These instructions are taken from the Chattanooga STABILIZER Pressure Bio-feedback device, with some editing and additions for clarity. 

Unfortunately it is difficult to source this device at the moment, but there are other similar devices on sale from physio supplies. A simple manual blood pressure cuff (sphygmomanometer) is also an excellent substitute - simply mark the dial with coloured lines:

40 mmHg = orange

70 mmHg = brown

The deep muscle system in the lumbar spine and pelvic region is directly responsible for stabilizing the vertebral segments and sacro-iliac joints. The larger, more superficial muscles are involved in moving the trunk.

The deep muscles are under-active in low back pain and the more superficial muscles are often over-active.

A biofeedback pressure device can help you to retrain the deep muscles so that they activate and support your spine appropriately throughout your normal daily activities as well as when you are exercising or training.

General instructions 

The cuff of the biofeedback device is placed between the part of the body requiring monitoring and a firm surface (e.g., floor, back of chair, plinth, bed, wall).

1. Tighten the screw at the base of the pressure gauge.
2. Pump to inflate the pressure cuff until it molds between the body part and the supporting surface. A pressure of 40 mmHg (orange band) is suitable for the resting pressure of the inflated cuff.
3. The initial baseline pressure may decrease initially as the air back-flows into the tube. Re-inflate before commencing exercise.
4. Changes in body weight on the cuff will register a pressure change on the gauge.
5. Pressure on the cuff can be increased, decreased or maintained depending on the exercise/movement required.
6. After exercise, air is released by loosening the screw.

The biofeedback device can be used to help you to learn to stabilise your lumbar spine and core while activating various upper and lower limb muscles. 



This will help you to perform training exercises more effectively as well as improving your body use and posture throughout your normal daily activities.

1. The Prone Test for Transversus Abdominis & Internal Oblique

1. Place the pressure cuff under the abdomen and inflate to baseline of 70 mmHg (brown band)
2. Draw abdominal wall up and in without moving the spine or pelvis.
3. Pressure should decrease 6-10 mmHg.
4. Hold 10-15 seconds, breathe normally.
5. Perform 10 repetitions.

2. Training the Corset Action of Transversus

Abdominis in Supine

1. Place the pressure cuff under the lumbar spine and inflate to a baseline of 40 mmHg (orange band).
2. Draw in the abdominal wall without moving the spine or pelvis.
3. Pressure should remain at 40 mmHg (i.e. no movement of the spine).
4. Hold for 10-15 seconds; breathe normally.
5. Perform 10 repetitions.

3. Training the Corset Action of Transversus

Abdominis with Leg Loading

• Practise this exercise in lying and standing.

1. Place the pressure cuff behind the lumbar spine and inflate to baseline of 40 mmHg (orange band).
2. Draw in the abdominal wall without moving the spine or pelvis.
3. Pressure should remain at 40 mmHg (i.e. no movement of the spine) while leg lifts.
4. Hold for 10-15 seconds; breathe normally.
5. Repeat 10 times with each leg.

Figs d & e illustrate the effect of using the pressure biofeedback to control core stability and lumbar spine control during leg movements.

The biofeedback device can be used to help you to learn to stabilise your lumbar spine and core while activating various upper and lower limb muscles.  This will help you to perform training exercises more effectively as well as improving your body use and posture throughout your normal daily activities.

4. Lumbar Stabilization During Stretching

Techniques.

These exercises use the biofeedback device to help you to continue to stabilize the spine while adjacent body segments are moved in order to stretch the appropriate muscles.

• For each muscle test/stretch, follow the basic stabilization procedure and maintain pressure during the stretch.

1. Test/stretch for tight hip flexors

(Thomas' Test)

2. Test/stretch for tight Rectus Femoris

3. Test/stretch for tight Latissimus Dorsi and Pectoralis Major

4. Test/stretch for tight Tensor Fascia Lata

1. Have patient lying on their side.
2. Place pressure cuff between lateral trunk (lumbar spine level) and supporting surface.
3. Inflate pressure cuff to 40 mmHg (orange band)
4. Maintain lumbo-pelvic stability by maintaining pressure at 40 mmHg during the stretching manoeuvres.

Remember to keep breathing steadily and quietly throughout all the exercises.

