The pelvic floor muscles (PFM) form the base of the abdominal canister, and like the other muscle groups around the canister, the abdominal muscles and the diaphragm, they contribute to and are affected by pressures within the canister. But they also have a role in organ support and continence. In urinary incontinence, clinical rehabilitation has targeted the PFM in isolation. It aims to build up strength and endurance of these muscles, but without consideration of the influence of intra-abdominal pressure, and therefore the co-ordination of muscles that generate that pressure, on PFM activity. Strengthening of the PFM has not resolved incontinence for all women, and the benefits are not sustained in the long term. Thus consideration of factors beyond the pelvic floor (PF) may lead to better outcomes for rehabilitation in both the short and long term. Thus these studies aimed to investigate the influences of abdominal muscle activity and spinal posture on the recruitment of the PFM. The studies firstly investigated the association between the abdominal and PFM during voluntary tasks. Further studies examined the effect of automatic recruitment of the PFM and the abdominal muscles with postural disturbances and changes in spinal posture, and whether there was a difference in recruitment between layers of the PFM complex during function. Electromyographic (EMG) studies, using fine wire and/or surface electrodes, were performed to record patterns of muscle activity, while, in selected studies, this was accompanied by pressures recorded within the stomach, urethra, bladder, vagina, anus and rectum, to monitor the effects of the striated muscle activity on intra-abdominal pressure and urethral function. When the PFM were voluntarily contracted in healthy women, there was a co-ordinated response in all the abdominal muscles, which varied with the position of the lumbar spine. Conversely, when the lower abdominal muscles were drawn in towards the spine there was an increase in IAP, urethral pressure and PFM EMG activity. Relaxation of the abdominal muscles and bulging of the relaxed abdominal wall decreased PFM activity and urethral pressure below their resting baselines. Thus, voluntary activation of the abdominal or PFM influences activity in the other muscle group. Other studies investigated the automatic responses of abdominal and PFM during breathing, postural perturbation, sitting and coughing. Quiet breathing was associated with modulation of PFM EMG with greater activity during expiration than inspiration, in association with variations in abdominal muscle activity. Hypercapnoea accentuated these results. Postural perturbations generated co-activation of the PF and abdominal muscles before the onset of deltoid activity with sustained activity through out repeated arm movements. Changes in spinal posture also affected PFM activity. Like the abdominal muscles, PFM were less active when sitting in a slumped position. Similar changes occurred in women with stress urinary incontinence but with lower pelvic floor muscle activity levels. Women with stress urinary incontinence also had less lordosis of the lumbar spine in upright sitting and a trend for greater superficial abdominal muscle activity than continent women. Activity of the superficial, but not deep, PFM during coughing, was affected by different sitting postures, with greater activity during coughing in slumped than in upright postures. Different breathing patterns and changes in posture also affected IAP and abdominal muscle recruitment patterns during coughing. Investigation of PFM activity during functional tasks indicates that factors beyond the PF influence its activity. The findings from these studies indicate that PFM activity is inter-related with spinal posture and abdominal muscle activity. While most of these studies were conducted in healthy women, there are a number of different types of PF problems in women, in which the mechanics of the dysfunction differ from stress urinary incontinence. PFM activity has not been investigated in all types of PF dysfunction. The findings of co-ordinated recruitment of the abdominal and PFM and the effect of spinal posture on PFM function provide some evidence that PFM rehabilitation should not be undertaken in isolation, and that there is a likely advantage from exercising with a neutral lumbar spine. There is a need for further investigation of this co-ordinated muscle recruitment in subjects with different types of dysfunction, not just stress urinary incontinence. Findings from such investigations could then point the way forward to improved rehabilitation methods for people with problems, and more suitable methods of maintaining pelvic floor health.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 8 uppsatser.

Thesis (M.S.)--University of Michigan, 1986.

