Um par de anos atrás, a Spinal Research recebeu um aplicativo de financiamento interessante que estávamos ansiosos para obter. Na época, o debate estava em torno do uso de ajustes quiropráticos durante a gravidez e a infância. A Dra. Heidi Haavik e seus co-investigadores, Dr. Jenny Kruger e a professora Bernadette Murphy, estavam ansiosos para investigar se o ajuste das subluxações vertebrais alteraria a função dos músculos do assoalho pélvico.
The results are in and the research report has been approved for publication, but as these things take time we thought youd like the scoop. This is big news for women and chiropractors alike!
- O estudo demonstrou que o ajuste das gestantes parece relaxar os músculos do assoalho pélvico em repouso. Como não houve alterações vistas quando ajustaram o grupo de comparação não grávida, esse achado nas gestantes parece ser um efeito único da gestação.
- Esse relaxamento dos músculos do assoalho pélvico, visto após sua adaptação, pode significar que a quiropraxia pode ser benéfica para as gestantes, pois pode ajudá-las a ter um parto vaginal natural.
- A secondary interesting finding of this study was that the non-pregnant chiropractic students in the comparison study were able to contract their pelvic floor muscles to a degree previously seen only in elite athletes. We dont yet know exactly why, but a possible explanation for this is that they were chiropractic students who were regularly getting checked and adjusted and this may have been why they had such amazing control over their pelvic floor muscles. Its also possible this would have a preventative effect against future pelvic floor dysfunction such as stress urinary incontinence! But the researchers say this needs to be followed up with future studies
Por que o estudo do assoalho pélvico é importante
Os músculos do assoalho pélvico (o complexo muscular Levator Ani) são conhecidos por terem papéis ativos na gravidez e no parto, bem como na estabilização da coluna vertebral. Quando os músculos do assoalho pélvico estão danificados ou estressados com o tempo, podem surgir problemas de saúde como incontinência e prolapsos vaginais. Sabemos que estes são problemas com enormes custos emocionais, físicos, sociais e financeiros em todo o mundo e uma causa significativa de estresse para essas mulheres.
For a woman in labour, the ability to relax pelvic floor muscles (as well as contract them) to allow the baby to move through the birth canal is incredibly important, especially as the baby crowns. If the woman cant relax these muscles as the baby moves through, she will tire more quickly and may require more interventions to assist the birthing process. Muscles that cannot relax could also interfere with a birth progressing without interference. In an ideal situation, strong pelvic floor muscles with an ability to relax would better prepare a mother for a natural, vaginal birth.
The primary findings of this study are incredibly encouraging, especially given the fact that quantitatively assessing the effect of spinal adjustment on pelvic floor muscle function has not previously been done! The study came about when Dr. Jenny Kruger, a midwife who completed her PhD on imaging the pelvic floor, approached Haavik. The two worked with Dr. Bernadette Murphy, who had supervised both of their PhDs. Kruger and Haavik decided to combine their interest areas to study the PFMs after spinal adjustments.
The study saw participants undergo ultrasounds, and perform three different manoeuvres squeezing as hard as they could, bearing down (that pushing which opens up the Hiatus hole in the pelvic floor) and at rest. They studied the women in the control group and the active group, and looked at them pre and post adjustment.
We were expecting to see changes on the squeezes and the pushes and all of that, but we saw nothing. But what was really interesting is that the actual (hiatus) hole itself got larger at rest. What it suggests is that those muscles that form the Pelvic Floor rim that holds all our internal organs and that move to give birth to the baby, must have relaxed, said Heidi Haavik in a recent interview with Spinal Research.
That alone is extremely exciting Opening up those muscles is so important to be able to give birth.
Uma segunda descoberta interessante do estudo
Dadas as mudanças hormonais e fisiológicas envolvidas na gravidez, os pesquisadores adicionaram um grupo de comparação à mistura. Este grupo era formado por estudantes de quiropraxia não grávidas, e é também onde este estudo ficou muito interessante.
Again there werent any major pre and post adjustment changes, but our students were capable of contracting their Pelvic Floor muscles to a degree that has only previously been seen in top, elite athletes. I was quite blown away. Jenny was quite blown away because this is very, very unusual, said Haavik.
This secondary finding is an incidental but interesting one. It raises enough questions to demand a study of its own as we dont yet know what it means. It could be that because they are chiropractic students who are being adjusted regularly, their sensory-motor control is greater. But far more work needs to be done before we accurately interpret the results.
O que este estudo poderia significar?
Again, its early days in terms of understanding the full impact of this studys findings. We do know that adjusting women in pregnancy gives them a greater ability to relax the pelvic floor. We also know that something very unusual occurs in chiropractic students who are being adjusted regularly.
- Para as mulheres grávidas, isso tem o potencial de lhes dar um maior grau de controle sobre os músculos do assoalho pélvico, o que, por sua vez, pode facilitar o parto vaginal. Neste ponto, podemos apenas especular sobre quais poderiam ser os impactos em termos de redução da necessidade de intervenções médicas ou aumento do bem-estar da mãe e da criança. Mas nos mostra que a quiropraxia pode ser benéfica para mulheres grávidas.
