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Why we sometimes can’t see any effects even though we exercise following the physiotherapist’s advice?

We happen to get contacted by women reporting they see no satisfying effects despite having consulted their therapists and exercised on a regular basis according to the physiotherapist’s recommendations.

Quite often, even if women are able to activate their pelvic floor muscles and relax them correctly, they still have a problem controlling the contraction at low force level. This ability is crucial to improving muscle endurance. In order to develop it, we need to exercise at up to 20% of our maximum voluntary contraction force.

A study by Burti et al. has shown reduced endurance of pelvic floor muscles in incontinent women compared to continent women. This proves how important of an exercise endurance training is.

It turns out that despite undergoing a transvaginal examination in the examination room and obtaining detailed instructions from the specialists, patients are unable to maintain a contraction at 20% MVC at home and usually exercise all the time by activating their pelvic floor muscles with maximum force. Only when they see the activity of their muscles displayed on the screen do they learn how to perform the home exercise given to them by their physiotherapist correctly.

Let’s test the endurance of pelvic floor muscles

One of the stages of the PelviFly muscle test taken by all patients starting exercising with the device and the app is muscle endurance assessment. It involves performing three 20-second contractions:

1) with an MVC effort without a set goal on the screen
2) at 20% of MVC (collecting flowers passing at the bottom of the screen)
3) with an MVC effort (collecting flowers passing at the top of the screen)

In the case of patients reporting having exercised according to recommendations but noticing a halt in their progress, we usually see that they have managed to reach a good level of contraction control and force. But they have a big problem with muscle endurance.

The chart below illustrates a very frequent situation we come across. During the first contraction (when there’s no set goal on the screen), we see muscle fatigue – the contraction force drops. When the patient performing the contraction sees her goal on the screen and collects flowers (during the third contraction), we can see that the trend in the chart is irregular. This means that she has a problem maintaining the contraction at the set level and that the muscle strength decreases over time. And in such a situation, patients often try to compensate for this ‘deficiency’ using other muscles.

Muscle test chart – step 4 (endurance assessment);
Green chart – patient’s result;
Blue chart – expected course of contraction

Gentle exercise

Women who exercised with biofeedback before ask after the first biofeedback-based training if this type of exercise is actually effective because it’s gentle and not exhausting. Our answer is always the same – YES. To increase muscle endurance, we exercise at low contraction force.

Even the specialists who deal with pelvic floor physiotherapy on an everyday basis and have very good body awareness are surprised that activating pelvic floor muscles at 20% of their capacity can be a challenge. Malgorzata Skolimowska, a physiotherapist who makes use of the PelviFly system in her treatment room, sent us the following message when she started the training herself:

“I don’t think I can imagine designing training plans for my patients without the device today. Since I have little control and problems with relaxation, how does someone who hears about pelvic floor muscles for the first time get to use this group of muscles at 20%, which is something I often recommend, and relax the right way at the same time?” – Malgorzata Skolimowska, physiotherapist

How to learn how to perform a gentle contraction?

At present, our endurance training is offered in the form of a game featuring a rocket in space. By activating and relaxing their muscles, patients control the rocket and fly through a tunnel, which indicates precisely 10%, 15% or 20% of their capacity, depending on the exercise stage. Our system knows how much exactly is 20% of a patient’s capacity – thanks to the muscle test which assesses the MVC force. Based on the determined MVC force value, the algorithms set the training load accordingly.

Endurance training – as viewed in the PelviFly app

From the point of view of an exerciser, it might seem that this exercise is just fun. But if we take a look at it from the perspective of a specialist who monitors the course of training, the case is quite different. The dedicated telecare platform gives us access to detailed records of the course of each training session. We can analyze both the charts and the parameters describing the exercise.

Endurance training – results available on the PelviFly telecare platform

The key to regularity

To achieve the desired effects, it’s not enough to learn how to activate and relax muscles correctly. If we don’t exercise regularly, we won’t see these effects. That’s why it’s important to bear in mind that we need to make the exercise plan diverse. This way we can make patients more engaged and motivate them to make exercising a regular thing. And this is why we create another endurance training together with you! We’ll update you on the details really soon.