REHABILITATIVE ULTRASOUND IMAGING
A Perfect Fit for Examining Deep Stabilizing Muscles
of the
Lumbar Spine and Pelvis, Presenting Patient Education,
and
as a Biofeedback Tool during Specific Exercise Training
Rehabilitative
ultrasound
imaging (RUSI) has many potential applications for physical therapy practice.
RTUI may be used by rehabilitation specialists during an examination, patient
education and treatment. This type of sonography is used during an
examination to provide direct measurements of muscle size, to assess of the
composition of muscle, and to identify clinical patterns of muscle dysfunction.
As a result of this imaging technology, we are able to transform a clinical impression into a verifiable diagnosis.
During treatment, RTUI may be utilized as a visual
biofeedback tool during specific exercise training. We also use RTUI to
identify optimal facilitation/feedback techniques and to identify
motor control milestones that
suggest that it's time to progress to the next stage. As an added bonus, RTUI
is an exceptional means of providing patient education as a "picture is worth a
thousand words."
The basic question for a low back pain patient that RTUI may be used to
answer is:
"Are the deep stabilizing muscles of the
lumbar spine and pelvis functioning optimally?"
More
specifically, we can answer all of the following questions or identify the
following problems during an examination
of a patient with lower back pain through sonographic scanning.
1. Identify unilateral muscle wasting
within a specific segment of lumbar multifidus.
2. If muscle wasting is identified, what is the %
difference between sides of the specific segment?
Identify change in motor control in individuals
with low back pain.
3. Does the patient display one of 5 clinical
patterns of transversus abdominis dysfunction (developed by Felicity Kermode, a
physiotherapist in Perth, Australia) during testing for the automatic
recruitment strategy used by the nervous system to control the trunk?
Observe the automatic recruitment strategy to
identify normal or abnormal control of TrA during load transfer involving
movement of limbs.
Test voluntary activation through conscious effort.
4. Is the patient able to maintain a tonic
hold of TrA without movement of the spine during testing for conscious
activation?
5. Is the patient able to consciously contract
lumbar multifidus while in an unloaded position without trunk movement or limb
loading?
6. Can the patient emphasize activation of deep
fibers of multifidus while limiting activation of superficial fibers? (Poor
quality of MF contraction?)
7. How long can a patient sustain a TrA or MF contraction before fatiguing?
8. Can the patient co-contract TrA and MF,
independent of the global superficial muscles of the back/abdomen?
9. Does the muscle composition of
multifidus look healthy, without fatty infiltrate, fluid from injury, fibrosis,
soft tissue adhesions, or calcium
deposits?
10. When the patient draws in the lower
abdomen, how much of a linear change in lateral pull of the fascia attachment
occurs from rest to active without significant IO thickness increase and with
minimal TrA thickness increase?
11. Does the patient have 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.
