• Do you work with postpartum patients and wish you could help them recover more quickly in the postpartum time period?
  Do you work with pelvic pain patients who have sacroiliac joint pain?
  Do you work with patients that have a weak core?

Rehabilitative ultrasound imaging is a tool that is very helpful for the clinician to assess motor control and muscle morphology. It is also very helpful as a biofeedback tool for patients trying to improve their pelvic floor or core strength.

In an article published in 2021, researchers performed a systematic review of the efficacy of rehabilitative ultrasound imaging for improving motor control exercises compared to no feedback and other feedback methods. Studies included in the systematic review assessed the abdominal wall muscles, pelvic floor, serratus anterior, and/or lumbar multifidus. What they found was that rehabilitative ultrasound imaging was more effective than tactile and verbal biofeedback for motor control exercise performance. Patients using ultrasound imaging demonstrated increased muscle activity, muscle thickness, and target exercise success compared to tactile and verbal biofeedback. Additionally, longer retention was noted when ultrasound imaging was used. Having constant feedback by watching the monitor of the ultrasound while performing an exercise compared to feedback after performing an exercise showed superior motor learning long-term (Valera-Calero, 2021).

Using ultrasound is a marketing tool and something that will enhance your clinical offerings. Patients enjoy using this biofeedback method!  When asked what they thought of the use of ultrasound, this is how a few patients responded:

• “Using the ultrasound has helped me to learn to use my deep core muscles. This has helped me to recover from back pain after having twins. I am a radiologist and Allison's use of ultrasound in therapy was very unique for me and made the difference between getting better and living with pain.”  (RK, 39 years)
• "I loved using ultrasound to view my pelvic floor muscles to help with my incontinence. It was so easy and made therapy kind of fun. I highly recommend using ultrasound.” (AJ, 65 years)
• “My doctor told me to get on the waitlist for therapy using ultrasound instead of going elsewhere. He was right, it was totally worth it! I have tried therapy several times before but this time, I feel I am actually getting stronger and better!” (MK, 29 years)

Learn to use rehabilitative ultrasound in your practice and take the course with Herman & Wallace. Rehabilitative Ultrasound Imaging: Pelvic Health and Orthopedic Topics is offered at multiple locations. If you have a  US machine with a curvilinear transducer that images a frequency that ranges from 3 to 10 MHz and is capable of abdominal viewing then you can also register as a "Self-hosted" attendee. This course is offered in a two-day option (Orthopedic Topics) with external labs, and a three-day option (Pelvic Health & Orthopedic Topics) that includes transperineal labs.

Join us to learn how to use this great clinical tool!

Rehabilitative Ultrasound Imaging: Orthopedic Topics - Satellite Lab Course - October 25-26, 2024

• Fort Wayne IN
• Little Rock AR
• Oklahoma City OK
• Self-Hosted

Rehabilitative Ultrasound Imaging: Pelvic Health & Orthopedic Topics - Satellite Lab Course - October 25-27, 2024

• Fort Wayne IN
• Little Rock AR
• Oklahoma City OK
• Self-Hosted

Reference:

Valera-Calero JA, Fernández-de-Las-Peñas C, Varol U, Ortega-Santiago R, Gallego-Sendarrubias GM, Arias-Buría JL.(2021). Ultrasound Imaging as a Visual Biofeedback Tool in Rehabilitation: An Updated Systematic Review. Int J Environ Res Public Health. 18(14):7554. doi: 10.3390/ijerph18147554. PMID: 34300002; PMCID: PMC8305734.

AUTHOR BIO:
Allison Ariail, PT, DPT, CLT-LANA, BCB-PMD, PRPC

Allison Ariail has been a physical therapist since 1999. She graduated with a BS in physical therapy from the University of Florida and earned a Doctor of Physical Therapy from Boston University in 2007. Also in 2007, Dr. Ariail qualified as a Certified Lymphatic Therapist. She became board-certified by the Lymphology Association of North America in 2011 and board-certified in Biofeedback Pelvic Muscle Dysfunction by the Biofeedback Certification International Alliance in 2012. In 2014, Allison earned her board certification as a Pelvic Rehabilitation Practitioner. Allison specializes in the treatment of the pelvic ring and back using manual therapy and ultrasound imaging for instruction in a stabilization program. She also specializes in women’s and men’s health including conditions of chronic pelvic pain, bowel and bladder disorders, and coccyx pain. Lastly, Allison has a passion for helping oncology patients, particularly gynecological, urological, and head and neck cancer patients.

