Real Time Ultrasound

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  • (07) 3342 4284
  • [email protected]
  • www.physiotec.com.au

  • 23 Weller Road
    Tarragindi
    Brisbane QLD 4121

Real Time Ultrasound

Real time ultrasound allows the capturing of real time pictures of structures within the body, using high frequency sound waves that are inaudible to human ears.The sound waves, which are completely safe for human tissue, are sent into the tissues, and the sound waves that are bounced back are used to create the picture. This amazing technology is widely used in medicine for assessing internal organs, blood vessels and developing babies. Ultrasound is also extremely useful for imaging muscles, tendons and ligaments when assessing the consequences of an injury or the cause of persisting musculoskeletal pain. Twenty years ago physiotherapists began using ultrasound not only to look at the size and health of muscles, but to look at activation patterns of muscle groups. There is now a large volume of scientific research confirming the validity, reliability and usefulness of such techniques.

While we can see and palpate the superficial muscles, it is not possible to accurately assess size, quality or activation patterns of deep muscles, as these muscles lay beneath other larger, more superficial muscles. While superficial muscles are generally our power producers for movement, the deeper shorter muscles hug around our joint providing protection, stability and fine control of movement. Researchers have shown that there are often ongoing problems in our deep muscle systems in persisting pain states or recurrent injury. General strengthening programmes in these cases have often failed to normalise function in the deep system, even though the superficial system has become larger and stronger. This can sometimes make the problem worse – if you have larger muscles placing greater loads across joints that are relatively unprotected by an inefficient deep system, worsening pain or re-injury can occur.

Deep muscles are often inhibited and superficial muscles overwork to compensate in persistent pain states or recurrent injuries, resulting in muscle imbalance, pain and stiffness, and reduced efficiency and physical performance.

Deep muscles are particularly prone to inhibition. We know from research that pain inhibits deep muscles, and a lack of weightbearing or poor postures can also negatively influence deep muscles around the spine and pelvis. The superficial muscles have been shown to be much less susceptible to inhibition, so if the deep system is not doing its job the brain ‘upregulates’  the superficial system to ensure you can still get from A to B (hunter & gatherer survival instinct).

However when superficial muscles try to do the ‘stabilising’ job – 1. You become much less efficient using lots more energy for each task (remember you usually only use small muscles to do this task with less metabolic cost) and 2.  The underlying joints are exposed to much higher compressive loads and shear forces imposed by the big superficial muscles. This can make you feel tight, rigid or less fluid in your movements, more fatigued, and more painful, and the loss of efficiency may reduce athletic performance.

Real time ultrasound provides an incredible opportunity to assess the health and function of these muscles, not only at rest, but during active movement. No other imaging modality has the same versatility as ultrasound. Physiotherapists can then use ultrasound to train you how to consciously activate your deep muscle systems and protect your joints more effectively prior to and throughout movement. It also helps us to teach you to ‘downregulate’ your superficial system making you less rigid and more efficient in your movements, and then we can strengthen the both systems together in safe and balanced way.

Real time ultrasound provides a unique window into the function of our deep muscles during movement. This level of information cannot be provided by visual assessment, palpation or any other imaging modality to date.

Real time ultrasound and lower back pain

The greatest volume of research surrounds the use of real time ultrasound in the assessment and retraining of muscles around the trunk in those with back and pelvic pain. Ultrasound is used to assess and retrain muscles of the abdominal wall, deep lumbar stabilisers (multifidus), and the pelvic floor musculature. Retraining these muscles with real time ultrasound is often an excellent first step in the recovery of optimal function.

Transversus Abdominis Ultrasound At Rest
Ultrasound retraining of the abdominal wall - Transversus abdominis

Ultrasound image of transversus abdominis contracted
Transversus abdominis contracted - note the deep muscle shortened to the right

Physio's skilled in RTUS
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Dr Alison Grimaldi
Principal Physiotherapist
PhD
BPhty
MPhtySt (Sports)

Dr Alison Grimaldi

Alison is our Principal Physiotherapist, with 28 years of clinical experience and particular expertise in the management of hip, groin and lumbo-pelvic pain and dysfunction. Alison also has a special interest in the assessment and optimisation of lumbo-pelvic and lower limb biomechanics for running, change of direction and all weightbearing sports, aiming to maximize an athlete’s performance outcomes and minimize risks of injury or re-injury.
Alison completed a Bachelor of Physiotherapy at the University of Queensland in 1990, a Masters of Sports Physiotherapy in 1997, and her Doctorate in Philosophy in the Field of Physiotherapy (PhD) in 2008. Her PhD studies were concerned with improving our understanding of hip muscle function and the relationship with hip joint pathology and weightbearing stimulus. These studies involved research collaboration with the European Space Agency. Alison continues to be passionate about extending our understanding of why we develop problems around the hip and pelvis, and what we can do to most effectively prevent and manage these problems. She is currently involved with research studies through the University of Queensland and University of Melbourne, has co-supervised a number of PhD students, and has pioneered the use of Real Time Ultrasound technology for the assessment and retraining of muscle function around the hip & pelvis. Due to her valuable contributions to research at the University of Queensland, Alison has been awarded the title Adjunct Senior Research Fellow in the School of Health & Rehabilitation Sciences.

