Biomechanical Properties of the Pelvic Floor and its Relation to Pelvic Floor Disorders

Pelvic organ prolapse and stress urinary incontinence remain a clinical challenge as they have unclear pathophysiology and suboptimal treatments. These common pelvic floor disorders (PFD) are characterized by the weakening of the pelvic floor supportive tissues that are directly related to their biomechanical properties. Characterizing the biomechanical properties of the pelvic floor tissues has been the focus of recent studies and researchers are using tools that are not always well understood by clinicians. Therefore, the aim of this review is to provide an overview of the most used methods to test the passive biomechanical properties of the human pelvic floor tissues. We also summarize recent findings from studies looking into the passive properties of the pelvic floor in pelvic floor disorders using the ex vivo tensile test and emerging in vivo techniques. Together, these studies provide valuable quantitative information about the different biomechanical properties of the supportive tissues of the pelvic floor under normal and pathological conditions. Results from ex vivo tests provide valuable data that needs to be correlated to the in vivo data and the clinical manifestations of the symptoms of the PFD. As more research is conducted we will obtain an enhanced understanding of the effect of age, PFD, and treatments on the biomechanical properties of the pelvic floor. This information can contribute to better identify individuals at risk, improve clinical diagnosis, and develop new treatments to advance clinical practice.     

Elongation of esophageal segments by bougienage stretching technique for long gap esophageal atresia to achieve delayed primary anastomosis by thoracotomy or thoracoscopic repair: A first experience from China

Objectives

The treatment of long gap esophageal atresia (LGEA) is one of the most challenging congenital malformations in neonatal surgery. A preoperative bougienage stretching technique for elongation of the two segments of esophagus is applied to achieve utilizing the native esophagus to establish esophageal continuity by open or thoracoscopic approach.

Intermittent stretching induces fibrosis in denervated rat muscle

Introduction: Stretching (St) has been used for treating denervated muscles. However, its effectiveness and safety claims require further study. Methods: Rats were divided into: (1) those with denervated (D) muscles, evaluated 7 or 15 days after sciatic nerve crush injury; (2) those with D muscles submitted to St during 7 or 15 days; and (3) those with normal muscles. Muscle fiber cross‐sectional area, serial sarcomere number, sarcomere length, and connective tissue density were measured. MMP‐2, MMP‐9, TIMP‐1, TGF‐β1, and myostatin mRNAs were determined by real‐time polymerase chain reaction. MMP‐2 and MMP‐9 activity was evaluated by zymography. Collagen I was localized using immunofluorescence. Results: St did not prevent muscle atrophy due to denervation, but it increased fibrosis and collagen I deposition at day 15. St also upregulated MMP‐9 and TGF‐β1 gene expressions at day 7, and myostatin at day 15. Conclusions: Stretching denervated muscle does not prevent atrophy, but it increases fibrosis via temporal modulation of TGF‐β1/myostatin and MMP‐9 cascades. Muscle Nerve 53 : 118–126, 2016     

Immediate effect of foam roller on pain and ankle range of motion in patients with plantar fasciitis: A randomized controlled trial

Background:Stretching has been proven to be effective on pain and range of motion (ROM) in patients with plantar fasciitis. Despite recent gain in popularity and the proposed theories of effectiveness of foam roller, there is a lack of literature on the effect of foam rolling on plantar fasciitis.Objective:The objective of this study was to compare the effects of foam rolling and stretching on pain and ankle ROM in patients with plantar fasciitis.Methods:A total of 50 participants were included and randomly allocated to the stretching and foam roller groups. Visual analog scale (VAS), pressure pain thresholds (PPTs) for gastrocnemius, soleus and plantar fascia and weight-bearing lunge test (WBLT) measurements were recorded at baseline and immediately after treatment.Results:Within-group analysis has shown there is a statistically significant difference (p<0.001) in all the outcome measures in both foam roller and self-stretching groups. The between-groups analysis showed no statistical significance difference in VAS, plantar fascia PPT and WBLT parameters (with p-values of 0.171, 0.372 and 0.861, respectively); however, significant differences were found in gastrocnemius PPT (p=0.029) and soleus PPT (p=0.013).Conclusion:It was seen that both stretching and foam rolling techniques helped in reducing pain and increasing the ROM. However, the effectiveness of foam roller was superior to stretching in terms of increase in PPTs at gastrocnemius and soleus.Clinical Trial Registration No:CTRI/2018/01/011398.Name of registry:The Clinical Trials Registry — India (CTRI); https://ctri.nic.in.     

