(646) 355-8777

Herman & Wallace Blog

Using Transabdominal Ultrasound to Assess Pelvic Floor Muscle Activation

Have you ever tried to teach a patient how to isolate their transversus abdominis (TA) contraction or a pelvic floor muscle (PFM) contraction and the patient had difficulty or you weren’t sure how well they were isolating it? Did you ever wish you had the ability to use real-time ultrasound (US) to confirm which abdominal layers they were isolating or use it for visual feedback to assist in your patient’s learning?  Could it be helpful to be able to use real-time US to identify if they were isolating the pelvic floor muscles and give your patient visual feedback? Of course!

Real- time US has been used as an assessment and teaching tool to directly visualize abdominal and PFMs.  PFM function can be assessed by observing movement at the bladder base and bladder neck.  Various studies have used US on women with and without urinary incontinence (UI).  These studies usually use transabdominal (TAUS) and transperineal (TPUS) ultrasound to measure if PFM isometrics or exercises are performed correctly or incorrectly, or how the muscles are functioning.

A 2015 study in the International Urogynecology Journal utilized TAUS to identify the ability to perform a correct elevating PFM contraction and assess bladder base movement during an abdominal curl up exercise. Abdominal curl ups are cited to increase intra-abdominal pressure.  Activities that increase intra-abdominal pressure have been cited to provoke stress urinary incontinence (SUI). Abdominal curl ups are often completed in group exercise classes and have been found to provoke SUI in up to 16% of women.

Use of PFM exercises and of “the knack” (performing an isometric pelvic contraction before an exertional activity where intra-abdominal pressure increases, such as before lifting or coughing) has been shown to help manage stress urinary incontinence.

The theory is that elevation of the PFMs during activities that increase intraabdominal pressure (like a curl up) assist in urethral closure and counter act the downward movement, therefore stabilizing the urethra and bladder neck. When using TAUS, while performing a correct PFM contraction, one might expect to see an elevating PFM contraction.  In the study, TAUS was used on 90 women participating in a variety of group exercise classes.  The participants completed a survey and then three attempts of an abdominal curl up exercise in hooklying.  During the curl ups, bladder base displacement was measured to determine correct or incorrect activation patterns.  It was found that 25% of the women were unable to demonstrate an elevating PFM contraction, and all women displayed bladder base depression on the abdominal curl exercise.  It was also found that parous women displayed more bladder base depression than nulliparous women, and overall 60% of the participants reported SUI.  Lastly, this study found there was no association between SUI and the inability to perform an elevating PFM contraction or the amount of bladder base depression.

What interesting information.  Using real time US in the clinic could help us identify if our patients were completing “the knack” correctly with specific activities. This study is a great example of how we can use real time US to help collect evidence to provide us with more information that can help us answer our own questions, patient questions, and improve our instructional methods to patients when teaching core or PFM exercises.


1) Barton, A., Serrao, C., Thompson, J., & Briffa, K. (2015). Transabdominal ultrasound to assess pelvic floor muscle performance during abdominal curl in exercising women. International urogynecology journal, 26(12), 1789-1795.

Continue reading

Upcoming Continuing Education Courses

Oct 18, 2019 - Oct 20, 2019
Location: The George Washington University

Oct 18, 2019 - Oct 20, 2019
Location: University Hospitals

Oct 19, 2019 - Oct 21, 2019
Location: Lee Memorial Health System

Oct 25, 2019 - Oct 27, 2019
Location: Core 3 Physical Therapy

Oct 26, 2019 - Oct 27, 2019
Location: Texas Children’s Hospital

Nov 1, 2019 - Nov 3, 2019
Location: Adena Rehabilitation and Wellness Center

Nov 1, 2019 - Nov 3, 2019
Location: Asante Rogue Valley Medical Center

Nov 1, 2019 - Nov 3, 2019
Location: Cancer Treatment Centers of America - Chicago, IL

Nov 1, 2019 - Nov 3, 2019
Location: Upper Chesapeake Health

Nov 2, 2019 - Nov 3, 2019
Location: University Hospitals

Nov 2, 2019 - Nov 3, 2019
Location: Griffin Hospital

Nov 3, 2019 - Nov 5, 2019
Location: Touro College: Bayshore

Nov 8, 2019 - Nov 10, 2019
Location: Washington Regional Medical Center

Nov 9, 2019 - Nov 11, 2019
Location: Comprehensive Therapy Services

Nov 9, 2019 - Nov 10, 2019
Location: Summa Health Center

Nov 9, 2019 - Nov 10, 2019
Location: STI PT and Rehab

Nov 9, 2019 - Nov 10, 2019
Location: Providence Holy Cross Medical Center of Mission Hills

Nov 15, 2019 - Nov 17, 2019
Location: Banner Physical Therapy and Rehabilitation

Nov 15, 2019 - Nov 17, 2019
Location: Ability Rehabilitation

Nov 15, 2019 - Nov 17, 2019
Location: Huntington Hospital

Nov 16, 2019 - Nov 17, 2019
Location: Princeton Healthcare System

Dec 6, 2019 - Dec 7, 2019
Location: Swedish Covenant Hospital

Dec 6, 2019 - Dec 8, 2019
Location: Swedish Covenant Hospital

Dec 6, 2019 - Dec 8, 2019
Location: Franklin Pierce University

Dec 6, 2019 - Dec 8, 2019
Location: Florida Hospital - Wesley Chapel

Jan 10, 2020 - Jan 12, 2020
Location: Dominican Hospital - Physical Therapy

Jan 17, 2020 - Jan 19, 2020
Location: Spooner Physical Therapy

Jan 17, 2020 - Jan 19, 2020
Location: Banner Physical Therapy and Rehabilitation

Jan 17, 2020 - Jan 19, 2020
Location: Our Lady of the Lake Children's Hospital

Jan 24, 2020 - Jan 26, 2020
Location: Nova Southeastern University