In 2009, Allison collaborated with the Primal Pictures team for the release of the Pelvic Floor Disorders program. Allison's publications include: “The Use of Transabdominal Ultrasound Imaging in Retraining the Pelvic-Floor Muscles of a Woman Postpartum.” Physical Therapy. Vol. 88, No. 10, October 2008, pp 1208-1217. (PMID: 18772276), “Beyond the Abstract” for Urotoday.com in October 2008, “Posters to Go” from APTA combined section meeting poster presentation in February 2009 and 2013. In 2016, Allison co-authored a chapter in “Healing in Urology: Clinical Guidebook to Herbal and Alternative Therapies.”

Allison works in the Denver metro area in her practice, Inspire Physical Therapy and Wellness, where she works in a more holistic setting than traditional therapy clinics. In addition to instructing Herman and Wallace on pelvic floor-related topics, Allison lectures nationally on lymphedema, cancer-related changes to the pelvic floor, and the sacroiliac joint. Allison serves as a consultant to medical companies, and physicians.

A different approach to treating prostatectomy patients.

The Pelvic Rehab Report sat down with Allison Ariail, PT, DPT, CLT-LANA, BCB-PMD, PRPC to discuss her upcoming courses Rehabilitative Ultrasound Imaging - Orthopedic Topics and Rehabilitative Ultrasound Imaging: Women's Health and Orthopedic Topics scheduled for November 12-14, 2021. Allison specializes in the treatment of the pelvic ring and back using manual therapy and ultrasound imaging for instruction in a stabilization program. She also specializes in women’s and men’s health including conditions of chronic pelvic pain, bowel and bladder disorders, and coccyx pain.

As a pelvic floor clinician, you may have worked with patients who are suffering from urinary incontinence following prostatectomy. During a prostatectomy the prostate, seminal vesicles, prostatic urethra, and some connective tissues are removed. The extent of the removal will depend on the size of the tumor and if the tumor has spread into the surrounding tissues.  Because of the surgery, and the loss of smooth muscle surrounding the urethra, there is an inherent risk that these patients will suffer from urinary incontinence. Recently, there have been studies that examined the difference between patients who return to continence and those who do not return to continence following prostatectomy. They found that continent prostatectomy men demonstrated increased displacement of the striated urethral sphincter, bulbocavernosus, and puborectalis compared to incontinent men. They also found that continent prostatectomy patients demonstrated better puborectalis and bulbocavernosus function than controls! (1) This has made researchers conclude that continent men following prostatectomy compensate for the loss of smooth muscle by having better than normal function in their pelvic floor.

In another recent article, researchers put together recommendations for a rehabilitation program. They argue that traditional methods that have been used in pelvic floor therapy are based on applied principles for stress incontinence in women, not men. Men suffer from incontinence for a different reason than women. Thus, their treatment should be approached differently as well.  Additionally, the authors state that examining the pelvic floor muscles via a digital rectal exam does not allow the examiner to assess the underlying issue that leads to incontinence in men, the striated urethral sphincter. Instead, a digital rectal exam identifies issues in the external anal sphincter and puborectalis. They highly recommend the use of transperineal ultrasound imaging in order to view the contraction of the pelvic floor and confirm where the contraction is originating from. They also highly recommend the use of ultrasound in treatment for the use of motor re-learning(2).

We will discuss this more in-depth as well as learn how to use ultrasound imaging to help both male and female patients suffering from incontinence. We also will be learning how to use ultrasound imaging to address orthopedic conditions such as back pain, sacroiliac joint pain, and diastasis rectus. The course “Rehabilitative Ultrasound Imaging for the Pelvic Girdle” is now being offered with satellite locations as well as a limited number of self-hosted online groups and is scheduled for November 12-14, 2021. There are two courses being offered. The 2-day version, Rehabilitative Ultrasound Imaging - Orthopedic Topics, addresses the use of ultrasound imaging to help back and lumbopelvic conditions. While the 3-day course, Rehabilitative Ultrasound Imaging: Women's Health and Orthopedic Topics, includes more pelvic floor related conditions such as prolapse and post-prostatectomy issues. The course includes ample lab time so participants leave with the clinical skills to be able to use ultrasound imaging in their practice.

1. Stafford R.E., Couglin G., Hodges P. Comparison of dynamic features of pelvic floor muscle contraction between men with and without incontinence after prostatectomy and men with no history of prostate cancer. Neurourology and Urodynamics. 2020; 39:170-180.
2. Hodges, PW., Stafford RE, Hall L., et al. (2020). Consideration of pelvic floor muscle training to prevent and treat incontinence after radical prostatectomy.  Urologic Oncology: Seminars and Original Investigations.  38: 354-371