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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   
 Back Stiffness: Exercise and Stretching
by Howard A. Knudsen, PT
Doctor of Physical Therapy


 BENEFITS OF REAL-TIME ULTRASOUND IMAGING IN REHABILITATION

 Identify the Optimal Facilitation/Feedback Technique

A problem that arises in clinical practice is the difficulty to assess an isolated, deep layer muscle contraction through indirect methods and clinical skills with any degree of certainty.  Since the transversus abdominis and multifidus that you are trying to retrain are 1-3 inches deep, the only way to accurately test and measure progress is to use an imaging modality like diagnostic ultrasound. 

One study demonstrated that these subtle isometric contractions can be difficult to examine and assess, even for physical therapists who have had long experience, but minimal training related to this specific task.  Their research analysis showed poor agreement between palpation findings versus ultrasound imaging findings in this population of physical therapists. 

This study showed the appropriateness of ultrasound imaging as an extension of a physical therapist's clinical assessment of contraction in deep abdominal muscles.  Ultrasound imaging provides the ability to visualize the contraction of deep muscles in order to assess and problem solve the best feedback/facilitation strategy for correct activation.

"The facilitation techniques necessary to achieve the isolated contraction of the deep muscles without the contraction of the global muscles can vary for each patient." 
Therapeutic Exercise For Spinal Segmental Stabilization In Low Back Pain
by Richardson, et al.

If we want to objectively find the optimal facilitation/feedback technique for a particular individual, then we must assess and problem solve until we find it.  Ultrasound imaging can confirm that the facilitation/feedback technique chosen is valid.

What do the experts say?

"For facilitation of the subtle corset like action of transversus abdominis in relative isolation, visual (ultrasound imaging) verification that the correct facilitation strategy has been used by the physiotherapist and the correct activation has been achieved by the patient is of benefit to patient and physiotherapist alike."
J. A. Hides, C. A. Richardson, and G. A. Jull.
  Use of real-time ultrasound imaging for feedback in rehabilitation, Manual Therapy 1998; 3: 125-13.

My college football coach used to say:

"Practice does not make perfect... Perfect practice makes perfect!  So let's do it right during practice and then maybe we'll do it right in the games..." - Paul Tidwell

When a patient leaves my office I know that the facilitation/feedback techniques that I have instructed them to use are appropriate for proper activation because they have been verified with ultrasound imaging.  Remember the quote: "Practice does not make perfect... Perfect practice makes perfect!"
 

 

 

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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