This post was written by H&W instructor, Ginger Garner, PT, MPT, ATC, PYT, who teaches the Yoga as Medicine for Pregnancy and Labor & Delivery and Postpartum courses, and is teaching her brand new course, Extra-Articular Pelvic and Hip Labrum Injury, in June in Akron, OH.

Pregnancy brings with it a bevy of physiological and hormonal changes, both of which greatly influence orthopaedic health, not to mention psychoemotional well-being. However, what has historically been overlooked is the risk at which the acetabular hip labrum and related structures are placed during pregnancy, labor, delivery, and the postpartum. Hip labral tears are debilitating and painful, preventing normal ambulation, ADL completion, or participation in any recreational activity, including sex. Tears can also lead or contribute to pelvic pain, with the average time of injury to diagnosis being an average of 2.5 years. This delay in diagnosis can put mothers at high risk for developing chronic pelvic pain.

Several theories have been posited as to why pregnancy brings increased risk of hip labral pathology. Increased joint laxity has been widely debated but is generally accepted as a plausible mechanism in back pain, sacroiliac joint dysfunction, pubic symphysis dysfunction, or related pain. Increased (axial) loading through the joint combined with joint laxity are thought to be compounding factors. These changes alone could explain the presence of a prenatal tear, says researchers Brooks et al (2012).

Unavoidable changes in joint structure and function during labor and delivery also place mothers at higher risk, which means screening for hip joint intra-articular pathology is vital in the clinical setting. Further, forces applied externally during labor can be responsible for hip labral tears. Brooks et al (2012) found 4 of 10 women (all with labral tears) reported a specific incidence during labor, such as a pop, twist, or sudden sharp pain in the hip, that led to their diagnosis of hip labral tear. The range of motion that is most often forced in the hip during labor is flexion and internal or external rotation, combined with abduction. This is a common mechanism of injury that applies torque at the hip joint and can commonly be delivered by a birth assistant (husband, relative, or health care professional). Birth biomechanics education is an important aspect of hip labrum preservation that should be included in interdisciplinary care.

Screens to identify mothers at highest risk for hip joint pathology and special tests to target the hip labrum and related structures should be considered a regular part of prenatal and postpartum care in women’s health physical therapy. Hunt et al (2007) raises the importance of interdisciplinary interaction in maternal health care since “differential diagnosis of anterior hip, groin, and pelvic pain spans many health care specialties from gynecology to general surgery to musculoskeletal medicine and orthopedic surgery.”

Finally, pre-existing conditions of the hip and pelvis, such as femoral torsion, femoracetabular impingement (FAI), hip dysplasia, shallow acetabulum, and lumbopelvic instability or failed load transfer can all contribute to the incidence of, and increased risk for, hip labral tears. Since over 80% of women give birth in the United States during their lifetime, the vast majority of women are at risk for hip labral tears. Universal screening and education for hip joint preservation should be made available, through women’s health PT, as part of national agenda to improve birth and maternal health outcomes.

A discussion of postpartum risk, screening, and education are offered in the new Hip Labrum Differential Diagnosis course. This course emphasizes evidence-based assessment and management of the hip in an interdisciplinary educational environment. My courses are known for their interprofessional focus on partnership in medicine and welcome physical therapists, physicians, physician assistants, midwives, physical therapy assistants, nurses, and anyone who works with populations where hip labral injury could be a concern. The course will address differential diagnosis and assessment of extra-articular factors that implicate hip labral injury. At the course, I will discuss both conventional rehabilitation and integrative medicine techniques for management and preservation of the hip.

Want more from Ginger on this topic? Join us in June!

This blog was written by H&W course instructor Ginger Garner PT, MPT, ATC, PYT, who will be teaching her brand-new course, Extra-Articular Pelvic and Hip Labrum Injury: Differential Diagnosis and Integrative Management, in Akron, OH this June.

Hip labral injury is now recognized as a “major cause of hip dysfunction and a primary precursor to hip osteoarthritis.” Although acetabular labral tears were first identified in 1957, attention has only been directed toward the acetabulum in the last 10-15 years.

Populations at highest risk for hip labral injury include women, expectant mothers, women who have had vaginal hysterectomies, and young and middle-aged athletes. Women suffer from hip labral injuries more frequently than men, putting women at highest risk for premature aging in the hip and osteoarthritis.

