3: Pelvic floor muscle motor unit recruitment: Kegels vs specialized movement

Abstract

Pelvic floor exercise is clearly established as appropriate first line treatment for stress urinary incontinence and overactive bladder. The effectiveness of exercise relates to the degree of motor unit recruitment achieved during exercise. To date the Kegel exercise has been the most common recommendation for pelvic floor conditioning and rehabilitation. The purpose of this study is to compare the traditional Kegel exercise to specialized movements that incorporate voluntary pelvic floor contraction at a point in the movement where the pelvic floor is naturally engaged. Between January 2014 and May 2015 one hundred consecutive patients referred for pelvic floor rehabilitation were instructed as to how to perform 10 different movements know to naturally engage the pelvic floor. Subjects wore small wireless surface EMG sensors recording muscular activity from the pelvic floor, gluteals, lower abdominal muscles, and the lower extremity adductors. Video clips synchronized to 4-channel EMG were recorded for each movement. Each clip began with an isolated pelvic floor contraction before the subject performed one of the ten specialized pelvic floor movements. Mean peak pelvic floor activity during the isolated PF contraction were compared to the peak pelvic floor activity achieved during the movement. Percent Greater Than Isolated Kegel1.Lunge: 42% (0-80) p<0.0012.Squat: 30% (-40-75) p<0.0013.Side Lying Bent Knee Lift: 25% (14-72) p<0.0014.Side Lying Straight Leg Circle: 25% (-33-63) p<0.0015.Butterfly: 36% (-25-90) p<0.0016.Bridge: 56% (15-82) p<0.0017.Corkscrew: 21% (-50-57) p<0.0018.Hovering: 49% (-12-80) p<0.0019.All 4s Bent Knee Lift: 30% (-22-71) p<0.00110.Cat Into Cow: 41% (-5-73) p<0.001 Each of the ten movements produced a mean statistically significant increase in PF activity than traditional (stationary) Kegel exercises. Specialized movements, when performed in conjunction with voluntary pelvic floor contractions may provide greater motor unit recruitment than traditional Kegel exercises. Individuals vary as to the degree of enhanced engagement with any given movement.