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Physical Therapy

Physical therapy is a health care specialty involved with the evaluation, diagnosis, and treatment of disorders of the musculoskeletal system. The ultimate goal of physical therapy is to restore maximal functional independence to each patient. Our rehabilitation team uses a variety of techniques which promote the ability to move, reduce pain, restore function, and prevent disability.

Our dynamic outpatient settings enable the therapist and patient to work side-by-side to achieve all of the patient’s goals. The techniques listed below are just some of the theories and strategies used to help return you to your optimal functional status. Our goal is to lend a helping hand in returning you to the lifestyle you deserve.

Exercise

Exercise is a very important part of the rehabilitation process. Exercises are used to correct physical deficits in order to help restore function. Exercise programs are designed to each individual’s needs and target areas of weakness and instability. Correcting these deficits allows the body to move more naturally and can often relieve pressure or correct dysfunction. A consistent individualized exercise routine has been proven to provide long term results in alleviating symptoms while decreasing the risk of re-injury.

Range of motion exercise refers to activity that improves movement of a specific joint. Joint motion is influenced by several structures: configuration of bony surfaces within the joint, joint capsule, ligaments, tendons, and muscles acting on the joint. There are three types of range of motion exercises: passive, active, and active assistive.

Strengthening exercises are performed to increases muscle strength, muscle mass, bone strength, and also increases the body's metabolism. A certain level of muscle strength is needed to perform daily activities such as walking, running, and climbing stairs. Muscles also help assist in skeletal alignment, stabilization of joints and contribute to maintenance of proper posture. Strengthening exercises increase muscle strength by putting more strain on a muscle than it is normally accustomed to receiving. This increased load stimulates the growth of proteins inside each muscle cell that allow the muscle as a whole to contract. Weight training allows immediate feedback, through observation of progress in muscle growth and improved muscle tone. Strengthening exercise can take the form of isometric, isotonic and isokinetic strengthening.

During isometric exercises, muscle contraction occurs, yet there is no motion in the affected joints. The muscle fibers maintain a constant length throughout the entire contraction. The exercises usually are performed against an immovable surface or object such as pressing one's hand against a wall. The muscles of the arm are contracting but the wall is not reacting or moving in response to the physical effort. Isometric training is effective for developing total strength and activation of a particular muscle or group of muscles. It often is used for rehabilitation since the exact area of muscle weakness can be isolated and strengthening can be administered at the proper joint angle. This kind of training can provide a relatively quick and convenient method for overloading and strengthening muscles without any special equipment and with little chance of injury.

Isotonic exercise differs from isometric exercise in that there is movement of a joint during the muscle contraction. A classic example of an isotonic exercise is weight training with dumbbells and barbells. As the weight is lifted throughout the range of motion, the muscle shortens and lengthens. Calisthenics are also an example of isotonic exercise. These would include chin-ups, push-ups, and sit-ups, all of which use body weight as the resistance force. Isokinetic exercise provides resistance at a constant velocity throughout a given range of motion. This type of exercise is difficult to replicate clinically and is not a particularly functional way of muscle strengthening. Isokinetic exercise is often used in research and is not often used clinically during rehabilitation.

The McKenzie Method

The McKenzie Method of treatment is primarily known as an extension based protocol for treating back pain related to a lumbar disc herniation. In fact, the McKenzie method is not merely extension exercises. In its truest sense, McKenzie is a comprehensive approach to the spine based on sound principles and fundamentals that when understood and followed accordingly are very successful.

McKenzie Assessment: Unique to the McKenzie Method is a well-defined algorithm that leads to the simple classification of spinal-related disorders. It is based on a consistent "cause and effect" relationship between historical pain behavior as well as the pain response to repeated test movements, positions and activities during the assessment process.

A systematic progression of applied mechanical forces (the cause) utilizes pain response (the effect) to monitor changes in motion/function. The underlying disorder can then be quickly identified through objective findings for each individual patient. The McKenzie classification of spinal pain provides reproducible means of separating patients with apparently similar presentations into definable sub-groups (syndromes) to determine appropriate treatment.

McKenzie has named these three mechanical syndromes: Postural, Dysfunction and Derangement.

*All three mechanical syndromes – postural, dysfunction, and derangement – occur in the cervical as well as thoracic and lumbar regions of the spine.

Each distinct syndrome is addressed according to it’s unique nature with mechanical procedures utilizing movement and positions. The Derangement syndrome where the phenomenon of "centralization" occurs is most common.

Practitioners of Mckenzie theory will be able to identify those more difficult cases where advanced McKenzie techniques might benefit the patient as opposed to those patients whose diagnosis is non-mechanical in nature. Those patients are then quickly referred for alternate care, thus avoiding unnecessary periods of inappropriate or expensive management.

Treatment: McKenzie treatment uniquely emphasizes education and active patient involvement in the management of their treatment in order to decrease pain quickly, and restore function and independence, minimizing the number of visits to the clinic. If a problem is more complex, self-treatment may not be possible right away. A clinician with an understanding of Mckenzie theory will know when to provide additional advanced hands-on techniques until the patient can successfully manage the prescribed skills on their own.
Ultimately, most patients can successfully treat themselves when provided the necessary knowledge and tools. An individualized self-treatment program tailored to the lifestyle of the patient puts the patient in control safely and effectively.

