real time ultrasound imaging references

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Volume 1
Spring/Summer 2011
Peak Performance
Physiotherapy
Physiotherapy and Massage Therapy
Clinical Pilates
Clinical (Rehabilitative) Pilates program 1st anniversary.
It’s been a year since we introduced Pilates equipment and
program to our list of services offered at Peak Performance
Physiotherapy
Page 3
Rehabilitative Real Time
Ultrasound imaging now
available
Peak Performance Physiotherapy is now offering Real
Time Ultrasound for imaging of the stabilising muscles
of the lumbar spine and pelvis and is conducted by
Peak Performance physiotherapists.
Real Time Ultrasound (RTUS) is a valuable tool for physiotherapists
in the assessment and treatment of sport/spinal injuries.
RTUS empowers us with instant information about the stabilising
muscles as we view the contraction as it occurs and provides an
accurate assessment of the quality, timing and endurance for precise
diagnosis. Patient care is enhanced as we can work with the patient
towards the goal of proper spinal stabilization by providing
biofeedback using RTUS. This is a powerful tool in the re-education or
re-installation of the motor program.
Continued on page 2
Spring is here after the Season of the “Pow” and we are
looking forward to an active and exciting summer…and
it’s all about the core!
Contents
Page 2
Real Time Ultrasound
Imaging…Urinary Stress
Incontinence, post
partum rectus diastases.
Page 3 Core training vs core
strengthening
Page 4
Real Time Ultrasound
imaging
Page 5
Pilates program 1st
Anniversary…What we
do to make a difference
to core rehabilitation.
Page 6
Complete Spinal Care
Peak Performance Physiotherapy
Spring/Summer 2011
(continued)
Real time Ultrasound
Weakness or poor motor firing patterns can lead to low back pain,
sacroiliac joint pain, poor pelvic control and overuse syndromes that
may effect everyday life, work and sporting performance
Clinically, RTUS is being used in response to the growing body of
recent research that shows that the primary impairment of the muscle
system in individuals with low back pain is not one of strength or
functional capacity, but one of motor control of the deep muscles of
the trunk. These muscles include the Transversus abdominus (TA),
deep segmental muscles of the lumbar multifidus, the pelvic floor and
the diaphragm. RTUS imaging allows us to view the real time
contraction of these deep and difficult to observe muscles.
Research also shows that in the event of a low back or pelvic injury,
these muscles become significantly inhibited which can lead to the
development of chronic low back pain and poor injury recovery. Even
more research has revealed that these stabilising muscles do not usually
recover from injury without specific exercise aimed at re-activating and
gaining control of them.
In addition to its role in assessment, RTUS is a great tool for “re-wiring
the brain” or re-educating the proper timing of muscle contraction
during both individual exercise and task/sport retraining.
Urinary Stress Incontinence
Post Partum or aging urinary
stress incontinence can be an
issue of poor pelvic muscle
control caused by hypoactive or
hyperactive muscles. RTUS
can determine the muscular
causes and we, as
physiotherapists, can treat the
muscle imbalance disorder.
Post Partum Diastases
Post partum rectus abdominus diastases separation can
lead to lumbopelvic instability. Monitoring the
progression of the closure of the diastases can aid in the
safe, proper prescription of abdominal and pelvic
exercise to prevent potential hernias or other
complications.
Real time ultrasound is ideal to evaluate and measure
the rectus diastases to determine return to exercise and
activity for post partum moms.
2
Peak Performance Physiotherapy
Spring/Summer 2011
Core Training vs
Core Strengthening
Core training is restoring the optimal
sequence and pattern of activation of the
core muscles (transversus abdominus,
segmental multifidus, pelvic floor and
diaphragm). This is different from Core
strengthening as you can’t strengthen a
muscle that you cannot activate (that your
brain can’t consciously find).
Core training will teach how to correct the
pattern of activation so that the right muscles
will work at the right time. Research shows us
that it takes at least 30 repetitions for your brain
to begin to remember the optimal way to use
these muscles…without this bit of training or
re-install of the motor program, you will
continue to use faulty patterns that have been
shown to cause pain/dysfunction.
Core strengthening
happens once you get the
right muscles to work at the
right time. Once this is
achieved then progress to
more “traditional” exercise
using BosuTM, gym ball
workout, TRXTM, CorexTM,
Pilates and sport specific
training exercise.
