Beitrag der Beckenbodenmuskulatur zur Stabilität des Beckenrings[1]

Zusammenfassung

Die biomechanische Studie untersuchte an einbalsamierten Präparaten den Zusammenhang zwischen einer simulierten Spannung in den Beckenbodenmuskeln, der Festigkeit des Beckenrings und dem Hervorrufen von Bewegung in den SIG. Bei Frauen haben die Beckenbodenmuskeln die Fähigkeit, die Festigkeit des Beckenrings zu steigern und ihn so zu stabilisieren. Außerdem können die Muskeln sowohl bei Männern als auch bei Frauen eine Rückwärtsrotation des Sakrums bewirken und auf diese Weise bei der Fortbewegung und Haltung eine Rolle spielen. Die Stabilisierung des Beckens durch stärkere Spannung der Beckenbodenmuskulatur ist bei beeinträchtigter Stabilität des Beckens wichtig, insbesondere bei Patienten mit Beckenschmerzen. Durch gesteigerte Aktivität kompensieren die Muskeln mangelnde Beckenstabilität, indem sie den Beckenring festigen und die geeignete Weitergabe von Belastung innerhalb des lumbopelvinen Bereichs wiederherstellen.

Abstract

The biomechanical study investigated the relationship between simulated contraction of the pelvic floor muscles, the stiffness of the pelvic ring and movement in the sacroiliac joint in embalmed preparations. In women the pelvic floor muscles are able to increase stiffness and to stabilise the pelvic ring. In addition, the muscles can cause a backwards rotation of the sacrum in men as well as in women and in this way play a role in movement and posture. Pelvic stabilisation through increased pelvic floor muscle contraction is important in limited pelvic stability, most of all in patients with pelvic pain. Increased activity of the muscles compensate for decreased pelvic stability by stiffening the pelvic ring and by restoring the adequate transmission of strain within the lumbo-pelvic area.

