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鄭詠庭 女性跑者的骨盆底承受負荷是否與跑後骨盆底形態或功能的改變有關? 2025/12/31 下午 03:39:43 0
原 文 題  目 Is pelvic floor loading in female runners associated with post-run changes in pelvic floor morphometry or function?
作  者 Marie-Eve Berube, Stefan Niederauer, Ryan Graham, Robert Hitchcock, Linda McLean
出  處 BJU Int. 2025 Oct;136(4):707-718. doi: 10.1111/bju.16842. Epub 2025 Jun 30.
出版日期 2025 Jun 30.
評 論 本研究發現,女性跑者在完成跑步後,提肛肌裂孔暫時變大、膀胱頸位置下降,顯示跑步會造成短暫的骨盆器官支撐改變。然而,骨盆底肌主動與被動肌力並未顯著改變,且這些變化在有無跑步誘發壓力性尿失禁(RI-SUI)的跑者之間並無差異。在負荷相關分析中,較高的骨盆加速度與跑步後骨盆底肌被動僵硬度下降有關,但與骨盆形態變化無關,也未影響骨盆底肌的出力能力。此外,在有 RI-SUI 的跑者中,跑步時骨盆加速度較慢者反而出現較多尿液滲漏。整體而言,跑步時骨盆底所承受的負荷程度,與跑步後短暫的骨盆支撐變化或尿液滲漏量並無明顯關聯。此研究顯示,跑步後觀察到的短暫骨盆支撐改變,未必是由跑步時承受較大機械負荷所導致,也未直接解釋跑步誘發尿失禁的發生機制。結果挑戰了「高衝擊跑步會因過度負荷導致尿失禁」的單一假設,暗示 神經肌肉控制、協調性或時間性肌肉反應 可能比單純負荷大小更為重要。這項發現對女性跑者的臨床建議具有重要意義,顯示不必僅因跑步的機械負荷而全面限制運動,而應更重視個別化的骨盆底功能評估與訓練策略。
abstract

Objectives
To investigate whether, among female runners, transient changes in pelvic floor morphometry, pelvic floor muscle (PFM) function, or pad weight gain observed after a standardised running protocol are associated with the exposure of the pelvic floor to loading during the run.

Methods
Adult female runners with (n = 19) and without (n = 19) running-induced stress urinary incontinence (RI-SUI) completed a 37-min treadmill-based running protocol with a pressure sensor placed in the posterior fornix of the vagina and a triaxial accelerometer adhered to the pelvis, and an incontinence pad adhered to their undergarment. Pelvic morphometry and PFM function were assessed before and after the run using transperineal ultrasonography and intra-vaginal dynamometry. Urine leakage volume was estimated based on incontinence pad weight gain. Separate linear regression models were used to evaluate the associations between variables representative of pelvic floor load exposure (posterior fornix sensor pressure [PFSP] and pelvic accelerations) and changes in pelvic morphometry, PFM function, and incontinence pad weight observed after the run.

Results
After the run, the levator hiatus was larger and the bladder neck sat lower in the pelvis, but there were no significant differences in PFM active or passive forces measured using dynamometry. These changes were not different between those with and those without RI-SUI. Higher pelvic accelerations were associated with greater reductions in passive PFM stiffness after the run (R2 = 20%–27%), but not with changes in pelvic morphometry. No associations were found between any measures of pelvic floor load exposure and changes in PFM force-generating capacity. Among runners with RI-SUI, greater pad weight gain occurred among those who ran with slower vector accelerations (R2 = 0.27).

Conclusion
The magnitude of pelvic floor loading experienced during running does not appear to influence the transient loss in static pelvic organ support observed after running nor urine leakage volume.

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