Ingeborg Hoff Brækken

Prevention of anterior cruciate ligament injuries in female team handball players: a prospective intervention study over three seasons.

ObjectiveTo assess the effect of a neuromuscular training program on the incidence of anterior cruciate ligament injuries in female team handball players. DesignProspective intervention study. SettingFemale team handball: Division I–III in Norway. ParticipantsPlayers from the three top divisions: control season (1998–1999), 60 teams (942 players); first intervention season (1999–2000), 58 teams (855 players); second intervention season (2000–2001), 52 teams (850 players). InterventionA five-phase program (duration, 15 min) with three different balance exercises focusing on neuromuscular control and planting/landing skills was developed and introduced to the players in the autumn of 1999 and revised before the start of the season in 2000. The teams were instructed in the program and supplied with an instructional video, poster, six balance mats, and six wobble boards. Additionally, a physical therapist was attached to each team to follow up with the intervention program during the second intervention period. Main Outcome MeasuresThe number of anterior cruciate ligament injuries during the three seasons and compliance with the program. ResultsThere were 29 anterior cruciate ligament injuries during the control season, 23 injuries during the first intervention season (OR, 0.87; CI, 0.50–1.52; p = 0.62), and 17 injuries during the second intervention season (OR, 0.64; CI, 0.35–1.18; p = 0.15). In the elite division, there were 13 injuries during the control season, six injuries during the first intervention season (OR, 0.51; CI, 0.19–1.35; p = 0.17), and five injuries in the second intervention season (OR, 0.37; CI, 0.13–1.05; p = 0.06). For the entire cohort, there was no difference in injury rates during the second intervention season between those who complied and those who did not comply (OR, 0.52; CI, 0.15–1.82; p = 0.31). In the elite division, the risk of injury was reduced among those who completed the anterior cruciate ligament injury prevention program (OR, 0.06; CI, 0.01–0.54; p = 0.01) compared with those who did not. ConclusionsThis study shows that it is possible to prevent anterior cruciate ligament injuries with specific neuromuscular training.

Test–retest and intra-observer repeatability of two-, three- and four-dimensional perineal ultrasound of pelvic floor muscle anatomy and function

The aims of the present study were to evaluate test–retest intra-observer repeatability of ultrasound measurement of the morphology and function of the pelvic floor muscles (PFMs). Seventeen subjects were tested twice. Two-, three- and four- dimensional ultrasound recorded cough, huff, muscle morphology and PFM contraction, respectively. Analyses were conducted offline. Measurements of levator hiatal dimensions demonstrated intra-class correlation coefficient (ICC) values of 0.61, 0.72, 0.86 and 0.92, for the anterior-posterior dimension, transverse dimension, resting area and narrowing during contraction, respectively. Muscle thickness showed variable reliability. ICC values for measurement of the position of the bladder neck were 0.86 and 0.82 at rest, in the vertical and horizontal direction. Displacement of the bladder neck during contraction, huff and cough demonstrated ICC values of 0.56, 0.59 and 0.51, respectively. Perineal ultrasound is a reliable method for measuring most of the tested parameters of morphology and function of the PFMs.

Morphological Changes After Pelvic Floor Muscle Training Measured by 3-Dimensional Ultrasonography: A Randomized Controlled Trial

OBJECTIVE: To investigate morphological and functional changes after pelvic floor muscle training in women with pelvic organ prolapse. METHODS: This randomized controlled trial was conducted at a university hospital and a physical therapy clinic. One hundred nine women with pelvic organ prolapse stages I, II, and III were randomly allocated by a computer-generated random number system to pelvic floor muscle training (n=59) or control (n=50). Both groups received lifestyle advice and learned to contract the pelvic floor muscles before and during increases in intraabdominal pressure. In addition the pelvic floor muscle training group did individual strength training with a physical therapist and daily home exercise for 6 months. Primary outcome measures were pelvic floor muscle (pubovisceral muscle) thickness, levator hiatus area, pubovisceral muscle length at rest and Valsalva, and resting position of bladder and rectum, measured by three-dimensional ultrasonography. RESULTS: Seventy-nine percent of women in the pelvic floor muscle training group adhered to at least 80% of the training protocol. Compared with women in the control group, women in the pelvic floor muscle training group increased muscle thickness (difference between groups: 1.9 mm, 95% confidence interval [CI] 1.1–2.7, P<.001), decreased hiatal area (1.8 cm2, 95% CI 0.4–3.1, P=.026), shortened muscle length (6.1 mm, 95% CI 1.5–10.7, P=.007), and elevated the position of the bladder (4.3 mm, 95% CI 2.1–6.5, P<.000) and rectum (6.7 mm, 95% CI 2.2–11.8, P=.007). Additionally, they reduced the hiatal area and muscle length at maximum Valsalva indicating increased pelvic floor muscle stiffness. CONCLUSION: Supervised pelvic floor muscle training can increase muscle volume, close the levator hiatus, shorten muscle length, and elevate the resting position of the bladder and rectum. CLINICAL TRIAL REGISTRATION: www.clinicaltrials.gov, NCT00271297. LEVEL OF EVIDENCE: I

