is the introduction of chemical ions into superficial body tissues
for medicinal purposes with the use of direct current electrical
stimulation. Like phonophoresis, it is designed to move medication
into injured tissues such as bursa and tendons. This makes it very
useful in treating bursitis and tendonitis. It is commonly used
in athletes and younger individuals. Often, dexamethasone is prescribed
for its anti-inflammatory effects.
is an approach to therapeutic exercise based on the principles of
functional human anatomy and neurophysiology. It uses specific sensory
(proprioceptive) inputs to produce functional improvement in motor
output. These techniques have been long recommended for increasing
strength, flexibility, and range of motion and are also useful for
enhancing neuromuscular control of both the pelvic and shoulder
girdles and the extremities. PNF is used for all types of orthopedic
and neurologic conditions.
as in PNF techniques, uses sensory information imparted by the therapist
to result in a desired motor response. Neuromuscular control activities
are intended to complement traditional rehabilitation protocols
which encompass the modulation of pain and inflammation as well
as regaining flexibility, strength and endurance.
as we sometimes call it, is used on all populations, unless contraindicated
(ie. Pacemaker or other implantable electrical device is present,
or the patient has an active disease process). There are different
types of currents that are used. Interferential current is used
for pain relief and for edema reduction. Low volt stimulation is
commonly used for pain relief. Direct current (DC) is used to stimulate
muscle that is severely weakened by peripheral nerve injury. And
Russian stimulation is often use post-operatively to assist with
atrophy prevention and muscular re-education.
and Post-Partum Exercise
exercises are designed to assist women in the conditioning of the
pelvic floor as well as the abdominal region either in preparation
of childbirth or for the after-effects of having been pregnant.
Positional education for labor and delivery as well as therapeutic
exercise to prevent excessive spinal strain are used. Post partum
treatment may include reeducation for diastisis rectus (separation
of the rectus abdominus muscle) reduction. Incontinence issues are
addressed as well.
is a system of breathing and strengthening of the entire body. The
focus of all the exercises begins at the core of the body, with
specific integration of the transversus abdominus, diaphragm and
gluteal regions. Very often people are weakened in these areas due
to postural dysfunctions, or from learned disuse habits. In the
progressed form of Pilates, it is actually a spinal stabilization
program. We use Pilates techniques on anyone who could benefit from
core strengthening, not just those with back pain.
is a taping method used to assist patellar position, and abnormal
tilt or tracking of the patella in the trochlear groove of the femur.
The theory is that by imparting specifically-placed external tape
to improve an abnormal tilt or glide, compressive forces are reduced.
Secondarily, normalized fiber orientation of the VMO (vastus medialis
obliquus) promotes improved muscular reeducation and a reduction
of pain. This is commonly used to treat chondromlacia patella, and
can be used post-operatively to reeducate inhibited muscular firing
is used for anyone with diminished balance due to either neurological
or orthopedic reasons (ie. Stroke, Parkinson’s, ankle or knee
injury, or vestibular disease) We utilize various methods such as
wobble boards, Airex pads, trampoline, and single leg stance for
balance training. Prior to any training, patients are thoroughly
evaluated to determine what type of training is most appropriate
for their condition.
therapy uses vibrational energy or sound waves at a high frequency
of 1-3 MHz. With the use of a water-based coupling gel, the sound
waves penetrate through the superficial layers to produce localized
effects on deep tissue. On a continuous setting ultrasound is used
as a deep heating mechanism. It can produce thermal effects on localized
areas of muscle and connective tissue that are too deep to be affected
by application of a hot pack. Ultrasound can also be used on a pulsed
setting to acquired non-thermal effects on the tissue where heat
is contraindicated. These non-thermal effects include: separation
of collagen fibers, increased skin and cell membrane permeability,
increased histamine release, increased macrophage activity, and
increased rate of protein synthesis. Some examples of conditions
that ultrasound is used to treat include: tendonitis, tendonosis,
hypertrophic scar formation, trigger points, bursitis, sprained/strained
ligaments, partiend tendon tears, neuromas, and muscle contractures.
uses ultrasound to drive whole medicinal molecules across localized
areas of the skin and deeper into the tissue layers where regular
topical application could not effect. With the use of hydrocortisone
cream or dexamethasone it can help treat inflammation of deep connective
tissue such as tendonitis, tendonosis, bursitis, or tenosynovitis.
