A research review from Julie Wiebe
"My review here is not intended to substitute for a full read of the article. However, in short they found that women with self-reported urinary urgency and frequency had significantly weaker hip external rotators and abductors than their case matched controls (measured by hand-held dynamometry). In addition, NO significant differences in pelvic floor strength and endurance were detected between those with and without symptoms (measured via vaginal squeeze pressure with perineometer). These results are consistent with other studies that have shown hip musculature weakness in women with stress urinary incontinence (SUI), in conjunction with no difference in the strength of the pelvic floors between those with or without SUI."
"The authors discussion made some great suggestions to help explain their findings that warmed my heart, as someone who has been looking outside the pelvis for solutions for a long time! In particular, they noted that studies similar to this one examine ONLY force production of the pelvic floor, while in clinical practice and interventional studies other variables are addressed and taken into consideration:
“Among PFM training programs is a wide variety in emphasis on improving parameters of PFM performance including strength, endurance, power, muscle tone, coordination, motor control, flexibility, and myofascial pain….” (Foster, 2021, pg 133).
AMEN! It is exciting to have more and more support for looking at other variables in pelvic health considerations. When we look to go beyond pelvic floor strengthening, a new world of integrated treatment options opens up for all us!
One finding that did not get a lot of attention in the discussion, but makes me go hmmmm*, were the UCLA Activity scores of those with and without symptoms. While they found a similar range of activity levels between those with and without symptoms, the median activity level for those with symptoms was on the more vigorous end of the scale. The sample size was not big enough to draw definitive conclusions. However, it is interesting to me and I’d like to know more about that relationship. Makes me go hmmmm....?
If some of the women with symptoms are involved in more vigorous activity how’d they get weak hips? I am fond of looking at HOW women move/run/lift to help answer that question. But does this study offer support for another thought process, too? As evidence grows to show the interrelationship and interdependence of the hip and pelvic musculature, is the absence of HIP strength, endurance, power, motor control, etc. asking more of the pelvic floor to pull off pelvic-hip movement patterns. This could lead to the over-recruitment patterns we see in women with urgency and frequency (and the other components of that symptom cluster noted above). I offer that interdependence as an intervention strategy demonstrating a movement based solution to help balance that hip and pelvic muscular interrelationship for a female athlete, not just strengthen components of the complex.
Lots to think about and great takeaways here! I am so grateful to those who are pursuing new questions for women!"
