One of the hidden treasures of a pelvic physical therapist is the use of ElectroMyoGraphy (EMG) The first question to answer is: what is it? Electromyography (also known as EMG) is a way in which I can look at the electrical activity of your muscles. We have heard of an EEG (ElectroEncephaloGram), which reads the wave patterns of the brain and nerve conduction studies in which they look at the electrical activity of the nerves. This is similar in that we are looking at electrical activity but EMG is focusing on your muscles. So, what? Big deal! What does that really mean?!? A muscle at rest, hanging out, doing nothing is still electrically active with a voltage of 3µV -4µV (micro-volts). When I have you laying on my table and have you and your muscles hooked into the system this is what I should see. If I see the resting EMG signal is higher than that – let’s say … 10µV to 20µV – then we have some work to do in order to quiet those muscles down. Essentially in that scenario they are working evenings, weekends, and holidays and could be the cause of your pain. The next step of testing is to then have you contract the muscles being tested. By looking at the EMG signal I can tell how well you can contract the muscle and for how long. We can look at “strength” and endurance. I say “strength” because there is only a loose correlation between EMG signal and overall strength of the muscle. All it means is that the muscle is more electrically active when working but we cannot take the EMG signal and tell if you lifted ten pounds or 25 pounds. It doesn’t work that way, sorry ☹
Great, we have the information from your first EMG study, now what?!? This is where biofeedback comes in. My computer is equipped with a program to read the EMG signal and if we need to get you to relax then you need to keep the voltage under a determined level in order to allow the music on the computer to keep playing. This is in part where we are reprogramming the subconscious brain to teach the affected muscles how to relax. We can use a different version of that same program to teach those muscles how to contract and work better/stronger by keeping the computer’s music playing if held above a determined threshold. Once again, the brain makes the connections on a subconscious level and you get stronger through more effective use of the muscles involved.
I use this equipment regularly to treat clients who have pelvic pain where they cannot sit down, stand up, painful erections, painful intercourse, genitals going numb, etc. … These are cases where the muscles often times are overworked. I have also used the same equipment to help retrain the muscle to work better when faced with incontinence (men and women) and erectile dysfunction.
Where do the electrodes go? I try to get them as close to the muscles we are working with as possible. When working on the pelvic floor muscles we can put them on the outside around the taint (formally known as the perineal body) but I am a firm believer that going internal gives the best signal quality because we are closer to the source and we are not picking up the glutes, hamstrings, etc. … which can interfere with and mask problems that are deeper in. Yes folks, this means inserting the sensor/stimulator into the rectum or vagina.
The EMG below belongs to a gentleman who came to me for pelvic pain. His resting signal was around 30µV. Remember what I said earlier, that is should be around 3µV or 4µV. He was high and tight! The muscles were pinching nerves which caused pain in the taint and into the penis and scrotum.
This is the same gentleman after 3 sessions of biofeedback for quieting the muscles. Vastly improved signal at 5µV – 10µV and his pain was greatly reduced, which made him and his girlfriend very happy!
If you have questions about EMG and biofeedback, pelvic problems with bladder, bowel, or sexual function then reach out to me either by phone/text 443-742-0019, fax 443-345-3414, email firstname.lastname@example.org, on Facebook messenger, or on my website, Dudleypt.com