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Pelvic floor muscle (PFM) strength is a critical factor for optimal pelvic floor function. Fluctuations in strength values based on different phases of the menstrual cycle (MC) could signify a need for a paradigm shift in evaluating, approaching, and planning training. This research aims to examine and contrast the pelvic floor muscle strength during different phases of the menstrual cycle. A prospective observational study employing digital assessment with the modified Oxford scale and vaginal dynamometry measurements was performed, in order to assess the baseline strength and the contraction strength of the PFMs in eumenorrheic females at three different phases of the MC: the early follicular phase (EFP), the late follicular phase (LFP), and the mid-luteal phase (MLP). During two complete cycles, tympanic temperature and body weight were measured and the urinary luteinizing hormone concentration was tested to determine the time of ovulation. In total, 216 dynamometric measurements of PFM strength were obtained from eighteen nulliparous women (25.72 ± 5.03 years). There were no differences between the baseline strength ( p = 0.886) and the contraction strength ( p = 0.756) with the dynamometric speculum. In the post hoc analysis, the baseline strength, contraction strength, and strength showed no significant differences between MC phases. As no differences in PFM strength in women were found, the PFMs do not seem to be weaker at any time during the menstrual cycle. It appears that the assessment, establishment, and monitoring of a PFM training program could be initiated at any point in the cycle.

(1) Background: Infantile colic (IC) is a functional gastrointestinal disorder that affects around 20% of infants, and postpartum (PPD) depression is a common disorder that affects between 15 and 22% of mothers. In this study, our objective was to evaluate the relationship between the maternal psychological state in the first postpartum year and IC, with the aim of assessing the importance of feeding type in infants and maternal well-being. (2) Methods: A cross-sectional study was conducted in women in their first year postpartum. Demographic, medical, and obstetric data of the mothers and infants were collected, and the type of feeding was identified. The emotional status of the mother was evaluated using the Edinburgh Postnatal Depression Scale (EPDS), and the Infant Colic Severity Questionnaire (ICSQ) was used for IC diagnosis. (3) Results: A total of 528 women were analyzed, of which 170 (32%) were diagnosed with possible PPD. Two-thirds of the women without depression breastfed their babies on demand; therefore, we report that exclusive breastfeeding (EBF) appears to reduce the risk of possible PPD ( p < 0.001; OR = 2.353). IC was present in 39% of babies, and around 70% of babies without colic were breastfed on demand. Infants who were not exclusively breastfed showed almost double the risk of developing colic ( p = 0.016; OR = 1.577). There was a significant association between the EPDS and ICSQ scores ( p < 0.001). More than half of the women with PPD had babies with colic. However, our results show that 75% of babies without colic had mothers who reported optimal postpartum emotional well-being ( p < 0.001; OR = 2.105). (4) Conclusions: The results of this study suggest that postpartum maternal psychological well-being reduces the risk of IC. Therefore, we report that EBF on demand, together with a healthy emotional state in new mothers, may be a protective factor against colic in infants., Competing Interests: The authors declare no conflicts of interest.

(1) Background: Pelvic-floor-muscle (PFM) activation acts synergistically with multiple muscles while performing functional actions in humans. The purpose of this study was to characterize the activity of the PFMs and gluteus medius (GM) while walking and running in physically active nulliparous females. (2) Methods: The peak and average amplitude of maximal voluntary contractions (MVCs) during 60 s of walking (5 and 7 km/h) and running (9 and 11 km/h) were measured with electromyography of the GM and PFMs in 10 healthy female runners. (3) Results: The activation of both muscles increased ( p < 0.001) while walking and running. The MVC of the GM was reached when walking and tripled when running, while the PFMs were activated at half their MVC when running. The global ratio of the GM (75.3%) was predominant over that of the PFMs (24.6%) while static and walking. The ratio reached 9/1 (GM/PFM) while running. (4) Conclusion: The GM and PFMs were active while walking and running. The GM's MVC tripled at high speeds, while the PFMs reached only half of their maximum contraction.