Preventive: Patients gain an experiential education learning to self-treat the present problem. The management of these skills and behaviors will minimize the risk of recurrence and allow patients to rapidly manage themselves when symptoms occur.

Soft Tissue Mobilization

It is important to recognize the role of muscles and their attachments around the joints. Muscle tension can often decrease once joint motion is restored, but many times the spasm will continue to be present. In such cases, muscle tension should be addressed or the joint dysfunction may return.

The goal of soft tissue mobilization (STM) is to break up inelastic or fibrous muscle tissue such as scar tissue. It can also be used to move tissue fluids, and relax muscle tension. This procedure commonly consists of rhythmic stretching and deep pressure. The therapist will localize the area of greatest tissue restriction through layer-by-layer assessment. Once identified, these restrictions can be mobilized with a wide variety of techniques. These techniques often involve placing a traction force on the tight area with an attempt to restore normal texture to tissue and reduce associated pain.

Strain Counterstrain

This technique focuses on correcting abnormal neuromuscular reflexes that cause structural and postural problems, resulting in painful ‘tenderpoints’. The therapist finds the patient’s position of comfort by asking the patient at which point the tenderness diminishes. The patient is held in this position of comfort for about 90 seconds, during which time asymptomatic strain is induced through mild stretching, and then slowly brought out of this position, allowing the body to reset its muscles to a normal level of tension. This normal tension in the muscles sets the stage for healing. Strain-counterstrain is tolerated quite well, especially in the acute stage, because it positions the patient opposite of the restricted barrier and towards the position of greatest comfort.

Joint Mobilization

Joint accessory motions occur naturally with movement at the joint, but are often inhibited when there is an injury or secondary to non-use of a joint. Inhibition of these motions is often related to soft tissue tightness or spasm. Joint mobilization involves loosening up the restricted joint and increasing its range of motion by providing slow velocity (i.e. speed) and increasing amplitude (i.e. distance of movement) movement directly into the barrier of a joint. These mobilizations will help increase range of motion and decrease pain at a particular joint.

Muscle Energy Techniques

Muscle energy techniques (MET’S) are designed to mobilize restricted joints and lengthen shortened muscles. This procedure is defined as utilizing a voluntary contraction of the patient’s muscles against a distinctly controlled counterforce applied from the practitioner from a precise position and in a specific direction.

Following a 3-5 second contraction, the operator takes the joint to its new barrier where the patient again performs a muscle contraction. This may be repeated two or more times. This technique is considered an active procedure as opposed to a passive procedure where the operator does all the work (such as joint mobilizations).

Muscle energy techniques are generally tolerated well by the patient and do not stress the joint.

Williams Flexion Exercises

Dr. Paul Williams first published his exercise program in 1937 for patients with chronic low back pain in response to his clinical observation that the majority of patients who experienced low back pain had degenerative vertebrae secondary to degenerative disk disease.  These exercises were developed for men under 50 and women under 40 years of age who had exaggerated lumbar lordosis, whose x-ray films showed decreased disc space between lumbar spine segments (L1-S1), and whose symptoms were chronic but low grade.  The goals of performing these exercises were to reduce pain and provide lower trunk stability by actively developing the "abdominal, gluteus maximus, and hamstring muscles as well as..." passively stretching the hip flexors and lower back (sacrospinalis) muscles.  Williams said: The exercises outlined will accomplish a proper balance between the flexor and the extensor groups of postural muscles.

Williams’ flexion exercises have been a cornerstone in the management of lower back pain for many years for treating a wide variety of back problems, regardless of diagnosis or chief complaint.  In many cases they are used when the disorder’s cause or characteristics were not fully understood by the physician or physical therapist.  Also, physical therapists often teach these exercises with their own modifications.  Williams suggested that a posterior pelvic-tilt position was necessary to obtain best results.

Maitland Approach

The Maitland Concept of Manipulative Physiotherapy as it is known, emphasizes a specific way of thinking and continuous evaluation and assessment of the patient. This approach focuses on positional mobilization. Maitland believes that the obligation of the therapist is to "know when, how and which techniques to perform, and adapt these to the individual patient".

Cyriax

James Cyriax is one of the original pioneers of physical therapy evaluation and treatment. His philosophy of selective tissue tension testing is one of the fundamental theories used in evaluations throughout the world. This theory revolves around the fact that positive tests are a result of pathology of certain tissues being stretched. Cyriax also introduced a specific, limited approach to massage, recommending a type of friction that goes across the fibers of the structure being treated. This allows the body to accelerate the healing process at that particular localized area. The Cyriax approach is still a gold standard for evaluation and treatment of musculoskeletal related problems.

Therapeutic Modalities

Modalities are used to facilitate the healing process, decrease pain, decrease inflammation, increase tissue elasticity and as a therapeutic aide to the rehabilitation process. Modalities are used on an as needed basis when indicated by a certain conditions. Modalities provide short term relief from the symptoms of specific conditions and can play a vital role in a patient’s recovery.