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2017-05-17T12:17:42Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertação versão final biblioteca com ficha catalográfica.pdf: 2468206 bytes, checksum: 29634da1f6a06a37cf1ae4db474e8060 (MD5) / Made available in DSpace on 2017-05-17T12:17:43Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertação versão final biblioteca com ficha catalográfica.pdf: 2468206 bytes, checksum: 29634da1f6a06a37cf1ae4db474e8060 (MD5) Previous issue date: 2016-03-29 / CENÁRIO: O paquímetro é um instrumento que vem sendo empregado na mensuração da distância inter-retos (DIR) e no diagnóstico da diástase dos músculos retos do abdome (DMRA), tanto na gestação, como no puerpério. Todavia, sua confiabilidade e acurácia precisam ser elucidadas no período gestacional. OBJETIVO: determinar a confiabilidade inter-avaliador do paquímetro na mensuração da Distância Inter-retos do abdome e a sua acurácia no diagnóstico da Diástase dos Músculos Retos do Abdome, no terceiro trimestre gestacional, em comparação com a ultrassonografia abdominal. MÉTODOS: trata-se de um estudo piloto de acurácia, aprovado pelo Comitê de Ética em Pesquisa (CAAE 30780314.2.0000.5182), realizado em uma maternidade pública na cidade de Campina Grande-PB, no período de junho à outubro de 2014. A amostra foi formada por 54 gestantes de baixo risco entre 28 e 41 semanas, na faixa etária de 18 a 35 anos. Medidas antropométricas foram coletadas e a DIR foi mensurada nos pontos: 3cm supra-umbilical (SU), na cicatriz umbilical (CU) e 2cm infra-umbilical. Com a paciente em decúbito dorsal, foi solicitado uma flexão anterior de tronco durante a expiração, e realizado a mensuração da DIR pelo avaliador 1 com o ultrassom (Philips HD3xe, transdutor linear de 5-9MHz). Em seguida, a DIR foi medida com o paquímetro digital (Starret 799), por dois avaliadores, nos mesmos pontos do avaliador 1. Os 3 avaliadores foram independentes e mascarados e cada um realizou 3 medições em cada ponto. A confiabilidade interavaliador na medição da DIR foi calculada através do coeficiente de correlação intra-classe (ICC) e intervalo de confiança (IC) à 95%, e no diagnóstico da DMRA através do Kappa e valor de p. A concordância de mensuração entre o paquímetro e a ultrassonografia foi apresentada através do gráfico de Bland-Altman. Para avaliação da acurácia, foram apresentados sensibilidade, especificidade, valores preditivo positivo (VPP) e negativo (VPN) e razões de verossimilhança positiva (RVP) e negativa (RVN).Utilizou-se o programa SPSS 20.0 e o Stata. RESULTADOS:. comparando-se os dois avaliadores do paquímetro, o instrumento apresentou ótima confiabilidade interavaliador especialmente no ponto supra-umbilical (ICC 0,86, IC95%= 0,72 - 0,92) e na CU (ICC 0,96, IC95%= 0,92 - 0,98). Porém, ao ser comparado com a USG, o instrumento apresentou reprodutibilidade pobre em todos os pontos, especialmente na CU (ICC -0,14, IC95%: -0,39 a 0,13). Na confiabilidade para o diagnóstico da DRAM, comparando-se os dois avaliadores do paquímetro, obteve-se um kappa de 0,56, p< 0,01 para a região infraumbilical (IU) e de 0,12, p= 0,19 para a região da CU. Ao ser comparado com a USG, o instrumento apresentou kappa de 0,02, p= 0,84 para a região IU e 0,05, p= 0,59 para a CU. Na região da CU, o paquímetro apresentou RVP de 1,05 (0,86 – 1,30), RVN de 0,63 (0,12 – 3,43); na região IU: RVP de 1,16 (0,6 a 1,9), RVN de 0,85 (0,48 a 1,41). Não foi possível calcular a confiabilidade no diagnóstico da DMRA, nem a acurácia do instrumento na