Let’s start by talking about what EMG biofeedback it. EMG biofeedback is a tool that allows us to monitor the muscle activity of the pelvic floor muscles, and display them in some kind of visual manner. Some units are hand held, while other larger units use computer programs so that the muscle activity can be monitored over time to show a patient’s change (we’ll get into that!).
How can we actually see the muscle activity in the pelvic muscles? The short answer is through electrodes that do not exude any electrical signals, but can monitor the electrical impulses of the muscles. The long answer is that this can be done a few ways. The most common way, and the way we perform it in our clinic, is through surface electrodes. This involves three small sticky pads, two of which are placed on the butt cheeks and one on the low back. The sticky pads are attached to lead wires which attach to the handheld device which displays the visual of the muscle activity. These surface electrodes lay right over the outside of the pelvic floor muscles, thus allowing them to read the muscle activity.
The other form of electrodes can include vaginal or rectal probes. These are less commonly used due to the invasive nature, but can give a more exact reading if the surface electrodes are not proving beneficial for a patient.
EMG biofeedback can be used for back strengthening purposes of relaxation purposes. In patients who may have stress incontinence or prolapse biofeedback can be used to help augment strengthening. It allows the patient to match the feeling of a contraction to what may or may not be showed on the screen. While allowing patients to visualize their kegel contractions, it also can show how long a patient is able to hold a contraction before the pelvic floor muscles tire out, as well as change over time. For example, it can be used during the first session of strengthening, and again at the end to help the patient get a visual
representation of how much their strength has improved over the course of their care.
Similarly, biofeedback can be used for those with urge incontinence, over active bladder, and pelvic pain for relaxation purposes. It can be useful to give a reading of resting muscle tension for those with tight pelvic floor muscles, but also allows patients to see whether they are able to relax their pelvic floor or if the relaxation is delayed. It also gives the patient a change to connect the feeling of what they think may be relaxation to what is actually going on in their pelvic floor. Many people find this helpful to master the technique of what proper relaxation should feel like.
The bottom line: EMG biofeedback is a great tool to help many conditions across the spectrum of pelvic floor therapy. It is generally non-invasive, gives the patient a visualization of their pelvic floor, and is completely safe – even for our pregnant patients!
Author: Shannon O’Brien, PT, DPT
References:
1) http://www.pelvicfloorcenter.org/content/biofeedback. Accessed September 27,
2019.
2) Herderschee R, Hay-Smith EJC, Herbison GP, Roovers JP, Heineman MJ, Herderschee
R. Feedback or biofeedback to augment pelvic floor muscle training for urinary
incontinence in women. Cochrane Database of Systematic Reviews. (7).
http://search.ebscohost.com/login.aspx?direct=true&db=chh&AN=CD009252&site
=eds-live.
3) Hermanwallace.com. (2019). EMG Biofeedback – The Principles. [online] Available at:
https://hermanwallace.com/images/Tim_Watson_Biofeedback_Intro.pdf