Ascent Physical Therapy offers Biofeedback Training, a combination of Ultrasound Imaging and Inner Core Training for patients to gain greater awareness of activating their deep local stabilizing muscles in order to move more efficiently.

Ultrasound Imaging
Ultrasound imaging has proven to be a useful biofeedback tool for reprogramming the brain or re-establishing proper activation patterns of muscle contractions during both individual exercises and functional tasks. It is particularly useful for the muscles of the abdominal wall and the pelvic floor. Restoring the optimal sequence and pattern of activation of the muscles around the trunk and pelvis is called core training. The local stabilizers of the body, or pre-movement muscles, activate prior to the larger global muscles. They are typically very small and lie deep under the skin and surround a single joint in our body. Their job is to control and protect movement at that joint while the larger global muscles create and control movement upon the joint. It is essential that the local muscles activate prior to and sufficiently enough to protect and guard the joint while the global muscles are directing forces and stress through it. Once this protective pattern of muscle activation has been established, smooth and efficient movement can occur. If this pattern is disrupted at all due to an injury, pain, fear of pain, or stress, alternate and less efficient patterns of muscle recruitment are created. This can leave the joints of the body susceptible to being overloaded and unprotected as well as general tightness and “knots” in the global muscles of the body which are now trying to protect the joints and move us at the same time.

Inner core or local muscle training will teach you how to correct the pattern of activation such that the right muscles work at the right time at the right amount. Following inner core or local pelvic muscle training, you can then progress to more traditional exercises for core strengthening (gym ball work, TRX, etc). Research has shown that in as little as 30 proper repetitions, your brain begins to remember the optimal way to use these muscles. Without this training piece, your brain often continues to use the old faulty patterns that got you into trouble in the first place, thereby perpetuating pain and dysfunction.

Inner core training, being able to provide stability and control of the joints, is the foundation for more efficient global muscles strengthening. Learn the proper muscle activation pattern first and then reinforce the pattern with lots of repetitions. Ultrasound imaging can expedite this learning curve.

Inner Core Training
Inner core training exercises focus on restoring the timing and sequencing of your deep muscles. For the lumbopelvic region these include transversus abdominis, multifidus, the pelvic floor and breathing diaghragm. Since this system is anticipatory and prepares you for movement, we cannot give you movement type exercises as your brain will fire the bigger global muscles that are responsible for creating movement. Instead, we use preparatory cues and images where you imagine guy wires and connections to increase the activation of these deep muscles before you then move. We use ultrasound imaging to view the muscles and visualize their firing patterns.

Ultrasound imaging is a powerful biofeedback tool to help you engage the right muscles at the right time.

Once you can activate the deep muscle system synergistically, it is time for core strengthening exercises. By adding loads through the trunk, leg or arms you will functionally strengthen an optimal pattern for stabilization that gives you stability but doesn’t limit your mobility. This pattern of muscle activation can, and should, be integrated into any exercise you do.

If you continue to use non-optimal strategies, such as inappropriate core strengthening exercises, while an underlying deep core muscle deficit is present, you will end up reinforcing the non-optimal pattern. Over time this can lead to tissue break down, pain or an inability to function at the level you used to. For some, the clue that their body isn’t working well is the onset of low back pain. For others, the pain can be remote such as knee pain, plantar fasciitis or perhaps shoulder pain; everything ultimately connects to your core!