November the 1st! Where did 2023 go?!
Once again I am excited to bring to you another research spotlight email.
If you missed last month’s email covering the common disorders and contributing factors of the female pelvic floor I recreated the content into a podcast episode for you. And if you prefer to watch this in video format you can view the recording of the podcast episode on my Youtube Channel.
Click here to listen to the podcast
Click here to watch on YouTube
This month I am sharing with you a randomized controlled trial that investigated the effect of treating women with stress or mixed urinary incontinence with an alternative intervention to pelvic floor muscle (PFM) exercises.
Here are the details of the paper if you wish to investigate it further…
Hung. H, Hsiao. S, Chih. A, Lin. H. Tsauo. J. An alternative intervention for urinary incontinence: Retraining diaphragmatic, deep abdominal and pelvic floor muscle coordinated function. Manual Therapy 2010; (15):273-279 An alternative intervention for urinary incontinence: Retraining diaphragmatic, deep abdominal and pelvic floor muscle coordinated function – ScienceDirect
Let’s dive into the nitty gritty.
Female volunteers were recruited for the trial and were deemed eligible if they were experiencing stress urinary incontinence or urge urinary incontinence.
This clinical trial allocated 70 eligible women into 2 groups:
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- Training group
- Control group
Both groups were given education that covered the anatomy of the pelvic floor and urinary system as well as continence mechanisms. They were internally examined for vaginal squeeze pressure as well as instructed on how to correctly contract the PFM.
The control group received oral instruction and information covering urinary incontinence, PFM exercise and bladder hygiene whereas the training group were given a 5 stage exercise regime designed to retrain diaphragmatic, deep abdominal and pelvic floor muscle coordinated function.
The 5 stages of the exercise regime were:
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- Diaphragmatic breathing
- Tonic activation of transverse abdominis and pelvic floor
- Muscle strengthening of transverse, pelvic floor and internal obliques
- Functional expiratory patterns
- Impact activities
Participants in the control group were instructed not to perform isolated pelvic floor muscle exercises and met with the therapist twice a month for the 4 month intervention to progress exercises to the next stage of the program.
The results of this study make my heart sing for joy. This is because I love movement and I believe movement, retraining muscle function and looking at the pelvic floor from a whole body perspective is so much more beneficial then locking eyes on the pelvic floor only and treating this in isolation.
So the outcomes that were measured in this study were:
- Self-reported improvement
- 20-min pad test whilst performing activities that included coughing, valsalva, deep knee bends, jump up and down on the spot and walk up and down 5 stairs
- 3-day voiding diary where they were asked to record every event of voiding, urgency, leaking as well as describe the amount of leakage
- PFM function including maximal vaginal squeeze pressure and holding time
- The impact of incontinence on health-related quality of life
Significant results were:
- 96.7% of women in the training group reported improvements in symptoms versus 66.6% in the control group – WOW… that is a 96.7% cure/improvement rate!
- There was significant improvement in the 20min pad test in the training group whilst the control group did not
- Those in the training group significantly reduced the number of leaks per day
- More improvement in quality of life was reported in the training group
The training group was put through a 4 month intervention that was not only designed to teach participants to coordinate their diaphragm, pelvic floor, transverse abdominis and internal obliques but was progressive in nature that it moved through 5 stages of retraining and integration into other activities.
This is exactly what we as exercise professionals have the skillset to do. Prescribe interventions that move people from acute isolated movements into functional movement patterns through graded progression. And this study has shown a program, like this, is superior to isolated pelvic floor muscle training in cure/improvement rate of urinary incontinence and urgency.
This is how you can help your clients improve pelvic floor symptoms and improve their quality of life.
I guess the difficulty in applying this resides in ‘the how’.
How do you put together a program that does this?
How do you piece together exercises that would move through 5 stages of progression to achieve trunk muscle synergy and strength such that it improves the function of the pelvic floor and resolves symptoms?
How do you know where to start and which muscles need work?
How do you know your client is in fact recruiting the pelvic floor, diaphragm, transverse abdominis and internal obliques correctly in activities that are more complex in nature?
It requires diving deep into all things pelvic floor and learning more than just the surface level of anatomy and basic exercise prescription. It requires lots of exposure to a variety of clients with varying symptom presentations and lots of practice applying the knowledge and skills you develop when you dive deep.
If you want to learn how to do this, my mentorship program is what you are looking for. Applications for the program will be opening in December for 2024 and I only have 10 spots. These spots will be offered to those on the waitlist first so I encourage you to join the waitlist if you would like to apply for the program.
I will be sharing more information closer to December but you can join the waitlist by clicking here.
If you aren’t quite ready for a deep dive then I hope you find value in these monthly research spotlight emails and find little golden snippets that you can use in your workplace.
Have a fantastic month and I’ll catch you in the next once BYE