The versatility and low risk of sEMG biofeedback mean that virtually any time you want to know more about muscle activation, you can. But once you’ve determined that a patient could benefit from biofeedback training, when should you use it?
The mTrigger Biofeedback System is all about adding value to the programs and exercises you already do. You are the expert on your patients. You know what your goals are and how to get there. Biofeedback makes getting there more efficient and enjoyable.
By making an invisible activity visible, we connect therapeutic exercise with real-life impact. When a patient can physically see their efforts appear in front of them, they can link activity to function for better results.
Audiovisual biofeedback opens up the communication from a patient’s body, to their mind, to their outcomes. Read on to learn how to use biofeedback in the best way for your patients and practice.
Finding Your Flow
So where does mTrigger fit in your practice? The first question to ask yourself is, “What do I want my patient / athlete to better understand about their performance?”
SCENARIO 1: BASIC ACTIVATION
If you’re just waking up muscles after surgery or immobilization, biofeedback will likely fall into a longer portion of your training session. Start off with warm-ups and/or manual therapy, then move into activation training with biofeedback during isometrics or basic exercises for 10-15 minutes. Running mTrigger throughout your standard reps – for example, a quad set – helps patients re-learn what proper activation feels like during various exercises, and ensures that they are comparing their efforts to their maximum voluntary contraction. You may also notice how the biofeedback impacts fatigue (note: it definitely will) and range of motion.
TIMING: Use mTrigger in the early stages of rehab; it works to wake up a muscle from inhibition and fight against atrophy and mobility issues. Compare to the healthy counterpart to assess progress in real time. See our case study on active rehab following medial meniscectomy.
SCENARIO 2: BASIC RELAXATION
Similar to basic activation training, relaxation training should be performed with mTrigger on for the duration of the relaxation reps. Once you have identified the target muscle, set up mTrigger and set your MVC goal at the level of activation you do NOT want the patient to reach. Remember, this is the opposite of activation training. The level you choose to set may be equivalent to resting tone, or it may be the level of activation you want to discourage during a particular exercise. To set a relaxation goal, enter Train mode and adjust the goal to match activation level at rest or during the monitored exercise, respectively. Let the patient view the feedback during their reps but cue them to keep the bars DOWN in the red zone. Relaxation/inhibition training can be performed using timed reps, or without the timer feature.
TIMING: Use mTrigger as soon as the issue is identified; in this case, an issue of hypertonicity or compensation may not be identified until later in the rehab process, but as soon as it begins to impact recovery, inhibition and relaxation training can help.
SCENARIO 3: INVOLVED VS HEALTHY
Perhaps you want to show your patient how their involved muscle is performing compared to the healthy contralateral. To get a baseline, set your goal for Channel 1, then perform the Neuromuscular Deficit Test at the start of your session. Compare bilateral activation during exercises throughout your training session, watch for fatigue in the involved vs. healthy muscles, and gauge symmetry in real time.
TIMING: Use mTrigger‘s Neuromuscular Deficit Test to establish a baseline and symmetry goal early in the program. Track progress by performing this assessment at either the beginning or end of sessions (see below) until symmetry and functional goals are achieved.
SCENARIO 4: TRAINING FOR CONTROL
Training to improve accuracy and control is the biofeedback sweet spot. Activation imbalances and improper recruitment negatively impact recovery. Combine the above tactics to identify areas of compensation or imbalance in dual channel mode – for example, using the hamstrings to achieve knee extension without engaging the quads, or over-activating the upper traps. Recruitment patterns mean everything to healthy return to sport and long-term safety. By reinforcing muscle memory accurately on every single rep, biofeedback makes the most of the work your patients are already doing.
TIMING: Use mTrigger throughout various exercises over the course of the program to improve muscle memory, accuracy, and efficiency of training; this application is about using biofeedback to engage motor learning for healthier long term recruitment habits.
SCENARIO 5: FUNCTIONAL MOVEMENT
When pain or injury prevent normal activation during functional movement, biofeedback can help assess the problem and monitor performance. Drilling with biofeedback during dynamic movements shows activation during different phases, and ensures muscle engagement during functional activity. Making sure patients are not only performing a functional movement, but recruiting accurately to do so, is critical for injury prevention and reinforcement of foundational movement.
TIMING: Use mTrigger during periodic screening or functional testing to identify any activation issues. For rehab programs, use biofeedback consistently as you increase exercise difficulty to provide data and help keep patients motivated.
Additional Notes on Timing
When it comes to the timing of using mTrigger in a training session, consider the following:
Timing in session
Whether you use mTrigger at the beginning, end, or throughout your rehab session, consistency is the name of the game.
NEUROMUSCULAR DEFICIT TEST… you may use the NMDT as a benchmark for progress towards symmetry; try to perform this assessment consistently at either the beginning or end of your sessions. Muscle fatigue tends to impact non-dominant, atrophied, or inhibited muscles more than their healthy counterparts. Because of this, assessments performed at the end of a training session may reflect a slightly higher deficit. Ensure you are comparing apples to apples!
GAMING… incorporating games into a training session is a fantastic way to engage a patient’s competitive nature and get them to maximize their efforts. Again, you may want to consider whether you’re gaming at the beginning or end of a session and accommodate for fatigue – lower the goal if you switch to games in the latter part of your session.
Measurements over time
We recommend using mTrigger consistently throughout your treatment programs as long as it adds value to your sessions. From prehab evaluations, to post-op isometrics, to functional drills, having real-time sEMG data improves patient performance as well as your ability to make evidence-based decisions. You will see average maximum contraction numbers increase as other indicators of progress – muscle mass, strength and force metrics, ROM – move your patients closer to return to function.
- Know what you want to know
- Add in mTrigger where you want more bang for your buck
- Keep it consistent for the best results