Adding to insult to injury is the average time between injury and diagnosis is typically 2.5 years, significantly reducing long-term outcomes for joint preservation. Pelvic girdle pain, lumbopelvic pain, and extra-articular hip injury are also common comorbidities that accompany hip labral tears, making differential diagnosis essential to successful management.

Hunt et al (2007) cites that “differential diagnosis of anterior hip, groin, and pelvic pain spans many health care specialties from gynecology to general surgery to musculoskeletal medicine and orthopedic surgery.” This statement underscores the vital importance of a collaborative, interdisciplinary partnership in medicine. Early intervention in hip joint preservation requires teamwork on the part of all health care specialties involved in a patient’s care. Physical therapists are a critical part of that team.

Structural disorders of the hip are not the only culprit for hip labral injury, and as a result, development of a unique skill set for hip labral injury assessment that includes soft tissue and structural integrity evaluation is required. This positions physical therapists as perhaps one of the most ideal clinicians to differentially diagnosis hip impairment due to their expertise in both structural and soft tissue assessment.

It cannot be overemphasized that missing a hip labral diagnosis can mean a devastating long-term prognosis for a patient. What’s more is diagnosis is elusive, making it even more important for physical therapists and related providers to establish parameters for early intervention through critical evaluation of the hip. Hunt et al (2007) state diagnosis requires “a high index of suspicion, special attention to subtle patterns of presentation, and timely consideration for imaging studies.” A 10-12 week trial of physical therapy is recognized in the literature as the standard for initial conservative management and should address not only the primary pathology but the sequela that complicates hip labral management, such as pelvic, spine and lower-extremity abnormalities.

If you would like more from Ginger on this topic, the new Hip Labrum Injury courseemphasizes evidence-based assessment and management of the hip in an interdisciplinary educational environment. Ginger's courses are known for their interprofessional focus on partnership in medicine and welcome physical therapists, physicians, physician assistants, midwives, physical therapy assistants, nurses, and anyone who works with populations where hip labral injury could be a concern. The course will address differential diagnosis and assessment of extra-articular factors that implicate hip labral injury. Ginger will discuss both conventional rehabilitation and integrative medicine techniques for management and preservation of the hip. Registration is available here.

This post was written by H&W instructor, Ginger Garner, PT, MPT, ATC, PYT, who teaches the Yoga as Medicine for Pregnancy and Labor & Delivery and Postpartum courses, and is teaching her brand new course, Extra-Articular Pelvic and Hip Labrum Injury, in June in Akron, OH.

In my previous two posts, I have discussed The Postpartum Hip and Labral Tear Risk and The Importance of Early Intervention in Labral Tears. Today I want to highlight the importance of the iliopsoas and its potential contribution to intraarticular injury sequelae at the hip joint.

A recent collaborative paper including Harvard University’s Department of Orthopaedic Surgery, New York’s Hospital for Special Surgery and the Midwest Bone and Joint Institute in Illinois took on the task of a 3-D cross-sectional analysis of the iliopsoas in order to explain its relationship to the acetabular labrum. The findings are important not only for athletes, the targeted population who most frequently experiences labral tears, but also for the postpartum population I discussed in a previous blog post, The Postpartum Hip. This study represented the first attempt of 3-D analysis of the iliopsoas musculotendinous unit, and here is what the study found from dissection of 8 joints:

• The iliopsoas is found anterior to, and at the level of, the anterosuperior capsulolabral complex at the 2-3 o’clock position, or slightly lateral.

• The iliopsoas is comprised of about 44.5% tendon and 55.5% muscle belly at the exact level of the anterior labrum.

• An inflexible, not just a snapping, iliopsoas could possibly increase labral tear risk and prevalence in athletes.

• A labral tear associated with FAI (femoroacetabular impingement) is typically found at the 11:30-1 o’clock position, as opposed to an iliopsoas-induced tear, which is found at the 2-3 o’clock position.

• The researchers were led to study the iliopsoas’ contribution because the 2-3 o’clock position labral tear was being found with similar frequency as the typically expected 11:30-1 o’clock position during hip arthroscopy.

The acetabular labrum is responsible for not only maintaining joint congruity but also for pressurization. This means that In the absence of an intact labrum, contact forces are greatly increased in the hip joint, leading to premature aging of the hip and early osteoarthritis. In addition, repeat hip arthroscopy can be reduced and hip labral injury prevented or even mediated by addressing the iliopsoas length/tension relationship conservatively. The option also exists to release the tendon surgically at the level of the labrum (rather than the trochanter), and for athletes, early intervention using a team approach could mean the difference between hip joint preservation or hip joint degeneration.

