Real Time Ultrasound (RTUS) imaging of the stabilizing muscles of the spine and torso is now available at Marda Loop Sport Physiotherapy.

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1 Real Time Ultrasound (RTUS) imaging of the stabilizing muscles of the spine and torso is now available at Marda Loop Sport Physiotherapy. Stabilizing Muscles of the Spine & Torso Core muscles that are strong and doing an efficient job at stabilizing are the key to wellbeing. These core muscles create a muscular girdle around your body to keep you upright and are the key to not just appearance, but to optimal health and strength. Having difficultly making the Core Connection? Working hard on your core exercises but unsure if you are actually using the muscles the exercises are meant to target? Have no idea what is meant by your deep abdominals and back muscles or inner unit? Come visit Marda Loop Sport Physiotherapy for a Real Time Ultrasound (RTUS) assessment that allows both you and your physiotherapist to see how your core muscles function as you perform your exercises!! This new & cutting edge RTUS service is available at Marda Loop Sport Physiotherapy as of December 1, RTUS assessments are ideal for accurate and objective assessment of the vital core stabilizing muscles. The RTUS display provides you with important visual feedback which enables you to learn to recognize the sensation of correctly contracting the core muscles, enabling you to train these muscles efficiently. Once this is achieved you will be given an individualized muscular retraining program and will receive either a digital video or photograph of your muscles functioning. Please feel free to contact us at to make an appointment for a RTUS assessment. All assessments are conducted by an experienced physiotherapist.

2 What is Real Time Ultrasound (RTUS) imaging? RTUS imaging is basically sonar, the same system used by bats, ships at sea and fisherman using fish finders. RTUS involves the sending of inaudible sound waves through the body with an ultrasound transducer. The transducer is placed on the client s skin and functions as a loudspeaker creating sound waves and functions as a microphone that records the resulting sound waves. These sound waves are reflected by internal body tissues and these reflections are then collected and displayed as a real-time picture on a computer monitor. The RTUS is used as a biofeedback tool that allows physiotherapists to visualize the contraction of the deep muscles of the trunk. Research has shown that these deep or core muscles are critical for stabilizing the spinal column and pelvis. Core muscles are located deeper than other layers of muscle and they are difficult to feel and cannot be seen without using this technology. With RTUS both the physiotherapist and the patient are able to watch and assess the efficiency of the muscle contraction as it occurs. Digital video or photographs from the examination can be provided. RTUS images of the abdominal muscles: (EO = external oblique, IO = internal oblique, TrA = transversus abdominis) Right abdominal muscles Relaxed Right abdominal muscles Contracted How can Real Time Ultrasound (RTUS) imaging help me? Core muscles protect and support the spine. Physiotherapists assess the core or deep muscle corset using RTUS by observing these muscles at rest and during contraction. In addition to RTUS s role in assessment, its imaging capability is used as a biofeedback tool for re-educating patients on the proper timing and sequencing of muscle contraction during exercises. With RTUS, patients will actually be able to watch the inner muscles contracting during exercise. Recent research has shown that in as little as 10 proper repetitions, your brain starts to remember proper recruitment and usage of the deep muscles. Following the RTUS assessment, a specialized exercise program can be designed to meet the needs of each patient. This exercise program can tone the deep muscles of the trunk to improve strength as well as protecting and supporting the spine. MicroMaxx Ultrasound Machine used at Marda Loop Sport Physiotherapy

3 Who Might Benefit From Real Time Ultrasound (RTUS) imaging? If you are a patient whose spinal pain has not improved with therapy, core muscle training, pilates, or yoga it may be because the muscles that ensure core stability are not contracting correctly. If you are unsure as to whether you can activate these muscles correctly, a RTUS assessment would be of great benefit. People of all ages can benefit from RTUS assessment: Poor core stability Recent, chronic or recurrent low back pain Osteoarthritis Obstetric back pain Women who wish to regain abdominal muscle tone post partum Pre and post spinal surgery conditions Post abdominal or pelvic surgery Sacroiliac joint (SIJ) dysfunction Pelvic floor incontinence Sports men and women with osteitis pubis RTUS is not just for those with pain. Anyone, Athletes included, can benefit greatly from RTUS: Recreational and Elite level athletes who want to determine if they are using their core muscles effectively during training or sporting activities. For example identifying over or under use of any component of the core muscles Athletes who may or may not recognize that they have poor core stability Those athletes who are finding that they are getting repetitive tightness in the same torso, hip or leg muscles that is not easing with stretching or other treatment Increased prevention of injury and enhanced performance by ensuring optimal core muscle usage The physiotherapists at Marda Loop Sport Physiotherapy welcome referrals from physiotherapists, athletic therapists, chiropractors, fitness trainers, strength and sport coaches, yoga and pilates instructors, massage therapists and physicians. Our goal is to augment and facilitate your existing treatment plans for your patients. To refer patients please contact us at Marda Loop Sport Physiotherapy at As well, please visit us online at We welcome you to book your own appointment with us to find your own core connection!