Remember….core training comes before core strengthening. You need to get
the right muscles firing and then repeat the pattern until it is installed (in your
subconscious). Ultrasound imaging can help expediate your learning curve!
3
Peak Performance Physiotherapy
Spring/Summer 2011
What do we assess for core training?
Posterior aspect of the lumbar spine:
The morphology {size, shape, quality of muscle tissue
(fibrofatty infiltrate)} of the deep segmental multifidus,
longisimus and iliocostalis muscles. We can compare each
level and side to side of the spine using exact cross sectional
and longitudinal measurements.
Assessment
requirements
This is done both at rest and during active contraction.
The firing pattern of the muscle complex (eg. does the
multifidus contract first or at all) again comparing each level
and side to side.
Abdominal wall
Morphology of the transversus abdominus, internal and
external oblique and rectus abdominus.
Thickness of each muscle (there is a normal ratio of relative
thickness at rest and during an active contraction)
Timing patterns (transversus should slide transversely to tense
the fasciae in preparation for movement)
Rectus abdominus diastasis measurements at each aponeurosis
during rest and active contraction
Pelvic Floor
Activation of the pelvic floor during rest and contraction
(transverse and sagittal views) of the moderately full bladder
to determine hypo or hypertonicity and activation patterns.
All of these assessments can be done during functional
movements to assess ‘training effects’.
Freeze frame images can be taken for future comparisons.
After assessment, then the motor retraining begins!
Patients need to:
Patients may be asked to book a
special appointment (more time
is required for the first
assessment).
Patients should have a
moderately full bladder.
Instructions to the patient are to
void one hour before
appointment and then drink 250
ml of water during this hour.
Cost
As Real Time Ultrasound is
provided by registered
physiotherapists trained in the
use of RTUS, the service is
claimable to third party insurers.
The cost of the initial visit will be
higher than that of our usual
physiotherapy treatment rate as
more time is required. Our
standard 1:1 appointment times
are 30 minutes. For Initial
assessments we will require 1
hour.
Booking Appointments:
604 932 7555
4
Peak Performance Physiotherapy
Spring/Summer 2011
CLINICAL (Rehabilitative) PILATES
It has been a year since we first introduced our
Pilates program. Our program was featured in the
Shaw network Express to showcase just how
fantastic Pilates is for rehabilitation or just to feel
good. Pilates is not just for dancers or just for
women (as so many of our male athletes have
found out!) oh …and not for person looking to do
10 Reps for 10 sets. Don’t get us wrong…you will
feel the burn once you get the right muscles in
gear. That’s where our expertise comes in. We
help you kept the proper control and timing of core
muscles as you work on the equipment.
What is Pilates?
Pilates is a system of over 500 controlled
exercises that engage the mind and
condition the entire body. It is a balanced
blend of strength and flexibility training that
improves posture, reduces stress and creates
long, lean muscles. Pilates works with a
Our goal is to help you get a strong, lean
particular concentration on retraining,
body that has a strong core.
strengthening and stabilizing the "core"
It will leave you invigorated.
The focus is on quality of movement and
using the proper muscles in each movement
Our equipment:
pattern.
StottTM reformers, trap table, barrel,
fitness rings and mats.
Recent exercise and sport science research
We also use TRXTM, BosuTM, gym ball,
and GymstiksTM , Corex TM to progress
core strengthening
has proven that core programs reduce injury
to the spine and extremities and improve
the quality of sport performance (parameters
Our Instructors:
of agility, accuracy and endurance).
5
Registered physiotherapists with postgraduate training in Clinical Pilates and
Kinesiologists with advanced
Peak Performance Physiotherapy
Spring/Summer 2011
Complete Spinal Care
 Precise diagnosis of faulty spinal stabilizing musculature using Real Time
Ultrasound (RTUS)
 RTUS for patient biofeedback for proper motor control and muscle contraction
 Mobilization/manipulation for proper spinal joint biomechanics and
neuromuscular release
 Rehabilitative Pilates based active exercise specific to the dysfunction in the
myofacial system
 Neuromuscular stimulation for atrophy and fibrofatty changes in muscle
 Intramuscular stimulation (IMS) for neuropathic hypertonic musculature
 Acupuncture for pain control, anti-inflammatory and balance of the autonomic
system
 Progressive active strengthening using TRX, Corex, Pilates for back to sport or
work.
Peak Performance Physiotherapy
11-4154 Village Green
Whistler, B.C.
