While updating the handouts for my next seminar I came across this interesting article. “Effectiveness of multidimensional exercises for the treatment of stress urinary incontinence in elderly community-dwelling Japanese women: a randomized, controlled, crossover trial.,” by Kim H, Suzuki T, Yoshida Y, Yoshida H.
While I continue to emphasize exercising specific components of the pelvic floor, I have long been aware of the importance of “multidimensional” or one might say, “global” approaches, as I demonstrate in my DVD, Pelvic Power, which has improved leakage in those who did not get results from isolated muscle work.
CONCLUSION: Decrease in BMI and increase in walking speed may contribute to the treatment of UI, although the data do not support a positive correlation between strengthening of adductor muscle and improvement of UI, which needs more research.
Since many PTs suggest squeezing the thighs together, with or without some resistive device, this is an important finding. Personally, I have always avoided adductor work (I think these muscles are over-developed in most women from years of keeping our legs crossed!). In my opinion, squatting is the key, and this requires abduction and external rotation of the hips. The pelvic floor interacts syngergistically with obturator internus. For me, I make sure I do plenty of squats, starting with feet flat and rising ONLY to a 90 degree angle at the knee. This is the range what demands the most muscle work.
I believe the majority of the older generation in Japan can still squat, although they are use commodes today. This study researched women aged 70 or older. The younger generation grew up with fancy toilets…the Japanese standard models come with a heated toilet seat, bidet spray and blow dryer. When I lectured at the World Confederation of Physical Therapy in Yokohoma, most of the audience was Japanese men. Few were able to squat as their grandparents could, when I asked them to all get out of their chairs and squat with their feet flat!
Unfortunately the authors did not use squatting as an exercise.
You can read the study at PMID: 17944890 [PubMed - indexed for MEDLINE]
