Patient Education

What we are asking the patient to do in our specific segmental stabilization exercise intervention is quite difficult.  I believe that if we provide substantial evidence of a patient's problem in a way that the patient can understand, then his or her motivation will dramatically improve. 

If you display the problem via real-time ultrasound imaging and thoroughly explain the solution, you may turn some less motivated patients into highly motivated patients.  Patients must "buy in" to the program, because the "home work" is obviously up to them and compliance is a critical feature of the rehabilitation program.

To be successful in retraining motor control of deep muscles, thousands of repetitions are necessary.  The clinical recommendation is a daily home exercise program with 2-3 sessions per day.  Then, they must also perform a 10 second co-contraction every hour.  There is no question in my mind that a motivated patient will succeed with this program.  And, when you let them know that they will be tested using ultrasound imaging on a future date, compliance with prescribed exercises may further improve. 

Providing background information on the impairment of the inner unit and the excessive activation of the outer unit will help orient the patient to the video data shown by ultrasonography.  It may be more beneficial to describe the inner unit as a group and the outer unit as group instead of just describing the impairment of the transversus abdominis and multifidus.  Only after this is establish and comprehended, will I move on to individual muscles.  The depth of explanation obviously depends on the background and education of the patient. 

Once the patient is oriented to the video data shown by ultrasound imaging, the physical therapist can demonstrate a correct pattern of muscle activation by personal display. 

Ultrasound imaging of the same patient on different occasions serves not only to explain clinical findings and to confirm improvement in motor control of the deep stabilizing muscles, but it also provides visual confirmation to our patients regarding the progress of their condition.  Real-time ultrasound imaging can also be used as a biofeedback tool.