Ginger's new Hip Labrum Injury course emphasizes evidence-based assessment and management of the hip in an interdisciplinary educational environment. Her courses are known for their interprofessional focus on partnership in medicine and welcome physical therapists, physicians, physician assistants, midwives, physical therapy assistants, nurses, and anyone who works with populations where hip labral injury could be a concern. The course will address differential diagnosis and assessment of extra-articular factors that implicate hip labral injury. Ginger will discuss both conventional rehabilitation and integrative medicine techniques for management and preservation of the hip.

This post was written by H&W instructor Lila Abbate PT, DPT, MS, OCS. Lila will be instructing Pelvic Floor Level 3 with Institute founder Holly Herman in San Diego at the end of this month! Sign up for the few remaining seats left in this popular course!

When treating your patient who has undergone a pelvic reconstruction in the not-so-distant past, does the mesh controversy come to your mind?Is the effect of the mesh causing your patient this dysfunction and is she complaining of urinary urgency, urinary frequency, or pelvic pain? Understanding pelvic muscle dysfunction, as pelvic rehabilitation providers do, can put us in a good position to help our patients, as well as to help our physicians with this oftentimes litigious issue.

Urogynecologists, gynecologists, urologists, or any surgeon who deals in the business of female sexual medicine and pelvic reconstruction seems to have been put in a position to defend their stance on the use of mesh when working with patients who present with any degree of pelvic organ prolapse (POP), be it complicated or simple.The decision to utilize mesh is now made with greater emphasis on education for the patient who is undergoing the procedure.

The Food and Drug Adminstration (FDA) has released a proposal on April 29, 2014 in order to address the potential reclassification of surgical mesh for transvaginal POP from a class II (moderate risk) to a class III (high risk) device and would “require manufacturers to submit a premarket approval (PMA) application for the agency to evaluate safety and effectiveness.” ¹ A similar proposal was put in place with breast implants in 1992 in order to create more awareness of safety concerns with the use of breast implants. ²

While older mesh kits (demonstrated to be more likely to cause complications) have been pulled from the market, any mesh surgery can create complications. As the body heals, scar tissue forms and contracts which is part of the normal healing process, and for some patients, this process can wreak havoc as the tissues and the mesh shrink. Muscles are bypassed, pressed upon, and ligaments are used as supportive measures for the mesh arms, and this can set up the pelvic floor muscles for edema, weakness, or even muscle over-activity. We know that different patients heal in different ways; just as a patient who has had a total hip replacement experiences muscle swelling, soreness, weakness, and scarring, a mesh surgery will necessarily create temporary dysfunction. However, physical therapists are skilled and well-versed in palpating and treating muscle dysfunction, scar tissue and adhesions, and we can educate our patients on the symptoms of mesh complication that may in fact be a muscle problem. Not every patient who has had mesh placement is suffering from mesh erosion, and physical therapists can help patients improve or resolve their symptoms over time through treatment.

Pelvic Floor Level 3 is an advanced course offered by the Institute that covers surgical procedures, pharmacology including hormone replacement, and other medical interventions that address pelvic muscle over-activity, tissue dysfunction, and surgical complications. Lab activities include manual techniques to downtrain (decrease muscle over-activity) such as Strain-Counterstrain of the pelvic floor muscles.

1.http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm395192.htm. Accessed on May 5, 2014.

2. http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/ucm064461.htm. Accessed on May 5, 2014.

This November, Herman & Wallace is thrilled to be offering a brand-new course instructed by Carolyn McManus, PT, MS, MA, called Mindfulness-Based Biopsychosocial Approach to Chronic Pain. This course will be offered November 15-16, 2014 in Seattle, WA. We sat down with Carolyn to learn more about her course.

The constant flood of information in today’s interconnected, wired world trains the mind in distraction and away from the immediate experience of life. Many people spend hours gazing down at quickly changing images on the small frame of an electronic device and only notice the body when it has its aches and pains! Mindful awareness offers us a skillful way to pay attention, build body awareness, touch life fully and provides a healing antidote to information overload.