Background : Exercise can stress the pelvic floor muscles (PFMs). This study sought to assess the strength of the PFMs according to the level of physical exercise. Methods : An analytical observational study was carried out using digital palpation and dynamometry measurements to assess PF strength. Healthy nulliparous women were stratified according to physical exercise (physically active and sedentary) and level of physical exercise (elite, amateur, and sedentary). Results : Fifty-four women were analyzed, with a mean age of 25.64 (5.33) years and a BMI of 21.41 (2.96) kg/m 2 . Differences in the passive force and strength were observed between both groups of women ( p < 0.05), and the strength was around two times higher in physically active women ( p < 0.05). The strength was similar between elite female athletes and sedentary women ( p > 0.05), but statistical differences were found with amateurs ( p < 0.05). The PFM strength ( p = 0.019) of elite female athletes (0.34 N) was almost half that of amateurs (0.63 N) and twice as strong as that of sedentary women (0.20 N). However, these differences were not significant using digital palpation ( p = 0.398). Conclusions : Women who exercise generally have greater PFM strength than women who do not exercise. Physical exercise could strengthen the PFM; however, the high intensity demanded by high-level sports does not seem to proportionally increase the strength of the PFMs.

Since there is an increasing rate of physiotherapists using invasive procedures during the clinical practice, understanding the cross-sectional anatomy and radiological images is essential for ensuring patients' safety during these interventions. Therefore, the aim of this study was to analyze the students' opinion of including cross-sectional and radiological images to traditional methodologies, to evaluate whether these additional resources improve their ability to identify musculoskeletal structures in radiological images and their understanding of neurovascular and visceral structures related with specific muscles to be avoided during invasive procedures. First-year undergraduate physiotherapy students were enrolled in the study. A brief online survey asking about their opinion about the use of cross-sectional and radiological images as complementary resources was built. In addition, two open-answer tests (before and after the inclusion of these resources) were conducted to evaluate their ability to identify correctly musculoskeletal structures in magnetic resonance and ultrasound images and to evaluate their awareness of high-risk structures related with specific muscles. One-hundred-thirty-two students returned the online survey and one-hundred-forty-eight completed all the tests. In general, students opined cross-sectional images to be of utility for learning anatomy (81.8%) and radiological images (93.9%) and felt they benefited from cross-sectional and ultrasound images (78.0%). All tests showed significant improvements after the inclusion of these complementary resources (all, p < 0.001) except for trunk structures in MRI (p = 0.777). The implementation of anatomical cross-sectional and radiological images resulted in better understanding of radiological images and better cognition of possible risk during invasive procedures., (© 2023 American Association for Anatomy.)

