Carla Dellabarba Petricelli

Pelvic floor muscle and transversus abdominis activation in abdominal hypopressive technique through surface electromyography

The abdominal hypopressive technique (AHT) is performed mainly via transversus abdominis (TrA) activation and has been indicated for pelvic floor muscle (PFM) disorders. In some European countries, this technique has become widely used. This study aimed to investigate PFM and TrA activation during the AHT through surface electromyography.

Effects of the Paula method in electromyographic activation of the pelvic floor: a comparative study

Introduction and hypothesisTo determine if Paula method of circular muscles contraction e.g., those surrounding the eyes, mouth and fingers, could increase pelvic floor muscle (PFM) activity.MethodsThirty-four healthy, nulliparous volunteers were included, with an average age of 28 (±5.9) years and body mass index of 23.8 (±3.3) kg/m2. They were assigned to randomly perform the sequence: a PFM maximal voluntary contraction, a contraction of circular muscles, followed by a simultaneous combination of PFM and circular muscle contraction. The PFM were evaluated using surface electromyography.ResultsPFM activity at baseline was 22.6 (±10.9) μv. It was unchanged with Paula method contraction (p = 0.322). There were also no differences between values of PFM maximal voluntary contraction alone, 99.8 (±44.3) μv and in combination with the Paula method, 91.8 (±35.3) μv (p = 0.093).ConclusionsThe Paula method seems not to increase PFM activity in nulliparous women.

Electromyographic evaluation of pelvic floor muscles in pregnant and nonpregnant women.

Introduction and hypothesisWe compared the maximal voluntary contraction (MVC) and strength of pelvic floor muscles (PFM) of pregnant and nonpregnant women using surface electromyography (SEMG).MethodsFifteen pregnant primiparous women and 15 nulliparous nonpregnant women were evaluated. The healthy pregnant women were in the third trimester of pregnancy with a single fetus and did not have any neuromuscular alterations. The nonpregnant women did not present with PF dysfunctions and, as with the pregnant women, did not have any previous gynecological surgeries or degenerative neuromuscular alterations. The evaluation methods used were digital palpation (Oxford Grading Scale, which ranges from 0 to 5) and SEMG. In the EMG exam, MVC activity was evaluated, and the better of two contractions was chosen. Before the evaluation, all women received information about PFM localization and function and how to correctly contract PFM.ResultsIn the EMG evaluation, MVC was significantly greater in the nonpregnant group (90.7 μv) than in the pregnant group (30 μv), with p < 0.001. The same results were observed after vaginal palpation, measured by the Oxford scale, which presented an average of 2.1 in the pregnant group and 4.5 in the nonpregnant group (p = 0.005).ConclusionIn comparison to nulliparous women, pregnant women demonstrated worse PFM function with decreased strength and electrical activity.

Distensibility and Strength of the Pelvic Floor Muscles of Women in the Third Trimester of Pregnancy

Objective. The objective of this study was to compare the role of the pelvic floor muscles between nulliparous and multiparous women in the third trimester of pregnancy, by analyzing the relationship between electrical activity (surface electromyography—EMG), vaginal palpation (modified Oxford scale), and perineal distensibility (Epi-no). Methods. This was an observational cross-sectional study on a sample of 60 healthy pregnant women with no cervical dilation, single fetus, gestational age between 35 and 40 weeks, and maternal age ranging from 15 to 40 years. The methods used were bidigital palpation (modified Oxford scale, graded 0–5), surface EMG (electrical activity during maximal voluntary contraction), and perineal distensibility (Epi-no device). The Pearson correlation coefficient (r) was used to analyze the Epi-no values and the surface EMG findings. The Kruskal-Wallis test was used to compare the median values from surface EMG and Epi-no, using the modified Oxford scale scores. Results. Among the 60 patients included in this study, 30 were nulliparous and 30 multiparous. The average maternal age and gestational age were 26.06 (±5.58) and 36.56 (±1.23), respectively. It was observed that nulliparous women had both higher perineal muscle strength (2.53 ± 0.57 versus 2.06 ± 0.64; P = 0.005) and higher electrical activity (45.35 ± 12.24 μV versus 35.79 ± 11.66 μV; P = 0.003), while among the multiparous women, distensibility was higher (19.39 ± 1.92 versus 18.05 ± 2.14; P = 0.013). We observed that there was no correlation between perineal distensibility and electrical activity during maximal voluntary contraction (r = − 0.193; P = 0.140). However, we found a positive relationship between vaginal palpation and surface electromyography (P = 0.008), but none between Epi-no values (P = 0.785). Conclusion. The electrical activity and muscle strength of the pelvic floor muscles of the multiparous women were damaged, in relation to the nulliparous women, while the perineal distensibility was lower in the latter group. There was a positive relationship between surface EMG and the modified Oxford scale.

