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.
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"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?
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"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.
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My college football coach used to say:
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"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!"