Interobserver repeatability of three- and four-dimensional transperineal ultrasound assessment of pelvic floor muscle anatomy and function

To evaluate the interobserver repeatability of measurement of the pubovisceral muscle and levator hiatus, and the position of related organs, during rest, muscle contraction and Valsalva maneuver using three‐ and four‐dimensional (3D and 4D) transperineal ultrasound.

Pelvic floor function is independently associated with pelvic organ prolapse

Objective  To investigate the risk factors for pelvic organ prolapse (POP), including physical activity, clinically measured joint mobility and pelvic floor muscle (PFM) function.

Test–retest reliability of pelvic floor muscle contraction measured by 4D ultrasound†‡

The aim of the present study was to evaluate test‐retest measurements of functional aspects of pelvic floor muscle (PFM) contraction using four dimensional (4D) ultrasound.

Validation of three-dimensional perineal ultrasound and magnetic resonance imaging measurements of the pubovisceral muscle at rest

To compare biometric measurements of the pubovisceral muscle during rest, measured using transperineal three‐dimensional (3D) ultrasound and magnetic resonance imaging (MRI).

Learning process for performing and analyzing 3D/4D transperineal ultrasound imaging and interobserver reliability study

To evaluate the learning process for acquiring three‐ and four‐dimensional (3D/4D) transperineal ultrasound volumes of the levator hiatus (LH) dimensions at rest, during pelvic floor muscle (PFM) contraction and on Valsalva maneuver, and for analyzing the ultrasound volumes, as well as to perform an interobserver reliability study between two independent ultrasound examiners.

Constriction of the levator hiatus during instruction of pelvic floor or transversus abdominis contraction: a 4D ultrasound study

A new theory claims that the pelvic floor muscles (PFM) can be trained via the transversus abdominis (TrA). The aim of the present study was to compare the effect of instruction of PFM and TrA contraction on constriction of the levator hiatus, using 4D perineal ultrasonography. Thirteen women with pelvic organ prolapse participated in the study. Perineal ultrasound in standing position was used to assess constriction of the levator hiatus. Analyses were conducted off-line with measurements in the axial plane of minimal hiatal dimensions. The reduction of all the hiatal dimensions was significantly greater during PFM than TrA contraction. All patients had a reduction of the levator hiatus area during PFM contraction (mean reduction 24.0%; range 6.1–49.2%). In two patients, there was an increase of the levator hiatus area during TrA contraction. Instruction of PFM contraction is more effective than TrA contraction.

Impact of childbirth and mode of delivery on vaginal resting pressure and on pelvic floor muscle strength and endurance.

OBJECTIVE We sought to study impact of delivery mode on vaginal resting pressure (VRP) and on pelvic floor muscle (PFM) strength and endurance, and whether these measurements differed in women with and without urinary incontinence. STUDY DESIGN We conducted a cohort study following 277 nulliparous women from midpregnancy to 6 weeks postpartum. Manometer was used for PFM measurements; differences were analyzed by t test (within groups) and analysis of variance (between groups). RESULTS Only VRP changed significantly (10% reduction, P = .001) after emergency cesarean section. After normal and instrumental vaginal delivery, VRP was reduced by 29% and 30%; PFM strength by 54% and 66%; and endurance by 53% and 65%, respectively. Significant differences for all PFM measures (P < .001) were found when comparing cesarean vs normal and instrumental vaginal delivery, respectively. Urinary continent women at both time points had significantly higher PFM strength and endurance than incontinent counterparts (P < .05). CONCLUSION Pronounced reductions in VRP and in PFM strength and endurance were found after vaginal delivery. Continent women were stronger than incontinent counterparts.