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abstract

398 - EVALUATION OF PELVIC FLOOR KINEMATICS IN CONTINENT AND INCONTINENT WOMEN DURING RUNNING

398

EVALUATION OF PELVIC FLOORKINEMATICS IN CONTINENT AND INCONTINENT WOMEN DURING RUNNING

M. LEITNER1, H. MOSER2, P. EICHELBERGER 3, A. KUHN 4, J.BAEYENS 5, L. RADLINGER 6;
1HealthDivision / aR&D Physiotherapy, Bern Univ. of Applied Sci., Bern,Switzerland, 2Vrije Universiteit Brussel, Faculty ofPhysical Ed. and Physiotherapy, Brussel, Belgium, 3BernUniv. of Applied Sci., Hlth., Bern, Switzerland, 4WomenHosp., Urogynaecology, Bern, Switzerland, 5VUB,Brasschaat, Belgium, 6Bern Univ. of Applied Sci. Hlth.,Bern, Switzerland.

Introduction: Physical activityis of vital importance for the individual health. However,participation in sport counts as main trigger for stress urinaryincontinence (SUI) and many women therefore reduce physical activity(1). A prevalence of 41% has been found in female athletes (2) and ishighest in sports involving high-impact (3). Impact activity likerunning is associated with an increase in intra-abdominal pressurewhich needs to be sufficiently countered by pelvic floor muscles(PFM) activity to secure continence.
Objective:Comprehension of PFM displacement is relevant for the development ofspecific approaches in PFM rehabilitation. So far the main focus ofresearch on PFM function has been on voluntary and concentriccontractions. MRI and ultrasound studies confirmed the elevatingcharacter of voluntary PFM contraction on PFM and viscera, as well asthe descending effect during coughing. There is a lack of knowledgeconcerning pathomechanism of involuntary, reflexive functional wholebody movements. Aim of this study was to investigate PFM kinematicsin continent and SUI women during running at three different speedsand thereby elucidate PFM dynamics and muscle action during impactactivity.
Methods: A cross-sectional, exploratory designwas applied and a sample of 50 women between 18 and 60 years wasrecruited. Screening for inclusion was performed by anurogynaecologist and SUI was diagnosed according to the ICIQ-UIsf.3-dimensional position and orientation was measured with theelectromagnetic tracking device trakSTAR™ at a sampling rate of 250Hz. The vaginal sensor was attached to the vaginal probe and thesacral sensor was secured to subjects’ skin at the height of thesecond sacral vertebrae. Translation (cranial-caudal) and rotationabout the lateral axis (forwards-backwards) of the vaginal probe withrespect to the body coordinate system was measured during 10 secondsrunning on a treadmill at the speeds 7, 11 and 15 km/h. Displacementdata from 100 ms before to 300 ms after heel-strike were analyzed. Inaddition the maximum and minimum displacements as well as theassociated time points within 300 ms after the foot strike wereextracted. A repeated measures model (ANOVA) was applied.
Results:Nineteen incontinent (SUI, mean age 45.3 ± 10.3) and twenty-sevencontinent (CON, mean age 38.7 ± 10.4) women were included in thisstudy. Before the foot touched the ground caudal displacement andforward rotation of the vaginal probe was detected, whereas afterheel-strike a cranial and backward displacement was measured. Withinthe time interval 0-300 ms after heel-strike, maximum translationswere 16.0 (±10.5) mm in cranial (reached after 153.2 (±72.8) ms)and 7.6 (±6.7) mm in caudal (reached after 171.6 (125.1) ms)direction, and 7.9° (±7.0) for backward (reached after 136.8(110.0) ms) and 7.0° (±5.6) for forward rotation (reached after184.5 (113.1) ms). Cranial-caudal translation as well asbackward-forward- rotation did not differ significantly between thetwo groups (CON and SUI subjects) for the three speeds (7, 11 and 15km/h). Analysis of maximum displacements (cranial-caudal androtation) showed increasing significant differences between thespeeds 7, 11 and 15 km/h (p<0.012).
Conclusions:Kinematic measurements in continent and incontinent women duringimpact activity of running demonstrated caudal translation before andcranial translation after heel-strike. The hypothesis of caudaltranslation through impact activity was not confirmed. Movementpatterns did not change within the three speeds and are similarbetween continent and incontinent subjects. Associations between thedirection of displacement and muscle action of PFMs remainassumptions. With this study results it can be hypothesized thatmuscle actions may be eccentric before and concentric afterheel-strike.
References: 1. British Journal Sports Med2009;43(14):1115-1118 2. Int J Gynaecol Obstet 2011;114(1):60-63 3.Sports Med 2004;34(7):451-464