CANADA
V0N 1B4
[Recipient]
Continuing to provide
patients with evidence
based practice
physiotherapy
treatment with years
of clinical experience
from registered
physiotherapists with
high level post
graduate
education...always.
www.peakperformancephysio.com
www.whistlerrealtimeultrasound.com
REAL TIME ULTRASOUND IMAGING REFERENCES
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Beer-Gabel M, Teshler M, Barzilai N, Lurie Y, Malnick S, Bass D, Zbar A. Dynamic transperineal ultrasound in the diagnosis of pelvic floor disorders, pilot
study. Dis Colon Rectum Feb 2002;239-248
Bernstein I, Juul N, Gronvall S, Bonde B, Klarskov P, Pelvic floor muscle thickness measured by perineal ultrasonography. Scand J Nephrol Suppl 1991; 137:
131-33
Blaney F et al, Sonographic measurement of diaphragmatic displacement during tidal breathing maneuvers. A reliability study. The Australian Journal of
Physiotherapy 1999; 45: 41-43
BØ K, Sherburn M, Allen T. Transabdominal ultrasound measurement of pelvic floor muscle activity when activated directly or via a transversus abdominis
muscle contraction. Neurourol Urodynam 2003; 22:582-588
Bump RC, Hurt GW, Fantl JA, Wyman JF, Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction. Am J Obstet Gynecol 1991;
165: 322-9
Bunce SM, Moore AP, Hough AD. M-mode ultrasound: a reliable measure of transversus abdominis thickness? Clinical Biomechanics 2002; 17: 315-317
Bunce SM, Hough AD, Moore AP. Measurement of abdominal muscle thickness using M-mode ultrasound imaging during functional activities. Manual
Therapy 2004; 9: 41-44
Coldron Y et al. Lumbar multifidus muscle size does not differ whether ultrasound imaging is performed in prone or side-lying. Man Ther 2003; 8(3): 161-165
Critchley D. Instructing pelvic floor contraction facilitates transversus abdominis thickness increase during lowabdominal hollowing. Physiother Res Int 2002;
7(2): 65-75
De Troyer A, Estenne M, Ninane V, Van Gansbeke D, Gorini M. Transversus abdominis muscle function in humans. J Appl Physiol 1990 68(3):1010-1016
Dietz HP, Wilson PD, Clarke B. The use of perineal ultrasound to quantify levator activity and teach pelvic floor muscle exercises. Int Urogynecol J Pelvic
Floor Dysfunct 2001; 12(3):166-8
Dietz HP, Jarvis SK, Vancaillie TG. The assessment of levator muscle strength: a validation of three ultrasound techniques. Int Urogynecol 2002; 13: 156-159
Elliott JM, Zylstra ED, Centeno CJ. Case Report: The presence and utilization of psoas musculature despite congenital absence of the right hip. Man Ther
2004; 9: 109-113
Ferreira PH, Ferreira ML, Hodges PW. Changes in recruitment of the abdominal muscles in people with low back pain, ultrasound measurement of muscle
activity. Spine 2004; 29(22): 2560-2566
Haberkorn U, Layer G, Rudat V, Zuna I, Lorenz A, VanKaick G. Ultrasound image properties influenced by abdominal wall thickness and composition. J Clin
Ultrasound 1993;21:423-429
Hashimoto BE, Dawna JK, Wiitala L, Applications of musculoskeletal sonography. J of Clinical Ultrasound 1999; 27: 293-318
Hedrick W R 1995 Ultrasound Physics and Instrumentation 3rd Ed. Mosby, St. Loius Henry S M, Westervelt K C. The use of real-time ultrasound feedback in
teaching abdominal hollowing exercises to healthy subjects. JOPST 2005;36(6):338-345
Hides J, Cooper DH, Stokes MJ, Diagnostic ultrasound imaging for measurement of the lumbar multifidus muscle in normal young adults, Physiotherapy
Theory and Practice 1992; 8: 19-26
Hides J, Richardson CA et al. MRI and ultrasonography of the lumbar multifidus muscle. Spine 1995a; 20: 54-58
Hides J, Richardson C, Jull G, Davies S, Ultrasound imaging in rehabilitation. Australian Journal of Physiotherapy 1995b; 41(3):187-193
Hides JA, Richardson CA, Jull GA, Multifidus muscle recovery is not automatic after resolution of acute, first-episode low back pain. Spine 1996; 21:27632769
Hides J et al, Use of real-time ultrasound imaging for feedback in rehabilitation, Manual Therapy 1998; 3: 125-131
Hides JA, Jull GA, Richardson CA, Long-term effects of specific stabilizing exercises for first-episode low back pain. Spine 2001; 26 (11): E243-E248