Mindful awareness invites us to rest the mind in the present moment with openness, friendliness and curiosity. This is not our natural tendency and requires training. Often we are caught in a struggle with the present moment, perceive it as flawed, find fault with ourselves and constantly drive ourselves to run, do and achieve. When mindful, we still have our plans, goals and to-do list, but this is not an obstacle to resting the mind here and now. We can stop the struggle with the present moment, touch life fully and open to the potential for ease and insight in the midst of things just as they are. New perceptions and an experience of aliveness can occur that can never happen when we are lost in distraction. Danna Faulds expresses this beautifully in her poem "Walk Slowly":

It only takes a reminder to breathe,
a moment to be still, and just like that,
something in me settles, softens, makes
space for imperfection. The harsh voice
of judgment drops to a whisper and I
remember again that life isn’t a relay
race; that we all will cross the finish
fine; that waking up to life is what we
were born for. As many times as I forget to catch myself charging forward
without even knowing where I am going,
that many times I can make the choice
to stop, to breathe, and be, and walk
slowly into the mystery.

I began practicing mindfulness meditation to help manage stress and heal from a back injury. I found the practice easily translated to patient care and helped my patients build body awareness, detach from maladaptive thinking habits and experience inner calm and relaxation. They gained insight into the reactions, behaviors and situations that escalated and de-escalated their symptoms. Research shows that mindfulness improves attention regulation and executive function, body awareness and emotional regulation. (1) I am excited to share with my colleagues what I have learned through the practice of mindfulness and its applications to both self-care and patient care in my November course.

Learn more about Carolyn's course and join her this November in Seattle to attend her Mindfulness course!

1. Holzel BK, Lazar SW, Guard T, et al. How Does Mindfulness Meditation Work? Proposing Mechanisms of Action From a Conceptual and Neural Perspective. Perspect Psychol Science. 2011;6: 537–559.

This blog was written by Carolyn McManus, PT, MS, MA, who will be presenting at the APTA's Virtual NEXT conference in North Carolina. Carolyn is instructing a new course with Mindfulness-Based Biopsychosocial Approach to Chronic Pain. This course will be offered November 15-16, 2014 in Seattle, WA.

Last fall, I was honored to receive an invitation from the APTA’s National Conference team to contribute to this year’s Virtual NEXT programming. Virtual NEXT offers live and on-demand streaming of annual conference's signature lectures and select educational sessions, worth up to 1.6 CEUs. New this year, you can purchase presentations individually. For the price of one registration, you and your colleagues can get together and be part of a worldwide Virtual NEXT viewing party!

The title of my presentation, to be delivered on Thursday, June 12th, is “The Pain Puzzle: Empowering Your Patients to Put the Pieces Together.” I will highlight basic chronic pain neurophysiology, and briefly discuss the brain in chronic pain, stress-induced hyperalgesia and the cognitive modulation of pain. I will describe how this current evidence affects our clinical practice and suggest evidence-based treatment strategies. These will include therapeutic pain neurophysiology education and mindful awareness training. I will close with a case study that demonstrates how our treatment choices must be based on an understanding of underlying pain generating mechanisms in order to achieve success with this complex patient population.

If you cannot join me in Charlotte, North Carolina for APTA’s NEXT conference, I hope you can make an online date! For more information, go to the APTA’s NEXT Conference website:

Want to learn more from Carolyn? Join us in November in Seattle!

This blog was written by Carolyn McManus, PT, MS, MA, who will be presenting at the APTA's Virtual NEXT conference in North Carolina. Carolyn is instructing a new course with Mindfulness-Based Biopsychosocial Approach to Chronic Pain. This course will be offered November 15-16, 2014 in Seattle, WA.

We all know a highly stressed patient will have a more complicated and prolonged healing process than a non-stressed patient. Recent research is finally illuminating possible mechanisms causing the amplification of pain by stress. For example, stress has been shown to enhance muscle nociceptor activity in rats. (1) In this study, water avoidance stress produced mechanical hyperalgesia in skeletal muscle and a significant decrease in the mechanical threshold of muscle nocicpetors, a nearly two fold increase in the number of action potentials produced by a fixed intensity stimulus and an increase in conduction velocity from 1.25 m/s to 2.09 m/s! Researchers suggest these effects are due, at least in part, to catecholamines and glucocorticoids acting on adrenergic and glucocorticoid receptors on sensory neurons.

I always talk about this study with my patients who have persistent pain. It helps them understand that pain can escalate, not because of tissue damage, but because of the effects of stress hormones on their nerves. They understand that if they persist in escalating their stress reaction they will limit their healing potential. There is more research on this topic and strategies to help patients self-regulate their stress reaction that I look forward to discussing in my upcoming course in November.

