Real time ultrasound has been used for many years in an obstetric setting for foetal monitoring, but in a physiotherapy setting, real time ultrasound is used as a diagnostic tool that allows us to watch our muscles working. Ultrasound is safe and produces pictures of the inside of the body by using sound waves. There is no radiation exposure to the patient at all. Real time ultrasound provides visual biofeedback of the movement of anatomical structures, like a muscle, so movement can be observed as it actually occurs, allowing a better understanding and perception of muscle action and activity levels. This immediate visual feedback improves your ability to learn to control your stabilising muscles, speeding up recovery time and producing a longer lasting outcome.

Depending on what your physiotherapist is looking at, your muscle function can be assessed by the real time ultrasound, and you will be shown any anomalies, if they’re present. You will then be shown the best way to use your muscles, with your efforts being relayed by the real time imaging. Most commonly, we look at the deep abdominals (transverse abs or TA), the pelvic floor muscles and the deep muscles of the lower back (multifidus), to assess their activation and function. Real Time Ultrasound can then be used as a training tool to help you to strengthen the muscles.

Medical Ultrasound

In a women’s health setting, real time ultrasound is most useful when helping to facilitate a correct pelvic floor muscle contraction. Having a strong and flexible pelvic floor is essential in the management of incontinence, prolapse, bowel dysfunction, bladder dysfunctions, and certain aspects of sexual dysfunction. Many women incorrectly activate their pelvic floor muscles, which can do more harm than good. Real time ultrasound is a non-invasive tool that provides a dynamic assessment of pelvic floor muscle function in as close to a “real-life” situation as possible. It should not be used as a substitute for a full pelvic floor assessment but it is an excellent adjunct.

Real time ultrasound can also be useful in the management of diastasis rectus abdominis muscles. When the fascia (linea alba) connecting the two rectus muscle bellies stretches, as often happens during pregnancy, the gap that is created along the line of the belly button is called diastasis rectus abdominis. A diastasis can usually be managed well with conventional measurement, appropriate exercises and lifestyle advice, but real time ultrasound allows for a more accurate assessment of the linea alba. It also provides excellent biofeedback as to how reactivating your core muscles prior to certain movements increases the tension of the linea alba, thereby enhancing your core’s ability to function correctly.

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