Also, with the use of acetic acid, Phonophoresis can be used to
aid in the reabsorption of calcium deposits.
re-ed can take many different forms. They are designed to reeducate
either postural muscles to stabilize the body, or muscles of the
extremities to move body parts. The therapist can either impart
manual forces on the body part, or as described above, electrical
stimulation can be applied to deliver currents into muscle to improve
muscle firing patterns. Neuro re-ed is used on all of our patients
regardless of age or dysfunction.
patients are first evaluated by our therapists, one of the main
things we look at is posture. Very often postural faults lead to
injury and either overuse or underuse of important muscles. For
example, lateral or medial epicondylitis (tennis elbow and golfer’s
elbow, respectively) are very often caused ultimately by weak scapular
muscles that are inhibited due to poor posture. The weakened proximal
muscles force the smaller muscles of the forearm and wrist to work
harder, putting stress on the insertion of those muscles at the
elbow. By retraining posture, very often the cause of the problem
is fixed and the patient can return to their prior work or spots
activities. Postural training is most often performed on older individuals
with long-standing faulty posture, however, we have seen and treated
many teenagers who, for various societal and social reasons, have
adapted poor posture and who are setting themselves up for future
back and extremity problems.
Return to Work Training
of our patients work in jobs that are not conducive to their specific
body type and/or muscular physique. We work with our patients to
identify physical problems that they have at their job site, and
find ways to either modify their activity level, reposition their
workstation for optimal sitting posture or to develop their body
to better handle the stresses of the work environment. Ergonomics
are discussed with relation to desk layout and seat height. Likewise,
lifting techniques are reviewed with patients who need to lift during
the course of their day.
perform various gait training techniques with our patients who
have difficulty walking or running. We are trained to identify
subtle nuances with a person’s gait pattern that they may
have never realized. We give both verbal direction and hands-on
guidance for improving gait. We work with patients who use walkers,
crutches and canes to ambulate. When it’s feasible, and
it’s the patient’s goal, we try to progress their
assistive device to either a less restrictive one, or to walking
without an assistive device. We train our patients to be able
to walk forwards, backwards, sideways, and to be able to step
over objects on the floor. Balance training is always incorporate
into gait training, as they work simultaneously.
utilize large Swiss balls most often for seated balance training
and spinal stabilization training. We have various sizes of these
balls for different sized patients. There are numerous exercises
for both the upper and lower extremities that patients perform
either while seated or lying on the ball, or by keeping the ball
behind their back while squatting against a wall.
is a great way to heat up the areas of the wrist and hand that
are not easily heated by a moist hot pack. The paraffin not only
softens scars and soft tissue of the wrist and hand; it also functions
as a heating modality to surround all of the fingers and to bring
increased blood flow to the area. As the wax cools rather rapidly,
we use a moist heating pack wrapped around the area to insulate
the heat a nd provide a more effective treatment.
mobilization is a manual therapy technique performed by a licensed
Physical Therapist to improve the mobility of any joint of the
shoulder or pelvic girdles or the extremities. Specific forces
are applied to the joint either at the begininning, middle, or
end range of motion to effect the mobility of that joint. Some
joint mobs are for increasing joint mobility and some are for
the neuromodulation of pain signals to the brain for pain reduction.
is a specific hands-on technique we use, in conjunction with joint
mobilization, to effect soft tissue for increasing flexibility,
decreasing hypertonicity when it’s not wanted, and to realign
muscle fibers for proper functioning. This is most often performed
on areas with larger muscle groups, such as the back muscles and
muscles of the shoulder girdle, hip and thigh. We incorporate
trigger point therapy, when necessary to loosen local trigger
points in the soft tissue.
to joint mobilization of the extremities, spinal mobilization
works on the joints of the spinal column to restore mobility in
restricted segments and to improve posture dysfunctions. This
is another manual technique that is regularly performed on our
patients with back pain and mechanical dysfunction of the spine.