região supra-umbilical, pois o paquímetro não detctou nenhum caso de DMRA nesse ponto. CONCLUSÃO: o paquímetro não apresenta boa confiabilidade interavaliador na medição da DIR nem no diagnóstico da DRAM no terceiro trimestre gestacional, especialmente ao ser comparado com o ultrassom. O instrumento apresenta acurácia ruim em todos os pontos investigados. / BACKGROUND: The caliper is an instrument that has been used in measuring the inter-recti distance (IRD) and diagnosing the Diastasis of the Recti Abdomini Muscles (DRAM) during pregnancy and puerperium. However, its reliability and accuracy still need to be elucidated during pregnancy. OBJECTIVE: assess caliper’s inter-rater reliability in measuring the inter-recti distance (IRD) and its accuracy in diagnosing the Diastasis of the Recti Abdomini Muscles in the third trimester compared to the ultrassound. METHODS: this was an accuracy and reliability pilot study approved by the Ethics Committee, CAAE 30780314.2.0000.5182, and conducted in a public maternity in the city of Campina Grande-PB, from June to October 2014. The sample consisted of 54 low risk pregnant women, between 28 and 41 weeks of gestation, aging between 18 and 35 years old. Patients underwent anthropometric measurements and the IRD was measured in the points located 3cm supra-umbilical (SU), in the umbilical scar (US) and 2cm infra-umbilical (IU), in supine position with feet flat on the bed, during expiration associated with trunk flexion. The examiner 1 used the ultrasound (Philips HD3xe, linear transducer of 5-9MHz) to measure the IRD, and then the IRD was measured with the digital caliper (Starret 799) by 2 blind and independent examiners. Each examiner measured each point three times. The data were processed and analyzed using SPSS 20.0, Stata and Medcalc software. The inter-rater reliability in measuring the IRD was calculated through de intraclass coefficient correlation (ICC) and confidence interval (CI) at 95%, and in diagnosing the DRAM trhough kappa and p-value. The concordance between caliper and ultrasound was presented by the Bland-Altman plot. For the accuracy evaluation, the variables sensibility, specificity, positive (PPV) and negative predictive value (NPV), positive (PLR) and negative likelihood ratio (NLR). RESULTS: comparing the two calipers’ evaluators, the instrument showed great inter-rater reliability especially in the SU (ICC 0.86; 95%CI: 0.72 to 0.92) and at the US (ICC 0.96; 95%CI: 0.92 to 0.98). However, when compared to the ultrasound (USG), the instrument showed poor reliability in all points, especially in the US (ICC -0.14; 95%CI: -0.39 to 0.13). In diagnosing the DRAM, comparing the two calipers’ evaluators, the instrument obtained a kappa of 0.56, p <0.01 for the IU and 0.12, p = 0.19 for US region. When compared to the USG, the instrument showed kappa 0.02, p = 0.84 for the IU region and 0,05, p = 0.59 for the US. In the US, the caliper presented a PLR of 1,05 (95%CI: 0,86 to 1,30), NLR of 0,63 (95%CI: 0,12 to 3,43); in the IU spot: PLR of 1,16 (95%CI: 0,6 to 1,9), NLR of 0,85 (95%CI: 0,48 to 1,41). It wasn’t possible to calculate neither the reliability nor the accuracy of the instrument in the SU due to the lack of positive cases diagnosed by the caliper. CONCLUSION: the caliper doesn’t present good inter-rater reliability neither in measuring the IRD, nor in diagnosing DRAM in the third trimester of pregnancy, especially when compared to the ultrasound. The instrument didn’t present good accuracy in any of the points investigated.