Background: Percutaneous neuromodulation (PNM) consists in using electrical stimulation on a peripheral nerve by using a needle as an electrode in order to lessen the pain and restore both neuromuscular and nervous system functions. The aims of the present study were to evaluate the current scientific evidence of the effects of PNM on pain and physical capabilities in neuromusculoskeletal injuries., Methods: Data sources: There was used the PRISMA protocol. In order to do the literature research, there were used the PubMed, Cochrane, Scopus, and Web of Science databases. Study selection or eligibility criteria: There were also included experimental clinical trials published between 2010 and nowadays, tested on humans, which feature treatment based on needles with electrical stimulation in order to treat neuromusculoskeletal injuries. Study appraisal and synthesis methods: A quality assessment was performed according to the PEDro scale and reviewed the impact factor and quartile of the journal., Results: The treatment resulted in significant improvement in terms of pain intensity, pressure pain threshold, balance, muscular endurance, functionality/disability, subjective improvement, function of the descending pain modulatory system, and intake of drugs. Limitations: the lack of previous research studies on the subject and the lack of data on opioid intake in the selected studies., Conclusion: Treatment based on PNM may be an alternative when treating injuries in soft tissues without significant side effects. However, there are few articles investigating the effects of PNM so more evidence is needed to draw solid conclusions., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Physical effort in sports practice is an important trigger for urinary incontinence (UI). Among high-impact sports, all track and field events require continuous ground impacts and/or abdominal contractions that increase intra-abdominal pressure and impact on the pelvic floor musculature. However, studies to date have not taken into account the specific sports tasks that elite track and field athletes perform according to the competitive events for which they are training., Methods: This cross-sectional study describes the prevalence, type, and severity of UI among elite track and field athletes considering their event specialization and training characteristics. A total of 211 female and 128 male elite track and field athletes answered an online questionnaire including anthropometric measures, medical history, training characteristics, and UI symptoms. To determine self-reported UI, the International Consultation on Incontinence Questionnaire-UI Short-Form (ICIQ-UI-SF) was used. To determine UI type and severity, the incontinence questionnaire and incontinence severity index were used, respectively., Results: The ICIQ-UI-SF showed that 51.7% of female and 18.8% of male athletes had UI, with stress UI (SUI) being the most frequent type (64.4%) for female and urge UI for male athletes (52.9%). Of athletes who were not identified as having UI according to the questionnaires, 24.6% of female and 13.6% of male athletes experienced urine leakage during training, mainly during jumping. Although training characteristics (experience, volume, and resting) were not related to UI, female athletes specializing in vertical jumps showed significantly lower UI prevalence compared to those specializing in horizontal jumps (χ 2 [1] = 4.409, p = 0.040), middle-distance running (χ 2 [1] = 4.523, p = 0.033), and sprint/hurdles events (χ 2 [1] = 4.113, p = 0.043). These female athletes also displayed the lowest training volume. No differences were shown for males (p > 0.05)., Conclusions: Over half of the elite track and field female athletes have self-reported UI, especially SUI, and prevalence is higher when considering urine leakage events during training. Training characteristics and specialization were not related to UI identified by questionnaires, but female athletes specializing in vertical jump events showed the lowest prevalence and training volume. Males showed significantly lower prevalence, without correlation with their specialization. Sport professionals should increase UI detection among elite athletes and design-specific approaches that consider their physical demands to make visible, prevent, or improve pelvic floor dysfunction in this population., (© 2022. The Author(s).)

Static posturography assessed with force platforms is a procedure used to obtain objective estimates related to postural adjustments. However, controlling multiple intrinsic and extrinsic factors influencing the diagnostic accuracy is essential to obtain reliable measurements and recommend its use with clinical or research purposes. We aimed to analyze how different environmental acoustic conditions affect the test−retest reliability and to analyze the most appropriate number of trials to calculate a valid mean average score. A diagnostic accuracy study was conducted enrolling 27 healthy volunteers. All procedures were taken considering consistent device settings, posture, feet position, recording time, and illumination of the room. Three trials were recorded in a silent environment (35−40 dB) and three trials were recorded in a noisy environment (85−90 dB). Results showed comparable reliability estimates for both acoustic conditions (ICC = 0.453−0.962 and 0.621−0.952), but silent conditions demonstrated better sensitivity to changes (MDC = 13.6−76%). Mean average calculations from 2 and 3 trials showed no statistically significant differences (p > 0.05). Cross-sectional studies can be conducted under noisy or silent conditions as no significantly different scores were obtained (p > 0.05) and ICC were comparable (except oscillation area). However, longitudinal studies should consider silent conditions as they demonstrated better sensitivity to real changes not derived from measurement errors.