Based on the type and severity of the problem, we use varying
amounts of pressure to effect change in the spinal joints.
and Manual Traction
is the application of a mechanical force to the body in a way
that separates or attempts to separate the joint surfaces and
helps elongate the surrounding soft tissue. Our traction table
provides cervical and lumbar mechanical traction, which helps
separate the joint surfaces of the vertebral bodies. This help
to widen the vertebral foramen to effect nerve root impingement,
stretch facet joint capsules for increased joint range of motion,
stretch soft tissue for decreased pain and muscle spasm, reduce
small disc protrusions and decrease intradiscal pressure. Traction
is indicated for patients with disc bulges or herniations, nerve
root impingement, hypo-mobility of joints, sub acute joint inflammation,
compression fracture, and muscle spasm/guarding. Our Therapists
are fully trained in the use of manual traction. Manual traction
can be used to slowly introduce traction to injured tissues prior
to the use of higher forces that can be applied using the mechanical
table. With manual traction the therapist is able to monitor the
patients response to determine the reaction to this treatment.
Manual traction can also be used in place of mechanical traction
for more sensitive patients or where precautions are indicated
such as pregnancy, respiratory problems, or position intolerance.
Band Resistence Training
band exercises are used to improve strength and motor control,
usually of the upper and lower extremities. We encourage patients
to utilize the bands for their home exercise programs, as they
are very easy to use and are simple to set up in the patient’s
home. We often encourage patients to bring the band with them
when they travel as it is easy to pack in a suitcase. Nearly every
muscle in the body can be trained using these bands. We have many
different colored bands which indicate the amount of resistance
that the patient will feel when pulling.
programs of therapeutic exercise, manual therapy, and modalities
developed for specific conditions such as: spndylosis, spondylolisthesis,
herniated nucleus propulsus, stenosis, scoliosis, hyper/hypo mobility,
illiosacral dysfunction, compression fracture, and whiplash. Therapeutic
exercise programs include lumbar stabilization TherEx, McKenzie
exercises, posture re-education, and general upper and lower extremity
strengthening. Manual therapy includes soft tissue massage, myofascial
release, sub occipital release, trigger point therapy, traction,
muscle energy techniques and mobilizations for cervical thoracic,
lumbar and sacroiliac areas. Modalities include hot/cold packs,
electrical stimulation, ultrasound, combo, and mechanical traction.
Each program, tailored to the needs of the patient, is closely
monitored by the therapist and progressed as needed to help the
patient reach his/her individual goals of function and activities
of daily living.
Braces must be prescribed by the treating Specialist.
Custom-molded Lumbar Orthoses:
We provide lumbar orthoses that are molded to the patient’s
body by his/her physical therapist. The molding process ensures
a custom fit that provides support for each individual’s
specific dysfunction as identified by his/her treating therapist.
Individuals with knee injuries are provided with a hinged knee
brace to provide support for compromised knee stability caused
by sprains/strains, or tears of ligaments / tendons / or cartilage.
It also provides compression to aid in the reduction of swelling,
and pressure reduction and support for the patella or knee cap.
Resting splints for the wrist are provided for overuse injuries
such as carpal tunnel syndrome or tenosynovitis.
Individuals with ankle injuries are provided with a pneumatic
(air) cast to provide support for compromised ankle stability
caused by sprains/strains, or tears of ligaments/tendons/or
cartilage. It also provides compression to aid in the reduction
Cervical Collars are provided to individuals suffering from
neck pain and muscle spasm resulting from injuries such as whiplash.
They provide support to the neck and reduce the workload on
the muscles for maintaining proper posture during the acute
phase of rehabilitation.
Private treatment areas for patient comfort and privacy
2. Individualized exercise programs
3. Caring team members
4. Experience clinical and support staff
5. Continued supervision of exercise program post clinical care
6. Personalized home exercise programs