Graded exercise program
Graded exercise is an exercise program that starts out slowly and adjusts in very small steps. Musculoskeletal physician will create a tailor-made exercise plan with the patient and require him/her to stay with it, even feeling like doing more. The physician will then carefully watch the patient’s progress so that the volume of exercise can be moved either upward or downward as needed. The principle of the exercise program is to increase the exercise very slowly and let the body to make the changes it needs to cope with activity and exercise. Such program is shown by studies especially helpful for patients with fibromyalgia and chronic fatigue syndrome.
Proprioception refers to a sense of joint position and balance. It provides messages to the central nervous system (CNS) which then relays information to rest of the body on how to respond and with what amount of tension in what muscle groups so that the body can react by changing the centre of gravity to match the moves and stay in balance.
Bodies can be trained to improve the proprioception by creating balance challenges. The musculoskeletal physician can prescribe a proprioceptive training program to patients, sometimes with the help of training aids to assist them to attain better muscle balance, strength and responsiveness. Proprioceptive training is commonly used to rehabilitate of injured persons, but it can also be used to prevent injury for healthy persons who would like to engage in sports.
Core strengthening under real-time ultrasound guidance
In anatomy, the word “core” refers to the body minus the legs and arms. Major muscles included are the pelvic floor muscles, transversus abdominis, multifidus, internal and external obliques, rectus abdominis, erector spinae (sacrospinalis) especially the longissimus thoracis, and the diaphragm. Minor core muscles include the latissimus dorsi, gluteus maximus, and trapezius. Core muscles stabilize the back and extend the entire length of the trunk and hip girdle. These muscles help in controlling movements, in transferring energy and in shifting the body weight when the body moves in any direction.
Sometimes chronic back pain can be attributed to weakness of core muscles of the abdomen and the low back. Clinical studies have proven that people who specifically re-train these core muscles can significantly reduce pain and reduce the risk of recurring back pain.
Real-time ultrasound imaging allows direct viewing of how the muscles are working. Actually seeing the muscle as it contracts and feeling the sensation of correct contraction technique is a powerful form of bio feedback and can speed up muscle training. Training of the transversus abdominis under real-time ultrasound guidance has been used quite extensively in back pain rehabilitation. The imaging can provide an accurate assessment of the quality, timing and endurance of patient’s abdominal muscle contraction, which in turn allows the musculoskeletal physician to organize individual tailor-made plans for different muscle groups to fine tune the rehabilitation.
Besides, such technique can be used in the area of Women's Health for rehabilitation of the support muscles of the pelvic floor. During pregnancy extreme pressure is placed on the abdomen and pelvic floor. It is vital that the core muscles are retrained correctly during and after pregnancy to prevent long term urinary incontinence, back pain and instability.