How Real-Time Ultrasound Can Improve Muscle Activation

Muscle activation is a critical component of effective rehabilitation. When muscles fail to activate correctly after injury, pain or surgery, recovery can stall and symptoms may persist. At Malvern Physiotherapy Clinic, we utilise real-time ultrasound (RTUS) to assess and retrain deep muscle function with precision. This technology provides immediate visual feedback, enabling more accurate rehabilitation and improved clinical outcomes.

What Is Real-Time Ultrasound in Physiotherapy?

Real-time ultrasound (RTUS) is a non-invasive imaging tool used by physiotherapists to visualise muscles during contraction. Unlike diagnostic imaging such as MRI or CT scans, RTUS focuses on muscle function rather than structure, allowing clinicians to assess how muscles behave during movement.

It enables physiotherapists to observe:

• Activation of deep stabilising muscles
• Timing and coordination of muscle contraction
• Muscle symmetry between left and right sides
• Changes in muscle thickness during activation

RTUS is particularly valuable for assessing the transversus abdominis, multifidus and the pelvic floor muscle group.  All structures that play a crucial role in stability and injury prevention.

External reference:
Australian Physiotherapy Association https://australian.physio
British Journal of Sports Medicine https://bjsm.bmj.com

Why Is Muscle Activation So Important?

Following injury or persistent pain, muscles often become inhibited. This phenomenon, known as arthrogenic muscle inhibition, prevents muscles from functioning effectively even after pain subsides.

Common examples include:

• Reduced activation of deep core muscles after lower back pain
• Weak gluteal activation following hip or knee injury
• Pelvic floor dysfunction after pregnancy
• Poor deep neck flexor activation in individuals with neck pain

If these muscles are not retrained correctly, the body compensates using superficial muscle groups. Over time, this can lead to inefficient movement patterns, increased joint stress, and a higher risk of reinjury.

Improving muscle activation may assist with:

• Reducing recurrence of injury
• Enhancing movement efficiency and control
• Supporting post-operative rehabilitation
• Improving athletic performance and load tolerance

External reference:
Sports Medicine Australia https://sma.org.au

How Does Real-Time Ultrasound Work During a Physiotherapy Session?

During an RTUS assessment at Malvern Physiotherapy Clinic, your physiotherapist will guide you through a series of targeted muscle contractions while visualising the muscle on screen in real time.

What to Expect During Your Session

1. Assessment – A small ultrasound probe is placed over the target muscle group.
2. Activation – You perform a gentle contraction guided by your physiotherapist.
3. Visual Feedback – The muscle contraction appears live on the screen, allowing both patient and clinician to observe activation patterns.
4. Correction & Training – Immediate feedback helps refine technique and improve motor control.

For example, when retraining the transversus abdominis, many patients unintentionally engage superficial abdominal muscles. RTUS provides confirmation that the correct muscle is activating, improving accuracy and effectiveness.

This process enhances motor learning, enabling patients to develop better neuromuscular control and long-term stability.

Who Can Benefit from Real-Time Ultrasound?

RTUS may be beneficial for individuals experiencing:

• Persistent or recurring lower back pain
• Post-operative abdominal or spinal rehabilitation
• Pelvic floor dysfunction or postnatal recovery
• Chronic neck pain associated with deep stabiliser weakness
• Sports-related injuries requiring precise muscle retraining
• Poor core control impacting performance or posture

At our Malvern East clinic, RTUS is commonly used for patients who have not responded fully to traditional strengthening programs. By identifying subtle dysfunction, physiotherapists can tailor rehabilitation more effectively.

Is Real-Time Ultrasound Safe?

Yes. Ultrasound imaging is widely recognised as a safe and non-invasive modality that does not involve radiation. It is commonly used in healthcare settings, including obstetrics and musculoskeletal assessment.

When applied by trained physiotherapists, RTUS is a valuable clinical tool for assessment and rehabilitation.

External reference:
World Health Organization https://www.who.int

How Is Real-Time Ultrasound Different from Standard Core Exercises?

Traditional core training relies on verbal cues and patient perception, which may not always result in accurate muscle activation. RTUS enhances rehabilitation by providing:

• Visual confirmation of correct muscle activation
• Immediate feedback to refine technique
• Objective measurement of muscle function
• Greater precision in rehabilitation programs

This technology is particularly effective for individuals with chronic pain, post-operative weakness, or difficulty engaging deep stabilising muscles.

When Should You See a Physiotherapist About Muscle Activation?

Consider a physiotherapy assessment if you:

• Experience recurring lower back or pelvic pain
• Feel unstable during sport or daily activities
• Have ongoing weakness following surgery or injury
• Struggle to engage your core despite regular exercise

A comprehensive physiotherapy assessment can determine whether impaired muscle activation is contributing to your symptoms and guide appropriate treatment.

Final Thoughts

Real-time ultrasound offers physiotherapists a deeper understanding of how muscles function beneath the surface. By improving activation, coordination and control, rehabilitation can be more targeted and effective. This technology plays a valuable role in managing persistent pain, enhancing recovery and supporting long-term performance.

If you are based in Malvern or Malvern East and would like to determine whether muscle activation is contributing to your symptoms, our physiotherapy team can assess your movement and guide appropriate treatment.

About the Author

Mark Fotheringham
Principal Physiotherapist & Director
Malvern Physiotherapy Clinic & Return Pilates

Mark Fotheringham is the Principal Physiotherapist and Director of Malvern Physiotherapy Clinic and the founder of Return Pilates. With over two decades of clinical experience, Mark is highly regarded for his expertise in musculoskeletal and sports physiotherapy, helping patients recover from injury, optimise performance, and return confidently to the activities they value most.

Mark holds a Bachelor of Physiotherapy and has undertaken extensive postgraduate professional development in sports rehabilitation, strength and conditioning, and clinical Pilates. He is committed to evidence-based practice and integrates objective assessment tools such as hand-held dynamometry and force plate technology to measure strength, monitor progress, and guide individualised rehabilitation programs.

Throughout his career, Mark has worked with a diverse patient population, including elite and recreational athletes, post-operative patients, and individuals managing persistent pain and complex musculoskeletal conditions. His clinical approach focuses on identifying the root cause of dysfunction, restoring optimal movement patterns, and empowering patients through education and tailored exercise programs.

As a recognised leader in physiotherapy and rehabilitation, Mark is passionate about mentoring clinicians and advancing clinical standards within the profession. He has played a key role in developing integrated rehabilitation pathways between Malvern Physiotherapy Clinic and Return Pilates, ensuring patients receive seamless, high-quality care from assessment through to long-term strength and conditioning.

Mark has a particular interest in:

• Musculoskeletal and sports injury rehabilitation

• Objective strength assessment and performance testing

• Post-operative rehabilitation and return-to-sport planning

• Clinical Pilates for injury prevention and recovery

• Evidence-based management of persistent pain

Through his leadership and clinical expertise, Mark remains dedicated to delivering personalised, results-driven care to the Malvern and Malvern East community.

 

Published March 30, 2026