{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T22:27:14Z","timestamp":1790807234593,"version":"4.1.0"},"reference-count":43,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2022,3,1]],"date-time":"2022-03-01T00:00:00Z","timestamp":1646092800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/501100004901","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado de Minas Gerais","doi-asserted-by":"publisher","award":["APQ-01085-15"],"award-info":[{"award-number":["APQ-01085-15"]}],"id":[{"id":"10.13039\/501100004901","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002322","name":"Coordena\u00e7\u00e3o de Aperfei\u00e7oamento de Pessoal de N\u00edvel Superior","doi-asserted-by":"publisher","award":["001"],"award-info":[{"award-number":["001"]}],"id":[{"id":"10.13039\/501100002322","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>The purpose of this study was to compare (1) the effects of the instrument-assisted perineal stretching technique with different application protocols in combination with perineal massage and (2) the effects of the isolated techniques on the extensibility and strength of the pelvic floor muscles (PFMs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A randomized controlled clinical trial with parallel randomization, assessor blinding, and concealed allocation was conducted in the Campus Physical Education at the Federal University of Uberl\u00e2ndia in Brazil. Ninety-six pregnant women (18\u201340\u00a0years of age) were allocated into 4 groups: perineal massage (PnM) group (PnM protocol for 10\u00a0minutes); instrument-assisted perineal stretching with a long static protocol for 15\u00a0minutes [IStrLS group]); PnM\u2009+\u2009IStrLS group (both techniques applied in the 2 previous groups); and PnM\u2009+\u2009IStrSR group (the same techniques as used in the PnM\u2009+\u2009IStrLS group but with a short repeated protocol; 4 sets lasting 30\u00a0seconds each). Eight interventions were performed in all 4 groups twice weekly (beginning at the 34th gestational week). The primary outcome was PFM extensibility, assessed using vaginal dilator circumference, and the secondary outcome was PFM strength, assessed using vaginal manometry.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>For the PFM extensibility variable, a significant main effect of time (F2,88\u2009=\u200987.951) and group (F3,88\u2009=\u20097.193) was found. Tukey post hoc test results showed that the PnM\u2009+\u2009IStrSR group presented greater extensibility than the PnM and IStrLS groups. The PnM group showed increased PFM strength after 8 sessions compared with the other groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Women who were pregnant and received the combination of perineal massage and instrument-assisted perineal stretching with short repeated application had a greater increase in PFM extensibility than perineal massage and instrument-assisted perineal stretching alone.<\/jats:p><\/jats:sec><jats:sec><jats:title>Impact<\/jats:title><jats:p>The combination of perineal massage and instrument-assisted perineal stretching techniques with a short, repeated protocol led to better PFM extensibility results than the application of the techniques alone in women who were pregnant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Lay summary<\/jats:title><jats:p>Pregnant women can benefit from intervention using the combination of perineal massage and instrument-assisted perineal stretching techniques with a short, repeated protocol.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ptj\/pzab305","type":"journal-article","created":{"date-parts":[[2022,3,2]],"date-time":"2022-03-02T04:11:40Z","timestamp":1646194300000},"source":"Crossref","is-referenced-by-count":6,"title":["Are Perineal Massage and Instrument-Assisted Perineal Stretching With Short Protocol Effective for Increasing Pelvic Floor Muscle Extensibility? A Randomized Controlled Trial"],"prefix":"10.1093","volume":"102","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4297-4984","authenticated-orcid":false,"given":"Alana Leandro","family":"Cabral","sequence":"first","affiliation":[{"name":"Postgraduate Program in Health Sciences , , Uberl\u00e2ndia, MG, Brazil"},{"name":"Federal University of Uberl\u00e2ndia , , Uberl\u00e2ndia, MG, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00edssi Sisconeto","family":"de Freitas","sequence":"additional","affiliation":[{"name":"Physical Therapy Postgraduate Program , , Uberl\u00e2ndia, MG, Brazil"},{"name":"Federal University of Tri\u00e2ngulo Mineiro associated with Federal University of Uberl\u00e2ndia , , Uberl\u00e2ndia, MG, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rog\u00e9rio de Melo Costa","family":"Pinto","sequence":"additional","affiliation":[{"name":"Mathematics Department , , Uberl\u00e2ndia, MG, Brazil"},{"name":"Federal University of Uberl\u00e2ndia , , Uberl\u00e2ndia, MG, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Paula Magalh\u00e3es","family":"Resende","sequence":"additional","affiliation":[{"name":"Physical Therapy Department , , Uberl\u00e2ndia, MG, Brazil"},{"name":"Federal University of Uberl\u00e2ndia , , Uberl\u00e2ndia, MG, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa Santos","family":"Pereira-Baldon","sequence":"additional","affiliation":[{"name":"Physical Therapy Department , , Uberl\u00e2ndia, MG, Brazil"},{"name":"Federal University of Uberl\u00e2ndia , , Uberl\u00e2ndia, MG, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,3,8]]},"reference":[{"key":"2023011808144877500_ref1","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1016\/S1701-2163(16)30081-0","article-title":"Obstetrical anal sphincter injuries (OASIS): prevention, recognition, and repair","volume":"37","author":"Harvey","year":"2015","journal-title":"J Obstet Gynaecol Can"},{"key":"2023011808144877500_ref2","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1111\/j.1552-6909.2001.tb00010.x","article-title":"Urinary incontinence in pregnancy and the puerperium","volume":"30","author":"Spellacy","year":"2001","journal-title":"J Obstet Gynecol Neonatal Nurs"},{"key":"2023011808144877500_ref3","doi-asserted-by":"crossref","first-page":"198.e1","DOI":"10.1016\/j.ajog.2008.04.027","article-title":"Quantity and distribution of levator ani stretch during simulated vaginal childbirth","volume":"199","author":"Hoyte","year":"2008","journal-title":"Am J Obstet Gynecol"},{"key":"2023011808144877500_ref4","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1097\/01.AOG.0000178779.62181.01","article-title":"Levator trauma after vaginal delivery","volume":"106","author":"Dietz","year":"2005","journal-title":"Obstet Gynecol"},{"key":"2023011808144877500_ref5","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1590\/1516-3180.2014.8581009","article-title":"Determination of a cutoff value for pelvic floor distensibility using the epi-no balloon to predict perineal integrity in vaginal delivery: ROC curve analysis. 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