Ultrasound Assessment of the Abdominal Wall Muscles in Women with and without Primary Dysmenorrhea: A Cross-Sectional Study

Endurance and electromyographic assessment of abdominopelvic motor control in women with primary dysmenorrhea: a cross-sectional study

Primary dysmenorrhea (PD), a prevalent menstrual condition characterized by pelvic pain during the menstrual cycle, significantly impacts the quality of life of women and produces increased pain sensitivity that can persist throughout the menstrual cycle. However, scientific literature has not studied whether there are implications for alterations in muscle function and endurance in the abdominopelvic region during the non-painful phases of the menstrual cycle. The aim of this study was to compare muscle function and endurance capacity in the abdominopelvic region in women with PD versus women without this condition. An observational, cross-sectional study was designed to analyze muscle activation and endurance capacity using electromyography (EMG) during McGill exercises. Forty-four women were included, 22 with PD and 22 without dysmenorrhea. The results did not indicate significant differences in muscle activation and endurance of the abdominopelvic musculature between the two groups (p > 0.05). However, the analysis suggests that women with primary dysmenorrhea might develop compensatory strategies that allow them to maintain physical function despite their condition. These results suggest that the approach to PD could focus more on pain management rather than physical functionality, and more studies are needed from a comprehensive approach to more accurately evaluate the relationship between PD and muscle function.

Associations between soft drinks intake and primary dysmenorrhea among Chinese undergraduate female students

Primary dysmenorrhea (PD) is a common global health concern. However, limited studies explored the association between soft drinks intake and PD among female undergraduates in China. To determine the association between soft drinks (carbonated soft drinks, etc.) as well coffee intake and the incidence/severity of PD among female undergraduates in China. We performed a cross-sectional study among 1809 female undergraduates in China from September 29, 2020 to October 22, 2020. The demographic information and menstrual information of the participants were collected by a self-administrated questionnaire. Chi-square test, ANOVA test, and logistic regression test were used to investigate the association between soft drinks intake and the incidence/severity of PD. We also conducted stratification analysis among different locations (rural or urban). The prevalence of PD was 47.1% (n = 852). There were 221 (25.9%) participants suffered from severe pain. In the participants with PD, the OR of carbonated soft drinks intake was 1.244 (95% CI 1.010-1.533). Among the participants with PD from rural areas, the OR of carbonated soft drinks intake was 1.402 (95% CI 1.045-1.881), compared with the non-carbonated soft drink group. In the participants with moderate and severe PD, the OR of coffee intake was 0.451 (95% CI 0.228-0.892), compared with the non-coffee-drinking group. There was a significant association between carbonated soft drinks intake frequency and the severity of PD (P < 0.05). Our study showed that carbonated soft drinks intake is a risk factor for PD, especially in participants from rural areas. Coffee intake is a protective factor for the severity of PD. Periodical awareness programs about adverse effects of excessive soft drink consumption should be introduced to reduce the prevalence and exacerbation of PD. Coffee intake might be helpful to relieve the severity of PD.

Evaluation of Abdominal Musculature Thickness, Pelvic Tilt, and Trunk Mobility in Women with Primary Dysmenorrhea: A Cross-Sectional Observational Study

Background: This cross-sectional observational study aimed to investigate differences in abdominal musculature thickness, pelvic tilt, and trunk mobility between women with primary dysmenorrhea (PD) and a control group (CG). Methods: Participants included 44 women (22 with PD and 22 controls) aged over 18, nulliparous, and of reproductive age. Ultrasound imaging was used to measure the thickness of the transverse abdominis (TrA), internal oblique (IO), external oblique (EO), and rectus abdominis (RA) muscles at rest and during contraction. Additionally, anterior pelvic tilt was assessed using the Palpation Meter (PALM), and trunk flexion and extension were measured using an accelerometer (activForce2). Results: Significant differences (p < 0.05) were found in RA and EO muscle thickness, with lower values in the PD group compared to CG. However, there were no significant differences (p > 0.05) in TrA and IO muscle thickness, anterior pelvic tilt, or trunk mobility between groups. Conclusions: These findings contribute to understanding the musculoskeletal factors potentially involved in dysmenorrhea. Further research is needed to explore associations between PD and structural and alignment parameters.

