Strengths and
limitations
Strengths: 1. A pioneer randomized controlled study performed by a
single operator with strict implementation of the exact same PFFM
method. 2. The high correlation between the subjective measurements via
perineometer and the objective measurement of pelvic strength via Oxford
grading scale in both groups validate our results. Limitations: 1. A
small sample size and due to moderate compliance only 26 out of 40
participants completed the study. 2. The assessment of the majority of
patients in both groups was done by the main researcher, which can
affect the objectivity of the measurements. However, each measurement
was performed independently and separately while the analysis and the
comparison of the results was only done at the end of the study.
Moreover, the results of the measurements performed by the researcher
agree with PFDI-20 questionnaire results filled by the participants. We
had positive effect for the PFFM, and our results, where manual therapy
is shown to improve muscle and joint function are in agreement with the
existing data in the literature57. 3. There was a
basal difference in the strength of the pelvic floor between the
treatment and the control group which made the comparison cumbersome.
However, most of our tests applied an intra group benefit for the
treatment method.
- The authors report no conflict of interests
- Contribution to Authorship:
N. S.-Planning, carrying out, analyzing and writing
M.S.A-Planning, carrying out
C.E- Planning, analyzing
H.I- Planning, carrying out, analyzing and writing
The study was approved by the IRB of the Sheba Medical Center,
(3722-16-SMC) on February 14th 2017. NIH registry.
(approval no. NCT03041246). Full trial protocol is available at the
NIH registry.First Posted: February 2, 2017, First enrollment: January
1, 2018
No funding was granted for this trial
References
1. Hallock JL, Handa VL. The Epidemiology of Pelvic Floor Disorders and
Childbirth: An Update. Obstet Gynecol Clin North Am2016;43(1):1-13. doi: 10.1016/j.ogc.2015.10.008 [published Online
First: 2016/02/18]
2. Van Veelen GA, Schweitzer KJ, van der Vaart CH. Ultrasound imaging of
the pelvic floor: changes in anatomy during and after first pregnancy.Ultrasound in obstetrics & gynecology : the official journal of
the International Society of Ultrasound in Obstetrics and Gynecology2014;44(4):476-80. doi: 10.1002/uog.13301
3. Rikard-Bell J, Iyer J, Rane A. Perineal outcome and the risk of
pelvic floor dysfunction: a cohort study of primiparous women.Aust N Z J Obstet Gynaecol 2014;54(4):371-6. doi:
10.1111/ajo.12222
4. Webb S, Sherburn M, Ismail KM. Managing perineal trauma after
childbirth. BMJ 2014;349:g6829. doi: 10.1136/bmj.g6829
5. Klein MC, Gauthier RJ, Robbins JM, et al. Relationship of episiotomy
to perineal trauma and morbidity, sexual dysfunction, and pelvic floor
relaxation. American Journal of Obstetrics and Gynecology1994;171(3):591-98. doi: 10.1016/0002-9378(94)90070-1
6. Eason E, Labrecque M, Marcoux S, et al. Anal incontinence after
childbirth. CMAJ 2002;166(3):326-30.