It is one of Alison’s core beliefs that research should be relevant to clinical practice and helping the patients we treat every day, and that physiotherapists in the community should have access to this valuable information to allow them to transfer this knowledge into clinical practice as quickly as possible. To this end, Alison continues to publish, present and provide practical workshops for other health professionals. Alison has published a number of papers in scientific journals, has contributed detailed information freely accessible via podcasts by PhysioEdge (itunes) and the British Journal of Sports Medicine (SoundCloud), and has recently contributed to 3 leading physiotherapy and sports medicine text books. Alison is a visiting lecturer at Masters level at Queensland University, and also runs weekend seminars and courses around Australia & overseas with a focus on muscle function, therapeutic exercise, and the use of real time ultrasound in clinical practice. She has presented at many state, national & international conferences as an Invited or Keynote Speaker, and has run international seminars in England, Ireland, Scotland, Wales, France, Belgium, Canada, United States of America, New Zealand, Singapore, Hong Kong and Dubai (UAE).

Alison established Physiotec in 2005 and continues a clinical load, working with patients with complex hip and lumbopelvic conditions, and across a broad spectrum of sports, including elite level triathlon, running, dance, cricket, athletics & swimming. She also spends a considerable amount of time mentoring her excellent staff, ensuring they are up-to-date and able to provide a high level of clinical expertise for management of musculoskeletal problems.

 
Eric Huang - A Qualified Physiotherapist - PhysioTec
Eric Huang
Physiotherapist
Bike Fit Analyst
BPhty



Eric Huang

Eric has been a qualified Physiotherapist since 2004, having worked in a variety of clinical settings from medical centres to holistic health centres before joining Physiotec in 2009. With this many years at Physiotec, Eric is currently our longest serving physiotherapist. For many years, Eric split his time between PhysioTec and providing onsite injury management services to a variety of manual handling industries. In 2018, Eric decided to move from onsite injury management to work with Dr Patrick Weinrauch at Brisbane Hip Clinic. His many years working and training under Dr Alison Grimaldi and now under Dr Weinrauch make him highly qualified in the management of Hip & Groin pain.

His other interests in physiotherapy are neck and upper back pain, cycling related pain and injuries and dry needling. Eric is a competitive cyclist himself, runs his own cycling crew, MIA, and is passionate about all things cycling. He has competed at both Australian and World Track Championships. Eric provides our bike fit service and has a personal and professional interest in strength & conditioning. This experience he brings to our GymStart programs, where Eric can teach, assess and correct your form with gym lifts to ensure you will be safe and gain maximum benefit from your gym program. He has a wealth of knowledge and experience where it comes to balancing optimal performance outcomes and recovery from injury or training fatigue. In his spare time he also enjoys spending quality time with his family and keeping a great looking tropical aquarium.
Joanne Manning
Physiotherapist
Pilates Instructor
Dance
BPhty(Hons)
MIADMS-Dance Medicine


Joanne Manning

Joanne graduated from the University of Queensland in 2014 with a Bachelor of Physiotherapy Honours Class l. A skilled dancer, choreographer and director, Joanne forged a highly successful career internationally and more specifically on Broadway before transitioning to a career in physiotherapy.

After completion of her physiotherapy degree, Joanne has worked in both private practice and hospital settings, gaining experience in outpatient musculoskeletal work, general hospital medical/surgical, and post-surgical rehabilitation.

With her extensive dance background Joanne has a special interest in dance rehabilitation and injury prevention for dancers and is a member of the International Association of Dance Medicine and Science.

Joanne is always looking to expand her knowledge and skills. She has trained in dry needling, pain sciences, dancer assessment and rehabilitation, kinesio-taping, vestibular dysfunction and APPI clinical Pilates.

Outside of work Joanne is an avid traveller, scuba diver and photographer, and enjoys spending time with family and friends while enjoying the Aussie lifestyle.
Irene Li
Musculoskeletal Physiotherapist
BPhty
MPhty (Musc)


Irene Li

Irene completed her Master of Musculoskeletal Physiotherapy in 2019 and graduated with a Bachelor of Physiotherapy in 2014 from the University of Queensland.

Over years of working in private practice setting, Irene developed special interests in treating spinal, hip and pelvis related conditions. Despite treating musculoskeletal disorders, Irene is also qualified in providing lymphoedema management. She is an Australasia Lymphology Association (ALA) accredited lymphoedema physiotherapist since 2015.

Irene is a lifelong learner who had additional training in dry needling and clinical Pilates, but also she is planning to advance her learning in women’s health area.