Introduction: Experienced high-level climbers are subject to a number of bone and soft tissue changes over the years and are also among the most exposed to pulley injuries. One of the main consequences of pulley rupture is the separation of the flexor tendons from the subjacent phalanges, also known as bowstringing. The purpose of this study was to determine whether this population has asymptomatic bowstringing of the A2 and/or A4 pulleys as determined by tendon-bone distance (TBD) values when compared to nonclimbers., Methods: High-resolution ultrasound TBD measurements in active forced flexion were made for the A2 and A4 pulley of the ring finger bilaterally. Participants were 21 asymptomatic sport climbers who had 21 consecutive years of climbing at a level above 9.66 in the International Mountaineering and Climbing Federation difficulty metric scale. Control subjects were 21 age-matched nonclimbers., Results: A significantly longer TBD-25% (0.3 mm) and 35% (0.4 mm) for the A2 and A4 pulleys, respectively-was found in the experienced climbers group (experienced climbers group: A2 1.6±0.5 mm and A4 1.6±0.4 mm; nonclimbers group: A2 1.2±0.1 mm and A4 1.2±0.2 mm)., Conclusions: Our results suggest that bowstringing of A2 and A4 pulleys occurs in asymptomatic experienced high-level climbers, which could be interpreted as either an adaptive mechanism to workloads endured over years of climbing or a consequence of underdiagnosed pulley ruptures., (Copyright © 2021 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.)

The current study was conducted to compare muscle damage biomarkers in single- vs. multi-match weeks in elite soccer players for two consecutive seasons. A secondary objective was to analyze the influence of playing position and exposure time on muscle damage in single- vs. multi-match weeks. This is a prospective cohort study performed in a professional elite soccer club in the English Premier League during the 2018-2019 and 2019-2020 seasons up until the lockdown due to the COVID-19 pandemic. Data were collected in the Medical Department Room of an English Premier League Club before and after the soccer game from a total of 29 elite soccer players (mean ± S.D.; age = 27.59 ± 3.83 years; height = 1.83 ± 0.05 m; body mass = 80.16 ± 7.45 kg) who were enrolled in the club during both seasons. The main outcome measurements were creatine kinase (CK), weight, lean mass, % fat DEXA, high speed running, total distance, density of total distance and high-speed running and wellbeing questionnaires. Significance was set at p < 0.05. Players who completed more than 60 min in the previous game had significantly increased pregame CK levels and fatigue in multi-match weeks. Midfielders had both significantly increased pregame CK and muscle soreness in multi-match weeks. Midfielders and players with an exposure time of at least 60 min showed higher pregame CK values that should play a key role for deciding substitutions.

Objectives: To determine the prevalence of urinary incontinence (UI) among elite athletes and to compare prevalences between sexes and across different sports modalities., Methods: This was a cross-sectional, observational study conducted in 754 elite athletes (455 women or girls and 299 men or boys). Participants completed a questionnaire to collect self-reported anthropometric measures, medical history and sport-related data, and the questionnaires International Consultation on Incontinence Questionnaire-UI Short-Form (ICQ-UI SF), Three Incontinence Questions (3IQ) and Incontinence Severity Index (ISI)., Results: According to replies to the ICQ-UI SF questionnaire, 33% of the athletes had UI at a mean age of 23.75±7.74 years. Prevalences were 45.1% in female compared to 14.7% male athletes (p<0.001) such that females were 5.45 times more likely to suffer this condition. In 59.9%, incontinence was stress UI. In 30.9%, UI was described as moderate to severe (according to ISI), and quality of life related to UI was scored 4.35±2.98 out of 10 (ICQ-UI SF). 22.7% reported they had experienced urine leakage while training; in 40.5% this occurred when jumping, in 19.6% while running and in 20.2% in different situations., Conclusions: The prevalence of UI observed in elite athletes was 33%. This prevalence was greater in females and also varied according to the sport practised., (Copyright © 2020 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

