Clinical Study Of Myofascial Manipulation Combined With Biofeedback In Treating Postpartum Myofascial Pelvic Pain

Objective: To evaluate the effectiveness of myofascial manipulation combined with biofeedback in treating postpartum pelvic myofascial pain.Methods: A total of 114 primiparous women who received a postpartum examination at 42-60 days after delivery at Chengdu Women’s and Children’s Center Hospital from November 2020 to October 2021 were randomly assigned to four groups: Myofascial manipulation group(n=29),Biofeedback group(n=28),Myofascial manipulation combined with Biofeedback group(n=28)and Control group(n=29).The control group received regular stretching and abdominal breathing exercises twice a week for a total of 10 sessions.Three treatment groups received an additional 10 treatment sessions,also twice a week,on top of the control group’s regimen.Basic information such as age,mode of delivery,newborn weight,body mass index(BMI)and postpartum duration were collected before treatment.The Numeric Rating Scale(NRS),Glazer Pelvic Floor Surface Electromyography(EMG)evaluation results and pelvic muscle strength measurements were used as outcome indicators before and after treatment.All patients signed informed consent forms.Results: 1.Among 114 patients enrolled in the study,eighteen dropped out;ultimately,a total of ninety-six completed this study including Control group(n=23),Manipulation group(n=24),Biofeedback group(n =24)and Combination group(n =25).After treatment,the NRS scores of palpation pelvic floor muscle pain in all four groups decreased compared to before treatment(P<0.05).Among them,the three treatment groups had significant differences compared with the control group in terms of NRS score reduction(P<0.05);both the combination and manipulation groups showed significantly lower NRS scores than those of the biofeedback and control groups(P<0.05),but there was no significant difference between the combination therapy and manipulation groups(P>0.05).2.Before treatment,the five indicators of Glazer surface electromyography assessment(average amplitude of pre-resting potential,average wave amplitude of post-resting potential,fast muscle contraction rise time,fast muscle contraction relaxation time,and slow muscle contraction relaxation time)measured from four groups of patients were all higher than normal reference values.After treatment,each treatment group showed significant improvement in all indicators compared to before treatment(P<0.05).Among the groups,the combination group had a significantly greater decrease in all indicators compared to the biofeedback and control groups(P<0.05).Compared with the manipulation group,except for the average amplitude of pre-resting potential,the other four indicators decreased more significantly(P<0.05);The manipulation group was superior to the biofeedback group in reducing the average amplitude of pre-resting potential(P<0.05),but there was no statistical difference between them for other items;Both manipulation and biofeedback groups had significant reductions in all four variables compared to control group except for fast muscle contraction relaxation time(P < 0.05).3.From the perspective of pelvic floor muscle strength,there was a significant increase in type I and type II muscle strength in all three treatment groups compared to before treatment(P<0.05).In the control group,there was a statistically significant improvement in type I muscle strength compared to before joining the study(P < 0.05),while there was no statistical difference observed in type II muscle strength(P > 0.05).Among the groups,both combination group and biofeedback group showed a significant increase in type I muscle strength compared to the other two groups(P < 0.05),with no statistical difference observed between them(P > 0.05).The manipulation group demonstrated a significant improvement in type I muscle strength when compared with the control group(P<0.05).Type II muscle strength increased significantly in the combination group when compared to the other three groups(P<0.05).The manipulation and biofeedback groups had higher increases in type II than the control group(P < 0.05),but no statistical difference was observed between the manipulation and biofeedback group on type II(P>0.05).Conclusions: Myofascial manipulation therapy,biofeedback and their combination can all improve postpartum pelvic floor myofascial pain and related muscle symptoms.However,the combination of manual therapy and biofeedback is significantly better than single-therapy in improving pain,reducing muscle tension and increasing muscle strength.