Relationship between lower limb position and pelvic floor muscle surface electromyography activity in menopausal women: a prospective observational study

Tomasz Halski,1 Kuba Ptaszkowski,2 Lucyna Słupska,1 Robert Dymarek,3 Małgorzata Paprocka-Borowicz2 1Department of Physiotherapy, Opole Medical School, Opole, 2Department of Clinical Biomechanics and Physiotherapy in Motor System Disorders, 3Department of Nervous System Diseases, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland Objectives: In physiotherapeutic practice, special attention is being given to the reciprocal anatomical, physiological, and biomechanical relationship of the pelvis and the structures connected to it. However, the scientific literature shows mainly the theoretical information about their mutual connections. The lack of information about these relations from a practical aspect coupled with the paucity of scientific papers on the impact of posture changes on the pelvic floor led the authors to conduct this study. The primary aim of this study was to compare the resting and functional bioelectrical activities of pelvic floor muscles (PFMs) depending on three different positions of the lower limbs (positions A, B, and C) in the supine position.Materials and methods: This was a prospective observational study evaluating resting and functional activities of the PFM depending on the position of the lower limbs. The study was carried out at the Department and Clinic of Urology, University Hospital in Wroclaw, Poland and the target group were women in the menopausal period. Bioelectrical activity of PFM was recorded using a surface electromyographic instrument in the supine position. Results of the values obtained in A, B, and C positions were compared using a one-way analysis of variance.Results: In position A, the average resting surface electromyography (sEMG) activity of PFM was 6.9±2.6 µV; in position B, the result was 6.9±2.5 µV and in position C, the resting sEMG activity was 5.7±1.8 µV (P=0.0102). The results of the functional bioelectrical activity of PFM were as follows: position A – 20.3±11.8 µV, position B – 19.9±10.6 µV, and position C – 25.3±10.9 µV (P=0.0104).Conclusion: The results showed that in the supine position, the PFM achieved the lowest resting activity and the highest functional activity. Therefore, the supine position can be recommended for the diagnosis and therapy of weakened PFM. Keywords: pelvic floor muscles, menopause, surface electromyography, synergistic muscl

Dry Needling with the Use of FRSc Technique in Addition to Standard Rehabilitation Program for Chronic Low Back Pain: A Randomized Controlled Trial Using Both PROMs and Measurement Tools

Joanna Rajfur,1 Katarzyna Rajfur,1 Tomasz Matusz,1 Maria Malarska,2 Karolina Walewicz,3 Kuba Ptaszkowski,4 Robert Dymarek,4 Jakub Taradaj5 1Institute of Health Sciences, University of Opole, Opole, 45-040, Poland; 2Department of Clinical Genetics, Medical University of Lodz, Lodz, 90-419, Poland; 3Department of Physiotherapy, Jan Grodek State University, Sanok, 38-500, Poland; 4Department of Physiotherapy, Wroclaw Medical University, Wroclaw, 50-368, Poland; 5Institute of Physiotherapy and Health Sciences, Academy of Physical Education, Katowice, 40-065, PolandCorrespondence: Joanna Rajfur, Institute of Health Sciences, University of Opole, Katowicka 68, Opole, 46-020, Poland, Tel +48 506 202 372, Email [email protected]: Dry needling (DN) has gained popularity for musculoskeletal conditions, but its commercial use often surpasses scientific evidence. The novel Five Regulatory Systems Concept (FRSc) of DN shows potential therapeutic mechanisms, including chronic low back pain (LBP). However, rigorous clinical assessment with patient-reported outcome measures (PROMs) and objective measures are necessary. This study aimed to evaluate the effect of DN according to pain levels, postural control and selected gait parameters in patients with chronic LBP.Patients and Methods: This prospective, double-blinded, randomized controlled study involved 30 patients with LBP allocated in the experimental (n=15, rehabilitation+ FRSc DN) or control group (n=15, rehabilitation + sham DN). The Roland-Morris questionnaire (RMQ) and Visual Analog Scale (VAS) were used as PROMs. Moreover, the posturography method for posture and balance control and the treadmill for gait analysis were used as objective tools. Measurements were taken before and immediately after the intervention and during 1- and 3-month follow up.Results: There was a statistically significantly greater improvement in the RMQ in the experimental group compared to the controls (p=0.923 before and p< 0.001 after treatment, as well as p< 0.001 after 1 and 3 months). Despite the favorable analgesic effect, a significant advantage of the experimental group over the controls in this respect is worth noting (p=0.001 in favor of DN in all intergroup comparisons concerning results from the subjective assessment of pain (VAS). A statistically insignificant post-treatment improvement in balance and postural stability was noted in both groups, although the effects appeared to be short-term. Surprisingly, again, DN had no advantage over sham interventions. In both groups, all changes in the swing phase were statistically insignificant (p=0.201 for the dominant and p=0.283 for the non-dominant side) for the initial swing phase. In both groups, all changes in the stance phase were statistically insignificant (p=0.480 for the dominant and p=0.410 for the non-dominant side of the body).Conclusion: DN based on the FRSc appears promising as an effective adjunct to standard rehabilitation for LBP, showing improvements in functional performance and pain reduction.Keywords: low back pain, dry needling, rehabilitation, postural control, gait analysi