7. Batista EM, Conde DM, Do Amaral WN, et al. Comparison of pelvic floor
muscle strength between women undergoing vaginal delivery, cesarean
section, and nulliparae using a perineometer and digital palpation.Gynecol Endocrinol 2011;27(11):910-4. doi:
10.3109/09513590.2011.569603
8. Caroci Ade S, Riesco ML, Rocha BM, et al. Evaluation of perineal
muscle strength in the first trimester of pregnancy. Rev Lat Am
Enfermagem 2014;22(6):893-901. doi: 10.1590/0104-1169.3600.2492
9. Dietz HP. Pelvic floor trauma in childbirth. Aust N Z J Obstet
Gynaecol 2013;53(3):220-30. doi: 10.1111/ajo.12059
10. Hall H, Cramer H, Sundberg T, et al. The effectiveness of
complementary manual therapies for pregnancy-related back and pelvic
pain: A systematic review with meta-analysis. Medicine
(Baltimore) 2016;95(38):e4723. doi: 10.1097/MD.0000000000004723
11. Boyle R, Hay-Smith EJ, Cody JD, et al. Pelvic floor muscle training
for prevention and treatment of urinary and faecal incontinence in
antenatal and postnatal women. Cochrane Database Syst Rev2012;10:CD007471. doi: 10.1002/14651858.CD007471.pub2
12. Boyle R, Hay-Smith EJ, Cody JD, et al. Pelvic floor muscle training
for prevention and treatment of urinary and fecal incontinence in
antenatal and postnatal women: a short version Cochrane review.Neurourol Urodyn 2014;33(3):269-76. doi: 10.1002/nau.22402
13. Woodley SJ, Lawrenson P, Boyle R, et al. Pelvic floor muscle
training for preventing and treating urinary and faecal incontinence in
antenatal and postnatal women. Cochrane Database Syst Rev2020;5:CD007471. doi: 10.1002/14651858.CD007471.pub4 [published Online
First: 2020/05/08]
14. Bo K, Haakstad LA. Is pelvic floor muscle training effective when
taught in a general fitness class in pregnancy? A randomised controlled
trial. Physiotherapy 2011;97(3):190-5. doi:
10.1016/j.physio.2010.08.014
15. FitzGerald MP, Kotarinos R. Rehabilitation of the short pelvic
floor. I: Background and patient evaluation. Int Urogynecol J
Pelvic Floor Dysfunct 2003;14(4):261-8. doi: 10.1007/s00192-003-1049-0
[published Online First: 2003/10/08]
16. FitzGerald MP, Kotarinos R. Rehabilitation of the short pelvic
floor. II: Treatment of the patient with the short pelvic floor.Int Urogynecol J Pelvic Floor Dysfunct 2003;14(4):269-75;
discussion 75. doi: 10.1007/s00192-003-1050-7 [published Online First:
2003/10/08]
17. Wallace SL, Miller LD, Mishra K. Pelvic floor physical therapy in
the treatment of pelvic floor dysfunction in women. Curr Opin
Obstet Gynecol 2019;31(6):485-93. doi: 10.1097/GCO.0000000000000584
[published Online First: 2019/10/15]
18. Oyama IA, Rejba A, Lukban JC, et al. Modified Thiele massage as
therapeutic intervention for female patients with interstitial cystitis
and high-tone pelvic floor dysfunction. Urology 2004;64(5):862-5.
doi: 10.1016/j.urology.2004.06.065 [published Online First:
2004/11/10]
19. Weiss JM. Pelvic Floor Myofascial Trigger Points: Manual Therapy for
Interstitial Cystitis and the Urgency-Frequency Syndrome. Journal
of Urology 2001;166(6):2226-31. doi: 10.1016/s0022-5347(05)65539-5
20. Grewar H, McLean L. The integrated continence system: a manual
therapy approach to the treatment of stress urinary incontinence.Man Ther 2008;13(5):375-86. doi: 10.1016/j.math.2008.01.003
[published Online First: 2008/03/15]
21. Beckmann MM, Stock OM. Antenatal perineal massage for reducing
perineal trauma. Cochrane Database Syst Rev 2013(4):CD005123.
doi: 10.1002/14651858.CD005123.pub3
22. Schleip R, Gabbiani G, Wilke J, et al. Fascia Is Able to Actively
Contract and May Thereby Influence Musculoskeletal Dynamics: A
Histochemical and Mechanographic Investigation. Front Physiol2019;10:336. doi: 10.3389/fphys.2019.00336 [published Online First:
2019/04/20]
23. Wong YY, Smith RW, Koppenhaver S. Soft Tissue Mobilization to
Resolve Chronic Pain and Dysfunction Associated With Postoperative
Abdominal and Pelvic Adhesions: A Case Report. J Orthop Sports
Phys Ther 2015;45(12):1006-16. doi: 10.2519/jospt.2015.5766
[published Online First: 2015/10/17]
24. Urbaniak G. C. PS. Research Randomizer. 4.0 ed, 2013.
25. Laycock J WM, Dumoulin C. Therapeutic management of incontinence and
pelvic pain. In: Haslam J LJ, ed. 2nd ed. London: Springer 2008:57-66.