The Relationship between Abdominal Diastasis and Lumbar Pain Pressure Threshold in Women Who Have Given Birth between the Ages of 30 and 45 Years-An Observational Pilot Study

Background and Objectives: Current evidence confirms that the magnitude of the inter-rectus distance (IRD) is associated with the severity of abdominal pain. Furthermore, evidence exists in the literature about the impact abdominal muscles have on low back pain, lumbopelvic pain, breathing and lumbar abdominal strength; however, no studies analysing the level of association between abdominal diastasis and lumbar pain pressure threshold (PPT) exist. The aim of this study was to analyse the level of association between the rectus abdominis distance and pain pressure threshold in the lumbar spinous processes in women who have given birth between the ages of 30 and 45 years. Secondly, it was to study the level of association between the time elapsed since the last delivery and low back pain in women who have given birth between 30 and 45 years of age. Material and Methods: This was a pilot observational study in which 21 females participated. The abdominal diastasis was measured by ultrasound, the pain pressure threshold was assessed by an algometer and the pain perception by the Mc Gill questionnaire. Results: There was no significant relationship between increased abdominal distance and increased lumbopelvic pain in women who gave birth between the ages of 30 and 45 years. However, there was a correlation between the time that had elapsed since the last delivery and low back pain. Conclusions: there was a correlation between the time that had elapsed since the last delivery and low back pain. Further studies analysing factors that may perpetuate the chronicity of symptoms, such as lifestyle and intrinsic factors, are needed.

Technical aspects of inter-recti distance measurement with ultrasonographic imaging for physiotherapy purposes: the scoping review

BACKGROUND

Inter-recti distance (IRD) measurement using musculoskeletal USI has been used in physiotherapy research, in particular, to investigate pregnancy-related diastasis recti abdominis (DRA) and to seek its effective treatment methods. Severe and untreated diastasis may result in the formation of umbilical or epigastric hernias.

OBJECTIVE

This study aimed to systematically map physiotherapy-related research articles that included descriptions of IRD measurement procedures using USI to present their similarities and differences, and formulate recommendations on the procedure.

DESIGN

A scoping review was conducted according to PRISMA-ScR guidelines, including 49 of 511 publications from three major databases. Publications were selected and screened by two independent reviewers whose decisions were consulted with a third reviewer. The main synthesized data items were: the examinees' body position, breathing phase, measurement sites, and DRA screening methods. The final conclusions and recommendations were the result of a consensus between seven reviewers from four research centers.

RESULTS

Studies used 1-5 measurement sites that were differently determined. IRD was measured at the umbilicus (n = 3), at its superior (n = 16) and/or inferior border (n = 9), and at different levels: between 2 and 12 cm above the umbilicus, or a third of the distance and halfway between the umbilicus and xiphoid (n = 37); between 2 and 4.5 cm below the umbilicus or halfway between the umbilicus and pubis (n = 27). Different approaches were used to screen subjects for DRA.

CONCLUSIONS

The discrepancies between the measurement procedures prevent between-study comparisons. The DRA screening method should be standardized. IRD measurement protocol standardization has been proposed.

CRITICAL RELEVANCE STATEMENT

This scoping review indicates that the inter-recti distance measurement procedures using ultrasound imaging differ between studies, preventing between-study comparisons. Based on the results synthesis, the measurement protocol standardization has been proposed.

