Korkmaz Dayican Damla, Keser Irem, Celiker Tosun Ozge, Yavuz Onur, Tosun Gokhan, Kurt Sefa, Baser Secer Melda
Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, İzmir Tınaztepe University, İzmir, Turkey.
Department of Physiotherapy and Rehabilitation, Faculty of Physiotherapy and Rehabilitation, Dokuz Eylül University, İzmir, Turkey.
J Manipulative Physiol Ther. 2023 May;46(4):201-211. doi: 10.1016/j.jmpt.2024.02.005. Epub 2024 Mar 23.
This study aimed to investigate the synergy between the diaphragm and pelvic floor muscles (PFM) according to different exercise positions in women with pelvic floor dysfunction. Our secondary aim was to determine the short-term effects of single-week pelvic floor muscle training (PFMT) program on diaphragmatic function.
The cross-sectional study included 64 women with pelvic floor dysfunction. The participants' diaphragm and abdominal muscle functions during voluntary PFM contraction and relaxation were assessed by surface electromyography and ultrasonography. The surface electromyography assessments were performed in supine (P1), crawling (P2) and sitting (P3) positions. A single week-PFMT was conducted on women who agreed to determine the short-term responses of the diaphragm function. The muscle functions according to exercise positions were compared with Friedman Analysis of Variance, and the short-term effects of single-week PFMT on diaphragm function was analyzed with Wilcoxon Signed-Ranks Test.
The diaphragm activity during voluntary PFM contraction was highest in P2 before and after single-week PFMT (P < .001). Positive significant correlations were found between the activities diaphragm and abdominal muscles in different exercise positions (P < .05). After single-week PFMT, diaphragm thickness increased (P = .030) in P1, but diaphragm activity did not change in all 3 exercise positions (P > .05).
The synergy between the diaphragm and PFM was greater in the crawling position in women with pelvic floor dysfunction. The abdominal muscles seemed to contribute to maintaining this synergy. Therefore, PFMT combined with diaphragmatic breathing exercises in the crawling position should be considered. In addition, single-week PFMT may positively affect diaphragm function in the short-term.
本研究旨在调查盆底功能障碍女性在不同运动姿势下膈肌与盆底肌肉（PFM）之间的协同作用。我们的次要目的是确定单周盆底肌肉训练（PFMT）计划对膈肌功能的短期影响。
这项横断面研究纳入了64名盆底功能障碍女性。通过表面肌电图和超声检查评估参与者在自主PFM收缩和放松过程中的膈肌和腹部肌肉功能。表面肌电图评估在仰卧位（P1）、爬行位（P2）和坐位（P3）进行。对同意确定膈肌功能短期反应的女性进行单周PFMT。根据运动姿势比较肌肉功能，采用Friedman方差分析，并用Wilcoxon符号秩检验分析单周PFMT对膈肌功能的短期影响。
在单周PFMT前后，自主PFM收缩期间的膈肌活动在P2时最高（P <.001）。在不同运动姿势下，膈肌和腹部肌肉的活动之间存在显著正相关（P <.05）。单周PFMT后，P1时膈肌厚度增加（P =.030），但在所有3种运动姿势下膈肌活动均未改变（P >.05）。
盆底功能障碍女性在爬行位时膈肌与PFM之间的协同作用更大。腹部肌肉似乎有助于维持这种协同作用。因此，应考虑在爬行位将PFMT与膈肌呼吸练习相结合。此外，单周PFMT可能在短期内对膈肌功能产生积极影响。
