EMG biofeedback as an add-on to pelvic floor muscle exercises

Pelvic floor physiotherapy is consistently being shown to have positive effects as a first line defense on urinary incontinence, including stress incontinence and mixed urinary incontinence. Pelvic floor muscle training is used to stabilize and support pelvic organs. It is also used to help increase contraction and holding strength, coordination, velocity, and endurance of the pelvic floor muscles in order to maintain adequate urethral closure. Clinicians are now starting to use electromyography biofeedback to assess the musculature activity of the pelvic floor, in addition to teaching patients to contract/relax the muscle in an appropriate, functional way while monitoring progress of the intervention.

A recent randomized controlled trial study compared the efficacy of pelvic floor muscle exercises with and without EMG biofeedback for postmenopausal woman with urinary incontinence. The study had the following inclusion criteria

• 50-65 years of age
• reports loss of urine on exertion (detected by an Incontinence questionnaire)

The three groups of the study were the following:

• Group one performed only pelvic floor muscle exercises
• Group two performed pelvic floor muscle exercise with biofeedback
• Group three was a control group

After initial assessment, groups 1 and 2 began an 8 session protocol (20 min sessions 2x a week) of pelvic floor muscle training and were reassessed 4 weeks later. The control group received no treatment during this time period. Patients performed pelvic floor contractions in supine, seated and standing positions.

Upon re-assessment, groups 1 and 2 both saw an improvement in their pelvic floor strength, a reduction in their incontinence and an improvement in their quality of life. However, the group that used EMG biofeedback saw a significantly superior improvement of muscle strength, pre-contraction while coughing, maximum voluntary contraction and duration of endurance contraction when compared to the group who did pelvic floor exercises alone. The researchers believe that the difference seen with the use of the EMG biofeedback was a result of exposing the central nervous system to a new demand. By doing so, we are inducing neuroplasticity or functional neural regenerations in the area of dysfunction. This study helps to prove that pelvic floor physiotherapy alone is an invaluable tool to help with incontinence, and the use of an EMG biofeedback could potentially be the key to tying everything together and bringing the patient to the next level of rehabilitation.

--Briana