26. Laycock J, Jerwood D. Pelvic Floor Muscle Assessment: The PERFECT
Scheme. Physiotherapy 2001;87(12):631-42. doi:
10.1016/s0031-9406(05)61108-x
27. Ribeiro Jdos S, Guirro EC, Franco Mde M, et al. Inter-rater
reliability study of the Peritron perineometer in pregnant women.Physiother Theory Pract 2016;32(3):209-17. doi:
10.3109/09593985.2015.1129654
28. Petricelli CD, Resende AP, Elito Junior J, et al. Distensibility and
strength of the pelvic floor muscles of women in the third trimester of
pregnancy. Biomed Res Int 2014;2014:437867. doi:
10.1155/2014/437867
29. Stecco L. Fascial Manipulation for Musculoskeletal Pain. Padova:
Piccin 2004:251.
30. Day JA CL, Rucli G. From clinical experience to a model for the
human fascial system. Journal of Bodywork and Movement Therapies2012;16:372-80.
31. Stecco L SC. Fascial Manipulation Practical Part. Padova: Piccin
2009.
32. Stecco C, Day JA. The fascial manipulation technique and its
biomechanical model: a guide to the human fascial system. Int J
Ther Massage Bodywork 2010;3(1):38-40. doi: 10.3822/ijtmb.v3i1.78
[published Online First: 2010/01/01]
33. Stecco A, Stern R, Fantoni I, et al. Fascial Disorders: Implications
for Treatment. PM R 2016;8(2):161-8. doi:
10.1016/j.pmrj.2015.06.006 [published Online First: 2015/06/17]
34. Casato G, Stecco C, Busin R. Role of fasciae in nonspecific low back
pain. Eur J Transl Myol 2019;29(3):8330. doi:
10.4081/ejtm.2019.8330 [published Online First: 2019/10/04]
35. Bordoni B, Zanier E. Clinical and symptomatological reflections: the
fascial system. J Multidiscip Healthc 2014;7:401-11. doi:
10.2147/JMDH.S68308 [published Online First: 2014/09/27]
36. Navot S, Kalichman L. Hip and groin pain in a cyclist resolved after
performing a pelvic floor fascial mobilization. J Bodyw Mov Ther2016;20(3):604-9. doi: 10.1016/j.jbmt.2016.04.005
37. Langevin HM, Fox JR, Koptiuch C, et al. Reduced thoracolumbar fascia
shear strain in human chronic low back pain. BMC Musculoskeletal
Disorders 2011;12(1):203. doi: 10.1186/1471-2474-12-203
38. Threlkeld AJ. The effects of manual therapy on connective tissue.Phys Ther 1992;72(12):893-902. doi: 10.1093/ptj/72.12.893
[published Online First: 1992/12/01]
39. Cyr LM, Ross RG. How controlled stress affects healing tissues.Journal of Hand Therapy 1998;11(2):125-30. doi:
10.1016/s0894-1130(98)80009-4
40. Harper B, Steinbeck L, Aron A. Fascial manipulation vs. standard
physical therapy practice for low back pain diagnoses: A pragmatic
study. J Bodyw Mov Ther 2019;23(1):115-21. doi:
10.1016/j.jbmt.2018.10.007 [published Online First: 2019/01/30]
41. Tozzi P, Bongiorno D, Vitturini C. Fascial release effects on
patients with non-specific cervical or lumbar pain. J Bodyw Mov
Ther 2011;15(4):405-16. doi: 10.1016/j.jbmt.2010.11.003 [published
Online First: 2011/09/29]
42. Salvesen KA, Morkved S. Randomised controlled trial of pelvic floor
muscle training during pregnancy. BMJ 2004;329(7462):378-80. doi:
