Rehabilitative Ultrasound and Low Back Pain

We know from research that the deep muscles of the lumbar spine (transversus abdominis, the pelvic floor and the deep fibers of the multifidus) are essential to intrinsic spinal stability. These "core" muscles should contract prior to any movement or loading of the spine. We also know that these muscles do not recover spontaneously following an episode of low back pain and that patients who have not undergone specific motor control retraining of these muscles are more likely to suffer a reoccurrence of low back pain. Current research further suggests that the primary muscular impairment in clients with low back, neck or pelvic girdle pain is not weakness, but rather a loss of the proper sequencing or timing of muscle contractions.

We refer to this as a deficit in motor control. Accurate assessment of the deep stabilizing muscles with normal palpation (touch) is very difficult because the stabilizing muscles are very deep and the timing and strength of their contraction is very subtle. In addition, patients with low back pain are often unable to contract the stabilizing muscles correctly and have difficulty learning appropriate exercises for these muscles. Real-time ultrasound imaging allows the therapist to view the stabilizing muscle contraction as it occurs and can provide an accurate assessment of the quality, timing and endurance of the stabilizing muscle contraction.

The therapist is then able to quantify the degree of stabilizing muscle dysfunction. Since the patient may also view the real-time video image of the muscle contraction as it occurs, ultrasound imaging can be an effective method of teaching the correct exercise techniques. Actually seeing the muscle as it contracts and feeling the sensation of a correct contraction technique is a powerful form of biofeedback and can speed up the rehabilitation of these critical muscles.