Ankle positions potentially facilitating greater maximal contraction of pelvic floor muscles: a systematic review and meta-analysis

Abstract

Pelvic floor muscle-training for women with urinary incontinence could be performed in standing with ankles in a neutral position or dorsiflexion to facilitate greater maximal pelvic floor muscle contraction. As urethral support requires resting contraction of pelvic floor muscles, decreased resting activity in plantar flexion identified in the meta-analysis indicates that high-heel wearers with urinary incontinence might potentially experience more leakage during exertion in a standing position. Implications for rehabilitation Pooled analyses revealed that maximal voluntary contraction of pelvic floor muscle is greater in induced ankle dorsiflexion than induced plantar flexion. As pelvic floor muscle strengthening involves achieving a greater maximal voluntary contraction, pelvic floor muscle training for women with stress urinary incontinence could be performed in standing either with ankles in a neutral position or dorsiflexion. Decreased resting activity in plantar flexion identified in the meta-analysis indicates that high-heel wearers with stress urinary incontinence might potentially experience more leakage during exertion in a standing position. Women with stress urinary incontinence should be advised to wear flat shoes instead of high-heels and should be cautioned about body posture and ankle positions assumed during exercise and daily activities.

Activation of Pelvic Floor Muscle During Ankle Posture Change on the Basis of a Three-Dimensional Motion Analysis System

“…The pelvis tilts anteriorly and the position of the sacrum opens the pelvic outlet, and both ischial tuberosities move away from each other, causing the PFMs to tighten [ 20 ]. Although ankle dorsiflexion is not directly related to the pelvic floor, it is thought to induce pelvic anterior tilting and increase the activation of the PFM [ 12 , 14 , 15 ].…”

“…Previous studies have compared the activation of PFMs during fixed posture of dorsiflexion and plantar flexion and reported that PFMs were activated in dorsiflexion and inactivated in plantar flexion [ 12 , 14 , 16 ]. Therefore, it was necessary to keep in mind the use of high heels in people with weak PFMs [ 15 ]. However, previous studies did not provide adequate information regarding ideal exercise posture to strengthen PFMs.…”

“…Therefore, it is important to confirm that the changes in activation of PFMs are in accordance with changes in posture [ 12 – 14 ]. Studies involving pelvic tilt and activation of PFMs while standing have shown greater activation of PFMs with posterior pelvic tilting compared to anterior pelvic tilting or neutral positions [ 12 , 14 , 15 ]. Depending on the ankle posture, the pelvic tilt can change [ 12 , 14 , 15 ].…”

“…Previous studies reported that the height of the heel caused an angle change in the pelvic tilt, and that pelvic muscles were activated upon ankle dorsiflexion [ 15 ]. Previous studies have also compared the activation of PFMs at fixed ankle positions [ 14 , 16 ].…”

Investigation of Electromyographic Activity of Pelvic Floor Muscles in Different Body Positions to Prevent Urinary Incontinence

“…Patients with urinary incontinence need to understand that physical posture during exercise and in daily life can affect urinary incontinence. Several studies have investigated the relationship between pelvic posture and PFM activation [7–9].…”