Dry needling of the trapezius muscle in office workers with neck pain: a randomized clinical trial

Background: Neck pain is a frequent complaint in office workers. This pain can be caused by myofascial trigger points (MTrPs) in the trapezius muscle. This study aimed to determine the effectiveness of deep dry needling (DDN) of active MTrPs in the trapezius muscle.

Methods: A randomized, single blinded clinical trial was carried out at the Physical Therapy Department at Physiotherapy in Women's Health Research Group at Physical Therapy Department of University of Alcalá, in Alcalá de Henares, Madrid, Spain. Forty-four office workers with neck pain and active MTrPs in the trapezius muscle were randomly allocated to either the DDN or the control group (CG). The participants in the DDN group were treated with DDN of all MTrPs found in the trapezius muscle. They also received passive stretch of the trapezius muscle. The CG received the same passive stretch of the trapezius muscle only. The primary outcome measure was subjective pain intensity, measured using a visual analogue scale (VAS). Secondary outcomes were pressure pain threshold (PPT), cervical range of motion (CROM) and muscle strength. Data were collected at baseline, after interventions and 15?days after the last treatment.

Results: Differences were found between the DDN group and the CG for the VAS (P?P?P?P?Discussion: Deep dry needling and passive stretch seems to be more effective than passive stretch only. The effects are maintained in the short term. The results support the use of DDN in the management of trapezius muscle myofascial pain syndrome in neck pain.     

手法拔伸结合曲面枕治疗颈椎病108例疗效观察

[目的]观察手法拔伸结合曲面枕治疗颈椎病的临床疗效。[方法]将211例随机分为治疗组108例,对照组103例。治疗组采用手法拔伸结合曲面枕治疗,对照组采用牵引加推拿治疗。对其治疗前后X线改变与临床表现进行比较分析。[结果]治疗组总有效率为94.4%,对照组总有效率为79.6%(P0.01)。[结论]手法拔伸结合曲面枕治疗颈椎病有较好的疗效。     

依赖Ca2+的ATP过量释放在机械牵张所致气道上皮黏蛋白5AC高分泌中的作用

目的探讨人气道上皮细胞三磷酸腺苷(ATP)释放量的改变在机械通气所致气道黏液高分泌中的作用。方法人气道黏膜上皮细胞(HBE16)体外培养,通过节律性倾斜细胞培养板,利用液体的表面张力、大气压及液体重力所产生的牵张力(剪应力)及压力(压应力)给予压力牵张刺激,并利用向密闭盒中注入医用氧气增加压力以模拟机械通气,各组培养细胞依施加条件不同而分为对照组、单纯倾斜组、倾斜+钙离子螯合剂BAPTA-AM、倾斜+BAPTA-AM+钙离子螯合剂EGTA、加压+倾斜、加压+倾斜+嘌呤P2Y受体阻断剂reactive blue-2(RB-2)、加压+倾斜+BAPTA-AM、加压+倾斜+BAPTA-AM+EGTA,共8组,分别采用四甲基偶氮唑盐法(MTT)测定细胞活性、逆转录聚合酶链反应(RT-PCR)检测各组黏蛋白(MUC)5AC mRNA表达水平、ELISA法检测细胞培养上清液中MUC5AC含量、高效液相色谱法(HPLC)检测培养液中ATP释放量。结果加压+倾斜组细胞MUC5AC mRNA相对含量、培养上清液中ATP释放量和MUC5AC蛋白分泌量分别为:(11.80±0.01)、(7.41±0.45)μmol/g、(0.77±0.26),显著高于单纯倾斜组的(6.60±0.01)、(2.76±0.47)μmol/g、(0.25±0.01)及对照组的(3.40±0.01)、(0.00±0.01)μmol/g、(0.02±0.01)(均P<0.05)。RB-2、EGTA+BAPTA-AM处理后的加压+倾斜组细胞的MUC5AC mRNA相对含量分别为:(10.5±0.03)、(11.9±0.11),与加压+倾斜组相比抑制作用不显著(P>0.05);培养上清液中ATP释放量分别为:(0.05±0.02)μmol/g、(0.08±0.02)μmol/g,较加压+倾斜组显著降低(均P<0.05)。结论机械通气可以显著提高气道黏膜上皮MUC5AC的分泌,其机制与气道上皮细胞依赖Ca2+的ATP的过量释放密切相关。     

