CLINICAL PERSPECTIVE: Diagnostic Ultra sound-An essential tool for the physiotherapists - MARIUS LEBERT, ANTHONY DEMONT, AYMERIC LE NEINDRE

The use of diagnostic ultrasound in physiotherapy was initiated in the 1980s following the work of Dr. Archie Young and his team at the University of Oxford in the UK (1). The first application was in patients with knee pain. Indeed, Young’s team highlighted a decrease in quadriceps strength (using dynamometry) despite normal cross-sectional area on ultrasound among those patients (see figure 1). The correlation between the quadriceps cross-sectional area with ultrasound scanning and its strength had been demonstrated earlier by the same team. Therefore, this explains that the quadriceps showed no strength deficit in itself (2). The assumption was an inhibition of motor control pain-related and non-muscle atrophy. Thus, from 1986 they recommended physiotherapists to use ultrasonography to identify the patient profile and adapt their rehabilitation.

From the 1990s, the use of diagnostic ultrasound has been extended to patients with chronic low back pain. This use on the trunk muscles, transversusabdominis and multifidusmuscles, enables for improving the physiotherapist clinical decisions in treating patients with chronic low back pain. Thus, as clinical examination failed to accurately assess the multifidus muscles, both physiotherapist and patient used ultrasound feedback contraction, in order to guide specific exercises (3). The use of ultrasound as a tool for diagnosis and feedback was then used in perineal rehabilitation in the assessment and training of the pelvic floor muscles (4). Then recently, the use of thoracic ultrasound in the ICU by physiotherapists has been described (5,6) and might become a quite reliable diagnostic tool in the monitoring of chest physiotherapy.

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