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Do international research studies reflect the power of Hypopressives?

I've been having a look at the international research to see if there are any obvious reasons for the (mostly) unremarkable results in the literature compared to the results I've been seeing through Create Lift.

Women I've been working with are getting on average a 79% improvement in their prolapse symptoms over a possible 15 symptom scores

The results are really exciting and bring so much hope to women who feel their only option after pelvic floor muscle training (PFMT) is surgery. However, these sort of results with Hypopressives aren't reflected in international research studies. Generally, PFMT perform as well as Hypopressives or better - so why would clinicians change the way they are doing things?

I've been looking at some of the most recent research, and as an experienced Hypopressives coach, I'm not surprised by their findings.

Through my experience of working with women with prolapse and incontinence, collecting and analysing data and monitoring their progress, often over extended periods of time, I have continued to adapt how I work and the following are now non-negotiable for how I work:

  1. Programme time - the programme needs to be long enough, usually a minimum of 12 weeks - consistent symptom improvements build over a period of time.

  2. 1:1 - regular 1:1 tuition is really important (virtually or in-person). With anytime support between sessions.

  3. Practise time - 15-20 mins 6 days a week is usually the most effective, but not always, so it needs to be tailored.

  4. Poses - I have found that foundational poses alongside symptom targeting advanced poses give better short and longer term outcomes for women. A small number of poses might work for a while, but variety is key to building and maintaining improvements.

If you look at the research studies, there are big variations in all of the above with:

  1. Shorter programme times - some studies are only 8 weeks long - which I don't believe is enough time for the majority of women to see the best results.

  2. Group coaching - did the women have enough support, and is the most effective way to teach? Studies indicate women had group rather than 1:1 coaching.

  3. Practise time variable - ranges vary for what appears to be very little practise time to a whopping 40 mins a day. Too much or too little practise can potentially adversely affect outcomes too.

  4. Poses - this is really interesting - women were instructed in either 2, 3, 5 or 7 poses in some of the most recent studies I've been looking at. These were only foundational poses - no advanced poses were taught - which scale up the difficulty and add in more glute work. Incorporating a wide variety of poses including advanced progressions appear to be highly beneficial for the majority of women I work with.

  5. Are they comparable? For example, in this study I recently discussed, the women in the Hypopressives exercise (HE) and the HE with PFMT group were doing different Hypopressives poses - within the same study. The HE group was doing 5 foundational poses and the HE with PFMT group only 3 foundational poses. The Hypopressives practise time was also different in both groups - shorter in with HE and PFMT group. This study was also only 8 weeks long.

Would the research have found better outcomes for women doing Hypopressives had the research studies been designed differently? This seems highly likely.

Women in the UK need more effective conservative treatment options for prolapse symptoms and incontinence now. After the devastating findings in the Cumberlege Report looking at vaginal mesh, one of the recommendations is for more innovative conservative treatments for women with pelvic floor symptoms such as prolapse and incontinence - instead of surgery.

We do need more research but this takes time - most women who hear about the benefits of Hypopressives want get going as soon as possible - this is how I felt too. Hopefully this blog post has thrown some light on why there are often such big differences between anecdotal evidence and collected data, and current research findings.

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