REHABILITATIVE ULTRASOUND IMAGING has been used by research driven clinicians as a safe and cost effective method to enhance both the assessment and treatment of patients with motor control deficits of their lumbo-pelvic ‘core’ muscles, (transverse abdominis, lumbar multifidus, the diaphram and the pelvic floor muscles). The value of Ultrasound Imaging (USI) in a clinical setting is that it allows for real time study of these deep muscles as they contract. This allows both the patient and the therapist to view the contraction as it happens, leaving little room for supposition. Consequently, USI can be used as both an assessment tool, and more importantly as a form of biofeedback, providing patients with knowledge of performance in the early stages of motor relearning.
Continued research highlights that a primary impaiment of the musculoskeletal system in individuals with lumbo-pelvic dysfunction is not one of strength, endurance or funcational capacity, but rather of motor control. In particular, there is a pattern of hyperactivity of the superficial, and hypoactivity of the deep muscles of the region. The clinical extrapolation of this is that the initial and pivotal focus in rehabilitation must address these motor control deficits by retraining a coordinated co-contraction of the deep trunk muscles, (segmental stabilization exercises), and restoring appropriate activation fo the superficial muscles. Success hinges on upon the ability to detect motor control deficits of the segmental stabilizing muscles. This requires a high level of clinical skill as thes muscles are located deep and their desired contraction is sub-maximal. Consequently, the evaluation and the initial retraining phase can be augmented with the aid of ULTRASOUND IMAGING (USI) technology.
Many thank s to Jackie Whittaker BScPT, FCAMT, CGIMS, CAFCI for the above introduction to RUSI.