Orientadores: Cássio Luís Zanettini Riccetto, Simone Botelho / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T20:25:50Z (GMT). No. of bitstreams: 1 Pereira_LarissaCarvalho_D.pdf: 1455670 bytes, checksum: 028e9285ce960006ae96f31fc2bd7369 (MD5) Previous issue date: 2015 / Resumo: O assoalho pélvico (AP) feminino é uma estrutura complexa e vulnerável, suscetível a uma série de alterações funcionais ao longo da vida. Ampliar o conhecimento sobre esta estrutura poderia prevenir ou mesmo tratar tais disfunções. Objetivo: (1) Avaliar e comparar a contratilidade dos músculos do assoalho pélvico (MAP) em diferentes fases do ciclo vital feminino: nuligestas; primigestas; puérperas primíparas; climatéricas e pós-menopausadas. (2) Correlacionar a contratilidade dos MAP e sua coativação a partir da contração dos músculos transverso abdome/oblique interno (TrA/OI) com os fatores: idade; prática de atividade física; gestação; Índice de Massa Corpórea (IMC); paridade; presença e severidade dos sintomas urinários. Métodos: 331 mulheres participaram do estudo e foram avaliadas através dos questionários: International Consultation on Incontinence Questionnaire - Short Form (ICIQ UI-SF) e International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) para estudo dos sintomas urinários e eletromiografia (EMG) dos MAP para avaliação da contratilidade. Destas mulheres 92 foram submetidas também à EMG dos músculos TrA/OI e analisadas de acordo com os fatores propostos para estudar a influenciar da contratilidade na coativação. Resultado: Entre os grupos estudados, as nuligestas apresentam maior contratilidade (46.59±16.83?V) dos MAP, seguido do grupo das primigestas (35.31±18.22?V), puérperas de parto cesariana (33.28±13.00?V), puérperas de parto vaginal (31.23±16.12?V), climatéricas (25.81±17.57?V) e pós menopausadas (21.23±15.11?V). Houve correlação negativa entre a contratilidade dos MAP e a idade (p<0.0001), paridade (p<0.0001), ICIQ-SF (p=0.0001) e ICIQ OAB (p=0.0006). Não foi verificada correlação entre MAP e IMC (p=0.1348) e as mulheres que praticam atividade físca apresentam maior contratilidade dos MAP (p=0.03). Sobre os fatores que podem interferir na coativação foram significativos: a gestação (p=0.01), prática de atividade física (p=0.03) e altos valores do escore do ICIQ IU SF (p<0.0001). Em análise multivariada a atividade física juntamente com ICIQ IU SF influenciaram a contratilidade dos MAP e TrA/OI (p<0.001). Conclusão: A contratilidade dos MAP durante o ciclo vital feminino apresenta-se na seguinte ordem decrescente: nuligestas, primigestas, primíparas pós parto cesariana, primíparas pós parto vaginal, climatéricas e pós menopausadas. Os MAP apresentam sua contratilidade correlacionada inversamente com a idade, paridade, e escores do ICIQ SF e ICIQ OAB. A coativação entre o TrA/OI e os MAP é influenciada diretamente pela atividade física, e inversamente pela gestação e ICIQ IU SF. Em análise multivariada, verificou-se que, conjuntamente, a coativação é influenciada diretamente pela prática de atividade física e inversamente pelo escore ICIQ IU SF / Abstract: The female pelvic floor (PF) is a complex and vulnerable structure, susceptible to a number of functional changes throughout life. Increasing the knowledge of this structure could prevent or even treat such disorders. Objective: (1) To evaluate and compare the contractility of the pelvic floor muscle (PFM) at different stages of the female life cycle: nulliparous; primigravidae; primiparous postpartum women; climacteric and menopause. (2) To correlate the contractility of the PFM and their coactivation from the contraction of the transversus abdomen muscles/ internal oblique (TrA/IO) with the following factors: age; physical activity; pregnancy; Body Mass Index (BMI); parity; presence and severity of urinary symptoms. Methods: 331 women were evaluated through questionnaires: International Consultation on Incontinence Questionnaire - Short Form (ICIQ-UI SF) and International Consultation on Incontinence Questionnaire Overactive Bladder (OAB-ICIQ) for study of urinary symptoms and PFM electromyography (EMG) for contractility assessment. Of these women 92 were also submitted to the TrA EMG / IO muscles and analyzed according to the proposed factors to study the influence of contractility in coactivation. Results: Among the groups, the nulliparous have greater contractility (46.59 ± 16.83_V) of PFM, followed by the group of first pregnancy (35.31 ± 18.22_V), cesarean birth mothers (33.28 ± 13.00_V), vaginal birth mothers (31.23 ± 16.12_V), weather (25.81 ± 17.57_V) and postmenopausal (± 15.11_V 21:23). There was a negative correlation between the contractility of PFM and age (p <0.0001), parity (p <0.0001), ICIQ-SF (p = 0.0001) and ICIQ OAB (p = 0.0006). There was no correlation between the contractility of PFM and BMI (p = 0.1348). Women who practice physical activity have greater contractility of PFM About the factors that can interfere with coactivation were significant: