Journal of Manipulative and Physiological Therapeutics
Volume 33, Issue 2 , Pages 109-116, February 2010

Effects of High-Velocity, Low-Amplitude Spinal Manipulation on Strength and the Basal Tonus of Female Pelvic Floor Muscles

  • Berta Simon Nogueira de Almeida, PhD, DO

      Affiliations

    • Physiotherapist, Department of Gynecology, UNICAMP (The State University of Campinas), Campinas, SP, Brazil
    • Corresponding Author InformationSubmit requests for reprints to: Berta Simon Nogueira de Almeida, PhD, DO, Physiotherapist, Department of Gynecology, UNICAMP (The State University of Campinas), Rua José Ferreira de Camargo, 333 13092-400-Campinas, SP Brazil
    • ,
  • José Hugo Sabatino, MD

      Affiliations

    • Gynecologist, Department of Gynecology, UNICAMP (The State University of Campinas), 1Campinas-SP, Brazil
    • ,
  • Paulo César Giraldo, MD

      Affiliations

    • Gynecologist, Department of Gynecology, UNICAMP (The State University of Campinas), Campinas-SP, Brazil

Received 21 February 2009; received in revised form 11 August 2009; accepted 25 September 2009.

Abstract 

Objective

Spinal manipulation with high-velocity and low-amplitude (HVLA) manipulation is frequently used for the treatment of lumbopelvic pain; however, the effect on the pelvic floor has been poorly studied in the past. The objective of this study was to quantify the intravaginal pressure (IVP) and the basal perineal tonus (BPT), measured in terms of pressure, before and after the HVLA manipulation in patients without neuromuscular and skeletal dysfunctions.

Methods

In this experimental, noncontrolled, nonrandomized study, IVP was obtained through a perineometer introduced into the volunteers' vagina while in dorsal horizontal decubitus. Forty young, healthy university volunteer women with no history of vaginal delivery participated. All voluntary contractions of the perineal muscles were measured in 3 different ways: phasic perineal contraction (PPC), tonic perineal contraction, and perineal contraction associated to accessory muscles. New pressure measurements were obtained immediately after the HVLA manipulation on the volunteers' sacrum. The pressures were registered and transcribed directly to a personal computer with specific software.

Results

The average IVPs obtained in millimeters of mercury before and after the HVLA manipulation were 56.01 (±25.54) and 64.65 (±25.63) for PPC, 445.90 (±186.84) and 483.14 (±175.29) for tonic perineal contraction, and 65.62 (±26.56) and 69.37 (±25.26) for perineal contraction associated to accessory muscles, respectively. There was significant statistical variation only for PPC (P = .0020) values. The BPT increased regardless of the type of contraction (P < .05).

Conclusion

High-velocity and low-amplitude manipulation of the sacrum was associated with an increase of PPC and of BPT in women who had no associated osteoarticular diseases. These preliminary discoveries could be helpful in the future study of the treatment of women with perineal hypotony.

Key Indexing Terms: Pelvic Floor, Perineum, Manipulation, Spinal, Muscle Tonus, Muscular Contraction

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PII: S0161-4754(09)00319-4

doi:10.1016/j.jmpt.2009.12.007

Journal of Manipulative and Physiological Therapeutics
Volume 33, Issue 2 , Pages 109-116, February 2010

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