Outside physiotherapy, Irene is a keen snowboarder and has a strong interest in rehabilitation of skiing or snowboarding related injuries as well as conditioning. Irene also enjoys hiking, weight training and travelling with her family during her spare time.
Julie Allen - Post Cancer Physiotherapist Brisbane - PhysioTec
Julie Allen
The Pentimento Project
Post Cancer
Physiotherapist
BPhty (Hons)



Julie Allen – Physiotherapist

Julie Allen is an empathetic, caring and delightful physiotherapist with over 20 years experience in both sports physiotherapy and rehabilitation for chronic neck and back pain. She is passionate about tailoring exercise filled with enjoyment, skills and interests. Her early career was filled with success as a sports physiotherapist who travelled with Australia’s top international sporting teams including the Australian Hockeyroos, Queensland Firebirds, the Brisbane Blades and Queensland Netball State teams. Her passion was rehabilitation after injury, helping athletes recover and return either to full function or transition to life post sport.

Julie is also a survivor of Non Hodgkins Lymphoma and has drawn on both her professional expertise and own cancer experience to develop the Pentimento Project – A physiotherapy approach to post cancer treatment rehabilitation. Julie offers individual tailored rehabilitation options, in addition to group support sessions. Her aim is to assist cancer survivors regain a level of physical and psychological health and wellbeing in a quest for improvement in quality of life.
She obtained her Bachelor of Physiotherapy with first class honours from the University of Queensland in 1994. She is a member of the Australian Physiotherapy Association (APA)and endorsed by the Australian Health Practioner Regulation Authority (AHPRA). She works closely with The Queensland Branch of the Leukaemia Foundation.  She also provides service to clients of Haematology Oncology Clinics of Australasia (HOCA) and their clinical network company: Integrated Clinical Oncology Network (ICON).

Visit The Pentimento Project founded by Julie Allen

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    Real time ultrasound and hip and groin pain

    Dr Alison Grimaldi has pioneered the use of real time ultrasound for assessment and retraining of the deep musculature of the hip and groin. She has been using these techniques very successfully for over 10 years, and teaches these techniques to other physiotherapists around Australia and abroad.

    Optimal function in the deep trunk and hip musculature is the foundation for optimal weightbearing function and ability to transfer load between the legs and body. These techniques can be useful for almost any musculoskeletal condition of the hip and groin.

    Ultrasound retraining of the deep gluteal muscle - gluteus minimus.

    Real time ultrasound and the foot intrinsics

    Ultrasound is a fantastic tool for assessing and retraining the deep muscles that lie within your foot. These muscles are crucial for support of the arches of your feet and for helping you monitor and adapt to the surface on which you are walking or running. They connect you to the earth and sensors within these muscles provide essential information for your brain and nervous system to help you plan how you should balance your body weight, or where you might place your next foot.

    These muscles often become inhibited and atrophied due to lack of stimulus – too much time sitting, not enough time barefoot or on stimulating surfaces (not that you should through off your shoes if you have foot pain – the muscles need to be strengthened first). Like other deep muscles these deep short muscles can be difficult to assess, especially when you are standing.

    Ultrasound however allows us to see these muscles and provides feedback on-screen so you can be sure you are activating them properly. This is great for plantar fasciopathy (plantar fasciitis), forefoot pain (metatarsalgia, Mortons neuroma), bunions (hallux valgus), arthritis, tibialis posterior dysfunction/tendinopathy, shins splints (medial tibial stress syndrome MTSS) and many more conditions of the foot, ankle and shins.

    Ultrasound of foot Intrinsics forefoot
    Ultrasound of foot intrinsics - we can imagine right through the foot with ultrasound

    Real time ultrasound and patellofemoral pain (PFPS - syndrome)

    Dysfunction of the quadriceps, particularly of the Vastus Medialis Oblique (VMO) has been shown to occur in those with pain around the kneecap (patella). The VMO is thought to be important in controlling loads, particularly shear forces, across the patellofemoral joint – where the kneecap slides up and down in a groove in the lower end of the femur.

    The VMO has become very inhibited but getting some real time biofeedback with ultrasound can help your brain connect with the muscle, and get it working for you again. Poor function of the hip abductors and rotators has also been closely linked in patellofemoral pain research studies. We also use ultrasound to help optimise muscle function at the hip in patients with patellofemoral pain.

    Ultrasound image of VMO
    Ultrasounding vastus medialis oblique (VMO)

    Real time ultrasound and shoulder pain and instability

    Real time ultrasound can also be an invaluable tool for managing shoulder pain and instability. It can be used to help you improve function of the muscles that control scapular position and movement, and for retraining of the rotator cuff. This is useful for conditions ranging from postural related pain, to rotator cuff tendinopathy or tears, glenohumeral joint instability or arthritis.

    Ultrasound imaging of the posterior cuff of the shoulder
    Ultrasound image of the rotator cuff- infraspinatus at the back of the shoulder

    Physio's skilled in RTUS
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