pregnancy (p = 0.01), physical activity (p = 0.03) and high values of the ICIQ UI SF score (p<0.0001). In multivariate analysis, physical activity along with ICIQ UI SF influence the contractility of PFM and TrA/IO (p<0.001). Conclusion: The contractility of PFM during the female life cycle is presented in the following descending order: nulliparous, primiparous, primiparous after cesarean delivery, primiparous after vaginal delivery, climateric and postmenopausal. The PFM present their contractility inversely correlated with age, parity, and scores of ICIQ SF and ICIQ OAB. The co-activation between the TrA /IO and PFM is directly influenced by physical activity, and inversely by pregnancy and ICIQ UI SF. In multivariate analysis, it was found that, together, the co-activation is directly influenced by physical activity and inversely by ICIQ UI SF score / Doutorado / Fisiopatologia Cirúrgica / Doutora em Ciências

Orientador: Antonio Carlos de Moraes / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Educação Física / Made available in DSpace on 2018-08-26T22:48:29Z (GMT). No. of bitstreams: 1 Gaviao_KellyCristina_M.pdf: 2542214 bytes, checksum: b165bdb8314f9d07e2bdb39460e1f45f (MD5) Previous issue date: 2015 / Resumo: O presente trabalho teve como objetivo verificar a influência de oito semanas de sessões de Método Pilates nas respostas eletromiográficas e pico de torque da musculatura abdominal, em jovens do sexo feminino. Foram selecionadas para o estudo 20 voluntárias universitárias, com idade entre 18 e 25 anos, fisicamente ativas, que foram classificadas, aleatoriamente, em dois grupos: Grupo experimental (GE) e grupo Controle (GC). As voluntárias do grupo experimental foram submetidas a oito semanas de treinamento utilizando exercícios do Método Pilates no solo (MAT Pilates), enquanto as voluntárias do grupo controle não receberam intervenção. Antes e após as oito semanas de treinamento, todas as voluntárias foram submetidas à avaliação isocinética da musculatura abdominal por meio do dinamômetro isocinético da marca BIODEX® e avaliação eletromiográfica da musculatura abdominal utilizando eletrodos (superfície) ativos e o Sistema de Aquisição e Análise de Sinais MP150 da BIOPAC System, contendo 16 canais. Os músculos abdominais foram analisados de forma conjunta e os eletrodos de superfície foram posicionados bilateralmente no ventre dos músculos reto abdominal, fibras superiores e inferiores, e músculos oblíquo externo abdominal. Os dados dos sinais eletromiográficos brutos foram expressos em RMS (root mean square). Os dados obtidos após o treinamento foram comparados com os dados obtidos no período pré-treinamento e aos dados obtidos na avaliação do grupo controle. Os valores referentes ao protocolo realizado no dinamômetro isocinético, expressos em newton metro (Nm), foram baseados no pico de torque de cada voluntária durante a execução do teste. Foi empregada a análise de variância (ANOVA) seguida de post hoc de Tukey. A significância estatística adotada foi de 5% (p < .05). Paras valores referentes ao protocolo de eletromiografia, expressos em root-mean-square (RMS), foi empregada a análise de variância (ANOVA). A significância estatística adotada foi de 5% (p < .05). Foi possível observar que os maiores valores de pico de torque de flexão de tronco foram encontrados nos indivíduos do grupo experimental quando comparados ao grupo controle após a realização do protocolo, porém sem diferença significativa nos valores de pico de torque da extensão de tronco. Para os dados de ativação de fibras musculares, houve aumento significativo na ativação da musculatura abdominal analisada do grupo experimental, após a realização do protocolo e quando comparado ao grupo controle. Em conclusão, o protocolo utilizado teve influência positiva no fortalecimento e ativação de fibras da musculatura abdominal analisada / Abstract: The purpose of this study was to verify the influence of eight weeks of Pilates sessions in electromyographic responses and peak torque of the abdominal muscles in young women. Twenty female university volunteers, aged between 18 and 25 years old, physically active participated in this investigation and were divided randomly into two groups: experimental group (GE) and control group (GC). The volunteers of the experimental group underwent eight weeks of training using the Pilates Method exercises on the ground (MAT Pilates), while the volunteers in the control group received no intervention. Before and after eight weeks of training, all the volunteers were submitted to isokinetic abdominal muscles evaluation using an isokinetic dynamometer (Biodex®), also electromyographic activity of the abdominal muscles using active electrodes (surface) using the Data Acquisition System MP150 (BIOPAC System) with 16 channels. The abdominal muscles were analyzed together. The surface electrodes were placed bilaterally in the rectus abdominis muscles, upper and lower fibers, and obliquus externus muscles. Data from raw