Biofeedback
Hello and welcome, Bestie. I think we’re overdue for a chat! Today, we’re discussing one of the most commonly used tools in pelvic health physical therapy: biofeedback. If you’ve ever suffered from any type of pelvic floor dysfunction and you went to see your primary care provider, I would bet my pelvic health on the fact that your provider referred you to pelvic health PT with the referral stating “treat with biofeedback.” I can’t tell you how many times patients’ physicians or OB-GYNs ask me to treat our mutual patient using biofeedback. In all fairness, biofeedback is a great tool that works well for many people and for a range of pelvic floor dysfunctions (PFDs). It also has a lot of research to back it up. I only chuckle because there are so many treatments for PFD in PT and sometimes it feels like our referring providers think all we do is biofeedback. Okay, enough with the vent sesh, onward!
What is biofeedback?
Biofeedback is a learning process in which an external source of feedback is used. In biofeedback, an instrument is used to amplify or mirror the patient’s activity and then it provides feedback to the patient in a visual, verbal, or auditory manner (1). By receiving feedback while performing a specific activity, one can learn how to change that activity and witness the changes they are making in real time.
Let’s use a simple form of biofeedback as an example: a mirror. When you look in a mirror, you are getting real-time feedback on what your body is doing while you are doing it. This feedback is coming from an external source, the mirror, rather than from you. Let’s say you want to work on planks and your trainer has told you that you need to try to keep a flat back while you are doing planks. However, whenever you perform them, you can’t tell if your back is flat or not. In this case, you could try working on your plank in front of a mirror and watch to see if your back is flat. If you notice your back rounding, you can see that in real-time and correct it. When you make that correction, you can see in the mirror whether you’ve corrected to a flat back or whether you’ve overcorrected to have a slight arch in your back. As you are making these changes and corrections, your brain is connecting the correct positioning with what your eyes are telling your brain is correct. This will eventually help you to develop the ability to feel where the correct position is even without the visual input from the mirror.
Common types of biofeedback in pelvic health:
- Education/feedback from a trainer: This can be in the form of tactile feedback where your trainer provides touch to help you move into the correct postures. It can also be verbal feedback where the trainer verbally communicates what changes they want you to make. Visual feedback may also come into play here.
- Simple biofeedback: Biofeedback that does not require special equipment. The mirror example above is a type of simple biofeedback.
- Surface Electromyographic Biofeedback (sEMG): This type of biofeedback uses changes in the electrical activity of the muscles and relays these changes in either visual or auditory forms.
- Pressure: Changes in pressure may be used as a cue for muscle contractions.
- Rehabilitative Ultrasound Imaging (RUSI) or Real-Time Ultrasound (RTUS): An ultrasound machine can be used to visualize the pelvic floor. This is similar to using a mirror, but it can visualize structures that are not possible to see with a mirror, such as the bladder.
What is biofeedback used for in pelvic health?
Biofeedback can play a role in almost any treatment plan. It is one of the more versatile treatment techniques used in pelvic health, but it should rarely be used in isolation. Biofeedback works best when it is combined with a robust and diverse treatment plan. It is often a great place to start treatment, but typically does not need to be used in every treatment session or throughout the entire treatment plan.
It can be useful in conditions of underactive pelvic floor muscles (PFMs), overactive PFMs, or PFM incoordination (2, 3). It can be as simple as looking at the vulva in a mirror and watching the tissue changes as you work on contracting and relaxing the PFMs.
In conditions of underactive PFMs, it can help improve muscle recruitment and activation by increasing awareness of the PFMs. This could include urinary incontinence, specifically stress urinary incontinence (SUI), prolapse, and more (4).
In conditions of overactive PFMs, it can be useful for learning how to relax the PFMs. These conditions could include constipation, pelvic pain, overactive bladder, urinary urgency, and more.
Certain types of biofeedback, such as sEMG biofeedback, can be used during all types of activities. This makes it a fantastic tool to understand what the PFMs are doing during your typical activities and how improve that muscle activity, as necessary.
Biofeedback is a great tool for pelvic health because it is minimally invasive and there are very few, if any, potential negative side effects. It is probably the safest treatment in the pelvic health realm, alongside education, and is extremely versatile. This makes it a widely used technique in pelvic health. While it is a wonderful tool, it should ultimately be a piece of a larger treatment plan and should, of course, be tailored to you and your needs.
Next time, we’ll dive deeper into the specifics of sEMG biofeedback, as there is a lot more to talk about on that topic. Until then, may your pelvic floor absolutely slay.
XOXO,
Your Pelvic Bestie
References:
1. Lee HN, Lee SY, Lee YS, Han JY, Choo MS, Lee KS. Pelvic floor muscle training using an extracorporeal biofeedback device for female stress urinary incontinence. Int Urogynecol J. 2013 May;24(5):831-8. doi: 10.1007/s00192-012-1943-4. Epub 2012 Sep 28. PMID: 23052631.
2. Newman DK. Clinical Manual for Pelvic Muscle Rehabilitation. The Prometheus Group; 2003.
3. Shelly B. Methodology for Evaluation and Treatment of Pelvic Floor Dysfunction: Manual for Pathway MR-20 and MR-10 Surface EMG Biofeedback Devices. The Prometheus Group; 1994.
4. Bernards AT, Berghmans BC, Slieker-Ten Hove MC, Staal JB, de Bie RA, Hendriks EJ. Dutch guidelines for physiotherapy in patients with stress urinary incontinence: an update. Int Urogynecol J. 2014 Feb;25(2):171-9. doi: 10.1007/s00192-013-2219-3. Epub 2013 Oct 1. PMID: 24081496; PMCID: PMC3906549.
*The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a qualified health provider regarding any questions you may have about a medical condition or health objectives.
