Workshop 30 “How to use abdominal muscles to protect the pelvic floor” Chairperson: Dr Els BAKKER¹ E mail address: ebakker@belgacom.net Other Speakers: Dr Dr Mr Mr Dominique BRAGARD, PT, PhD Cécile FAYT, MD, PhD Peter MEYERS, PT Guy VALANCOGNE, PT
Aims: Understand the protecting (or threatening) mechanisms of the pelvic floor and the pelvic content related to abdominal activity. Objectives: The integration of the above objectives should allow participants to take advantage of the abdominal muscle activity in the treatment of pelvic floor disorders. To end the workshop different tips for “safe” abdominal exercises will be given and discussed. Outline Workshop Programme: Functions and synergies of abdominal muscles Dr D BRAGARD, PT, PhD¹ The superficial abdominal muscles (rectus abdominis, obliquus internis, obliquus externis) are classically associated with mobilizing functions of the trunk. When considering different movements (flexion, lateral bending or rotations) one can observe different synergistic patterns with homo - or contra-lateral muscles. The deepest layer of the abdominal wall is represented by the transversus abdominis (TrA) that is often considered as a belt for maintaining the viscera. This muscle is also unconsciously activated during cough, phonation or defecation. Besides these functions, the abdominal muscles also take part to the respiratory mechanics especially during forced expiration. So they are generally considered as antagonists of the inspiratory diaphragmatic function. However, during inspiration against resistance, the diaphragm needs to take support on the viscera. This function is again provided by the TrA. Abdominal muscles are also involved in postural functions to compensate trunk movements. Whatever the voluntary moveme nt, TrA, diaphragm and, probably, pelvic floor muscles present an anticipative activation that allows to rigidify the abdominal cavity and then stabilize trunk before starting the disturbing movement. These functions are present throughout various physiological or biomechanical demands and imply complex synergies between all the muscles around the abdominal cavity. Neuro-physiological aspects of abdominal muscles Dr C. FAYT¹ Each learning process involves cerebral plasticity. During reeducation we should be well aware of the impact of our therapy on the activation of these neuronal pathways. It is therefore very important to understand the mechanism involved in the neural control of the abdominal and pelvic muscles. How do abdominal muscles cope with different and sometimes contradictory tasks? Are there different motor-units recruited during the execution of such a task? What are the practical consequences of these findings for our therapy and for the instructions we give to our patients.
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What means “a competent abdominal wall” and how to test it? dr E BAKKER, PT, PhD¹ Presentation of different ways of testing the abdomi nal muscles according to their function and the relationship between those tests Ø Coughing test [Guillarme] Ø [O’Sullivan] Ø Stability platform Ø VEM Normative data of the coughing-test on a population of 364 healthy subjects, aged between 18 and 20 years. Results of a study on the influence of abdominal incompetence in young Belgian gymnasts, and the effect of abdominal training on these symptoms.
Abdomino-pelvic floor dyssynergie G.VALANCOGNE, PT² Abdominal muscles need to protect the pelvic floor and his contents. It therefore needs to contract in answer to abdominal hyperpressure, in order to direct these pressures upwards. At the same time there should be a co-activation of pelvic floor muscles. Many incontinent patients have lost the synergic movement between abdominal and pelvic floor muscles.
Practical tips for “safe” abdominal muscle exercises P. MEYERS, PT³ Exercising “safely” to get a strong abdominal wall is clearly not an easy thing to do. Any raise in abdominal pressure is to avoid as this would be bad for the pelvic floor. On the other hand, that same raise of intra-abdominal pressure is used to stabilise the lower trunk. This should lead to well chosen exercises not only for the abdominal wall but at the same time working on the surrounding stabilising muscles and keeping an eye on all their functions.
Target Audience: Physiotherapists Length of Workshop: 180mins __________________________________________________________ ¹ HE Leonard de Vinci - IES Parnasse-Deux Alice – Brussels - Belgium ² President of SIREPP ³ President of the Belgian association for Pelvic Therapy- Pelvired
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