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Introduction and Hypothesis: Pelvic floor muscle ultrasound is an important clinical tool for improving motor coordination and even strength. Although the gold standard approach involves transperineal probe placement, this is not always feasible with sensitive populations, requires privacy owing to probe placement, and additional sonography training. This article introduces a novel transabdominal method for measuring pelvic floor muscle motion that incorporates a reference point within the bladder. The hypothesis is that the novel measurement will correlate positively with transperineal measurements. Methods: A total of 55 women (15 nulliparous, 40 parous; 20 continent, 35 incontinent) performed pelvic floor muscle contraction and strain. Transabdominal ultrasound measured bladder diagonal length (BDL) and transperineal ultrasound measured bladder neck height (BNH), levator plate length (LPL), and levator plate angle (LPA). Spearman's test measured the correlation between the measurement outcomes and an independent t test compared outcomes based on parity and stress urinary incontinence symptom status. Results: Spearman's correlation showed moderate positive correlations between the pelvic floor measurements for both tasks, which reduced slightly when grouping by parity and symptom status. Group differences were significant for BDL during the muscle contraction, factoring in SUI symptoms (p = 0.019) and parity status (p = 0.005) and LPL during contraction, factoring in parity status (p = 0.033). Conclusions: BDL correlates with BNH, LPL, and LPA with slightly reduced correlation when factoring in parity and continence status. The advantages of the method include accessibility for sensitive populations, nontraditional positions due to the anatomical reference point, functional locations due to limited privacy needs, and minimal training required for pelvic floor therapists to incorporate into rehabilitation. [ABSTRACT FROM AUTHOR]

The pelvic floor responds to changes in trunk pressure, elevating during low‐pressure exhale and descending during high‐pressure exhale. Voicing occurs during exhalation, spanning low‐to‐high trunk‐pressure, yet it is unknown how voicing affects the pelvic floor. The aim of this study was to quantify pelvic floor response to voicing and identify if there are differences for women with stress urinary incontinence. We hypothesized that shouting would cause pelvic floor descent, with greater magnitude for incontinent women. Sixty women (38 incontinent, 22 continent) performed four voicing tasks (counting to "4" in speaking/shouting/low‐pitch/high‐pitch voice) while transperineal ultrasound measured changes in pelvic floor morphology. ANOVA compared variance of responses to voicing and t‐tests compared groups. Bladder neck height shortened, levator plate length increased and levator plate angle decreased more during shouting compared to speaking; consistent with pelvic floor straining. There were no differences for high versus low pitch‐voicing and small group differences based on continence status. Voicing causes pelvic floor muscles to strain, with greater strain during shouting. Changing vocal pitch does not affect pelvic floor morphology and incontinent women had slight differences from continent women. Voicing may be a safe way to lengthen the pelvic floor without provoking incontinence. [ABSTRACT FROM AUTHOR]

Introduction: Pelvic floor physical therapists have long utilized breathing cues with exercises and are beginning to incorporate vocalization tasks. To date, there have been no publications describing pelvic floor displacement during vocalization tasks. This study is a preliminary investigation into the changes in bladder shape distortion as a proxy for pelvic floor muscle displacement during respiratory and phonatory tasks. Methods: Bladders were imaged using two-dimensional ultrasound in standing position. Measurement consisted of a diagonal line from the most anterior–superior aspect of the bladder to the most inferior–posterior aspect of the bladder. Length was measured at baseline and maximum distortion for each task. The first two tasks cued pelvic floor muscles to contract and then strain. Subsequent tasks only cued glottis function. A linear regression tested correlation between bladder distortion response to glottis tasks and cued pelvic floor tasks. The hypothesis was that diagonal would shorten with contraction, lengthen with strain, and follow a similar pattern seen in respiration for phonation tasks. Results: Ten asymptomatic participants (5 men, 5 women) showed bladder diagonal shortening when cuing pelvic floor contraction for all participants and lengthening for 7 of the 10 participants when cued to strain the pelvic floor. The response of bladder length change was variable for glottis tasks, trending toward lengthening and significantly different in response to contraction. Conclusions: When cuing pelvic floor to contract, healthy individuals showed shortening of bladder length and most lengthened during strain. When cuing phonation and respiration tasks, there was a tendency toward bladder lengthening. [ABSTRACT FROM AUTHOR]

Background: It is unknown how and when the proximal attachment of the patellar tendon matures; puberty may be key in ensuring normal tendon formation. The aim of this study was to investigate the features of the proximal patellar tendon attachment at different stages of skeletal maturity, to help gain an understanding of how and when the tendon attachment matures. Methods: Sixty adolescent elite ballet students (ages 11-18) and eight mature adults participated. Peak height velocity (PHV) estimated skeletal maturity. Ultrasound tissue characterisation (UTC) scan was taken of the left knee and analysed for stability of echopattern. An image-based grading scale for greyscale ultrasound was developed to describe the tendon appearance. Anterior-posterior thickness was measured at the inferior pole of the patella, 1 and 2 centimetres distally. Outcomes were compared with skeletal maturity. Results: Mid-portion patellar tendon thickness increased with skeletal maturity (p=0.001 at 1cm and p=0.007 at 2 cm). There was more variance in structural appearance (greyscale classification and UTC echopattern) in pre and peri-PHV participants. Tendon attachment one-year post PHV appeared similar to mature tendons. Conclusions: Early adolescence was associated with highly variable tendon appearance, whereas the tendon appeared mature after PHV. Adolescence may be a critical time for the formation of normal tendon attachment. Level of evidence: IIb individual cohort study. [ABSTRACT FROM AUTHOR]