Hodges PW, Pengel LHM, Herbert RD Gandevia SC. Measurement of muscle contraction with ultrasound imaging. Muscle and Nerve 2003; 27: 682-692
Hodges PW. Core stability exercises in chronic low back pain. Orthop Clin N Am 2003; 34:245-254 Hodges P W 2005 Ultrasound imaging in rehabilitation:
just a fad? JOSPT 35(6):333-337
Hodgson T J, Collins M C. Anterior abdominal wall hernia: Diagnosis by ultrasound and tangential radiographs. Clin Radiology 1991;44:185
Hough AD, Moore AP, Jones MP. Measuring longitudinal nerve motion using ultrasonography. Manual Therapy 2000; 5(3) 173-180
Jull GA, Richardson CA. Motor control problems in patients with spinal pain: A new direction for therapeutic exercises. J Manip Physiol Therapeutics 2000:
23 (2); 115-117
Kermode F. Benefits of utilizing real-time ultrasound imaging in the rehabilitation of the lumbar spine stabilising muscles following low back injury in the elite
athlete: a singe case study. Physical Therapy in Sport 2004;5: 13-16
Kremkau F.W. Diagnostic Ultrasound: Principles and instruments 6th Edition, Saunders, Philadelphia 2002 Kristjansson E. Reliability of ultrasonography for
the cervical multifidus muscle in asymptomatic and symptomatic subjects. Man Ther 2004; 9: 83-88
Krupinski et al, Ultrasound evaluation of sacro-iliac motion in normal volunteers, Acad Radiol 1996; Mar (3) 3: 192-6
Lee DG, The pelvic girdle, 3rd ed. Churchill Livingston London 2004
Martan A, Masata J, Halaska M, Otcenasek M, Svabik K. Ultrasound imaging of paravaginal defects in women with stress incontinence before and after
paravaginal defect repair. Ultrasound Obstet Gynecol 2002;19:496-500
McKenzie D, Gandevia. Dynamic changes in the zone of apposition and diaphragm length during maximal respiratory efforts. Thorax 1994; 49: 634-638
McMeeken JM, Beith ID, Newhan DJ, Milligan P, Critchley DJ. The relationship between EMG and changes in thickness of transversus abdominis. Clin
Biomech 2004; 19: 337-342
Misuri G, Colagrande S, Gorini M, Iamdelli I, Mancini M, Duranti R, Scano G. In vivo ultrasound assessment of respiratory function of abdominal muscles in
normal subjects. Eur Respir J 1997; 10: 2861-2867
Mosely LG, Hodges PW, Gandevia SC, Deep and superficial fibers of the lumbar multifidus muscle are differentially active during voluntary arm movements,
Spine 2002; 27(2): E29-E36
Ninane V, Rypens F, Yernault JC, DeTroyer A. Abdominal muscle use during breathing in patients with chronic airflow obstruction. Am Rev Respir Dis 1992;
146: 16-21
Nyborg W L. Biological effects of ultrasound: development of safety guidelines. Part II: general review. Ultrasound in Med & Bio 2001;27(3):301-333
Nyborg W L. Safety of Medical Diagnostic Ultrasound. Seminars in Ultrasound, CT and MRI 2002;23(5):377-386
Ostrzenski A, Osborne NG. Ultrasonography as a screening tool for paravaginal defects in women with stress incontinence: A pilot study. Int Urogynecol J
1998;9:105-1999
























O’Sullivan PB, Beales DJ, Beetham JA, Cripps J, Graf F, Lin IB, Tucker B, Avery A. Altered motor control strategies in subjects with sacro-iliac joint
pain during the active straight leg raise test. Spine 2002; 27(1):E1-E8
Peschers UM, Gingelmaier A, Jundt K, Leib B, Dimpfl T. Evaluation of pelvic floor muscle strength using four different techniques. Int Urogynecol J
Pelvic Floor Dysfunct 2001; 12: 27-30
Pranathi Reddy A, DeLancey JOL, Zwica L, Ashton-Miller JA, On-screen vector-based ultrasound assessment of vesical neck movement. Am J Obstet
Gynecol 2001; 185:65-70
Raadsheer MC, VanEijden TMGJ, VanSpronsen PH, VanGinkel FC, Kiliaridis S, Prahl-Andersen B. A comparison of human masseter muscle thickness
measured by ultrasonography and magnetic resonance imaging. Archs oral boil 1994;39(12):1079-1094
Rath A M, Attali P, Dumas J L, et al 1996 The abdominal linea alba: an anatomo-radiologic and biomechanical study. Surgical Radiologic Anatomy
18:281-288
Rettenbacher T, Hollerweger A, Macheiner P et al. Abdominal wall hernias: Cross sectional imaging signs of incarcerateion determined with sonography.
