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TA, LM, USI
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TA, LM, USI - February 5, 2007 7:56:00 AM
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JoshPT
Posts: 4
Joined: February 4, 2007
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Looking for feedback and thoughts on teaching patients exercises to retrain the transverse abdominus and lumbar multifidus musculature. Do you incorporate this into your treatment plan for patients with low back pain? If so, how do you teach your patients to perform these exercises/which exercises do you use. What are you thoughts on teaching isolated TA contraction versus overall abdominal bracing type stabilization exercises. And finally, what are you thoughts, experiances, comments, and concerns about using real time ultrasound imaging in the PT clinic to either assess for the need for training, monitor outcomes, or as a training/biofeedback aid. I'll add my opionions/experiances as we go
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Re: TA, LM, USI - February 9, 2007 1:36:00 AM
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Alex Brenner PT MPT OCS
Posts: 1057
Joined: February 29, 2004
From: Kentucky
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Josh,
I don't apply TrA or mulitifidus training for all my back pain patients, however, I think there are certainly some subgroups that these are very effective for. The Hicks et al study (Archives of Phys Med Rehab Sept 2005) presents a clinical prediction rule that is a great way to help identify which patients with low back pain will respond to this type of training. I typically train these muscles during one on one training sessions and will sometimes use rehabilitative ultrasound imaging (RUSI) to monitor contraction of these deep muscles or to aid in training. In my opinion it is very powerful to visually show the patient their Tra on the screen and teach them to contract it. It usually only takes 2 or 3 training sessions and the patient learns it well enough to do it on their own.
I personally have found RUSI also very helpful in assessing the ability for one to contract these muscles because you can easily measure the thickness of contraction. I have a case study that will be published in JOSPT in the coming months on this topic and will be presenting it at CSM. Come by and say hello.
_____________________________
Alex Brenner, PT, MPT, OCS
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Re: TA, LM, USI - February 9, 2007 2:50:00 AM
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FLAOrthoPT
Posts: 1011
Joined: May 8, 2004
From: West Palm Beach
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Very cool. I am a big believer as well, there is a pretty good book about segmental stabilization that has won me over. but I still believe it is not a tool for every back patient as Alex has mentioned. I do however try to find some provicative active test, even an ASLR test and see if reinforced verbal, tactile cues to contract help alleviate or reduce the pain, if so, bingo good candidate for stab re-training. I also will do some instability testing in prone, and functional in standing.
Typically, i use a blood pressure cuff for biofeedback and progress in supine to sitting, to standing in front of mirror etc. I've tinkered around with russian stim as well with timed contractions.
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Re: TA, LM, USI - February 9, 2007 6:35:00 AM
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Alex Brenner PT MPT OCS
Posts: 1057
Joined: February 29, 2004
From: Kentucky
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[QUOTE]however try to find some provicative active test, even an ASLR test and see if reinforced verbal, tactile cues to contract help alleviate or reduce the pain, if so, bingo good candidate for stab re-training[/QUOTE]Ben,
Acutally this is exactly what the Hides study indicates. A positive Prone Instabilty Test, presence of one of these abberant motions (painful arc during flexion, painful arc on return from flexion, + Gowers sign, reversal of lumbopelvic rhythm), lumbar hypermobility at any lumbar level as measured with spring test and FABQ. Get any 3 positives out of these 5 and the patient has the potential to demonstrate substantial improvement with lumbar stabilization intervention. There were some other factors involved too but I can not recall them from memory.
_____________________________
Alex Brenner, PT, MPT, OCS
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Re: TA, LM, USI - February 9, 2007 10:03:00 AM
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FLAOrthoPT
Posts: 1011
Joined: May 8, 2004
From: West Palm Beach
Status: offline
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then what good are you?
lol
kidding
thanks I love when my practice is supported by EBM, supposed to be the other way around though I suppose
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