KEY POINTS

The inter-recti distance measurement procedures using USI differ between studies. Proposed standardization concerns body position, breathing phase, measurements number per location. Determination of measurement locations considering individual linea alba length is suggested. Recommended locations: umbilical top, ½ of umbilical top-xiphoid, ¼ of umbilical top-xiphoid/pubis distances. Diastasis recti abdominis diagnostic criteria are needed for proposed measurement locations.

The Effect of Yoga on Pain and Quality of Life in Primary Dysmenorrhea: A Cross Sectional Survey

Dysmenorrhea is a painful syndrome that accompanies the menstrual cycles. Objectives: The main objective of this research was to determine the effects of yoga exercises on pain and quality of life in female undergraduate students suffering from primary dysmenorrhea. Methods: After taking approval from Ethical review committee of Rawal Institute of Health Sciences, an observation type of cross-section survey was conducted in 470 young undergraduate female students of age between 17-26, suffering from primary dysmenorrhea. By non-probability sampling participants were divided into two groups. Group-1 was of those females who had active lifestyle and doing yoga exercises and group-2 were of those who had sedentary lifestyle and didn’t do any kind of exercise. To measure the outcome variables, EQ-5D-5L questionnaire was used to measure QoL & NPRS to measure pain. Data were taken at baseline and after 12th week. Wilcoxon rank test was used for within group analysis and Mann Whitney U test was used to compare mean between groups. Data was analyzed in SPSS software version 21 along with Microsoft Excel 2019. Results: 21.16+2.66 &22.27+2.53 was the Mean+SD of age of group-1 & group-2 respectively. Between groups analysis revealed that p-value for NPRS was <0.05 but was >0.05 in quality of life. Conclusion: Yoga exercises are safer and easiest way to manage pain of primary dysmenorrhea in undergraduate females without any drug use.

Myofascial Trigger Points and Central Sensitization Signs, but No Anxiety, Are Shown in Women with Dysmenorrhea: A Case-Control Study

Background primary dysmenorrhea (PD) is considered to be a cyclic chronic pelvic pain, with its onset in menstrual periods, often accompanied by the presence of myofascial trigger points (MTP). Most MTPs in subjects with chronic pelvic pain are in the inferior part of the abdomen, in the rectus abdominis (RA) area. Central sensitization is closely related to chronic pain processes. Previous studies in women with chronic pelvic pain reported central sensitization signs in their subjects, such as lower pain pressure threshold (PPT). Several authors agree that PPT in the tibialis anterior (TA) muscle, seems to be a reliable reference for signs of central sensitization. Amongst the factors that seem to accompany central sensitization, the presence of anxiety needs to be considered. The aim of the present study was to analyze the existence of hyperalgesic MTPs in RA, central sensitization signs and anxiety in women with PD, in comparison with a control group (CG). Methods: This study was designed following an observational, cross-sectional, case-control model. A total sample of 80 subjects was recruited trough social webs and advertising (PD n = 39) (CG n = 41). PPT in RA and AT was assessed bilaterally through algometry, and anxiety was evaluated through the State−Trait Anxiety Inventory. Results: Statistically significant differences (p < 0.001) were shown for NRS average and maximum increase, as well as lower bilaterally RA and TA PPT in favor of PD group compared to CG. State or trait STAI did not show any statistically significant differences (p > 0.05) between groups. Conclusions: In this study, women with PD reported symptoms of myofascial pain syndrome and central sensitization, when compared with healthy controls, without any sign of anxiety acting as a confounder for pain sensitivity.

