de Almeida Berta Simon Nogueira, Sabatino José Hugo, Giraldo Paulo César
Department of Gynecology, UNICAMP (The State University of Campinas), Campinas, SP, Brazil.
J Manipulative Physiol Ther. 2010 Feb;33(2):109-16. doi: 10.1016/j.jmpt.2009.12.007.
Spinal manipulation with high-velocity and low-amplitude (HVLA) manipulation is frequently used for the treatment of lumbopelvic pain; however, the effect on the pelvic floor has been poorly studied in the past. The objective of this study was to quantify the intravaginal pressure (IVP) and the basal perineal tonus (BPT), measured in terms of pressure, before and after the HVLA manipulation in patients without neuromuscular and skeletal dysfunctions.
In this experimental, noncontrolled, nonrandomized study, IVP was obtained through a perineometer introduced into the volunteers' vagina while in dorsal horizontal decubitus. Forty young, healthy university volunteer women with no history of vaginal delivery participated. All voluntary contractions of the perineal muscles were measured in 3 different ways: phasic perineal contraction (PPC), tonic perineal contraction, and perineal contraction associated to accessory muscles. New pressure measurements were obtained immediately after the HVLA manipulation on the volunteers' sacrum. The pressures were registered and transcribed directly to a personal computer with specific software.
The average IVPs obtained in millimeters of mercury before and after the HVLA manipulation were 56.01 (+/-25.54) and 64.65 (+/-25.63) for PPC, 445.90 (+/-186.84) and 483.14 (+/-175.29) for tonic perineal contraction, and 65.62 (+/-26.56) and 69.37 (+/-25.26) for perineal contraction associated to accessory muscles, respectively. There was significant statistical variation only for PPC (P = .0020) values. The BPT increased regardless of the type of contraction (P < .05).
High-velocity and low-amplitude manipulation of the sacrum was associated with an increase of PPC and of BPT in women who had no associated osteoarticular diseases. These preliminary discoveries could be helpful in the future study of the treatment of women with perineal hypotony.
高速度低幅度（HVLA）脊柱手法常用于治疗腰骶部疼痛；然而，过去对其对盆底的影响研究较少。本研究的目的是量化在无神经肌肉和骨骼功能障碍的患者中，HVLA手法前后通过压力测量的阴道内压力（IVP）和会阴基础张力（BPT）。
在这项实验性、非对照、非随机研究中，通过将会阴压力计插入处于背部水平卧位的志愿者阴道内来获取IVP。40名无阴道分娩史的年轻、健康的大学志愿者女性参与。会阴肌肉的所有自主收缩通过3种不同方式测量：阶段性会阴收缩（PPC）、持续性会阴收缩和与辅助肌肉相关的会阴收缩。在对志愿者骶骨进行HVLA手法后立即获得新的压力测量值。压力通过特定软件直接记录并转录到个人电脑上。
HVLA手法前后以毫米汞柱为单位获得的平均IVP，PPC分别为56.01（±25.54）和64.65（±25.63），持续性会阴收缩分别为445.90（±186.84）和483.14（±175.29），与辅助肌肉相关的会阴收缩分别为65.62（±26.56）和69.37（±25.26）。仅PPC值存在显著统计学差异（P = 0.0020）。无论收缩类型如何，BPT均增加（P < 0.05）。
在无相关骨关节疾病的女性中，骶骨的高速度低幅度手法与PPC和BPT的增加有关。这些初步发现可能有助于未来对会阴张力减退女性的治疗研究。