4 Is there evidence to support the use of Real Time Ultrasound (RTUS) and Core muscle recruitment training? Ongoing research has confirmed the importance of spinal segmental muscular control via the transversus abdominis, multifidus and pelvic floor muscles and highlights how, with acute low back pain, inhibition of these muscles occurs at a segmental level. Research has demonstrated motor control problems in these muscles during the presence of low back pain. This is evidenced by an inability to activate a corset like contraction. Research has shown that not only is RTUS an effective inexpensive and non invasive technology for the retraining of the core stabilizing muscles (transversus abdominis, multifidus and the pelvic floor muscles) but it can substantially reduce the risk of both chronic back pain and its recurrence. Clinical research is showing that specific exercises taught by your physiotherapist may be effective in the management of pain and prevention of recurrence. Note a full list of relevant studies is available upon request. What is the risks with Real Time Ultrasound (RTUS)? The use of biofeedback ultrasound has no known harmful effects. What the difference between Real Time Ultrasound (RTUS) and the regular ultrasound that I usually receive in physiotherapy? In order to generate an image where you can see the muscles, RTUS uses lower energy and often different frequencies then therapeutic ultrasound. Therapeutic ultrasound is the form of ultrasound that you may be more familiar with as it is commonly used in physiotherapy practices. Therapeutic ultrasound uses sound waves to bring heat or high frequency vibration to the body tissues and therefore uses much higher energy in this application. This is why with therapeutic ultrasound the clinician must be continually moving the sound head (probe) over your skin but in RTUS the sound head (probe) can be held still. What do I wear for the Real Time Ultrasound (RTUS) assessment and treatment sessions? Comfortable active wear is suitable for the RTUS assessment. Will my treatment consist of only Real Time Ultrasound (RTUS)? Neck, mid back and low back pain can be complex conditions especially when the condition is chronic. Retraining the core muscles can be important in the road to recovery and RTUS is a useful tool for both the assessment and treatment of the core muscles that are difficult to palpate and observe during activity. Often retraining is not the sole solution and RTUS is used in conjunction with many other forms of physiotherapy and medical interventions to reduce or eliminate your pain.

5 What is involved with the Real Time Ultrasound (RTUS) procedure? The first examination with RTUS provides a baseline measure of your muscle activation (transversus abdominis as well as multifidus and pelvic floor muscles). Once assessed, we will know if there will be a benefit to using RTUS as a feed back tool during rehabilitation. A report will be generated for you to give to your fitness trainer, strength and/or sport coach, yoga or pilates instructor, medical doctor, massage therapist, chiropractor, etc. If it is determined that you are not recruiting your core muscle effectively during the initial assessment, the RTUS is complemented by a home exercise program. Without RTUS retraining, many patients find it difficult to isolate and contract core muscles correctly. The RTUS display provides important visual feedback to the patient. Enabling them to learn to associate the correct contraction of the transversus abdominis, multifidus (back muscles) and pelvic floor muscles identified via the ultrasound, with the appropriate sensation. Once the patient can achieve the contraction in the lying position, exercise is progressed to the standing position and from there more complex exercises can be introduced. Please note that the type of training program is dependent upon the individual patient and their sporting, work or recreational demands and goals. In order to develop the proper training program the initial RTUS assessment is followed by review sessions to modify the difficulty and functional relevance of the exercises. You may be requested to attend a follow-up appointment 1-2 weeks later with a third visit 6 weeks after that. Any further visits are rare but may occur in chronic situations. Each examination will take up to 40 minutes and RTUS assessment involves no cost beyond a typical physiotherapy appointment. Please note that if you have joint or muscle pain you are more then welcome to request that these concerns also be assessed at another time by our very highly skilled and educated physiotherapists. In addition to recruiting your muscles better with exercises, you may benefit from any of the additional physiotherapy treatment tools : spinal or peripheral joint mobilization, spinal or peripheral joint manipulation (spinal adjustment), acupuncture, Gunn Intramuscular Stimulation (IMS), Active Release Techniques (ART), thermal/electrotherapy (therapeutic ultrasound, interferential current, electrical muscle stimulation), taping/bracing or orthotics. How many Real Time Ultrasound (RTUS) assessment and treatment sessions will I need? If you have no back pain and just want to ensure you are using your muscles correctly you often only need one session. If you have back pain of recent onset then you may find that one or two sessions is enough to learn to contract the core muscles. Effectively activating these core muscles may prevent a lifetime of recurring injuries. If you have had pain for many years it may take longer to teach you the optimal contraction because these core muscle have not be used efficiently worked for a long time. This may involve as many as 8-10 sessions over six months.

6 What does Real Time Ultrasound (RTUS) assessment and treatment cost? Each consultation will be a standard 40 minute physiotherapist visit ($85.00). You may claim this as a physiotherapy session if you have physiotherapy coverage with your health insurance provider. If you have any enquiries or would like to view what we are doing, please give us a call at Marda Loop Sport Physiotherapy as we would be happy to help you.