Parturient perineal distensibility tolerance assessed by EPI-NO: an observational study

ABSTRACT Objective: To determine how parturient women tolerate the use of a perineal distensibility assessment technique using the EPI-NO device. Methods: An observational study with a total of 227 full-term parturient women was performed. During the evaluation with EPI-NO, parturient patients were asked about their sensation of discomfort. The degree of discomfort was measured using the Visual Analogue Scale, with a score from zero to 10. The Mann-Whitney test was applied to assess perineal distensibility measured by EPI-NO and the degree of discomfort caused by the test according to parity. The relation between perineal distensibility and discomfort was analyzed by using the Spearman correlation test (r). Results: The test with EPI-NO caused only slight discomfort (mean Visual Analogue Scale of 3.8), and primiparous women reported significantly greater discomfort (mean Visual Analogue Scale of 4.5) than did multiparous (mean Visual Analogue Scale=3.1), with p<0.001 women. A negative correlation was observed, in other words, the greater the perineal distensibility on the EPI-NO, the lower the pain reported by the patients (r=-0.424; p<0.001). Conclusion: The assessment of perineal distensibility with EPI-NO was well tolerated by the parturient women.

Eletromiografia de superfície para avaliação dos músculos do assoalho pélvico feminino: revisão de literatura

A eletromiografia de superficie tem grande importância clinica e de pesquisa para o fisioterapeuta. Apesar de captar a atividade eletrica promovida pelo recrutamento das unidades motoras, ha boa correlacao entre o numero de unidades ativadas e a forca muscular. E um dos metodos de maior especificidade na avaliacao do assoalho pelvico, embora nao haja consenso em relacao a sua aplicacao. Essa revisao de literatura foi desenvolvida com o objetivo de agrupar as informacoes sobre o uso da eletromiografia de superficie na avaliacao do assoalho pelvico. Foram pesquisados artigos nas bases de dados Medline, PubMed, Lilacs, SciELO e Biblioteca Cochrane, e selecionados os que avaliassem o assoalho pelvico feminino por meio de eletromiografia de superficie. Apesar de sua metodologia ainda carecer de padronizacao, e um instrumento que deve ser considerado nas pesquisas cientificas em nosso meio, pois parece apresentar boa reprodutibilidade e confiabilidade. Pacientes com disfuncoes do assoalho pelvico possuem alteracoes no tempo de ativacao dos musculos do assoalho pelvico (MAP) e musculos abdominais. Quanto a gestacao e puerperio, ainda faltam evidencias sobre possiveis alteracoes da ativacao eletrica dos MAP nesses periodos.

The Paula method and the pelvic floor: reply by the authors 2

Dear Editor, We are pleased to read that Liebergall-Wischnitzer agrees that pelvic floor muscle training (PFMT) is effective and should be recommended as level A evidence for pelvic floor dysfunction [1]. Although in a previous paper, he and colleagues claim that the Paula method is superior in terms of cure rate (p. 377) [2]. We used surface electromyography to evaluate the pelvic floor muscle (PFM) activation during the contraction of circular muscles (Paula method). In nulliparous women, these exercises did not increase PFM activation. In two previous papers by Liebergall-Wischnitzer et al. [2, 3], patients included in the Paula group practiced, besides contraction of circular muscles, PFM voluntary contraction in a weekly individual 45-minute sessions for 12 weeks and were encouraged to practice daily for 45 min at home (p.378) [2]. Patients included in the PFMT group did structured exercise program in groups of 1–10 people for 30 min once weekly for 4 weeks, followed by two more lessons 4 weeks apart each (overall six lessons) (p.378) [2]. How can one compare so distinct training programs? Actually, the patients in both groups practiced PFMT in different proportions. What is the benefit of adding circular muscle contractions? It is well established that supervised training significantly improves the results of PFMT [4, 5]. The only way to investigate if circular contractions are more effective than the PFMT alone is to do a head-to-head assessor blinded RCT with the same training dosage and therapist contact in both arms, or add the new concept to current practice in one arm. According to Liebergall-Wischnitzer’s letter [1], PFM strength is not a desirable outcome of Paula exercises, but according to Liebergall-Wischnitzer et al. in 2005, exercising the ring muscles in a certain area of the body will result in strengthening the circular muscles in other areas (p. 345) [3]. With this phrase, we understood that strengthening was the main goal of Paula exercises. At first, how can you be sure that any circular muscle contraction leads to contraction of the others? What are the evidences for that? If this is proven, could external sphincter ani contract alone? Or PFM will be recruited too? How could the external sphincter ani be strengthened and not the PFM? Liebergall’s letter also said that when contracting the eyes/mouth and the PFM, co-contraction is not a reflex, but training is required. After a training period, the trainee begins to feel that these muscles can work together and naturally integrate with PFMT. However, in the article they say “The theory that lies behind the Paula method is that all sphincters in the human body work simultaneously, mutually affecting one another possibly mediated by oscillation of the spinal cord” (p. 345) [3]. If they naturally affect one another because of spinal cord oscillation, how could the spinal cord be trained? If it could be trained, how long this training is necessary to these muscles work together? Moreover, if a patient is taught to contract PFM during some exercises such as Pilates and yoga, with some A. P. M. Resende (*) :C. D. Petricelli : S. M. Alexandre : M. U. Nakamura :M. R. D. Zanetti Obstetrics Department, Federal University of Sao Paulo, Rua Napoleao de Barros, 875, Sao Paulo 04024–002, Brazil e-mail: anapaulamrb@gmail.com