Our physical therapy program borrows equally from the rheumatologic and orthopedic philosophies of physical medicine. We emphasize the patient’s role as an active participant in the four phases of their rehabilitation. Patients are taught to protect the injured area as the first step toward healing. A basic premise is to use physical therapy modalities to treat symptoms as we progress the patient through a therapeutic exercise program. Exercise and manual therapies are the mainstay of our rehabilitation programs because it is our belief that the body, being a mechanical device, requires mechanical treatment (i.e. stretching, strengthening and manual therapy techniques). Modalities alone do not constitute a physical therapy program. Although exercise is the focus of our treatments, physical therapy modalities are utilized to suppress symptoms so we can move faster through the exercise progressions. These modalities are physical agents such as ultrasound, electrical stimulation, ice and sometimes heat. The role of these treatments is to create changes in the local tissues, which are then exploited to achieve our desired therapeutic results. These are an important part of the early phases of treatment.
CROSS FIBER FRICTION MASSAGE
“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.
Forster’s science-based recovery and rehabilitation programs progress through prescription phases with the objective of building and sustaining individualized structural health and joint stability while rooting out the cause of pain and injury, and solving imbalances and weaknesses exploited by the need for ergonomic adjustments. The fourth phase of rehab provides the whole solution to health and fitness encompassing the four pillars of health and performance which include nutritional optimization and weight management, metabolic development, periodized strength and flexibility training exercise programs, as well as technique and gait analysis.
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).
ICE AND COMPRESSION
Cold application is another general type of therapy for musculoskeletal injuries. When ice is applied to the body, there is a heat transfer from the body to the ice, which causes the tissues to cool. The amount of cooling that happens is directly related to the type of tissue, the type of cold application that is applied, and the length of exposure. For example, muscle will get colder than fat tissue; this is due to the amount of water that is in the tissue. Types of cold therapy that can be use include ice massage, ice packs, cold immersion, or vapocoolant sprays. The most common are ice packs and ice massage. By wearing compression garments, and orthopedic sleeves and braces a person is able to increase their blood circulation in the covered areas thereby increasing oxygen flow to the affected areas, delivering more nutrients and removing cellular waste. Additionally, they also assist with swelling, inflammation, and temperature regulation. There are a wide range of compression garments used both medically and for performance athletes; from running and cycling, to just about any sport imaginable, compression garments have proved that they can significantly impact an athletes endurance and overall fitness by improving the circulation of waste products from the muscles and speeding recovery.
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.
ICE OR HEAT MASSAGE
Heat and ice massage therapy are among the most commonly used treatments in physical therapy to help decrease pain from both chronic and acute injuries. Ice is commonly used immediately after an acute injury, such as an ankle sprain. Ice is also used to massage overuse injuries after strenuous activity or after sports and exercise to prevent or decrease inflammation. Heat is used for chronic injuries or injuries without swelling or inflammation. Heat is good for treating some types of muscle spasms and sore, stiff or tight muscles and joint pain. Heat may also be used before exercise to stimulate blood flow, but never after.
PROFESSIONAL THERAPEUTIC MASSAGE
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