Analyzing hypopressive exercises

​A recent British study analyzed the evidence behind abdominal hypopressive technique for the treatment of urinary incontinence (UI) and pelvic organ prolapse (POP).1 This technique has been gaining notoriety across fitness and physical therapy industries in Europe, Canada, South America, and more recently in the U.S. However, the study found no sound evidence supporting its use.
Abdominal Hypopressive Technique (AHT) utilizes the diaphragm by having the patient breathe deeply on inspiration and contracting the abdominal muscles after fully breathing out and holding the breath before relaxing. The theory posed by its founders is that the exercise involuntarily contracts the pelvic floor muscles through reduced intra-abdominal pressure, thereby reducing symptoms of UI and POP.
Though AHT has been utilized in clinical practices for 20 years, the authors of the study note that no published evidence exists to support it. On the other hand, APTA SoWH Vice President Carrie Pagliano, PT, DPT is quoted in PT in Motion as saying, “There is some anecdotal, case-by-case support for this technique, and clinicians who use it in practice do identify hypopressives as a small component of treatment.”2
This sparks an interesting question as to how we lean on evidence versus anecdotal clinical reports. How do we analyze our knowledge of anatomy, physiology, and neuromotor control, and use that knowledge to determine which exercises are best for our patients? Evidence-informed and evidence-based clinical decision-making models are two hot topics now. Additionally, we as practitioners tend to use what we feel comfortable instructing, don’t we?