Ultrasonography Comparison of Pelvic Floor and Abdominal Wall Muscles in Women with and without Dyspareunia: A Cross-Sectional Study

Pelvic floor hypertonicity and narrowing of the levator ani hiatus is traditionally assumed in women with dyspareunia and considered a therapeutical target by physical therapists. However, accurate pre-treatment assessment of pelvic floor muscles is difficult to perform in clinical sites. In addition, the abdominal musculature has not been evaluated in this population, despite its relationship with pelvic floor disfunctions. The purpose of this study was to determine the existence of differences in the length of the anteroposterior diameter of the levator ani hiatus (APDH), the thickness of the abdominal wall musculature and the interrecti distance (IRD) in subjects with dyspareunia compared to a control group. A cross-sectional observational study was designed using ultrasound imaging to measure the APH, the thickness of the abdominal musculature—rectus abdominis (RA), transverse abdominis (TrAb), internal oblique (IO), external oblique (EO)—and IRD at rest and during contraction. Thirty-two women were recruited through advertising and social webs and divided into two groups: dyspareunia (n = 16) and no dyspareunia (n = 16). There were no statistically significant differences (p < 0.05) in RA, TrAb, OI and OE muscle thickness. No differences in APH or in supraumbilical and infraumbilical IRD were found. The findings of this study suggest that the relationship between the abdominal structure/levator ani hypertonia and dyspareunia remains uncertain.

Lumbopelvic muscle endurance, morphology, alignment, and mobility in women with primary dysmenorrhea: A case-control study

BACKGROUND

In the literature, it is thought that spine or pelvic malalignment and changes in the abdominal muscle structure may affect the uterine position and cause menstrual pain. However, the overall lumbopelvic structure related to lumbopelvic muscle endurance, thickness, alignment, and mobility in women with primary dysmenorrhea has not been well investigated. This study aimed to compare women with primary dysmenorrhea and asymptomatic controls in terms of lumbopelvic structure.

METHODS

Women with primary dysmenorrhea (primary dysmenorrhea group, n: 38, age: 21 years (18-28), body mass index (BMI): 20.70 (17.31-28.73) kg/m²) and without primary dysmenorrhea (asymptomatic group, n: 39, age: 20 years (19-23), BMI: 20.83 (17.31-27.10) kg/m²) were included. The severity of menstrual pain, lumbopelvic muscle endurance, morphology, alignment, and mobility were assessed with the Visual Analogue Scale, McGill trunk muscle endurance tests, ultrasonographic imaging, and a Valedo® Shape device, respectively.

FINDINGS

The median value of the menstrual pain in the primary dysmenorrhea group was 6.5 cm (min-max: 4.0-10.0). Lumbopelvic muscle endurance (p < 0.001), muscle thickness (p < 0.001), frontal lumbar angle (p: 0.05), sagittal pelvic mobility (p < 0.001), and frontal lumbar mobility (p: 0.002) were lower in the primary dysmenorrhea group compared to the asymptomatic group.

INTERPRETATION

Muscle endurance, thickness, alignment, and mobility of the lumbopelvic structure in women with primary dysmenorrhea compared to asymptomatic women have been affected negatively. These findings should be considered in management of primary dysmenorrhea.

Current advances and research in ultrasound imaging to the assessment and management of musculoskeletal disorders

Currently evidence-based practice has given scientific weight to the physical therapist profession; it is essential that all medical professional and physical therapists know the usefulness of new tools that optimize the effectiveness of their interventions and allow the growing of the scientific knowledge base. The use of ultrasound imaging (USI) by physiotherapists has evolved in recent years, consolidating as an increasingly standardized technique, low cost compared to other imaging techniques, quickly of execution, feasible and reliable tool. USI offers a wide range of opportunities in clinical practice as well as in different research areas. Therefore, ultrasound has been currently used as a diagnostic tool by physicians and in recent years there has been an expansion of the use of ultrasound equipment by non-physicians professionals such as physical therapist or physical trainers, who incorporates USI as a means of assessing musculoskeletal system architecture and composition, musculoskeletal changes in dysfunction, pain or injury conditions, as an interventional technique assisting echo-guided procedures or using the visual real-time information as a biofeedback in control motor approaches, as guiding tool in clinical decisions as well as to improve the understanding of tissue adaptations to exercise or movement. The purpose of this article is to review and provide an overview about the currently research of the USI applications and their benefits for the diagnosis and management in individuals with musculoskeletal conditions.