floor muscles. Bladder neck mobility did not increase after attempts to fatigue the pelvic floor muscles. Bladder neck descent was significantly less when the women were instructed to contract the pelvic floor muscles before coughing. The contraction of the pelvic floor muscles stabilizes the vesical neck in nulliparous women.
To determine the prevalence of urinary incontinence (UI) in female patients (aged > or = 15 years) attending a cystic fibrosis (CF) centre, in whom stress UI could be common, as chronic coughing and sputum production are frequent symptoms associated with progressive lung disease in these patients.
An anonymous questionnaire was completed by 176 women with CF (mean age 24.6 years, SD 5.8) during routine assessments as outpatients.
In all, 72 patients (41%) were classified as never incontinent; occasional UI was reported in 61 women (35%). Regular UI, occurring twice or more a month for at least two consecutive months in the last year, was reported in 43 patients (24%). Regular UI was associated with increasing age and a lower mean (SD) forced expiratory volume/s (of that predicted) than in women with no urinary symptoms, at 26.9 (6.5) years and 53.5 (23.5)%, and 23.1 (5.4) years and 65.5 (23.2)%, respectively (P < 0.01 and P < 0.05, respectively). All incontinent women recorded stress UI; coughing, laughing and physical activity were associated with UI in 92%, 33% and 21% of the patients, respectively.
Stress UI is a common symptom in women with CF. As urine loss can be under-reported to the healthcare providers, women should be asked about incontinence as part of their routine follow-up. Pelvic floor muscle exercises are effective in treating stress UI and should be considered for those with CF and regular UI.
To determine whether voluntary abdominal muscle contraction is associated with pelvic floor muscle activity.
Pelvic floor muscle activity was recorded during contractions of the abdominal muscles at 3 different intensities in supine and standing positions.
Research laboratory.
Six women and 1 man with no histories of lower back pain.
Not applicable.
Electromyographic activity of the pelvic floor muscles was recorded with surface electrodes inserted into the anus and vagina. These recordings were corroborated by measurements of anal and vaginal pressures. Gastric pressure was recorded in 2 subjects.
Pelvic floor muscle electromyography increased with contraction of the abdominal muscles. With strong abdominal contraction, pelvic floor muscle activity did not differ from that recorded during a maximal pelvic floor muscle effort. The pressure recordings confirmed these data. The increase in pressure recorded in the anus and vagina preceded the pressure in the abdomen.
In healthy subjects, voluntary activity in the abdominal muscles results in increased pelvic floor muscle activity. The increase in pelvic floor pressure before the increase in the abdomen pressure indicates that this response is preprogrammed. Dysfunction of the pelvic floor muscles can result in urinary and fecal incontinence. Abdominal muscle training to rehabilitate those muscles may be useful in treating these conditions.
An experimental study of respiratory function and kinematics of the diaphragm and pelvic floor in subjects with a clinical diagnosis of sacroiliac joint pain and in a comparable pain-free subject group was conducted.
To gain insight into the motor control strategies of subjects with sacroiliac joint pain and the resultant effect on breathing pattern.
The active straight-leg-raise test has been proposed as a clinical test for the assessment of load transfer through the pelvis. Clinical observations show that patients with sacroiliac joint pain have suboptimal motor control strategies and alterations in respiratory function when performing low-load tasks such as an active straight leg raise.
In this study, 13 participants with a clinical diagnosis of sacroiliac joint pain and 13 matched control subjects in the supine resting position were tested with the active straight leg raise and the active straight leg raise with manual compression through the ilia. Respiratory patterns were recorded using spirometry, and minute ventilation was calculated. Diaphragmatic excursion and pelvic floor descent were measured using ultrasonography.
The participants with sacroiliac joint pain exhibited increased minute ventilation, decreased diaphragmatic excursion, and increased pelvic floor descent, as compared with pain-free subjects. Considerable variation was observed in respiratory patterns. Enhancement of pelvis stability via manual compression through the ilia reversed these differences.
The study findings formally identified altered motor control strategies and alterations of respiratory function in subjects with sacroiliac joint pain. The changes observed appear to represent a compensatory strategy of the neuromuscular system to enhance force closure of the pelvis where stability has been compromised by injury.
Low abdominal hollowing in four-point kneeling is used clinically to test and rehabilitate transversus abdominis (TrA) but many people find this exercise difficult to perform. Contracting pelvic floor muscles (PF) during low abdominal hollowing may facilitate contraction of TrA. Thickness increase in the abdominal muscles during low abdominal hollowing has been measured with real-time ultrasound scanning and may indicate muscle contraction. The present study investigated the effect of instructing PF contraction on TrA thickness increase during low abdominal hollowing.
Twelve females and eight males with no reported pelvic floor dysfunction or low back pain in the last two years were taught low abdominal hollowing in four-point kneeling. Subjects performed low abdominal hollowing with and without instruction to contract PF in random order. Transversus abdominis, obliquus internus (OI) and obliquus externus (OE) thickness were measured with ultrasound scanning at rest and during both tests.
Mean increase in TrA thickness during low abdominal hollowing was 49.71% (SD 26.76%), during low abdominal hollowing with PF it was 65.81% (SD 23.53%). Paired Student's t-tests indicated a significant difference between tests (p = 0.015). There were no significant differences between tests for OE or OI thickness increase.
Instructing healthy subjects to co-contract PF results in greater increase in TrA thickness during low abdominal hollowing in four-point kneeling. This may indicate greater contraction of TrA and thus be useful for clinicians training TrA. Further research could investigate the validity of change of thickness as a measure of abdominal muscle contraction, investigate the effect of instructing PF co-contraction on TrA in patients with low back pain and measure PF and TrA activity simultaneously.