electromyographic signals were expressed in RMS (root mean square). The data obtained after training were compared with the data obtained in the pre-training period and also obtained in the evaluation of the control group. The values regarding the protocol performed at the isokinetic dynamometer expressed in newton meters (Nm), were based on peak torque of each volunteer during the test run. Analysis of variance (ANOVA) followed by post hoc Tukey was used. The used statistical significance was 5% (p <.05). For figures on electromyography protocol, expressed in root-mean-square (RMS), we used analysis of variance (ANOVA). The statistical significance used was 5% (p <.05). It was observed that the highest peak values of trunk flexion torque were found in the subjects in the experimental group compared with the control group after the completion of the protocol, but with no significant difference in the peak torque values of trunk extension. For muscle fiber activation data, there was a significant increase activation of the abdominal muscles analyzed in the experimental group after the completion of the protocol and compared to the control group. In conclusion, the protocol used had a positive influence in strengthening and activation of the abdominal muscles analyzed fibers / Mestrado / Biodinamica do Movimento e Esporte / Mestra em Educação Física

Bakgrund: Graviditetsrelaterad bäcken- och ländryggssmärta är vanligt förekommande. Smärtan försvinner oftast efter förlossning men för 7–10% kvarstår den i mer än två år. Det finns väl utformade behandlingsrekommendationer för den gravida kvinnan, men desto mindre för kvinnor med långvariga smärtbesvär. Stabiliserande träning är en typ av behandling som kan innefatta övningar för de olika muskelsystem som stabiliserar vår bål. Syfte: Att genom en strukturerad litteraturstudie undersöka vilken effekt stabiliserande träning har avseende smärta och funktion vid långvarig bäcken- och ländryggssmärta hos kvinnor efter förlossning. Metod: Datainsamlingen genomfördes i de elektroniska databaserna PubMed, CINAHL och PEDro. Urval gjordes utifrån studiens syfte, frågeställningar och uppsatta inklusions- och exklusionskriterier. De potentiellt relevanta artiklarnas metodologiska och etiska kvalitetgranskades. Data extraherades, sammanställdes i tabeller och analyserades kvalitativt. Smärta skattades genom Visual Analogue Scale (VAS) eller Numeric Pain Rating Scale (NPRS), funktion genom Oswestry Disability Index (ODI) eller Modified Oswestry Disability Questionnaire (MODQ). Resultat: Totalt inkluderades sju randomiserade kontrollerade studier (RCT) och 393 studiedeltagare. Studiekvaliteten varierade, tre studier bedömdes ha hög risk för bias, tre medelhög och en låg. Fem av sju studier uppvisade en statistiskt signifikant förbättring av utfallsmåtten smärta och/eller funktion efter avslutad intervention till förde linterventionsgruppen. Slutsats: Litteraturstudien indikerar positiva resultat för effekter av stabiliserande träning som behandling till kvinnor med långvarig bäcken- och ländryggssmärta efter förlossning, avseende smärta och funktion. För att med högre tillförlitlighet få veta vilken effekt stabiliserande träning har jämfört med andra behandlingsmetoder, samt hur vi bör utforma träningen i klinik, behövs mer forskning på området. / Background: Pregnancy related pelvic- and low back pain is common. The pain often disappears after childbirth but for 7-10% this pain remains for more than two years. There are treatment recommendations for the pregnant woman but limited for women with long lasting pain after childbirth. Stabilizing training is a treatment that includes exercises for the different muscle systems that stabilize our trunk. Aim: Through this structured literature study investigate the effects of stabilizing training, on pain and disability, for women with persistent pelvic-and low back pain after childbirth. Method: Data collection was performed in the databases Pubmed, CINAHL and PEDro. Selection was made from the aim, inclusion-and exclusion criteria of the study. An assessment of quality and ethical aspects of the articles was made. Data were extracted, compiled in tables and analyzed qualitatively. Pain was estimated by Visual Analogue Scale(VAS)/Numeric Pain Rating Scale (NPRS), disability by Oswestry Disability Index(ODI)/Modified Oswestry Disability Questionnaire (MODQ). Results: Totally seven RCT-studies and 393 study participants were included. Quality of the studies varied, three studies assessed to be high risk of bias, three medium and one low risk.Five of seven studies showed statistically significant improvement by the outcomes pain and function to advantage the intervention group. Conclusion: The review indicates positive results for the effects of stabilizing training for women with pelvic- and low back pain after childbirth. To assess the effects of stabilizing training with higher reliability, and how we should design the training in clinic, more research is needed.

