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
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