Impact of external soft tissue manipulation on bioelectrical activity of the pelvic floor muscles in continent and incontinent women with and without lumbopelvic assymetry.

Intervention: 1. An interview 2. Instruction of the measurement and testing procedures 3. Signing the constent for participant 4. Examination of pelvis orientation on sagittal, frontal and horizontal plane 5. Electromyographic examination of pelvic floor muscles strength (5 second maximal contractions with 5 second release), endurance (30 second maximal contractions) and rest (60 second release) by means of intravaginal electrode 6. The measurement of the pressure pain threshold with the use of an algometer on erector spinae muscles, diaphragm, sacrotuberus ligament 7. Soft tissue manipulation techniques: A. Technique one: Patient: supine lying with the knees flexed and feet resting flat on the table Therapist: stands behind patients head and do longitudinal strokes with the thumb over rectus abdominis muscle, from a cranial to caudal direction for 90 seconds. The degree of pressure should be sufficient to maintain pain at a level of between 5 and 7- where 10 is the maximum that can be tolerated and reported by the patient. B. Technique two: Patient: supine lying with the knees flexed and feet resting flat on the table Therapist: stands at the level of the abdomen contralateral to the side being treated. A combination of thumbs of both hands gently insinuate contact beneath the lower border of the rib cage, directed cephalad and laterally, until barrier is noted and applies compression for 90 seconds. The degree of pressure should be sufficient to maintain pain at a level of between 5 and 7- where 10 is the maximum that can be tolerated and reported by the patient. C. Technique three: Patient: first right, then left side lying with 45 degree flexion in hips and knees Therapist: sits from the patients back, localizes the ischiorectal fossa and applies compression for 90 seconds. The degree of pressure should be sufficient to maintain pain at a level of between 5 and 7- where 10 is the maximum that can be tolerated and reported by the patient. D. Technique four: Patient: prone lying Therapist: stands behind patients legs with both thumbs on the sacrotuberous ligament and applies compression for 90 seconds. The degree of pressure should be sufficient to maintain pain at a level of between 5 and 7- where 10 is the maximum that can be tolerated and reported by the patient. 8. After soft tissue manipulation techniques: a. Examination of pelvis orientation on sagittal, frontal and horizontal plane b. Electromyographic examination of pelvic floor muscles strength (5 second maximal contractions with 5 second release), endurance (30 second maximal contractions) and rest (60 second release) by means of intravaginal electrode c. The measurement of the pressure pain threshold with the use of an algometer on erector spinae muscles, diaphragm, sacrotuberus ligament All of the techniques described are performed at each session (30 minutes) by physical therapist with three year experience in physcial therapy of pelvic floor dysfunction. Each participant receives one sessions (four techniques).