The diploma thesis evaluates the morphology of the abdominal wall muscles focusing on the assessment of lateral symmetry in elite female floorball players and its relationship with the occurrence of back pain in these players. The theoretical part of the thesis includes an overview of the physiological mechanisms of postural stabilization in comparison with deviations in patients with back pain and describes the principles of sonographic examination and its use in physiotherapy. The theoretical part is also focused on the imagining of the abdominal muscles and the summary of specific findings in floorball players and other athletes, with a predominant one-sided load related to the biomechanics of movement in these sports. Methodology: A total of 20 female players of the highest floorball competition in the Czech Republic participated in this research. The linear parameters of the abdominal muscles (m. RA, m. TrA, m. OI and m. OE) and the whole lateral abdominal muscles were measured in players on both sides at rest using sonography. The participants also filled in an electronic questionnaire evaluating back pain. Results: Significant lateral asymmetry of linear parameters of abdominal muscles was demonstrated in the work (p = 0,017; d = 0,52). The relationship between the lateral asymmetry and the...

Диссертационное исследование посвящено определению эффективности разработанной методики формирования нейтрального положения позвоночника в фитнесе. Результаты исследования подтвердили выдвинутую гипотезу о том, что тренировка абдоминальных мышц при нейтральном положении позвоночника наиболее эффективна и безопасна, чем использование в тренировочном процессе классических упражнений для пресса. / The dissertation research is devoted to determining the effectiveness of the developed method of forming the neutral position of the spine in fitness. The results of the study confirmed the hypothesis that training the abdominal muscles in a neutral position of the spine is more effective and safer than using classical exercises for the press in the training process.

Tyrime dalyvavo moterys dirbančios sėdimą, protinį darbą įmonėse „Eligita“ ir „Kauno Dujos“. Tyrime dalyvauti buvo kviečiamos moterys nesportavusios dvejus metus ar ilgiau, ir, kurios buvo 40 m. ar vyresnės. Savanorės buvo suskirstytos į dvi grupes: tiriamąją (32 moterys) ir kontrolinę (30 moterų). Tiriamosios grupės moterys dalyvavo sveikatinimo programoje, kurią sudarė mankšta visoms raumenų grupėms, akcentuojant giliųjų pilvo raumenų stiprinimą ir paskaitų ciklas apie mitybą, fizinį aktyvumą ir amžinius moterų kūno sandaros pokyčius. Kontrolinei grupei sveikatinimo programa nebuvo taikyta. Abiems grupėms prieš ir po sveikatinimo programos buvo tirta 3 dienų mityba 72 val. mitybos apklausos metodu, atlikta anketinė apklausa (klausimai apie mitybą, fizinį aktyvumą ir sveikatą), pasvertos, išmatuoti ūgis, juosmens ir klubų apimtis, riebalų, vidinių riebalų ir raumenų dalis, giliųjų pilvo raumenų jėga. Iš gautų rezultatų buvo apskaičiuoti kūno masės indeksas ir juosmens ir klubų apimties santykis. / The study included women working in a sedentary and mental work in companies called “Eligita” and “Kaunas Gas”. To participate in the experiment were invited 40 years and older women, who didn’t exercise for two years or longer. Volunteers were divided into two groups: the case group (32 women) and a control group (30 women). Women in the case group participated in the health program, which consisted of exercises for all muscle groups, it was focused on the deep abdominal muscles strengthening and lectures about nutrition, physical activity and age-related changes of women body composition. Women in the control group didn’t take part in the health program. Before and after the health program were studied 3 days diet by 72 dietary recall method, conducted a survey (included questions about diet, physical activity and health), after that women were weighed, measured their height, waist and hip circumference, fat, internal fat and muscle part of the body and the deep abdominal muscle strength. Based on the results body mass index, waist and hip ratio was calculated.