shelbourne Physical Therapy

Real Time Ultrasound

Real time ultrasound Victoria BC

Real Time Ultrasound (RTUS) is a tool used by specially trained Victoria Shelbourne Physiotherapists Penny Salmas and Holly Mallari to look at the muscles inside your body from the outside. RTUS provides a moving image of the muscles, allowing your Physiotherapist to point out which muscles should be working and when you are activating them correctly. Real Time Ultrasound is a great tool to assist in the evaluation of pelvic floor muscle tone and activation. RTUS helps our Physiotherapists to evaluate Diastatsis Rectus abdominus and helps for functional retraining biofeedback of deep abdominal musculature. Discover and retrain your deep core.

Seeing is believing!

Using a diagnostic ultrasound, our Shelbourne Physiotherapists can watch your different layers of muscles contract, relax and most importantly look at their muscle contraction timing, size and even how much fatty tissue is contained within your muscle. Sometimes it is hard to get the right muscle contracting in the right way. Seeing the muscle working on the screen as you contract it and relax it can make learning the correct contraction so much easier. Most commonly we look at the Deep Abdominals (Transverse Abs or TA), the Pelvic Floor Muscles and the deep muscles of the lower back (Multifidus) to assess their activation and function. The RTUS can then be used as a training tool to help you recruit and strengthen the muscles. Being able to see the muscles as you exercise leads to a better understanding of how to activate them because you get immediate visual feedback as you learn.

Real Time Ultrasound in Victoria BCThe equipment used in RTUS imaging is non-invasive (does not pierce the skin) and does not use radiation. Ultrasound uses high frequency sound waves and their echoes to produce an image, it is the same type of machine that is used to look at unborn babies in the womb. The Physiotherapist uses a hand-held probe which transmits high frequency sound waves into your body. The soundwaves are reflected back into the probe when they hit a boundary between tissues (eg. between muscle and fluid, or bone and muscle) and then relayed back to the machine for processing. Some waves travel further than others, hence the ability to see the layers at different depths within the body.

In cases of Acute or Chronic Lower Back Pain, Poor Posture, Incontinence or following spinal and abdominal surgery (including C-sections) your Physiotherapist may suggest using RTUS as part of your treatment. The core stabilizing muscles often switch off when you are experiencing pain, but with training you can learn to switch these muscles back on helping them to start activating automatically on a day to day basis.

When attending a real-time ultrasound appointment, please ensure you have an ‘almost full’ bladder as this greatly enhances the image clarity. The first session will typically take up to an hour and you may require one or more 30 minute follow up sessions. Your sessions will be claimable through your private extended health plan as Physiotherapy.

Real Time Ultrasound VictoriaContinued research highlights that the primary impairment of the muscular system in individuals with lumbopelvic dysfunction is not one of strength, endurance or functional capacity, but rather of motor impairment. In particular it has been suggested that there is a pattern of hyperactivity of the superficial, and hypoactivity of the deep muscles of the region. The clinical extrapolation of this is that the initial and pivotal focus in rehabilitation must address these motor impairments by retraining a coordinated contraction of the deep trunk muscles, and restoring appropriate activation of the superficial muscles. Success hinges upon the ability to detect the specific motor deficits of each individual patient. This requires a high level of clinical skill as some of these muscles are located deep and their desired contraction is sub-maximal. Consequently, the evaluation and the initial retraining phase can be augmented with the aid of ULTRASOUND IMAGING technology. REHABILITATIVE ULTRASOUND IMAGING (RUSI) has been used by research driven clinicians as a safe and cost effective method to enhance both the assessment and treatment of patients with motor impairments of the lumbo-pelvic muscles, (including; external and internal oblique, rectus abdominis, transversus abdominis, lumbar multifidus, the diaphragm and the pelvic floor muscles).

The value of RUSI is that it allows for real time study of these muscles as they contract and impact their associated fascial attachments. This allows both the patient and the therapist to view the contraction as it happens, leaving little room for supposition. Consequently RUSI can be used as both an assessment tool, and maybe more importantly as a form of biofeedback, providing patients with knowledge of performance, in the early stages of motor relearning. We look forward to helping you in our Victoria Physiotherapy Clinic.

What Conditions Benefit from Real Time Ultrasound Physiotherapy in Victoria BC?

