“Physical therapists are movement experts who treat people of all ages and abilities, helping them to improve and maintain function and quality of life.”
Physical therapists create individual treatment plans to match each patient’s goals, helping each patient to improve their fitness and function, avoid surgery, and reduce the use of opioids and other drugs.
“Pain-free movement is crucial to your quality of life, your ability to earn a living, and your independence. Physical therapists are movement experts who can identify, diagnose, and treat movement problems.”
What to Expect From a Physical Therapist:
Evidence-Based Treatment to Meet Your Needs: Physical therapists combine extensive education, clinical experience, and the latest research to create treatment plans tailored to a patient’s specific needs and goals.
P.T. may include: Passive modalities, such as moist heat and electrical stimulation; Manual techniques including mobilization, myofascial release, stretching, and massage; education in biomechanics and ergonomics; and therapeutic activities and exercise.
Physical therapists care for patients of all ages and abilities. They diagnose and treat existing health conditions, but they also provide patient education, customize plans of care, and preventative treatments that can help patients avoid many health problems before they occur.
Pediatric physical therapy encompasses a broad spectrum of conditions and treatment approaches. The two primary categories of conditions treated in most outpatient clinics are orthopedic and neurodevelopmental. Orthopedic conditions in children can be congenital, acquired due to injury, or developed through repetitive strain or postural misalignment.
A common congenital condition in infants is Torticollis which is characterized by a shortening of the sternocleidomastoid muscle on one side of the neck. The can cause the child's head to tilt toward one side while rotating to the other. It is often associated with plagiocephaly, a flattening of an area of the child's head. Torticollis can vary in severity but typically responds well to conservative management which focuses on educating parents and caregivers about proper positioning, age-appropriate activities, and a combination of stretching and strengthening exercises.
Acquired orthopedic conditions are often those that occur as the result of an injury or accident. In younger children this can be fractures or soft tissue injuries that come as the result of a fall in the playground, while in pre-adolescent or adolescent children sports-related injuries such as ligament sprains or muscle strains are common.
Finally, children are susceptible to a unique category of repetitive strain injuries such as Osgood-schlatters disease which is an inflammatory condition at the insertion of the patellar tendon just below the knee. Or Sever's disease, a similar condition where the Achilles tendon attaches to the back of the heel.
Additionally, children are becoming increasingly likely to develop neck and back pain due to prolonged passive positioning and excessive screen-time when using tablets, phones, laptops, and video games. Pediatric physical therapists address these issues using a variety of techniques such as taping, massage, and the use of modalities to protect the injured area and reduce pain. Innovative functional strengthening and flexibility exercises are necessary to effectively engage younger children and teach good habits to help address the symptoms and prevent future episodes. A hallmark of pediatric treatment is creating a strong working relationship with parents and caregivers who become partners in implementing recommendations and achieving goals.
Occupational therapists (O.T.’s) help people across the lifespan participate in the things they want and need to do through the therapeutic use of everyday activities and exercises. At Physical Medicine and Rehabilitation our main focus is to help people recover from injuries to the hands and the “upper quarter” of the body. These injuries can occur in accidents, when people have surgery, as symptoms of chronic illnesses and pain or as a repetitive stress injury. Post- surgical hand therapy involves treatment of fractures, tendon, muscle, ligaments, soft tissue injuries and joint replacements. O.T.’s help patients to regain skills and to maximize their performance of everyday activities of daily living (ADL’s). Occupational therapy/hand therapy addresses areas such as improving strength and range of motion, decreasing pain and swelling, managing scar formation, fabricating orthoses and recommending over the counter splints and adaptive equipment to help people gain greater independence.
O.T. services include:
At The PMR Center we understand that staying in shape should be an important component in everyone's life. Unfortunately, not everyone can adapt to traditional exercise facilities. This is where our Supervised Fitness Programs can help. The programs are run by our Exercise Physiologists after close collaboration with our Physicians and Physical Therapists. Whether it is transitioning from therapy to a home exercise program or to a normal gym program, we can address the unique health needs of each individual. We also offer a Guided Fitness Program for our ambulatory challenged population. Medically supervised fitness is a safe way to achieve health and fitness goals.
Some causes of knee pain, including pain due to osteoarthritis, can be treated with injections of gel into the knee. This is known as viscosupplementation. It is often used in concert with physical therapy, and possibly after steroid injections have been utilized. The idea of viscosupplementation injections is to lubricate the knee joint when wear and tear have led to pain in the joint. The gel that is injected allows the bones of the knee to move against each other more smoothly, reducing pain with weight bearing and with activity. This can not only decrease pain, but allow for increased activity. Various types of gel can be used – common brands include Euflexxa®, Synvisc®, and Orthovisc®.
Viscosupplementation injections may be given under live ultrasound guidance. This method, which simply involves placing a probe on the skin by the knee, can allow the doctor to see the needle during the procedure, to make sure that it is going into the correct place. The doctor can also see the medication being injected into the knee to increase the accuracy of the injection.
At The PMR Center, we have had good results with viscosupplementation injections. Feel free to talk to a doctor at The PMR Center to find out more.
EMG stands for electromyography, which is a test of the function of the muscles in the body. An EMG test is almost always performed along with a test of the nerves, known as nerve conduction studies (NCS). Together, EMG and NCS are called electrodiagnostics.
Electrodiagnostics can be thought of as a “stethoscope for the nerves”. When a doctor wants to evaluate the lungs, they often take a picture of the lungs, with an x-ray. But as most people have experienced, the doctor usually wants to hear how the air is moving through the lungs, so they listen with a stethoscope as well. Similarly, electrodiagnosis allows the doctor to see, and even hear, the flow of electricity through the nerves. Just like a stethoscope complements and adds extra information to an x-ray of the lungs, electrodiagnostic testing compliments and adds extra information to other tests, such as MRI and x-ray. This is why your doctor will often order electrodiagnostic testing in addition to an MRI or x-ray.
The electrodiagnostic test itself takes anywhere from 20 to 45 minutes, and most of that time, the doctor is working with the equipment, not actually examining you. Although you will be in the room with the doctor the whole time, only a small fraction of the test actually involves the doctor directly examining you. After the test, the doctor usually can give you a rough idea of the results immediately. It takes about a day for a formal report to be generated. So generally, by the next day, you can contact the doctor who ordered the test to find out any results.
Prolotherapy, also known as Regenerative Injection Therapy, is an injection technique used to treat chronic pain related to damage to underlying ligament and/or tendon structures. It involves injecting a small amount of a mixture of local anesthetic and dextrose (sugar), or other similar solution, directly at the site of damage. The sugar stimulates the body’s natural healing and repair processes.
Prolotherapy is used successfully to treat many different paintful conditions, including:
Prolotherapy is designed to be a permanent fix, not simply a temporary procedure. Approximately 80-90% of patients appropriately treated with prolotherapy will experience benefit; some get 40-50% improvement, while others may get 90-100% improvement.
Effective treatment usually takes between 3 and 6 treatments. Treatments are given approximately once a month.
Physical Medicine and Rehabilitation (Physiatry) is a specialty of medicine concerned with the diagnosis and treatment of aches and pains and other disabling conditions. Board- certified physiatrists must complete, in addition to medical school, a four year residency program. The training develops skills in areas of orthopedics, neurology, and rheumatology. This places the physiatrist in an advantageous position to decide upon the cause of a patient’s symptoms: Nerve, muscle, joint, bone, ligament, etc. In addition to the conventional use of medications, we have expertise in the use of modalities (heat and cold modalities, ultrasound, electrical stimulation, etc.), exercise programs, manual techniques, equipment (splints, corsets, braces,) and coordination of therapy programs.
Having doctors who listen carefully when patients “tell us where it hurts” is more than common sense. It’s good medicine. At The PMR, we take the time to learn about your pain, about its history, and what we can do to make you feel better. Our commitment to enhance patient-doctor communication led us to create a center where doctors and therapists work together for a carefully coordinated level of patient care that’s truly unique.
The center is a multidisciplinary outpatient facility. Our goal is to provide the highest level of care for patients with neuromuscular conditions, pain, and sports/orthopedic problems. We have a highly trained medical and therapy staff that have committed themselves to continuing education and have had extensive experience.
Epidural Steroid Injection has been found to be an effective adjunct to treatment for patients with neck, lower back, arm, and leg pain. Commonly, nerves in the neck or back are compressed near the spine by a bulging disc, a bone spur, or scar tissue. This causes the nerve to become irritated and swollen, causing pain, numbness or tingling radiating into the arms or legs. The purpose of the epidural injection is to decrease inflammation and provide pain relief, thereby facilitating active therapy. Their primary use is as one component of a comprehensive treatment plan that includes medication, physical therapy, and education in body mechanics.
The success of the epidural steroid injection in relieving pain is due to the potency of the anti-inflammatory medication introduced into the epidural space. Cortisone is a powerful anti-inflammatory medication which reduces nerve irritation, thus reducing pain. As you may have heard, cortisone is sometimes associated with side effects such as puffy face, brittle bones, etc. These side effects typically occur in patients who are taking cortisone by mouth for long periods of time. With epidural injection, the cortisone acts locally on the nerves and herniated disc and systemic reactions are very rare.
The medication starts to work immediately, but can take up to 2 weeks before it is entirely effective. Some patients feel relief upon injection, others after a few days to a week. You will be given an appointment for a follow up visit with your doctor to evaluate the success of the epidural injection approximately 4-7 days following epidural. If pain relief is not complete, the injection can be repeated after two weeks.
Possible side effects associated with the procedure include: numbness, dizziness, weakness for ½ hour to 4 hours after the injection; reaction to medication include minor or temporary allergic reaction which may include a temporary decrease in blood pressure (about 1 percent of the time); increased pain for one to seven days after injection; headache with or without spinal tap.
