The Benefits Of Real Time Ultrasound For Men

The Benefits Of Real Time Ultrasound For Men

Real-time ultrasound (RTUS) is a highly beneficial and specialised diagnostic imaging tool that our physiotherapists use to gain very valuable information about a range of musculoskeletal problems.

Given the extensive use of RTUS with women during pregnancy and postpartum, many of our clients are surprised to learn that we use RTUS extensively for men, too.

First, What Is Real-Time Ultrasound?

At its core, RTUS utilises high-frequency sound waves emitted by a transducer to create live images of our internal body structures. When these sound waves encounter our internal tissues, they create ‘echoes’ that the transducer captures and translates into live, moving images that we see on a screen. This process means that our physios can continuously observe the physiological processes happening inside the body, such as muscle contractions.

Using RTUS means that a lot of the guesswork is removed when it comes to knowing whether you’re performing a movement accurately. If we ask you to contract a specific muscle, like when working with your pelvic floor, we can observe this happening as it happens. This enables us to make a confident assessment of the efficacy of the movement, as well as helping us provide the right, tailored education about what proper muscle activation and contraction should feel like for you. Simply put, it’s a great, beneficial physiotherapy tool that helps us optimise our assessment and management processes so you can get the best outcomes.

How Does RTUS Differ From Therapeutic Ultrasound?

Therapeutic ultrasound is another common treatment modality we use extensively. Therapeutic ultrasound uses mechanical energy to generate high-frequency sound waves that have a healing and regenerative effect, as opposed to being able to visualise images in real time, like with RTUS.

Therapeutic ultrasound is able to promote healing by causing the particles in our tissues to oscillate. This oscillation increases blood flow to the affected area, which can significantly aid in managing pain, reducing inflammation, and enhancing the tissue healing response.

We use therapeutic ultrasound extensively when working with damaged muscles, ligaments, and bones. When tissues vibrate (through the high-frequency vibration mechanism the therapeutic ultrasound machine delivers), friction is created at a molecular level, resulting in more blood flow and, in some cases raising the tissue temperature to deeper tissues. This process offers beneficial effects throughout the tissue repair lifecycle, including the inflammatory phase, proliferative phase, and the remodelling phase.

How Does RTUS Differ From Traditional Diagnostic Ultrasound?

Traditional ultrasounds, where you go for imaging and lay down while your radiographer takes examines structures and takes images, holds great value through the ‘snapshots’ it offers. These images allow your radiographer to see things like the extent of a musculoskeletal injury - such as whether there is a tear present in a tendon versus a sprain. This information is then passed onto us as health professionals, so we can best guide your management plan. Having a traditional ultrasound requires very little engagement from the client - mainly just getting in the right position for the images to be captured.

Real time ultrasound is very different in that it provides a dynamic, real-time view. This distinction is crucial in situations where movement and function play a vital role in a person’s diagnosis, such as when assessing joint mobility, looking at the muscle activation and contractions, and monitoring the effectiveness of a rehabilitation program - to name a few. The ability to observe these functions as they happen is the key.

Real Time Ultrasound For Men’s Pelvic Health

Assessing the pelvic floor

While pelvic floor problems are often thought to be linked to women, pelvic floor dysfunction can be a very common problem for men too. Pelvic floor weakness and dysfunction can have a wide range of causes including constipation (straining), excessive coughing, heavy lifting or high-impact activities, being overweight, age-related changes, having surgery for bladder or bowel problems, prostate removal surgery.[1]

Signs in men that the pelvic floor muscles may not be working effectively include:

  • Leaking urine or faeces (incontinence) during activities such as running, jumping, sneezing, coughing or sexual activity
  • A sudden and urgent need to pass urine, frequent urination, or starting and stopping when passing urine
  • Symptoms of erectile dysfunction

To illustrate the benefits of real time ultrasound: try to recall the last time you were told to perform a specific movement, like contracting your pelvic floor. Your practitioner may have described what it should feel like using a variety of imagery cues such as “shorten the penis” or “elevate the scrotum”) and you might think you’ve got it, but as you continue the movements at home, you’re still left with a level of uncertainty as to whether you’re doing it right. RTUS removes this uncertainty because at your appointment, we were able to see that you were doing it right without any guesswork, so you know exactly what ‘right’ feels like.

Core assessment and training (including for low back pain, pelvic girdle pain, and pelvic pain)

We use RTUS to evaluate and enhance the function of the deep core muscles, which are also crucial for helping manage and prevent low back and pelvic pain and dysfunction. We can use RTUS to examine:

  • The transversus abdominis (TA): this is the deepest layer of abdominal muscles, playing a pivotal role in spinal stability.
  • Multifidus: an essential back muscle that contributes to deep segmental spinal control
  • The pelvic floor: that supports the organs in the pelvis, also contributing to muscular stability.

Ideally, these muscles should activate collaboratively, providing a stable foundation that promotes efficient movement and good management of intraabdominal pressure. However, accurately gauging their activation can be challenging due to their deep location and the subtle nature of their movements. Additionally, when there is an injury, the muscles that support the spine and pelvis may not work as efficiently. Even when the painful symptoms resolve, these vital stability muscles often have trouble performing effectively.This is where RTUS can really help - providing visual feedback in a way that overcomes the limitations of traditional palpation methods.

As an example, the transversus abdominis is known to be one of the first muscles to be inhibited by pain, compromising its automatic engagement that's essential prior to any movement.[2] Similarly, the multifidus muscle, integral for segmental spinal stability, may also suffer from inhibited activation following back pain or injury.[3] This disruption in muscle function can lead to a delayed response in core activation before movement, fostering poor motor control and inefficient movement patterns that can exacerbate pain. Here, RTUS means our physiotherapists can both assess the current state of these core muscles while providing real-time, visual feedback to our clients during retraining exercises. This approach ensures that our clients can learn to correctly engage their core, restoring proper muscle function, supporting a stronger and more resilient core unit.

RTUS For Men Has Two Primary Views

We perform real time ultrasound with male patients both transabdominally and transperineally.

  • Transabdominally, we use it over the abdominal muscles to observe the activation of the TA along with external and internal obliques, assessing for proper activation of the TA and looking at how the body responds to functional tasks and exercises. We also use this view to look for bladder base displacement with pelvic floor contraction and relaxation.
  • Transperineally, the probe is over the perineum between scrotum and anus. It shows a broader picture of the pelvic region. We use this for pelvic floor biofeedback training and it can be very useful with men with any pelvic floor dysfunction

Benefits of Real Time Ultrasound:

  • Is proven to be safe and effective with no side effects (such as radiation) [4]
  • Offers immediate (real time) detection and reporting of body structures and function
  • Provides the ability to view moving structures which can identify and treat dysfunction (and teach correct function through immediate feedback)
  • Is pain free and non-invasive

You can book your appointment with our experienced physiotherapy team here. To learn more about real time ultrasound, and how it can help women in pregnancy, read this.