Ultrasound Physiotherapy can be used for any muscle retraining. The most popular conditions we see in Victoria that can be assisted by real time ultrasound Physiotherapy include:

  • Lower Back Pain-Transverse Abdominus and Multifidus
  • Sciatica
  • Sacro-Iliac Joint Pain
  • Pregnancy Back Pain
  • Pelvic Instability
  • Hip Pain-Gluteal Tendinopathy
  • Shoulder Pain-Rotator Cuff
  • Knee Pain
  • Foot Exercises
  • Core Exercises
  • Pelvic Floor
  • Pilates

Core Exercises Real Time Ultrasound & Back Pain

Back pain researchers pioneered real time ultrasound physiotherapy in the successful treatment of lower back pain. They found that the  best way to activate the correct core stability muscles is to actually see them working on a real-time ultrasound scan as you perform the core exercises. When we attempt to retrain your deep core stability muscle such as Transversus Abdominis or Multifidus being able to feel the muscle working is very important. Unfortunately, since the Transversus Abdominis muscle is located deep in your abdomen and beneath two outer muscles, it can be quite hard to feel whether it is switching on or not. And, it's almost impossible to detect whether the outer two muscles are working rather than the correct muscle. This is where the real time ultrasound scanner comes into its own. The technique of ultrasound retraining, carried out with the guidance of a specially trained ultrasound Physiotherapists such as Penny Salmas and Holly Mallari enables you to quickly learn how to correctly contract your transversus abdominis, multifidus and other core muscles. The ultrasound scanner provides you and your Victoria Physiotherapist with a video picture of your muscles working. This enables you to precisely match up what you think you feel with what is actually happening beneath your skin at that very moment. This makes it much easier for you to correctly do your deep core stability exercises at home, which will quicken the solution to your pain. 

Why do oue Victoria Physiotherapists perform Ultrasound?

Physiotherapists use real-time ultrasound to examine how the deep stabilizing muscles of the spine are functioning. This assessment screens if the core muscles of the spine or what we are now referring to as the “abdominal cylinder” muscles or “cannister” muscles of the trunk are being recruited ideally to best supports the spine. Real Time Ultrasound is a hands on, dynamic, and interactive examination which allows our Physiotherapists to use real time high resolution soft tissue imaging. It also facilitates dynamic examination of anantomic structures whle interacting with you during the imaging process.

Why is Real Time Ultrasound important?

In episodes of low back pain these deep stabilising muscles get inhibited and on the real time ultrasound we can see poor timing, incorrect recruitment and muscular movement patterns that can exacerbate the back condition. Abdominal muscle cannister includes the transverse abdominas (which is the lower abdominal muscles), pelvic floor muscles, deep lower back muscles (multifidis) and diaphragm. The four parts of the abdominal cannister work synergistically together to best support the spine. This is referred to lumber pelvic stability in the literature and often spoken of as “neutral” spine. The deep abdominal muscle transversus abdominus, surrounds the trunk and acts like a natural back brace. The pelvic floor works to regulate bladder and bowel control, support the pelvic organs and is important in sexual function. These muscles work in unison with the diaphragm and other spinal stabilising muscles to provide core stability.

Scientific research has shown that during an episode of low back pain these important deep stabilizing muscles can switch off, waste away long after the pain has settled. They do not automatically return to ideal function on resolution of pain. This is why it is vital after an episode of low back pain that your deep stabilising muscles are assessed. The real time ultrasound is a fantastic biofeedback tool to help you see and understand how these muscles work to prevent reoccurence of low back pain and possible spinal degeneration over time.

What is involved?

A specially trained physiotherapist will measure the function, the hold time and overall contraction sequences between your muscles. This is performed in different positions and can be customised for each individual. Real time ultrasound is safe, effective non invasive and pain free. A small ultrasound head and water soluble gel are placed on various muscles and the images are viewed on a screen. Images can be recorded and measured for future comparison.

Who needs Real Time Ultrasound assessment?

Real time ultrasound is recommended for a wide range of people including:

  • low back pain (acute, chronic or recurrent),
  • sacrioliac joint pain or excess pelvic joint movement
  • mid back pain
  • neck pain
  • hip pain
  • knee pain
  • foot pain
  • shoulder pain
  • bladder dysfunction
  • pelvic floor muscle contraction (correct movement pattern)
  • residual urine volumes
  • pre and post spinal surgery
  • ante/post natal mothers
  • injured workers
  • athletes/dancers/gymnasts

Real Time Ultrasound Research

Real-Time Ultrasound Feedback and Abdominal Hollowing Exercises for People with Low Back Pain

Musculoskeletal Ultrasound- A brief overview of diagnostic and therapeutic applications in musculoskeletal medicine


Real Time Ultrasound in Victoria at Shelbourne Physiotherapy
Shelbourne Physiotherapy 3200 Shelbourne Street #100B Victoria, BC V8P 5G8 CA
Phone: 250-598-9828 Website: