Dynamic Neuromuscular Stabilization Exercises in Women With Urinary Incontinence

NCT ID: NCT07009249

Last Updated: 2025-06-06

Basic Information

• Recruitment Status: RECRUITING
• Clinical Phase: NA
• Total Enrollment: 62 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2025-05-21
• Study Completion Date: 2026-02-01

Brief Summary

Stress urinary incontinence (SUI) is defined by the International Continence Society as the complaint of involuntary leakage of urine during physical exertion, including sports activities, or during sneezing or coughing. In continent women, an automatic response-namely, a reflex pelvic floor muscle (PFM) contraction, also known as pre-contraction-occurs either prior to or during physical exertion. Although there is strong evidence supporting the effectiveness of pelvic floor muscle training (PFMT) in the treatment of SUI, there has been a growing interest in exploring alternative exercise-based interventions.

Dynamic Neuromuscular Stabilization (DNS) is a manual and rehabilitative approach developed by Professor Pavel Kolar. It is grounded in the scientific principles of developmental kinesiology and aims to optimize the function of the movement system. Currently, DNS is successfully employed in the rehabilitation of various neurological, musculoskeletal, pediatric, and sports-related injuries. DNS incorporates the subconscious and synergistic activation of the deep core muscles responsible for intra-abdominal pressure (IAP) regulation and spinal stability-namely, the diaphragm, transversus abdominis, multifidus, and pelvic floor muscles-as well as the global musculature.

Considering the potential mechanisms of DNS, we hypothesize that DNS exercises, through IAP regulation directed toward the pelvic cavity and contributing to stabilization, could serve as an effective and innovative approach for women with SUI.

The hypotheses of this study are as follows:

H1.1: DNS is as effective as PFMT in reducing urinary symptoms in women with SUI.

H1.2: DNS is as effective as PFMT in improving PFM function in women with SUI.

Conditions

Stress Urinary Incontinence (SUI); Dynamic Neuromuscular Stabilization; Pelvic Floor Muscle Training; Urinary Symptoms; Biofeedback Training

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

Pelvic Floor Muscle Training Group (PFMT Group)

Women aged 18-62 who have stress or stress-dominant mixed urinary incontinence and can read and write in Turkish

Group Type: ACTIVE_COMPARATOR

Pelvic floor muscle training

Intervention Type: BEHAVIORAL

Women in this group will undergo pelvic floor muscle training (PFMT) using the NeuroTrac MyoPlus 4 PRO EMG biofeedback device. Prior to the training, diaphragmatic breathing will be taught to all participants in this position to facilitate relaxation and prepare for PFMT. During the training, participants will perform pelvic floor muscle contractions while observing the real-time feedback of slow and fast contractions, as well as relaxation phases, on the computer screen connected to the device. Concurrently, the physiotherapist will guide the participants with verbal cues such as "squeeze-lift-release." Participants will be instructed to avoid holding their breath, pulling in their abdomen, straining, contracting the thigh or gluteal muscles, or moving the pelvis during the exercises. The PFMT protocol will follow the principles of motor learning stages to ensure proper skill acquisition.

Dynamic Neuromuscular Stabilization Group (DNS Group)

Women aged 18-62 who have stress or stress-dominant mixed urinary incontinence and can read and write in Turkish

Group Type: EXPERIMENTAL

Dynamic neuromuscular stabilization

Intervention Type: BEHAVIORAL

Women in this group will be instructed in exercises based on the principles of Dynamic Neuromuscular Stabilization (DNS). Prior to the exercises, intra-abdominal pressure regulation through breathing techniques will be demonstrated. In this study, the Core 360 belt with OhmTrack sensors will be used. Both breathing exercises and DNS exercises will be taught with the belt in place. In a corrected posture, participants will be instructed to gently press the abdominal wall toward the sensors and to maintain expansion of the abdominal wall during both inspiration and expiration, while keeping the spine in a neutral position. The exercise program will begin with a preparatory training phase, which includes fascial mobilizations applied to the feet and hands. DNS exercises will start with the 4.5-month supine developmental position for sagittal stabilization. As the program progresses, exercises will be advanced according to developmental kinesiology positions.

Interventions

Pelvic floor muscle training

Women in this group will undergo pelvic floor muscle training (PFMT) using the NeuroTrac MyoPlus 4 PRO EMG biofeedback device. Prior to the training, diaphragmatic breathing will be taught to all participants in this position to facilitate relaxation and prepare for PFMT. During the training, participants will perform pelvic floor muscle contractions while observing the real-time feedback of slow and fast contractions, as well as relaxation phases, on the computer screen connected to the device. Concurrently, the physiotherapist will guide the participants with verbal cues such as "squeeze-lift-release." Participants will be instructed to avoid holding their breath, pulling in their abdomen, straining, contracting the thigh or gluteal muscles, or moving the pelvis during the exercises. The PFMT protocol will follow the principles of motor learning stages to ensure proper skill acquisition.

Intervention Type: BEHAVIORAL

Dynamic neuromuscular stabilization

Women in this group will be instructed in exercises based on the principles of Dynamic Neuromuscular Stabilization (DNS). Prior to the exercises, intra-abdominal pressure regulation through breathing techniques will be demonstrated. In this study, the Core 360 belt with OhmTrack sensors will be used. Both breathing exercises and DNS exercises will be taught with the belt in place. In a corrected posture, participants will be instructed to gently press the abdominal wall toward the sensors and to maintain expansion of the abdominal wall during both inspiration and expiration, while keeping the spine in a neutral position. The exercise program will begin with a preparatory training phase, which includes fascial mobilizations applied to the feet and hands. DNS exercises will start with the 4.5-month supine developmental position for sagittal stabilization. As the program progresses, exercises will be advanced according to developmental kinesiology positions.

Intervention Type: BEHAVIORAL

Eligibility Criteria

Inclusion Criteria

• Female gender,
• Voluntary participation in the study,
• Aged between 18 and 62 years,
• Ability to read and write in Turkish,
• No mental disorders that would impair cooperation or comprehension,
• Complaint of stress urinary incontinence (SUI) or stress-predominant mixed urinary incontinence.

Exclusion Criteria

• Prior history of pelvic floor muscle training,
• Presence of any neurological disorder,
• Pelvic organ prolapse stage II or higher,
• Presence of fecal incontinence,
• Pregnancy,
• Lower extremity conditions that may affect pelvic alignment (e.g., leg length discrepancy, total hip arthroplasty),
• Active lower urinary tract infection,
• Presence of respiratory disorders such as chronic obstructive pulmonary disease or asthma,
• History of hysterectomy.

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 62 Years
• Eligible Sex: FEMALE
• Accepts Healthy Volunteers: No

Sponsors

Izmir University of Economics

OTHER

Sponsor Role: lead

Responsible Party

Seda Yakit Yesilyurt

Asst. Prof.

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Seda Yakıt Yeşilyurt

Role: PRINCIPAL_INVESTIGATOR

Izmir University of Economics

Locations

Izmir University of Economics

Izmir, İzmir, Turkey (Türkiye)

Site Status: RECRUITING

Countries

Turkey (Türkiye)

Central Contacts

Seda Yakıt Yeşilyurt, Asst. Prof., PhD

Role: CONTACT

sedayakit01@gmail.com

+902324888439 ext. 8439

Facility Contacts

Seda Yakıt Yeşilyurt

Role: primary

sedayakit01@gmail.com

+902324888439

Other Identifiers

SYY_IEU_5

Identifier Type: -

Identifier Source: org_study_id