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1. STABILIZE: The Essential
     Exercise For Your Back
2. Science of Back Exercises
3. Spinal Segmental            
     Stabilization
4. Ultrasound Imaging Of
     Deep Stabilizing Muscles
5. Integration of Inner &
     Outer Units
6. Roman Chair Back
    Exercises For Strengthening
7. Functional Exercises For
     Your Back
8. Back Stiffness: Exercises
    And Stretching
9. Inversion Tables For
     Vertebral Distraction


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multifidus forward shift back exercise   
 REHABILITATIVE ULTRASOUND IMAGING
by Howard A. Knudsen, PT
Doctor of Physical Therapy

 BENEFITS OF REAL-TIME ULTRASOUND IMAGING
 IN REHABILITATION

 Identify Motor Control "Milestones" that Suggest it is Time
 to Progress to the Next Stage of Rehabilitation.

Repeat ultrasound imaging scans of the same patient on different occasions serves not only to confirm the process of retraining motor control, but also to guide our clinical decision making. 

Hodges lists the following as steps of progression in this specific segmental stabilization exercise program.

1. Independent activation of transversus
    abdominis and multifidus.
2. Independent co-activation of
    transversus abdominis and multifidus.
3. Improve precision.
4. Co-ordination of breathing.
5. Function: Static tasks.
6. Function: Light dynamic tasks.
7. Local and global co-activation.
8. Specific functional retraining.
Reference: 2003 seminar notes by Paul Hodges.

Once we have verified by ultrasound imaging that a patient has performed an "ideal response" of independent activation, we transition to working on co-activation and so on.  At each step of progression we can verify correct activation with sonography.

We can also use ultrasound imaging to grade function.  In fact, for a reliable and repeatable grading system you must utilize ultrasound imaging.  Study results indicate that this grading system is reliable and repeatable when real time ultrasound imaging is used in the clinical setting by physical therapists with specific training.  The grading system is as follows:

Grading of lumbar spine stabilizing muscle function utilizing real-time ultrasound imaging (Kermode, 2001)
0 -- No active contraction
1 -- Able to maintain an isolated tonic hold for 10 s
2 -- Able to maintain an isolated tonic hold for 10 s 10 times
3 -- Able to maintain a tonic hold with movement
4 -- Automatic tonic contraction occurring with movement


 

 

Click the links below to explore MORE about the benefits of real-time ultrasound imaging in rehabilitation...
 
Transform a clinical impression into a verifiable diagnosis.
 
Provide objective, direct measurements of muscle size and excursion. 
 
Provide patient education on muscle impairments. 
 
Provide visual biofeedback during specific exercise training.
  Identify optimal facilitation/feedback techniques.
  Identify motor control milestones that suggest it is time to progress to the next stage.

 

 

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Spinal Segmental Stabilization

Ultrasound Imaging
of the Deep Stabilizing Muscles

Integration of Inner &
Outer Units

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Last update:
 Saturday April 21, 2007

Contents at a Glance
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