“Hands-on” procedures are utilized to accelerate the rehabilitative process. These techniques, delivered only by a licensed therapist, include therapeutic massage, x-fiber friction massage and joint mobilization. As adjuncts to the exercise program, these techniques facilitate quicker improvements in function than exercise alone.

The therapeutic effect of sound waves passing through the skin cause a vibration of the local tissues causing a deep heating effect with no sensation of heat being felt by the patient. In situations where a heating effect is not desirable, such as a fresh injury with acute inflammation, the ultrasound can be pulsed rather than continuously transmitted. Ultrasound can produce many effects other than just the potential heating effect. It has been shown to cause increases in tissue relaxation, local blood flow, and scar tissue breakdown. The effect of the increase in local blood flow can be used to help reduce local swelling and chronic inflammation, and, according to some studies, promote bone fracture healing. The intensity or power density of the ultrasound can be adjusted depending on the desired effect. A greater power density (measured in watt/cm2 is often used in cases where scar tissue breakdown is the goal. Ultrasound can also be used to achieve phonophoresis. This is a non-invasive way of administering medications to tissues below the skin; this is perfect for patients who are uncomfortable with injections. With this technique, the ultrasonic energy forces the medication through the skin. Cortisone, used to reduce inflammation, is one of the more commonly used substances delivered in this way. A typical ultrasound treatment will take from 3-5 minutes depending on the size of the area being treated. In cases where scar tissue breakdown is the goal, this treatment time can be much longer. During the treatment the head of the ultrasound probe is kept in constant motion. If kept in constant motion, the patient should feel no discomfort at all. If the probe is held in one place for more than just a few seconds, a build up of the sound energy can result which can become uncomfortable. Interestingly, if there is even a very minor break in a bone in the area that is close to the surface, a sharp pain may be felt. This occurs as the sound waves get trapped between the two parts of the break and build up until becoming painful. In this way ultrasound can often be used as a fairly accurate tool for diagnosing minor fractures that may not be obvious on x-ray. Some conditions treated with ultrasound include tendonitis (or tendinitis if you prefer), non-acute joint swelling, muscle spasm, and even Peyronie’s Disease (to break down the scar tissue).

We use electrical stimulation or e-stim as one part of your rehabilitation program. E-stim is a type of physical therapy modality used to reduce pain and improve functional mobility. Your physical therapist will use different types of electrical stimulation to accomplish different tasks. These may include: TENS: Transcutaneus electrical neuromuscular stimulation (TENS) is a physical therapy modality used to manage acute and chronic pain in physical therapy. Your PT will use TENS to decrease your pain by applying electrodes to your body over painful areas. The intensity of the electricity will be adjusted to block the painful signals traveling from your body to your brain. Iontophoresis: Iontophoresis is a type of electrical stimulation that is used to help administer medication to you in physical therapy. The electrical current pushes various medication in through your skin and into your body. Your PT will likely use medicine to decrease inflammation or muscle spasm, or iontophoresis drugs can be used to break up calcium deposits that may occur in conditions like shoulder calcific tendonitis. Different medicines are used to accomplish different goals using iontophoresis. Neuromuscular electrical stimulation (NMES): NMES uses an electrical current to cause a single muscle or a group of muscles to contract. By placing electrodes on the skin in various locations the physical therapist can recruit the appropriate muscle fibers. Contracting the muscle via electrical stimulation helps improve the way your affected muscle contracts. The physical therapist can change the current setting to allow for a forceful or gentle muscle contraction. Along with increasing muscle function, the contraction of the muscle also promotes blood flow to the area that assists in healing. NMES can also be used to help decrease muscular spasm by artificially tiring your muscle in spasm, allowing it to relax. Interferential current: Interferrnetial current (IFC) may be used to decrease pain, decrease muscular spasm, or improve localized blood flow to various muscles or tissues. It is often used to decrease low back pain and muscular spasm. Interferrnetial current typically uses 4 electrodes in a crisscross pattern. This causes the currents running between the electrodes to “interfere” with one another, and allows your PT to use a higher intensity current while still maintaining maximum comfort for you. Electrical stimulation is never the only treatment you receive during physical therapy. Research and thirty five years of experience with difficult injuries indicates that active engagement in your physical therapy program – with or without electrical stimulation – yields the best results. E-stim is used to augment your active physical therapy program which includes prescription exercises to treat your condition.

Forster Physical Therapy Voted Best Place to Go for A Sports Massage, Competitor Magazine The human body is a vulnerable place, especially when you are pushing it to the limits with athletics! Stretching, foam rolling, and massaging are CRITICAL parts of a training optimization plan that will keep you fit, uninjured, and ready to take on the next big athletic feat.