This study aimed to determine whether osteopathic manipulation of the T9-T10 vertebrae improves the evolution of tonsillitis. A randomized, stratified, controlled clinical trial with blinded patients, evaluator and data analyst was performed. The patients in the control group (CG) underwent a "sham" manipulation. A high-speed, low-amplitude technique was applied to the T9-T10 vertebrae in the osteopathic manipulative group (OMG) patients. The number of days needed to resolve the tonsillitis was significantly lower ( p = 0.025) in the OMG (2.03 ± 0.95 days) than the CG (2.39 ± 0.82 days). Additionally, the number of episodes of tonsillitis after the treatment decreased significantly more in the OMG (0.8 ± 1.88 episodes/year in total) than the CG (2 ± 2.12) ( p = 0.005). In the OMG, 60.8% had no recurrences of tonsillitis, compared to 22.5% of the CG, in the following year (χ 2 (1) = 15.57, p < 0.001). No patients reported adverse effects. It has been concluded that during an episode of tonsillitis, the number of days to resolution was significantly lower after the application of an osteopathic manipulation of the T9-T10 vertebrae, compared to a sham manipulation. The number of subsequent year tonsillitis episodes was greatly reduced in both groups, significantly more in the OMG than in the CG patients.

A2 or A4 annular finger pulley tears are common injuries in rock climbers. This study reviews the measurement procedures used and tendon-to-bone distance data obtained on high-resolution ultrasound images when diagnosing isolated rupture of the A2 or A4 pulleys. Out of 3447 records extracted, only 7 remained after applying the exclusion criteria. In diagnosing a complete rupture, tendon-to-bone distance used varied widely from 1.9 to 5.1 mm for A2 and from 1.8 to 3.1 mm for A4. Our findings point to a lack of consensus diagnostic criteria for pulley injuries and identify technical details needing further research., (Copyright © 2020 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.)

Introduction: Chronic prostatitis is one of the most common diagnoses in outpatient clinics in Urology. It is presented as a heterogeneous group of diseases, whose etiology is often unknown, showing as a common denominator a set of painful, irritative and obstructive symptoms of the genitourinary tract and perineum., Objectives: A systematic review and updated meta-analysis of this pathology was performed in relation to the damages or benefits that physical activity could have in chronic prostatitis or chronic pelvic pain., Methods: The Scopus, PubMed, ScienceDirect, PEDro, The Cochrane Library, Dialnet and SciELO databases were consulted until June 2018 (the last paper used in this meta-analysis was published in March 2018)., Results: The research team reviewed a total of 93 studies, of which 10 were selected, with a subsequent examination of their methodological quality using the PEDro scale. The comparison of the body mass index, the quality of life related to the body mass index and the correlation of the urinary incontinence were made. The overall analysis of the interventions within the urinary incontinence was significant (effect size: 0.11; 95% CI 0.038 to 0.43; P=.024)., Conclusions: The variability associated with experimental designs represents a heterogeneity in the effects of different programs or physical activity interventions for the treatment of chronic prostatitis. The effect sizes obtained suggest that the effectiveness of alternative treatment programs, using vehicular physical activity, may be related to the type of intervention performed., (Copyright © 2019 Asociación Española de Andrología, Medicina Sexual y Reproductiva. Publicado por Elsevier España, S.L.U. All rights reserved.)

The ability of finger flexors to generate force has been studied in relation to climbing performance. However, not much attention has been paid to the decrease in finger grip force in relation to annular pulley injuries. The purpose of the present study was to determine if an injured annular pulley implies a finger flexor force decrease, as well as its relation to clinical and sonographic changes. We performed an observational study in 39 rock climbers with A2 or A4 pulley injuries to the 3rd or 4th fingers. The variables considered were pain upon palpation, ultrasound tendon-bone distance, and finger grip strength decrease. Three rock climbing grip types were considered: the one finger crimp, open crimp, and close crimp. Injured rock climbers presented a decrease in finger grip strength compared to non-injured controls when performing a one finger crimp ( p < 0.001). There exists a significant correlation between a tendon-bone distance at the level of the injured pulley and a decreased finger grip strength measured by performing a one finger crimp ( p = 0.006). A decrease in finger grip strength could be considered in the diagnostic and follow-up process of A2 and A4 pulley injuries to the 3rd and 4th fingers.