The attempt of objective evaluation of the lower leg classical massage effects - three cases report

Masaż klasyczny należy do często stosowanych zabiegów fizjoterapeutycznych. W literaturze można znaleźć wiele doniesień na temat terapeutycznych efektów masażu, zarówno na poziomie miejscowym (lokalnym), jak i ogólnoustrojowym (globalnym). Korzystne oddziaływanie wykazano również w sferze psychiki pacjenta. Jednak wiele efektów ma charakter subiektywny, co znacznie utrudnia wiarygodną ocenę kliniczną w procesie leczenia. W pracy dokonano analizy efektów masażu na podstawie pomiarów fizjologicznych wybranych parametrów, badań elektromiograficznych i termograficznych.The classical massage is an important method of physiotherapy. Therapeutic effects are observed locally, as well as on systemic level (globally). The massage has beneficial influence on the psychical sphere, too. However, there not many reports on objective evaluation of massage effects. In this paper, the massage effects were examined by analysis of chosen physiological, electromyographic and termoghraphic measurements

Assessment of bioelectrical activity of synergistic muscles during pelvic floor muscles activation in postmenopausal women with and without stress urinary incontinence: a preliminary observational study

Kuba Ptaszkowski,1 Małgorzata Paprocka-Borowicz,2 Lucyna Słupska,2 Janusz Bartnicki,1,3 Robert Dymarek,4 Joanna Rosińczuk,4 Jerzy Heimrath,5 Janusz Dembowski,6 Romuald Zdrojowy6 1Department of Obstetrics, 2Department of Clinical Biomechanics and Physiotherapy in Motor System Disorders, Wroclaw Medical University, Wroclaw, Poland; 3Department of Obstetrics and Gynecology, Health Center Bitterfeld/Wolfen gGmbH, Bitterfeld-Wolfen, Germany; 4Department of Nervous System Diseases, 5Department of Gynaecology and Obstetrics, Faculty of Health Science, 6Department and Clinic of Urology, Faculty of Postgraduate Medical Training, Wroclaw Medical University, Wroclaw,&nbsp;Poland Objective: Muscles such as adductor magnus (AM), gluteus maximus (GM), rectus abdominis (RA), and abdominal external and internal oblique muscles are considered to play an important role in the treatment of stress urinary incontinence (SUI), and the relationship between contraction of these muscles and pelvic floor muscles (PFM) has been established in previous studies. Synergistic muscle activation intensifies a woman&rsquo;s ability to contract the PFM. In some cases, even for continent women, it is not possible to fully contract their PFM without involving the synergistic muscles. The primary aim of this study was to assess the surface electromyographic activity of synergistic muscles to PFM (SPFM) during resting and functional PFM activation in postmenopausal women with and without SUI.Materials and methods: This study was a preliminary, prospective, cross-sectional observational study and included volunteers and patients who visited the Department and Clinic of Urology, University Hospital in Wroclaw, Poland. Forty-two patients participated in the study and were screened for eligibility criteria. Thirty participants satisfied the criteria and were categorized into two groups: women with SUI (n=16) and continent women (n=14). The bioelectrical activity of PFM and SPFM (AM, RA, GM) was recorded with a surface electromyographic instrument in a standing position during resting and functional PFM activity.Results: Bioelectrical activity of RA was significantly higher in the incontinent group than in the continent group. These results concern the RA activity during resting and functional PFM activity. The results for other muscles showed no significant difference in bioelectrical activity between groups.Conclusion: In women with SUI, during the isolated activation of PFM, an increased synergistic activity of RA muscle was observed; however, this activity was not observed in asymptomatic women. This may indicate the important accessory contribution of these muscles in the mechanism of continence. Keywords: pelvic floor muscles, postmenopausal period, stress urinary incontinence, surface electromyography, synergistic muscl