10.1136/bmj.38163.724306.3A
43. Urbaniak G. C. PS. Research Randomizer 4.0 ed, 2013.
44. Resende APM, Petricelli CD, Bernardes BT, et al. Electromyographic
evaluation of pelvic floor muscles in pregnant and nonpregnant women.International Urogynecology Journal 2012;23(8):1041-45. doi:
10.1007/s00192-012-1702-6
45. Da Roza T, Mascarenhas T, Araujo M, et al. Oxford Grading Scale vs
manometer for assessment of pelvic floor strength in nulliparous sports
students. Physiotherapy 2013;99(3):207-11. doi:
10.1016/j.physio.2012.05.014
46. Gameiro MO, Sousa VO, Gameiro LF, et al. Comparison of pelvic floor
muscle strength evaluations in nulliparous and primiparous women: a
prospective study. Clinics (Sao Paulo) 2011;66(8):1389-94. doi:
10.1590/s1807-59322011000800014
47. Martinez Franco E, Pares D, Lorente Colome N, et al. Urinary
incontinence during pregnancy. Is there a difference between first and
third trimester? Eur J Obstet Gynecol Reprod Biol 2014;182:86-90.
doi: 10.1016/j.ejogrb.2014.08.035
48. Davenport MH, Nagpal TS, Mottola MF, et al. Prenatal exercise
(including but not limited to pelvic floor muscle training) and urinary
incontinence during and following pregnancy: a systematic review and
meta-analysis. Br J Sports Med 2018;52(21):1397-404. doi:
10.1136/bjsports-2018-099780
49. Schreiner L, Crivelatti I, de Oliveira JM, et al. Systematic review
of pelvic floor interventions during pregnancy. Int J Gynaecol
Obstet 2018;143(1):10-18. doi: 10.1002/ijgo.12513
50. Papageorghiou AT, Yu CK, Nicolaides KH. The role of uterine artery
Doppler in predicting adverse pregnancy outcome. Best Pract Res
Clin Obstet Gynaecol 2004;18(3):383-96. doi:
10.1016/j.bpobgyn.2004.02.003
51. Chan FY, Pun TC, Khoo J, et al. Pregnancy Screening by Uterine
Artery Doppler Velocimetry – Which Criterion Performs Best?Obstetrics & Gynecology 1995;85(4):596-602. doi:
10.1016/0029-7844(95)00006-d
52. Arrue M, Garcia M, Rodriguez-Bengoa MT, et al. Do low-risk
nulliparous women with abnormal uterine artery Doppler in the third
trimester have poorer perinatal outcomes? A longitudinal prospective
study on uterine artery Doppler in low-risk nulliparous women and
correlation with pregnancy outcomes. The journal of maternal-fetal
& neonatal medicine : the official journal of the European Association
of Perinatal Medicine, the Federation of Asia and Oceania Perinatal
Societies, the International Society of Perinatal Obstet2017;30(7):877-80. doi: 10.1080/14767058.2016.1190822
53. Okido MM, Valeri FL, Martins WP, et al. Assessment of foetal
wellbeing in pregnant women subjected to pelvic floor muscle training: a
controlled randomised study. Int Urogynecol J2015;26(10):1475-81. doi: 10.1007/s00192-015-2719-4
54. Aran T, Pekgoz I, Bozkaya H, et al. Association between preterm
labour and pelvic floor muscle function. J Obstet Gynaecol2018;38(8):1060-64. doi: 10.1080/01443615.2018.1446922
55. Vu D, Haylen BT, Tse K, et al. Surgical anatomy of the uterosacral
ligament. Int Urogynecol J 2010;21(9):1123-8. doi:
10.1007/s00192-010-1147-8
56. B CG. The Female Pelvis. Seattle: Eastland Press Inc. 2003.
57. Buscemi A, Petralia MC, Ramaci T, et al. Ergojump evaluation of the
explosive strength in volleyball athletes pre- and post-fascial
treatment. Exp Ther Med 2019;18(2):1470-76. doi:
10.3892/etm.2019.7628 [published Online First: 2019/08/07]