Bio stabilizer and ACL Injury: A Holistic Look Into The Biofeedback System

Vanessa Denny

Physical therapy is an essential tool sought after by patients recovering from a variety of injuries. However, the key to success lies in the utilization of appropriate feedback systems. In the past, Pressure Biofeedback Units (PBU) have been proven to have a substantial impact in terms of investigating TrA muscle activity. Although bio stabilizers have seen tremendous improvements for people strengthening their core for issues with lower back pain during its pilot studies, the burning question is, could bio stabilizers prove to be useful for other injuries as well? 

Recently biofeedback devices have been gaining popularity in the forms of smartwatches and rings. The core idea is not revolutionary at all and people have utilized heart rate monitors and other fitness trackers in therapy and for workouts before. However, such mobile devices are becoming more accessible and more pragmatic in our everyday life. This has not only made it possible for startups but also big tech companies to create a market for smaller and more comfortable gadgets, making the technology more appealing to the ordinary masses. Devices like Fitbits and Oura Rings can help you track and assist with your sleep, workout, alcohol consumption, and much more. Although the technology is generally low risk; those with medical conditions should always consult a doctor for medical opinions [1].

However, can advances in this type of technology provide better guidance for physical therapists? 

In early 2000, a study done on 45 patients looked at the use of PBUs in abdominal-strengthening activities. They found that these devices are useful as an indicator for deep abdominal function. This is essential for patients struggling with lower back pain and is supportive of previous research done on the correlation between the function of these abdominal muscles and pain in the lower back [2].

Another study done in 2015 found the use of PBUs in stability training in dancers recovering from injuries due to lower back pain significantly improved their activity levels and decreased their pain levels [3].

According to the National Institute of Complementary and Alternative Medicines, biofeedback is a mind-body therapy growing in popularity among many doctors and patients [4]. In 2012, the Center for Disease Control and Prevention released their National Health Interview Survey, where it was reported that 30% of children aged 4-17 (n = 10,233) were using Complementary and Alternative Medicine (CAM) with 5.5% using mind-body therapies. Over half of the adults that responded also reported using CAM in some form [5].

Electromyography (EMG) is another form of biofeedback where an electrode is placed on the user’s muscle and produces a signal (can be visual or auditory) in response to muscle activation. It’s been used in therapy for various knee conditions with success in improving pain levels, range of motion, muscle strength, gait velocity, and functional levels. 

Twenty-two patients who had undergone Anterior Cruciate Ligament (ACL) reconstruction underwent a trial to test the efficacy of EMG biofeedback. Participants saw a significant increase in peak torque at three angles of knee extension, compared to the control group. When compared to electrical stimulation alone, those in the EMG group saw significant improvement compared to the non-operative limb [6].

A study done in 2012 found that when EMG was added to the standard therapeutic practice, patients recovering from ACL reconstruction showed significantly more improvement (p < 0.002) in passive knee extension than those in the control group. The paper concluded that the simplicity and inexpensiveness of an EMG biofeedback device makes it an invaluable addition to ACL reconstruction postoperative rehabilitation [7].

Given the success of various types of biofeedback systems in ACL reconstruction and recovery, PBU devices such as the bio stabilizer certainly hold great promise.

This article has been approved and reviewed by the Scientific Writing Team Lead of Esurgi : Ishtiak Ahmed Chowdhury

Sources:

1. Biofeedback. Mayo Clinic. https://www.mayoclinic.org/tests-procedures/biofeedback/about/pac-20384664. Published March 18, 2021. Accessed October 1, 2021. 
2. Cairns MC, Harrison K, Wright C. Pressure biofeedback: A useful tool in the quantification of abdominal muscular dysfunction? Physiotherapy. https://www.sciencedirect.com/science/article/abs/pii/S0031940605611558. Published October 13, 2005. Accessed October 1, 2021. 
3. Małecki J, Kokosz M, Saulicz E, Świat-Borowczyk I. The effectiveness of stability training of the lumbo-pelvic-hip complex in ballroom dancers with low back pain. Physiotherapy and Health Activity. 2015;23(1):17-22. doi:10.1515/pha-2015-0010
4. Frank DL, Khorshid L, Kiffer JF, Moravec CS, McKee MG. Biofeedback in medicine: Who, when, why and how? Mental health in family medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2939454/. Published June 2010. Accessed October 1, 2021. 
5. Wang C, Preisser J, Chung Y, Li K. Complementary and alternative medicine use among children with mental health issues: Results from the National Health Interview Survey. BMC Complementary Medicine and Therapies. https://bmccomplementmedtherapies.biomedcentral.com/articles/10.1186/s12906-018-2307-5. Published August 29, 2018. Accessed October 1, 2021. 
6. EMG-Biofeedback Therapy in Knee Rehabilitation: A Review. International research journal of advanced engineering and science. https://portal.issn.org/resource/ISSN/2455-9024. Published June 25, 2016. Accessed October 1, 2021. 
7. Christanell F, Hoser C, Huber R, Fink C, Luomajoki H. The influence of electromyographic biofeedback therapy on knee extension following anterior cruciate ligament reconstruction: a randomized controlled trial. BMC Sports Sci Med Rehabil. 2012;4(1). doi:10.1186/1758-2555-4-41