Schlüsselwörter

Beckenbodenmuskulatur - SIG - Biomechanik - Stabilität

Key words

Pelvic floor muscles - sacroiliac joint - biomechanics - stability

1 Engl. Original erschienen in: Clinical Biomechanics. 2004; 19: 564 - 571.

Literatur

• 1 Abel-Aziz Y I, Karara H M. Direct linear transformation from comparator coordinates into object space coordinates. Proc. ASP/UI Symposium on Close-Range Photogrammetry, Urbana, Illinois. Falls Church; American Society of Photogrammetry 1971: 1-18
• 2 Avery A F, O’Sullivan P B, McCallum M J. Evidence of pelvic floor muscle dysfunction in subjects with chronic sacro-iliac joint pain syndrome.  Proceedings of the 7th Scientific Conference of the IFOMT in Perth. 2000;  35-38
• 3 Bernstein I T. The pelvic floor muscles: Muscle thickness in healthy and urinary-incontinent women measured by perineal ultrasonography with reference to the effect of pelvic floor training. Estrogen receptor studies.  Neurour & Urodyn. 1997;  16 237-275
• 4 Bowen V, Cassidy J D. Macroscopic and microscopic anatomy of the sacro-iliac joints from embryonic life until the eight decade.  Spine. 1981;  6 620-628
• 5 Cholewicky J, Juluru K, McGill S M. Intra-abdominal pressure mechanism for stabilizing the lumbar spine.  J Biomech. 1999;  32 13-17
• 6 Cholewicky J, Juluru K, Radebold A. et al . Lumbar spine stability can be augmented with an abdominal belt and/or increased intra-abdominal pressure.  Eur Spine J. 1999;  8 388-395
• 7 Delancey J O. The anatomy of the pelvic floor.  Curr Opin Obstet Gynecol. 1994;  6 313-316
• 8 Fairbank J C, O’Brien J P, Davis P R. Intra-abdominal pressure rise during weightlifting as an objective measure of low back pain.  Spine. 1980;  5 179-184
• 9 Hemborg B, Moritz U, Lowing H. Intra-abdominal pressure and trunk muscle activity during lifting. The causal factors of the intra-abdominal pressure rise.  Scand J Rehabil Med. 1985;  17 25-38
• 10 Hides J A, Stokes N J, Saide M. et al . Evidence of lumbar multifidus wasting ipsilateral to symptoms in patients with acute/subacute low back pain.  Spine. 1994;  19 165-177
• 11 Hodges P W, Butler J E, McKenzie D K. et al . Contraction of the human diaphragm during rapid postural adjustments.  J Physiol (Br). 1997;  505 539-548
• 12 International Association for the Study of Pain. Classification of chronic pain syndromes and definition of pain terms.  Pain. 1986;  Suppl. 3 S1-S25
• 13 Kim N H, Suks K S. Clinical and radiological differences between traumatic and idiopathic coccygodynia.  Yonsei Med J. 1999;  40 215-220
• 14 Maigne J Y, Tamalet B. Standardized radiologic protocol for the study of common coccygodynia and characteristics of the lesions observed in sitting position. Clinical elements differentiating luxation, hypermobility and normal mobility.  Spine. 1996;  21 2588-2593
• 15 Mens J MA, Stam H J, Vleeming A. et al . Understanding peripartum pelvic pain; implications of a patient survey.  Spine. 1995;  21 207-220
• 16 Mens J MA, Vleeming A, Snijders C J. et al . The active straight leg raising test and mobility of the pelvic joints.  Eur Spine. 1999;  8 468-473
• 17 Morris J M, Lucas D M, Bresler B. Role of trunk in stability of the spine.  J Bone Joint Surg (Am) . 43 327-351
• 18 Njoo K H. Nonspecific low back pain in general practice: a delicate point [Thesis]. Rotterdam; Erasmus University 1996
• 19 O’Sullivan P, Beales D, Beetham J. et al . Altered motor control strategies in subjects with sacroiliac joint pain during the active straight leg raise test.  Spine. 2002;  27 E1-E8
• 20 Pool-Goudzwaard A L, Vleeming A, Stoeckart R. et al . Insufficient lumbopelvic stability - a clinical, anatomical and biomechanical approach to a specific low back pain.  Manual Therapy. 1998;  3 12-20
• 21 Pool-Goudzwaard A L, Stoeckart R, Snijders C J. The need for assessment of the pelvic floor in patients with low back and pelvic pain.  Proceedings of the 7th Scientific Conference of the IFOMT in Perth. 2000;  144
• 22 Pool-Goudzwaard A L, Kleinrensink G J, Entius C. et al . The sacroiliac part of the iliolumbar ligament.  J Anat. 2001;  199 457-463
• 23 Pool-Goudzwaard A L, van Hoek D ijke G, Mulder P. et al . The iliolumbar ligament: its influence on stability of the sacroiliac joint.  Clin Biomech. 2003;  18 99-105
• 24 Richardson C, Jull G, Hodges P. et al .Therapeutic exercise for spinal segmental stabilization in low back pain. New York; Churchill Livingstone 1999
• 25 Richardson C A, Snijders C J, Hides J A. et al . The relationship between the transversus abdominis muscles, sacroiliac joint mechanics and low back pain.  Spine. 2002;  27 399-405
• 26 Sapsford R R, Hodges P W. Contraction of the pelvic floor muscles during abdominal maneuvers.  Arch Phys Med Rehab. 2001;  82 1081-1088
• 27 Snijders C J, Vleeming A, Stoeckart R. Transfer of lumbosacral load to iliac bones and legs. Part 1: Biomechanics of selfbracing of the sacroiliac joints and its significance for treatment and exercise.  Clin Biomech. 1993;  8 285-294
• 28 Snijders C J, Vleeming A, Stoeckart R. Transfer of lumbosacral load to iliac bones and legs. Part 2: Loading of the sacroiliac joint when lifting in stooped posture.  Clin Biomech. 1993;  8 295-301
• 29 Vleeming A. The Sacroiliac Joint. A clinical-anatomical, biomechanical and radiological study [Thesis]. Rotterdam; Erasmus University 1990
• 30 Vleeming A, Pool-Goudzwaard A L, Stoeckart R. et al . The function of the long dorsal ligament: its implication for understanding low back pain.  Spine. 1996;  21 562-565
• 31 Vleeming A, de Vries H J, Mens J MA. et al . Possible role of the long sacroiliac ligament in women with peripartum pelvic pain.  Acta Obstet Gynecol Scand. 2002;  81 430-436
• 32 Williams P L, Bannister L H, Berry M M. et al .Gray’s anatomy. The anatomical basis of medicine and surgery. 38th ed. Edinburgh; Churchill Livingstone 1995

1 Engl. Original erschienen in: Clinical Biomechanics. 2004; 19: 564 - 571.