Functional and Synergistic Relationship of Pelvic Floor and Some Hip Joint Muscles

Pelvic Floor Muscle (PFM) training is the primary therapeutic intervention of PFM dysfunctions. In addition, strengthening some other muscles such as; Gluteus Maximus, Obturator Internus, Adductor Magnus, and D2 extension PNF pattern is suggested as complementary therapeutic methods. This study aimed to investigate the synergistic relationship between these muscles and PFM function using Transabdominal Ultrasonography and bladder base displacement.

Twenty-one healthy multiparous women, aged 20-40 years, participated in this cross-sectional and analytical study. Transabdominal Ultrasonography was used to measure the bladder base displacement. The following five different interventions were randomly performed, 1) PFM contraction, 2) Gluteus Maximus contraction, 3) Obturator Internus, 4) Adductor Magnus contraction, and 5) D2 extension PNF pattern. All participants did contractions three times with a 30 second rest period between each contraction. The mean of three measurements in each position was compared with the PFM contraction. Kolmogorov-Smirnov fitness test and Repeated Measures ANOVA were used to analyze the data. A level of P≤0.05 was considered significant.

The main effect of all interventions was significant compared to the contraction of the PFM (P=0.0001 and F=392.9). The amount of the bladder wall base displacement during Obturator Internus contraction and PNF D2 Extensor Pattern was more significant than the PFM contraction and in the same direction. With the Gluteus Maximus muscle contraction, the bladder base displacement was more significant than the contraction of the PFM. Still, in the opposite direction, and with the contraction of the Adductor Magnus muscle, it was approximately equal to the contraction of the PFM (P≤0.0001).

This study showed that the contraction of Adductor Magnus, Obturator, pelvic floor muscles, and also the PNF D2 Extensor Pattern could increase the bladder base displacement, which could confirm the synergistic relationship between these muscles and the PFM. However, this relationship was not observed in Gluteus Maximus muscle contraction.