As most people come to learn, our joints and tendons can start to hurt us over time. This can be due to normal degenerative processes, such as those that cause knee or hip arthritis, or due to acute injuries, such as a pulled hamstring. In either case, there may be degenerative changes in the painful area, such as thinning cartilage in the knee, rotator cuff wear and tear in the shoulder, or joint space narrowing in the hip. Also commonly present is a process that cannot be seen on x-ray or MRI, but is just as important: the process of inflammation.
Inflammation is a chemical process at the microscopic level, in which the body’s tissue reacts to overuse or injury. Inflammation can be painful. If you’ve ever had an ache or pain that was improved after taking an oral anti-inflammatory medicine, such as Alleve, Naprosyn, or aspirin, you’ve actually felt how inflammation can be painful, and how blocking inflammation can reduce pain. Taking an anti-inflammatory via the oral route (i.e. swallowing a pill) can be helpful, but has its limitations. One limitation is side-effects: taking oral anti-inflammatories can affect the lining of the stomach and esophagus, and can lead to side effects such as stomach upset, gastritis, or even ulcer. Another limitation of oral anti-inflammatory treatment comes from the fact that the stomach and intestines, were oral anti-inflammatory agents are absorbed, are organs that are designed to distribute what one eats everywhere in the body. So an anti-inflammatory pill taken orally is distributed throughout the body, and is therefore very diluted. A diluted medication can be much less effective.
A solution to the above problem of side-effects and dilution of oral anti-inflammatory medications is to place such medications directly on, or very close to, the area that is inflamed and painful. This allows the medications to pretty much stay on the area of the body we are trying to treat. This localized medication is much more concentrated, providing a stronger pain relieving effect. Localized medication also doesn’t spread throughout the body as much as if it were taken orally, reducing side-effects. Such localized anti-inflammatory treatment can be delivered by way of steroid injection.
In joint and tendon injections of steroid, we achieve a strong, localized treatment of pain due to inflammation. To assist in localizing application of the medication, we often use ultrasound guidance while providing this treatment, so that the doctor can see where the medicine is going as he or she injects it. This treatment has often provided great relief in joint and tendon pain.
Examples of such injections include:
There are many other areas where steroid injections can help. If you are experiencing longstanding, or new onset, pain anywhere in teh arms or legs, it is recommended that you seek the advice of a doctor, preferably one specializing in musculoskeletal medicine (such as a physiatrist), to help diagnose your problem. Once you've done this, it is quite possible that, among other treatments that will be provided, a joint or tendon injection may be helpful.
OMT is a form of non invasive hands on manual medicine which focuses on treating the body’s interconnected system of bones, muscles, and nerves. Osteopathic physicians (DO’s) have undergone special training in the musculoskeletal system. They use their hands to treat patients by applying gentle pressure, resistance, and stretching in attempts to alleviate pain, promote improved mobility of joints, and facilitate the body’s innate ability to heal. Some of the techniques used by Osteopathic physicians include Myofascial release, Muscle energy, Counter strain, and Soft tissue stretching. Here at Physical Medicine and Rehabilitation our physicians use a combination of the latest advances in medical technology along with the healing touch of OMT when appropriate.
More information coming soon.
Platelet rich plasma (PRP) is derived from your own blood. Your blood is mainly liquid and contains small solid components including red and white blood cells along with platelets. Platelets are integral in blood clotting. They also contain a number of proteins called growth factors which can help in healing of injuries. To obtain the PRP, a sample of your blood is taken and placed into a centrifuge. The spinning of the blood then separates the platelets from the other components. This sample is what is then injected.
The goal of PRP is to stimulate a healing response and reduced inflammation by sending a high concentration of growth factors to injured tissue. PRP has been used in several musculoskeletal settings, including injuries to muscles, tendons, joints, and ligaments. Injection of PRP is minimally invasive and is generally performed with ultrasound or fluoroscopic guidance to assist in correct placement. Risks of side effects are limited as your own blood is being used for the procedure and are usually limited to risks of infection. A short-term local irritation may occur after the injection which is normal and part of the healing. Fifty percent relief is usually reached at six weeks and greatest relief is achieved at 12 weeks.
Botulinum toxin, commonly known as Botox and/or Xeomin, is a potent neurotoxin produced by the bacterium Clostridium botulinum.
While it is famous for its cosmetic applications, such as reducing facial wrinkles, it also has therapeutic uses, particularly in managing spasticity.
Spasticity is a condition characterized by increased muscle tone and stiffness, often resulting from neurological disorders like cerebral palsy, multiple sclerosis, or stroke. It can cause muscle tightness, pain, and difficulty with movement. Botulinum toxin injections have been found to be effective in reducing spasticity and improving functional abilities in affected individuals.
Here's how botulinum toxin is used for spasticity management:
Botulinum toxin, commonly referred to as Botox, has been approved by regulatory authorities for the preventive treatment of chronic migraines.
Chronic migraines are defined as headaches occurring on 15 or more days per month, with at least 8 of those days being associated with migrainous features. Here's how Botox is used for the management of migraines:
Vestibular therapy, also known as vestibular rehabilitation therapy (VRT), is a specialized form of physical therapy focused on treating disorders of the vestibular system, which controls balance and spatial orientation.
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