1. Chen X , Green PG, Levine JD. Stress enhances muscle nociceptor activity in the rat. Neuroscience 2011;185:166-73.

Learn more about Carolyn's course Mindfulness-Based Biopsychosocial Approach to Chronic Pain

This post was written by H&W instructor Carolyn McManus, PT, MS, MA. Carolyn will be instructing the course that she wrote on "Mindfulness-Based Biopsychosocial Approach to the Treatment of Chronic Pain" in Seattle this November.

I have taught Mindfulness Based Stress Reduction at Swedish Medical Center (SMC) since 1998. Over the years I have had many healthcare providers take the course and have long thought it would be wonderful to tailor a program specifically for healthcare professionals. I had the opportunity to do so this summer when, along with my colleague Diane Hetrick, PT, we designed and taught Mindfulness and Compassion Cultivation Training for physicians at SMC. The course was a great success. Physicians reported one of the most popular components of the program were our “on the spot” mindful practices. These are simple, easy-to-do strategies that any provider can employ to center, calm the body and steady the mind during a busy workday. They not only help reduce stress, but can influence brain activation to promote better decision making.

Research shows, under stress conditions, the amygdala activates stress pathways in hypothalamus and brainstem, evoking high levels of noradrenaline and dopamine release, impairing prefrontal cortex function. (1) Research also shows mindful practices reduce stress-related brain activity and improve executive functioning. (2, 3) I am delighted to share these powerful and practical “on the spot” mindful practices in my November course. My intention is for participants to have mindfulness skills to use for their own well-being the minute they walk in their clinic door on Monday.

Learn more about Carolyn's course Mindfulness-Based Biopsychosocial Approach to Chronic Pain and join her in Seattle this fall!

1. Arnsten AF. Stress signaling pathways that impair prefrontal cortex structure and function. Nat Rev Neurosci 2009:10(6):410-422.

2. Holzel BK, Carmody J, Evans KC, et al. Stress reduction correlates with structural changes in the amygdala. Soc Cogn Affect Neurosci. 2010;5(1):11–17.

3. van den Hurk PA, Giommi F, Gielen SC, et al. Greater efficiency in attentional processing related to mindfulness meditation. Q J Exp Psychol (Hove) 2010;63(6);1168–1180.

This November, Herman & Wallace is thrilled to be offering a brand-new course instructed by Carolyn McManus, PT, MS, MA, called Mindfulness-Based Biopsychosocial Approach to Chronic Pain. This course will be offered November 15-16, 2014 in Seattle, WA. We sat down with Carolyn to learn more about her course.

What inspired you to create this course?

I want to improve the lives of people with chronic pain and help my colleagues be successful in providing care to this often challenging patient population. With my academic training in both PT and psychology, my longstanding mindfulness meditation practice and over 25 years specializing in the care of people with chronic pain, I have a wealth of information and a wide range of practical skills to share with my colleagues.

Among my co-workers at Swedish Medical Center, I learned that those who liked working with patients with persistent pain felt they had something to offer that would help. Those who did not like this patient population felt there was nothing they could do to make a difference in the lives of these patients. I want physical therapists to have the skills and confidence to make a difference and improve the lives of people with chronic pain. I want others to know the same feeling of reward I feel when I have made that difference.

I have had colleagues comment to me that although they understand the basic principles of chronic pain, they do not feel confident to explain pain to patients or talk about the role of stress, cognitions and emotions in amplifying pain. I want to give my colleagues the language to do just that. I do not mean stepping beyond our comfort zone or scope of practice, but rather to offer patients a basic framework for the mind body relationship, based in neuroscience, that can change a patient’s attitude and belief system about pain.

I also want to introduce my colleagues to mindfulness. Mindfulness is the ability to rest the mind in the present moment with an open, friendly, curious attitude. This skillful way to pay attention has made an enormous difference in my personal and professional life and in my patient’s lives. Although it takes years of training to teach mindfulness meditation, any healthcare provider can draw on the basic principles of mindfulness to support a patient’s well being and healing.

What resources and research were used when writing this course?

I track the pain literature closely and am especially interested in how the brain changes with chronic pain and the role of stress, emotions and cognitive variables in contributing to chronic pain conditions. PTs are highly skilled to address the nociceptive component of a patient’s pain complaints. As our understanding of chronic pain has broadened to include principles of central sensitization, structural and functional brain changes and the cognitive modulation of nociceptive input, we need to have the training and skills to address these multiple and complex components that give rise to chronic pain conditions. I draw from literature in physical therapy, pain, psychology and mindfulness meditation.

