Iontophoresis 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.
Proprioceptive Neuromuscular Facilitation
 (PNF) 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.
Neurodevelopmental Technique
 (NDT) 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.
Electrical Stimulation
 E-stim, 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.
Prenatal and Post-Partum Exercise
 These 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.
Pilates Training
 Pilates 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.
McConnell Taping
 This 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 patterns.
Balance Training
 This 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.
Ultrasound Therapy
 Ultrasound 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.
 Phonophoresis 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.
Neuromuscular Reeducation
 Neuro 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.
Postural Training
 When 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.
Functional Return to Work Training
 Many 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.
Gait Training
We 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.
Swiss Ball Training
We 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.
Paraffin Wax Treatment
Paraffin 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.
Joint Mobilization
Joint 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.
Deep Tissue Mobilization
This 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.
Spinal Mobilization
Similar 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.
Mechanical and Manual Traction
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.
Therapy Band Resistence Training
Resistive 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.
Spine Rehabilitation
Individual 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.
All 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.

Hinged Knee Brace:
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.

Wrist Resting Splint:
Resting splints for the wrist are provided for overuse injuries such as carpal tunnel syndrome or tenosynovitis.

Pneumatic Ankle Cast:
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 of swelling.

Cervical Collars:
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.

1. 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 and injury
6. Personalized home exercise programs

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