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Ultrasound in Rehabilitation and Biofeedback

 

Rehabilitative ultrasound, both as an assessment and biofeedback tool has developed out of the research carried out by Maria Stokes, Paul Hides and many others into muscle function. 

Ultrasound evaluation of the deep abdominal musculature, in particular transverse abdominus and deep multifidus, in conjunction with ultrasound guided fine needle EMG studies has been responsible for major advances in our understanding of spinal pathology and dysfunction.

ultrasound of lateral abdominal wall, relaxed ultrasound lateral abominal wall contracted
Ultrasound image of relaxed abdominal wall
Subject in standing
Concious active contraction of transverse abdominus

Unsurprisingly as the price of scanners has fallen physiotherapists have begun applying these techniques for evaluating the activity of the deep abdominal and lumbar musculature in clinical practice.

 

Advantages of ultrasound evaluation of muscle function.

Direct visualisation of difficult to palpate/examine deep muscles.
Objective evaluation of muscle activity
Accurate evaluation and reevaluation of exercise specificity
Objective evaluation of atrophy and hypertrophy.
Effective biofeedback tool.
Quick, safe and painless examination technique
Effective evaluation of pelvic diaphragm pelvic floor and continence mechanism.

 

Disadvantages

Cost of scanners (from £5000)
Valueable equipement requires safe storage when not in use.
Easily damaged with improper use
Training required for effective and appropriate use.
Some muscles (eg deep multifidus need considerable experience to evaluate)
Leads to ineffective treatment if not used in conjunction with sound clinical assessment.

 
ultrasound image showing deep multifidus
Ultrasound image - transverse section through L4  spinous process (SP), with the echogenic laminae (L) deep to the multifdus muscles (M) 
Image taken with a 5MHz curvilinear probe.

International Symposium on Ultrasound Imaging in Physiotherapy

Conclusion

Falling prices will soon make ultrasound scanners an everyday part of clinical practice for physiotherapists as well as medics. The experiences of women’s health physiotherapists have shown that ultrasound imaging can dramatically improve the efficacy of physiotherapy in evaluating and rehabilitating deep and difficult to access systems.

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