Biofeedback is a type of neuromuscular re-education treatment. It is not a stand-alone treatment, but an integral part of a full care plan. It helps patients understand where their body is in a given space, allowing them to improve their control and become more aware of muscle contraction and relaxation during movement.

While it may seem like a physical exercise in and of itself, the true purpose of this treatment is to improve one’s neuromotor control (the connection between the brain and muscles).

Depending on the patient’s needs and comfort, a physical therapist may use several tools and methods in this type of treatment. The tools may include the provider’s hands (in the facilitation or inhibition of movements or muscles), a biofeedback unit that can utilize sticky pads on the skin or internal probes, a mirror, and/or a laser. The tool selected for this treatment will depend on the patient’s comfort, tolerance to the activity or device, and particular condition.

Treatment using these various tools provides feedback via tactile, auditory, or visual cues, which help increase sensation and awareness of muscle activation and relaxation during a particular movement.

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As mentioned, this treatment strategy is only one component of a larger, more comprehensive care plan; it is not designed to be a single stand-alone treatment. Many times, biofeedback is paired with other forms of treatment such as therapeutic exercise or therapeutic activities, to help reinforce proper muscle activation and movement patterns—leading to better outcomes.

It is a helpful treatment technique that provides valuable feedback to help patients feel more in control of their health. This is especially true due to the fact that biofeedback units can be taken home for continued treatment!

Because biofeedback is utilized as a part of a larger care plan, it is suitable for many conditions, such as:

• Neck pain, shoulder pain, TMJ, or chronic pain 
  • When used with other treatments, biofeedback can be useful in addressing pain in the body. It allows patients to be more in-tune with their bodies and better identify the location of their muscle tension and tone. Therefore, it also allows them to make the necessary postural or positional changes that will help relieve their pain.
• Pelvic floor dysfunctions
  • This can include, but is not limited to incontinence, constipation, or pain with intercourse. These dysfunctions are often directly related to a patient’s ability to contract or relax their muscles. Therefore, this can be a helpful treatment in improving a patient’s understanding of their muscles in real-time, while helping them improve their control.
• Injury or surgery
  • After injury or surgery, patients can struggle with connecting to a specific area of their body. Often, getting a muscle or group of muscles to engage can be hard, especially if they are experiencing pain or weakness compared to the unaffected side. Biofeedback is a wonderful tool that helps patients remap their brains for this area by increasing engagement and awareness.
• Pregnant or postpartum patients
  • This treatment is safe for pregnant and postpartum patients. It helps prepare patients for birth by teaching them how to relax and lengthen their muscles in various birthing postures. Conversely, following delivery, it helps promote proper activation, shortening, and contracting of the pelvic floor muscles. 
• Stress Management
  • Stress is oftentimes referred to as neuromuscular up-regulation and is becoming a systemic problem that leads to chronic pain and poor health. Biofeedback is an excellent tool to help identify which down-regulation activities promote stress reduction and pain relief.  

As stated, biofeedback can be utilized as part of a treatment plan and is not limited to the examples above. Because it is not a billing code that is reimbursed through insurance, you will often see it documented and billed as neuromuscular re-education. When patients need to retrain their muscles’ coordination, decrease pain, or induce relaxation, this treatment can be a great supplementary activity to their overall care plan.

There is more than one way to experience biofeedback, and the treatment will vary based on your needs, condition, and health goals. Your physical therapist will work with you to decide on suitable methods that match your health needs and comfort level. As with all treatment strategies, the purpose and goals will be fully explained to you, and the provider will always obtain consent before moving forward with any type of biofeedback.

If your physical therapist chooses to utilize biofeedback as part of your care plan, you can expect to utilize one or more of the modalities listed below. These will provide real-time information about your body and movements through visual, tactile, or auditory feedback. The feedback will allow you to make modifications as needed, such as changing your breathing, how you perform muscle contractions (speed, intensity, duration), and more. Below, you can read about some of the tools in a bit more detail:

• A head-mounted laser is helpful for patients with a condition affecting the head, neck, or shoulders. This can include patients who have experienced a whiplash injury, chronic neck pain, or a concussion. The provider will place the laser on the patient’s head and have them work on moving the laser to targets or working their way through a maze. This will help retrain not only the muscles but also the proprioceptors in the head and neck. 
• A handheld or computer unit will use sticky pads superficially on the skin or internal probes (rectal or vaginal). The type of pad or probe used is determined by your provider and based on your specific condition. These devices aim to provide real-time feedback using visual and auditory cues to inform the patient and the provider of the level and duration of muscle activation. Handheld units can be obtained to continue practicing these concepts and techniques at home, while computer units are only used in session. 

At Hive Therapy and Wellness, your physical therapist will perform a thorough evaluation to determine if you are a candidate for biofeedback. If it is determined that this tool is a good fit for you, they will initiate this treatment during your therapy session, working to improve the movement pattern and coordination of specific muscles. Ultimately, they aim to help you learn how to perform activities independently without relying on the external cuing from the unit.

If appropriate and necessary, they will provide resources for you to obtain your own unit to practice with at home. If internal biofeedback is indicated, your provider will provide their clinical reasoning and be sure to obtain consent before starting any treatment. If you are uncomfortable with internal treatments, your provider will work with you using other methods you may find more comfortable.