The effect of chiropractic care on synchronised pelvic floor muscle contraction
The effects of chiropractic care compared to passive movement on pelvic floor muscle function in women with non-synchronised pelvic floor muscle contractions
New Zealand College of Chiropractic
15 participants
Aug 28, 2014
Interventional
Conditions
Summary
This project will investigate whether adjusting lumbopelvic vertebral subluxations alters pelvic floor muscle function using a novel multiarray surface electrode vaginal probe. Pelvic floor muscles are fundamental in the birth process, mainly during the pushing stage of labour. They normally contract in a synchronised coordinated fashion. However, nonsynchronised pelvic floor muscle contractions are often detected and this is thought to be the cause of pelvic floor dysfunction such as urinary incontinence. If spinal adjustments are able to improve pelvic floor muscle function then this could have important benefits for both delivery and pelvic floor health. Spinal adjustments are known to improve the timing and ability to contract the deep abdominal muscles. Since the pelvic floor muscles work together with the abdominal muscles, it is possible that adjustments will also be able to improve the timing and the synchronization of the pelvic floor muscles.
Eligibility
Inclusion Criteria5
- Women aged 18-55 with non-synchronised pelvic floor muscle contractions, as observed during ultrasound examination,
- A body mass index of less than 25 kg/m2 to achieve reliable EMG recordings
- Normal perineal sensibility
- Detectable non-synchronised pelvic floor muscle contractions, as observed during electromyography (EMG) examination.
- (Participants in this trial will be included whether they are pregnant or not)
Exclusion Criteria7
- Any history of pelvic floor dysfunction, stress incontinence, pelvic organ prolapse, pelvic floor muscle avulsions, etc.
- Women with vaginal, urethral or bladder infection,
- Significant back pain in the last 3 months
- Known neurological diseases
- If currently taking antidepressant, analgesic or sedative medication.
- Known contraindication to receiving chiropractic adjustments. This includes a history of recent trauma, or known conditions such as inflammatory or infectious arthropathies, or bone malignancies.
- Previous adverse reactions to spinal adjustments
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Interventions
Individuals who are identified as having non-synchronous pelvic floor muscle contraction during the baseline/control session will be assessed a second time within one month of the initial assessment. At the second assessment all measures will be recorded before and after lumbopelvic chiropractic adjustments. The order of the various measures will be pseudo-randomised (e.g. order of assessment of maximal voluntary contractions, submaximal contractions and voluntary coughs). No control setup will be performed during the second assessment as control data will be available from the first assessment. All of the spinal adjustments to be carried out in this study will be high-velocity, low-amplitude thrusts to the spine. This is a standard adjustment technique used by manipulative physicians, physiotherapists, and chiropractors. The mechanical properties of this type of CNS perturbation have been investigated; and although the actual force applied to the subject's spine depends on the therapist, the patient, and the spinal location of the adjustment, the general shape of the force-time history of spinal adjustments is very consistent (Hessell, Herzog, Conway, & McEwen, 1990) and the duration of the thrust is always less than 200 milliseconds (for review see Herzog, 1996).The high-velocity type of adjustment was chosen specifically because previous research (Herzog, Conway, Zhang, Gail, & Guimaraes, 1995) has shown that reflex EMG activation observed after adjustments only occurred after high-velocity, low-amplitude adjustments (as compared with lower-velocity mobilizations). This adjustment technique has also been previously used in studies that have investigated neurophysiological effects of spinal adjustments (for review see Haavik & Murphy, 2012). After each individual segmental adjustment the spine will be re-checked in order to determine if the subsequent levels identified as subluxated still require an adjustment. The levels of the spine adjusted for each subject will be recorded in an experimental log book. The adjustment intervention will take approximately 5 minutes and will be administered once.
Locations(1)
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ACTRN12614000795695