LDN - Health and Fitness

Widely used pelvic floor exercise lacks supporting evidence

[November 10, 2017] By Mary Gillis

(Reuters Health) - An abdominal breathing exercise that’s supposed to help women with prolapsed uterus or a type of urinary incontinence has been taught for more than 30 years, but so far there’s little evidence showing it works, researchers say.

Just two studies have tested the effectiveness of adding the hypopressive abdominal technique (AHT) to another physical therapy regimen, and neither experiment found any added benefit, according to the authors of a “discussion” in the British Journal of Sports Medicine.

“Many physical therapists act as gurus and make a fortune on giving courses. Today we have a totally different background, and all should have some scientific background . . . to be able to ask important questions,” coauthor of the discussion Kari Bo, of the Norwegian School of Sports Science in Oslo, told Reuters Health in an email.

Without adequate evidence, clinicians shouldn’t be prescribing the AHT technique over and above traditional pelvic floor muscle training, Bo and his coauthor Saul Martin-Rodriguez of the COLEF physical education training school in Las Palmas de Gran Canaria, Spain, conclude.

The hypopressive abdominal technique emphasizes breathing and attention to posture, they write. The goal is to activate pelvic floor muscles as well as a major muscle of the stomach called the transverse abdominis. Clinicians behind the technique theorize that this decreases overall abdominal pressure, which should help reduce what’s known as stress urinary incontinence as well as pelvic organ prolapse.

But it’s possible this exercise could worsen certain conditions, especially those involving overactive pelvic pain, according to Amy Stein, who wasn’t involved in the study.

“For overactive pelvic pain, you should be relaxing the pelvic floor, but AHT is saying to engage the pelvic floor,” said Stein, founder of Beyond Basics Physical Therapy in New York and president of the International Pelvic Pain Society.

“In overactive patients, the muscles are already shortened and this would further shorten them. In fact, if you engage the pelvic floor too much, this could lead to further pelvic floor dysfunctions such as an underactive pelvis, back issues and abdominal pain,” Stein told Reuters Health in a phone interview.

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Pelvic floor muscle training does include some pelvic floor contraction. But the relaxation phase of the exercise is equally important, she noted.

The abdominal hypopressive technique, first developed in the 1980s, remains widely used across Europe, Canada and South America, and is gaining popularity in the U.S. - mainly because of its strong social media presence designed to attract practitioners to pursue “AHT certification,” Bo said.

In the end, the responsibility falls on the individual practitioner to stay current with the scientific literature in order to provide the best possible treatment for their patients, he said. Hype, theory or a strong marketing campaign is not considered an appropriate rationale for prescribing treatment.

“There is strong evidence that pelvic floor muscle training is effective in both stress urinary incontinence and pelvic organ prolapse. We must anticipate that clinicians are updated on these studies and follow protocols that have shown effects are based on a biological rationale and, in addition, years of clinical experience,” Bo added.

“Clinicians who are not up to date and who prescribe non-evidence (based) treatments are violating the responsibility they have to their patients,” Martin-Rodriguez said by email.

SOURCE: http://bit.ly/2jfIcUJ British Journal of Sports Medicine, online October 16, 2017.

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