5. Lower Trapezius

Trapezius should be correctly activated through a range of shoulder and arm activities including pull-ups and press-ups.

This exercise uses the biofeedback device to help you to maintain stability of your lumbar spine while activating trapezius.

1. Place the  pressure cuff under abdomen and inflate to baseline of 70 mmHg (brown band)
2. Draw abdominal wall up and in as described in exercise 1 (prone test for transverse abdominis and internal obliques).
3. Lift one arm and draw the scapula down and in, towards the spine. The pressure must remain constant.
4. Hold for 5 seconds.
5. Perform 10 repetitions.
   

Isolating hip flexion & extension

A surprising amount of low back pain is caused by over-use of the lumbar spine muscles. 

Many of us spend large amounts of our time sitting - as part of working lives or when relaxing at home. This leads to chronic shortening of our hip flexors (at the front of our hips and spine) and chronic lengthening of the gluteal muscles of our buttock. 

This means that these sets of muscles become weak and 'de-activated', while your spinal muscles become over active, tight and reactive.

The biofeedback device can be used to monitor your spinal muscle activity in order to detect substitution for the tested muscle’s action and to help you re-train those muscles so that they activate appropriately.

6. Iliopsoas

1. Place the pressure cuff behind the lumbar spine and inflate to baseline of 40 mmHg (orange band)
2. Draw in abdominal wall without thoracic or pelvic movement.
3. Pressure should increase 8-10 mmHg.
4. Lift one leg slowly to test position with the other leg unsupported (i.e. no stool). Pressure should remain constant at 48-50 mmHg.
5. Hold for 5 seconds.
6. Perform 10 repetitions.

7. Gluteus Maximus

1. Place the presssure cuff under the abdomen and inflate to baseline of 70 mmHg (brown band)
2. Draw abdominal wall up and in as described in Exercise 1 (prone test for transverse abdominis & internal obliques).
3. Extend hip by lifting knee up 5 cm (2 in) off supporting surface. The pressure must remain constant.
4. Hold for 5 seconds.
5. Perform 10 repetitions.

Monitoring of unilateral lumbar spine stabilisation for safety & precision of exercises and for protection of the lumbar spine

These exercises use the biofeedback device to monitor the appropriate use of the muscles required in the stabilisation and protection of the lumbar spine during lower limb movements.

The cuff is placed under the opposite side of the spine to the leg movements in order to monitor the correct balancing and stabilisation of the spine and core.

Stabilization Procedure

1. Place the pressure cuff longitudinally under the back of the side on the spine opposite the limb being lifted in exercise and inflate to baseline of 40 mmHg (orange band)
2. Control the back position during limb loading activities and keep the pressure on the cuff constant.
3. In addition, a presetting action of the abdominals may be performed prior to limb loading.

Either

• Presetting as for Exercise 2. The pressure will increase 8-10 mmHg. Keep pressure constant.

Or

• Presetting with a pelvic tilt position. The pressure will increase 20-50 mmHg. Keep pressure constant.

8. Training of the Deep Cervical Flexors

You will need to mark additional points on the pressure dial:

• 20 mmHg = red
• 22 mmHg = green
• 24 mmHg = yellow
• 26 mmHg = blue
• 28 mmHg = grey
• 30 mmHg = black

1. Position the pressure cuff under the neck so that it abuts against the occiput. Do not let it slide down to the lower cervical area.
2. Inflate to a baseline of 20 mmHg (red band)

NOTE: Do not inflate the cuff before insertion behind the neck so as to not disturb your normal cervical curve.

1. The movement to perform is a gentle nodding of the head as if saying “yes”.
2. Place the tongue on the roof of the mouth, lips together but teeth just separated. This will discourage substitution with the platysma or hyoids.
3. Gently nod to target 22 mmHg, just one mark on the pressure dial (green band). See if you can hold the position steadily. If successful, relax and repeat at each target position of 24 mmHg through 30 mmHg (yellow, blue, gray & black bands)
4. The pressure that the patient can hold steady, with minimal superficial muscle activity, is the one on which you will measure endurance capacity. (i.e. 10 repetitions held for 10 seconds each).



Using the inappropriate muscles to control our posture results in muscle imbalances throughout the body.

Some will be very strong, others will be weak.

Retraining your core stability using pressure biofeedback will go a long way to helping these muscles rebalance.