Hypopressive technique versus pelvic floor muscle training for postpartum pelvic floor rehabilitation: A prospective cohort study

Abstract

Aims: Abdominal hypopressive technique (AHT) is gaining popularity as an alternative to pelvic floor muscle training (PFMT) during postpartum. Although, there is no solid evidence for its recommendation. Methods:We conducted a prospective observational cohort study in a university hospital with 105 primiparae who performed a two-month PFMT or AHT program. The aim was to compare the effectiveness of both treatments in terms of morphofunctional changes in 3D transperineal ultrasound, manometry, dynamometry, and differences in urinary incontinence symptoms (ICIQ-IU-SF) and satisfaction. Results: The average change in levator ani muscle was 1.2 mm higher in AHT group vs PFMT (95% confidence interval [CI], −2.2 to −0.2; P = .017). No statistically significant differences were shown in maximal strength changes between groups. After AHT, basal tone change was 63.0 g/cm 2 higher than PFMT (95% CI, −129 to 2.9; P = .06). A statistically significant reduction in ICIQ-IU-SF was observed after both treatments [(PFMT, −0.8 points; 95% CI, −1.4 to −0.1; P = .015), (AHT, −0.7 points; 95% CI, −1.3 to −0.1; P = .018]. AHT showed a higher median satisfaction score than PFMT (P = .004). Conclusions: This preliminary study is the first that analyses the effect of AHT vs PFMT during postpartum. The results suggest a higher improve for AHT in levator muscle thickness and satisfaction compared to PFMT. These must be considered with caution due to the limitations of the study. Further randomized clinical trials about both techniques during postpartum are required. K E Y W O R D S 3D transperineal ultrasound, abdominal hypopressive technique, muscle tone, pelvic floor muscle training, postpartum

The Effects of Abdominal Hypopressive Training on Postural Control and Deep Trunk Muscle Activation: A Randomized Controlled Trial

“…Evidence suggests that physical training focused on deep trunk muscle stabilization improves postural control [1]. Caufriez et al, in 1980 [11], proposed Abdominal Hypopressive Training (AHT) as a method to prevent pelvic floor dysfunction after pregnancy [12], then as training to improve postural control [13]. It consists of postural and breathing techniques [14,15] which decrease the pressure in three compartments: the thoracic, abdominal, and perineal [11].…”

“…It consists of postural and breathing techniques [14,15] which decrease the pressure in three compartments: the thoracic, abdominal, and perineal [11]. It has been hypothesized that complete exhalation, followed by apnea, blocks the glottis and opens the chest cavity in such a way that the diaphragm is stretched, causing involuntary trunk deep muscle activation [12][13][14]. This maneuver, added to postural techniques, aims to induce activation of tonic muscle fibers (type I), which should increase the synergistic activation of all postural muscles, including the deep trunk muscles [13,14,16].…”

Aplicación clínica de los ejercicios hipopresivos: una revisión sistemática

“…En cuanto a los resultados, aquellos estudios que analizan los efectos del ejercicio hipopresivo sobre la MSP obtienen beneficios con su realización 5,9,25,26,30,31 . Sin embargo, cuando estos ejercicios se comparan con otros de entrenamiento de la MSP como los ejercicios de Kegel o contracciones voluntarias 21,25,26,29,31 , el efecto del ejercicio hipopresivo es menor a excepción del reciente estudio de Juez et al 30 en el que se obtienen mayores cambios en la MSP con los ejercicios hipopresivos.…”

“…Por último, señalar que esta técnica es ampliamente conocida y utilizada en España, Francia, Italia, Alemania, Canadá y Brasil por este motivo los artículos seleccionados en esta revisión se localizan en estos países, la mayoría en España 5,9,19,20,[22][23][24]27,28,30,31 esto puede deberse a que las grandes empresas o estudiosos de la Gimnasia Abdominal Hipopresiva tienen sede en nuestro país.…”

“…La mayoría de los trabajos solo presentan un grupo de intervención basado en ejercicios hipopresivos 5,7,9,21,23,24,28,31 . En otros casos, los comparan con un grupo control 20,22 o con otras técnicas de fisioterapia, entre las que se encuentran el entrenamiento de la MSP 25,26,29,30 , masoterapia 27 o la técnica Schroth 19 .…”