Objective: to investigate the influence of the application of new methodologies on learning and the motivation of students of the Anatomy discipline., Method: randomized, longitudinal, prospective, intervention study. Sixty-two students were recruited to assess the impact of different methodologies. The sample was randomized to compare the results of teaching with a 3D atlas, ultrasound and the traditional method. The parameters were assessed through a satisfaction evaluation questionnaire and anatomical charts. Repeated measures ANOVA was used to determine statistical significance., Results: in terms of the usefulness of the seminars, 98.1% of the students considered them to be very positive or positive, stating that they had stimulated their interest in anatomy. The students who learned with the 3D atlas improved their understanding of anatomy (p=0.040). In general, the students improved their grades by around 20%., Conclusion: the traditional method combined with new technologies increases the interest of students in human anatomy and enables them to acquire skills and competencies during the learning process.

Osteopathic manual treatment has been recommended as a non-pharmacological therapy for Gastroesophageal Reflux Disease (GERD). However, to date, no study has supported the effectiveness of this intervention with respect to the symptoms of the disease. Our goal was to assess the effect of an osteopathic manual technique for the lower esophageal sphincter on GERD symptoms, cervical mobility and on the C4 spinous process pressure pain threshold (PPTs)., Methods: A randomized, double-blind placebo-controlled trial was performed. Sixty subjects suffering from GERD participated in this study and were randomly assigned to either an experimental group (EG) ( n = 29), who received the osteopathic technique for the lower esophageal sphincter, or to a control group (CG) ( n = 31), who received a manual contact, which mimicked the osteopathic technique without exerting any therapeutic force. Randomization was computer-generated, with allocation concealed by sequentially numbered, opaque, sealed envelopes. The GerdQ questionnaire was used to assess symptom changes the week after intervention. Cervical Range of Motion (CROM) and algometer were used to evaluate cervical mobility and PPTs before and after both treatments. Before-after between groups comparison ( t -test) was used for statistical analysis of the outcome, with two measurement points (GerdQ), while repeated-measures ANOVA was used for those outcomes with four measurement points (CROM and PPT)., Results: The application of the osteopathic manual treatment in subjects with GERD produced a significant improvement in symptoms one week after the intervention ( p = 0.005) with a between-groups difference of 1.49 points in GerdQ score (95% CI: 0.47-2.49). PPT C4 improved in the EG after the treatment ( p = 0.034; η 2 = 0.048) (between-groups difference 8.78 Newton/cm 2 ; 95% CI: 0.48-17.09). CROM also increased in the EG compared to the CG ( p < 0.001; η 2 = 0.108) (between-groups difference 33.89 degrees; 95% CI: 15.17-52.61)., Conclusions: The manual osteopathic technique produces an improvement in GERD symptoms one week after treatment, cervical mobility, and PPTs. This may mean that osteopathic treatment is useful for improving symptoms of GERD.

Objectives: This prospective long-term study examines the effects of a Pilates training intervention on spinal mobility, disease activity, and functional capacity in patients with ankylosing spondylitis (AS). Design: The study design was quasi experimental and single blind. Subjects: 11 subjects were recruited among patients undergoing followup of AS diagnosed according to modified New York criteria at the rheumatology clinic. Interventions: Over a 12-month period, 11 patients completed a training program consisting of two sessions per week of selected Pilates exercises. There was no control group. Outcome measures: The primary outcome variable was functional capacity measured using the Bath Ankylosing Spondylitis Functional Index (BASFI) questionnaire. Exploratory outcome measures were Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Metrology Index (BASMI), and chest expansion and fingertip-to-floor (FTF) test. Baseline and follow-up examinations were performed immediately before the intervention and during the course of treatment at 4, 8, and 12 months. Results: After the exercise intervention, improvements were observed in BASFI (77.51%), BASDAI (64.39%) and BASMI (58.95%) scores, FTF distance (71.92%), and chest expansion (88.74%). Conclusions: These findings suggest that Pilates training could be useful in AS patients and provide direction for larger controlled trials designed to determine the therapeutic benefits of Pilates in the management of these patients.