Sunday, June 14, 2009

What RUSI answars in LBA cases

According to Knudson HA (a doctor of physical therapy) real time ultrasound imaging can provide answer all of the following questions or identify the following problems associated with LBA.

1. Test voluntary activation through conscious effort. Identify change in motor control in individuals with low back pain. If muscle wasting is identified, what is the % difference between sides of the specific segment? Identify unilateral muscle wasting within a specific segment of lumbar multifidus. Is the patient able to consciously contract lumbar multifidus while in an unloaded position without trunk movement or limb loading? Can the patient emphasize activation of deep fibers of multifidus while limiting activation of superficial fibers? (Poor quality of lumbar multifidus contraction?) Does the muscle composition of multifidus look healthy, without fatty infiltrate, fluid from injury, fibrosis, soft tissue adhesions, or calcium deposits?

2. Does the patient display one of 5 clinical patterns of transversus abdominis dysfunction during testing for the automatic recruitment strategy used by the nervous system to control the trunk? Observe the automatic recruitment strategy to identify normal or abnormal control of transverse abdominis during load transfer involving movement of limbs. Is the patient able to maintain a tonic hold of transverse abdominis without movement of the spine during testing for conscious activation?

3. How long can a patient sustain a transverse abdominis or lumbar multifidus contraction before fatiguing? Can the patient co-contract transverse abdominis and lumbar multifidus, independent of the global superficial muscles of the back/abdomen?

4. When the patient draws in the lower abdomen, how much of a linear change in lateral pull of the fascia attachment occurs from rest to active without significant internal obliques thickness increase and with minimal transverse abdominis thickness increase? Does the patient have automatic tonic contraction occurring with movement?


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