Pelvic floor and abdominal muscles response during a hypopressive exercise in women with pelvic floor dysfunction.

B Navarro Brazález, M Torres Lacomba, V Prieto Gómez, B Arranz Martín, B Sánchez Sánchez, Ó Sánchez Méndez.

Grupo de Investigación Fisioterapia en los Procesos de Salud de la Mujer. Unidad Docente, Asistencial y de Investigación en Fisioterapia. Universidad de Alcalá.

Key Words: Hypopressive exercises. Pelvic floor. Physiotherapy. Pelvic floor dysfunction. Therapeutic exercise.

Palabras clave: Ejercicios hipopresivos. Suelo Pélvico. Fisioterapia. Disfunciones del suelo pélvico. Ejercicio terapéutico.

ABSTRACT:

Objective:

To understand the neuromuscular activation of the pelvic floor and abdominal muscles, and vaginal closure forces induced during a hypopressive exercise, which imply the performance of a hypopressive maneuver in expiratory apnea during a described hypopressive posture.

Methods:

A cross-sectional study was performed in sixty-six women who were participating in a physical therapy program based on hypopressive exercises. Pelvic floor muscle (PFM) activation was measured using surface (transperineal) electromyography (sEMG) in supine and orthostatic position, and vaginal closure force was measured through vaginal dynamometry in supine position. Participants performed first three maximum effort voluntary contraction of PFMs and then, a hypopressive exercise in supine position with one leg raised and a hypopressive exercise in an orthostatic position. Activation of the abdominal, gluteal, and hip adductor muscles was concurrently assessed using sEMG.

Results:

Forty-six (70%) women reported symptoms of urinary incontinence, twenty-six (39%) women reported symptoms of anal incontinence, and thirty-four (51%) were medically diagnosed with mild pelvic organ prolapse. During the supine hypopressive exercise, PFM peak   sEMG amplitude was 74.4-86.5% of that recorded during the maximum voluntary PFM contraction, and between 51.2-55.7% of peak vaginal closure force measured by dynamometer. The muscles of the lateral abdominal wall were activated between 25.4% to 35.3% compared to the maximum voluntary abdominal contraction. In the hypopressive orthostatic exercise, the sEMG activation was of 61.4%, and the lateral abdominal muscles contraction of 22.8%. However, during hypopressive exercises compared to an isolated PFM contraction, there was found statistical significant differences in the neuromuscular activation of rectus abdominis muscles, gluteus muscles and adductors muscles, which could lead in a crosstalk influence.

Conclusions:

Pelvic floor muscles and deep abdominal muscles are activated during the performance of a hypopressive exercise, however, the produced activation would be insufficient to strengthen them. Hypopressive exercises would be used only to train tonic aspects of pelvic floor muscles, nor to hypertrophy them. More studies are needed to understand the mechanism of action of hypopressive exercise, and to know the real efficacy and safety of these exercises.