Why should a therapist take this course? How can these skill sets benefit his/ her practice?

If you ever feel overwhelmed, frustrated or challenged by patients with persistent pain conditions, this is the course for you. You will learn the about the exciting new science of pain, the amazing ways stress and cognitive modulation impacts the pain system, and how to apply mindfulness to help manage your own stress during your workday. In addition, you will be able to explain pain, the role of stress in amplifying pain, the mind-body connection and mindfulness to your patients to help empower them to maximize what they can do for themselves to promote healing and well being.

Want to learn more from Carolyn? Join us in November in Seattle!

This post was written by H&W instructor Allison Ariail, PT, DPT, CLT-LANA, BCB-PMD. Allison will be instructing the Rehabilitative Ultrasound course in Seatlte in May.

In the past decades, evidence has been established showing the importance of the local stabilizing muscles, including the transverse abdominis, the lumbar multifidus, and the pelvic floor muscles on the stability of the pelvic ring and lumbar spine. Many therapists have embraced this knowledge and incorporate a specific stabilization program into their plan of care for patients with dysfunction in the lumbar spine or pelvic ring. This plan of care can be more time consuming for the therapist since we are no longer simply prescribing strengthening exercises to the patient, but instead are using neuromuscular re-education to retrain recruitment patterns and improve motor control. For many patients, learning to activate these muscles can be very difficult and frustrating. This is where biofeedback comes in. For years, women’s health therapists have been using biofeedback to retrain the pelvic floor muscles. Biofeedback is the process of bringing unconscious physiological processes to consciousness and gaining control over it. These same principles can be used in retraining the lumbar multifidus and the transverse abdominis, in addition to the pelvic floor. Currently, biofeedback methods used in treating low back pain include rehabilitative ultrasound imaging (RUSI) and the pressure cuff. My preferred method is using RUSI. This tool not only provides biofeedback for the patient but allows for real-time assessment of the muscle activation. Thus, providing the clinician valuable feedback on timing of recruitment and strategy used by the patient that would not be assessed with palpation alone.

Giggins et al recently released a literature review that covered different forms of biofeedback used in rehabilitation. Interestingly, there is little evidence to support the use of pressure cuff. Some of the research reported found significant increases in gluteus medius and internal oblique activity. In 2013, Grooms et al also determined that correlation and likelihood coefficients indicate that the pressure cuff is likely of minimal value to detect transverse abdominis activation. I personally have had patients referred to me from other therapists to confirm whether or not they were activating their transverse abdominis. In previous treatments, the patients had been using the pressure cuff and palpation by the therapist as confirmation of proper activation. What I found was consistently the patients were not achieving good contractions in their transverse abdominis muscles. Most of these patients were able to learn in one or two sessions how to properly contract their transverse abdominis, and were later able to progress to performing a co-contraction of all the local stabilizers during motor tasks.

Hides et al published a study that demonstrated a specific stabilization rehabilitation program using RUSI was successful in decreasing pain, increasing muscle cross sectional area, and improving motor control in elite cricket players that had previously experienced low back pain. This is a great example of how neuromuscular re-education using RUSI works for the patient when the therapist is using it as both an assessment tool, as well as a biofeedback tool.

So far the limiting drawback of RUSI is the cost of the ultrasound unit. However, companies are constantly coming out with more affordable units making this useful tool more available for clinics. If you are interested in learning more about using US imaging as both an assessment and biofeedback tool join me in Seattle this May for a course that addresses the use of Rehabilitative Ultrasound Imaging in conjunction with a specific stabilization program.

References:

Giggins, Persson, Caulfield. Biofeedback in Rehabilitation. Journal of Neuroengineering and Rehabilitation.2013; 10:60.

http://www.biomedcentral.com/content/pdf/1743-0003-10-60.pdf

Grooms, Grindstaff, Croy et al. Clinimetric Analysis of Pressure Biofeedback and Transversus Abdominis Function in Individuals With Stabilization Classification Low Back Pain. JOSPT.2013; 43(3):184-193

http://www.jospt.org/doi/abs/10.2519/jospt.2013.4397

Hides, Stanton, Wilson et al. Retraining motor control of abdominal muscles among elite cricketers with low back pain. Scand J Med Sci Sports.2010; 20: 834-842.

http://www.ncbi.nlm.nih.gov/pubmed/19804578