Muscle stretching technique increases vital capacity and range of motion in patients with chronic obstructive pulmonary disease

Putt MT, Watson M, Seale H, Paratz JD. Muscle stretching technique increases vital capacity and range of motion in patients with chronic obstructive pulmonary disease.

Objectives

To determine if a specific hold and relax stretching technique was capable of (1) reversing the effect of tight chest wall muscles by increasing chest expansion, vital capacity, and shoulder range of motion and (2) decreasing perceived dyspnea and respiratory rate in persons with chronic obstructive pulmonary disease (COPD).

Design

Double-blind crossover trial.

Setting

A physiotherapy department at a major metropolitan hospital.

Participants

Fourteen stable patients with COPD who had recently completed a pulmonary rehabilitation program were enrolled, with 10 patients completing the study.

Intervention

A hold and relax stretching technique of the pectoralis major and a sham technique each for 2 days.

Main Outcome Measures

The primary outcome measure was vital capacity (VC), with secondary outcome measures being perceived dyspnea, axillary (ACE) and xiphisternal chest expansion (XCE), right and left shoulder horizontal extension, and respiratory rate.

Results

The hold and relax technique to the pectoralis major compared with the sham technique produced significant effects on VC (P<.01), and right (P<.01) and left (P<.05) upper-limb range of motion. There was no significant effect on ACE, XCE, perceived dyspnea, or respiratory rate. There was no order effect for either technique.

Conclusions

The hold and relax technique produces short-term benefits in patients with COPD and should be investigated further.     

Effects of compression/stretching of the spermatic cord and blunt dissection on testicular growth and fertility

Purpose

This study was performed to investigate whether compression/stretching of the spermatic cord or blunt dissection influences testicular development and fertility. In addition, the authors evaluated whether the extents of testicular damage differ between these 2 surgical manipulations.

Methods

Forty-four prepubertal male Sprague-Dawley (SD) rats (Harlan Sprague-Dawley Inc, Indianapolis, Ind) were divided into 3 groups: (1) the control group (CG) animals underwent a sham operation in the right groin, (2) the experimental group 1 (EG1) underwent compression/stretching of the right spermatic cord, and (3) the experimental group 2 (EG2) underwent dissection around the right spermatic cord structures. Testicular volumes, weights, mean seminiferous tubular diameters (MSTDs), mean testicular biopsy scores, and numbers of offspring and of pregnant females were evaluated.

Results

Right (operative) and left (nonoperative) testicular volumes were smaller in the EG2 group than in the CG or EG1 groups. Left MSTDs in the EG1 and EG2 groups increased more than in the CG group. Numbers of Sertoli cells in left testes differed in the 3 groups, in the order EG1 < CG < EG2. Mean testicular biopsy scores, offspring numbers, and pregnant female numbers were no different in the 3 groups.

Conclusions

Both surgical manipulations influenced testicular growth, but they did not compromise spermatogenesis or fertility in SD rats.