- Para mulheres não grávidas que são checadas e ajustadas regularmente, podemos estar olhando para um conjunto completamente diferente de benefícios. É possível que isso melhore a condição dos músculos do assoalho pélvico, permita um maior controle sensório-motor e diminua potencialmente o risco de incontinência urinária de esforço, incontinência fecal e prolapso vaginal. Esta é uma possibilidade extremamente excitante!
Haavik concedes that these are big ifs. Once again, more research is required but the flow on effects could be far reaching.
Why Im even bothering with this line of research is because 1) we could potentially increase the rate of healthy, uncomplicated vaginal births and deliveries. As soon as you add interventions, their problems just skyrocket. Increasing the chances for women to have a natural, vaginal delivery is where Im headed with this work. 2) Also preventing pelvic floor muscle problems for women, preventing stress urinary incontinence for example. Theres actually very little research on female pelvic floor problems. Its surprising! If we can have uncomplicated, natural vaginal delivery without drugs and intervention, the baby is better off and the woman is better off. Im quite convinced that chiropractic care can actually help with this, but this needs to be systematically explored with properly conducted scientific studies.
Whats Next For This Area Of Study?
Weve started a second study, which again A Spinal Research financiou, and we have reached the point where we are getting preliminary results, says Haavik. Again, Dr. Jenny Kruger approached Dr. Haavik with a topic to collaborate on. This time it focused on stress urinary incontinence (SUI).
At present, whether or not a woman will get SUI post-childbirth is a bit of a lottery. Some get it, some dont.
O que é suposto acontecer é que quando contraimos esses músculos, os lados esquerdo e direito devem se contrair ao mesmo tempo. Supõe-se que os músculos superficiais se contraiam primeiro, e então os músculos mais profundos seguem apenas 21 milissegundos depois. Mas em mulheres com SUI, esse momento está fora de sintonia.
It could be that when we are subluxated, that the timing of the muscle contractions become stuffed up, says Haavik. The researchers have been screening women with timing issues and adjusting them. Weve screened hundreds of women and adjusted a lot of them too. We are looking at several measures all in one go.
We will save the results of this study for another blog post, but its another study chiropractors and their female patients are going to want to know about!
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Being a Chiropractor is not just a job to many doctors, but a lifelong mission. It starts as a passion to help others and then transcends into a lifestyle and mission to serve the world. The thought of retirement to many DCs is nothing more than just decreasing the amount of people they can physically care for each day.
Caso em questão, o Dr. Jean Koffel.
A história do Dr. Koffel foi originalmente publicada em seu jornal local, Sheboygan Press. Aqui está:
Chiropractic care has been Koffels vocation since relocating to Sheboygan in 1945 with a Chiropractic degree from Palmer College em Davenport, Iowa, a primeira escola do gênero.
Ela se tornou o primeiro quiroprático do sexo feminino no município.
Nascido em Racine, Koffel foi criado em West Bend entre parentes dedicados à filosofia quiroprática, incluindo seu falecido pai, Alfred E Koffel, que atuou na profissão por mais de 60 anos.
Her first office was located above the Kresge store on Eighth Street during a time when Pranges sold eggs and businesses such as The Bismarck, Keitels Candy Store and Ford Hopkins Drug Store were the happening spots.
Koffel testemunhou muitas mudanças e transformações e, por meio de tudo isso, se manteve fiel a um estilo de vida equilibrado, incluindo boa nutrição, exercícios moderados (ela anda regularmente), sono tranquilo e cuidados quiropráticos de rotina.
Shes been practicing out of the business end of her home since 1967, after her marriage to Mike Brendzej, who passed away in 1990.
Koffel doesnt operate on scheduled appointments, but instead offers hands-on manual adjustments during her select business hours. She sticks to hands-on manipulation without using any gadgets or heat and light modalities.
Ao longo dos anos, Koffel manteve-se ocupado com atividades como golfe e boliche, mas hoje, depende de seus passeios regulares.
Even getting hit by a car last November, while walking with her friend, didnt stop Koffel, who was back practicing the next business day. Her friend just recently completed healing from two broken wrists.
If it were me, I would be out of business, she said, feeling thankful.
Koffel has patients who have grown up with her and now treats their children and their childrens children, down to the fourth generation. Her oldest patient was 100.
Shes a very, very wise lady. What she lacks in size, she has in strength and common sense, said Lori. She provides mental and physical relief.
Quiropraxia não é um trabalho. É uma missão de vida! Obrigado Dr. Koffel e todos os nossos antepassados e irmãs por seu trabalho ao longo da vida na profissão de Quiropraxia. Sem você, milhões de pessoas em todo o mundo nunca teriam sido capazes de experimentar o poder do ajuste da Quiropraxia de cima para baixo, de dentro para fora!