American Journal of Radiology 2001;177:1061-1066
Rezasoltani A, Kallinen M, Malkia E, Vihko V. Neck Semispinalis capitus muscle size in sitting and prone positions measured by real-time
ultrasonography. Clinical Rehabilitation 1998; 12: 36-44
Rezasoltani A, Malkia E, Vihko V. Neck muscle ultrasonography of male weight-lifters, wrestlers and controls. Scandinavian Journal of Medicine and
Science in Sports 1999; 9: 214-218
Richardson C, Jull G, Hodges PW, Hides J, Therapeutic exercise for spinal segmental stabilization in low back pain - scientific basis and clinical approach,
Churchill Livingstone, Edinburgh 1999
Richardson CA, Snijders CJ, Hides JA, Damen L, Pas MS, Storm J, The relation between the transversus abdominis muscles, sacroiliac joint mechanics,
and low back pain. Spine 2002; 27 (4): 399-405
Schaer G, et al, Sonographic evaluation of bladder neck in continent and stress-incontinent women. Obstet Gynecol 1999; 93:412-16
Sherburn M, Murphy C A, Carroll S, Allen T J, Galea M P. Investigation of transabdominal real-time ultrasound to visualize the muscles of the pelvic
floor. Australian J Physiotherapy 2005;51:167-170
Stokes M, Hiders J, Nassiri D K. Musculoskeletal ultrasound imaging: diagnostic and treatment aid in rehabilitation. Phys. Ther. Rev1997;2:73-92
Stokes M, Rankin G, Newham D J. Ultrasound imaging of lumbar multifidus muscle: normal reference ranges for measurements and practical guidance on
the technique. Manual Therapy 2005;10:116-126
Teyhan D, Miltenberger C E, Deiters H M. The use of ultrasound imaging of the abdominal drawing in maneuver in subjects with low back pain. JOSPT
2005;35(6):346-355
Thompson JA, O’Sullivan PB. Levator plate movement during voluntary pelvic floor muscle contraction in subjects with incontinence and prolapse: a
cross-sectional study and review. Int Urogynecol J 2003; 14:84-88
Thompson J A, O’Sullivan P B, Briffa K, Neumann P, Court S. Assessment of pelvic flor movement using transpabdominal and transperineal ultrasound.
Int Urogynecol J Pelvic Dysfunction 2005;16(4) 285-292
Ueki J, De Bruin PF, Pride NB. In vivo assessment of diaphragm contraction by ultrasound in normal subjects. Thorax 1995;50:1157-1161
Van Holsbeeck M T, Introcas J H Musculoskeletal Ultrasound, 2001, Mosby Press
Watanabe K, Miyamoto K, Masuda T, Shimizu K. Use of ultrasonography to evaluate thickness of the erector spiane muscle in maximum flexion and
extension of the lumbar spine. Spine 2004l;29(13):1472-1477
Whittaker JL. Abdominal ultrasound imaging of pelvic floor muscle function in individuals with low back pain. J Man Manip Ther 2004: 12(1) 44-49
Whittaker JL. Real-time ultrasound analysis of local system function. In Lee DG, The Pelvic Girdle; An approach to the examination and treatment of the
lumbopelvic-hip region 3rd edn. Churchill Livingston, London 2004, pgs120-129
Whittaker J L. Ultrasound imaging characteristics of individuals with pelvic instability and concurrent respiratory dysfunction. Manual Therapy
(submitted)
Wijma J, Tinga DJ et al. Perineal ultrasonography in women with stress incontinence and controls: The role of the pelvic floor muscles. Gynecologic and
Obstetric Investigations 1991; 32: 176-179
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