Friday, March 06, 2015 Use Your Words: Small Study Says Descriptions Make a Difference in Men's Pelvic Floor Training When it comes to training men to activate their pelvic floor muscles, it may be good to have a way with words. A new study from Australia conducted on a small group of men has found that the words used to describe activation of pelvic floor muscles (PFM) made a difference in the extent to which the striated urethral sphincter (SUS) muscle is activated with limited increase in intra-abdominal pressure (IAP)—the optimal combination to help men counter urinary incontinence, authors believe. Researchers recruited 15 healthy men under the age of 50 (6 of whom were physical therapists) to respond to verbal instructions aimed at activation of pelvic floor muscles. Activation was monitored through ultrasound imaging, and 3 of the 15 individuals participated in a follow-up experiment that used invasive fine-wire electromyography (EMG) to measure the effectiveness of sonography as a way of tracking activation. Results were published in Neurourology and Urodynamics (abstract only available for free). Authors write that they used 4 specific instructions: "tighten around the anus," "elevate the bladder," "stop the flow of urine," and "shorten the penis." Participants were instructed to follow the verbal cues to perform 3 repetitions, with each contraction sustained for 3 seconds and separated by an approximate 10-second rest. The verbal instructions were given in random order. The most effective instruction in terms of midurethra (MU) displacement? "Shorten the penis," followed by "stop the flow of urine." The instructions that resulted in the best anorectal junction displacement were "tighten around the anus," followed by "stop the flow of urine." A secondary finding: results from the 3 individuals who participated in EMG monitoring seemed to reveal that sonography captured displacement effectively enough to serve as a useful monitoring system—a result that researchers believe could help foster further noninvasive studies. Authors note that results of clinical trials on the effectiveness of pelvic floor muscle exercises for men with incontinence have been "mixed"—but that inconsistency may be linked to the instructions men were given. "It is plausible that the variability in results between seemingly similar clinical trials might be influenced by the strategies used to train muscular mechanisms for urinary continence," they write. "The optimal instructions to activate the pelvic floor muscles are likely those that induce the greatest amplitude of pelvic floor muscle shortening with minimal increase in abdominal muscle activity and IAP. From the current data, the best instruction to shorten the SUS is 'shorten the penis' or 'stop the flow of urine.'" Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.