Cold Laser Treatments are easily the newest modality physical therapists have at our disposal for controlling pain. - only recently certified by the FDA for clinic use. Possibly the most versatile modality we have, there are few contraindications for trials of cold laser.
With more traditional physical agents physical therapists often rely on increasing or decreasing blood flow to an area to effect the underlying tissue inflammation. Cold laser has no effect on blood flow, but rather goes to some of the smallest cellular components of the tissues to “jump start” the healing process. Like all of the clinical modalities we use in physical therapy, our licensure acts control the access to level of sophistication and/or intensity/power and/or ultimately the effectiveness of treatments.
We've been pleased with not only the versatility of cold laser but the dramatic effects of some of our more stubborn pathologies of trigger points or tendinitis.
Electrical Stimulation has been used since the 1940's and may be best described as an electrical muscle massage. It is used primarily for treating muscle spasms, but since many tissues in the body are receptive to electrical currents, we are able to get a carry over to hyperactive nervous tissue also. The electric current not only works to relax tight spasmed muscles, but also at a cellular level to help normalize the microscopic function of the cells. E-Stim is typically used in conjunction with cold packs and and/or hot packs to further benefit the effects of both.
Spinal Decompressive Traction has brought cervical and lumbar traction into the 21st century. Traction has been a long standing tool in the physical therapy arsenal for controlling spine pain. The new research associated with spinal decompression has had a tremendous benefit for not only controlling pain in the short term, but creating the longer, more lasting benefit of increasing “circulation” to the discs of the spine and thus controlling inflammation which has proven, the majority of the time, to be the source of the pain. In the proper experienced hands we have seen a dramatic benefit in helping us get to a >90% success rate with our spine pain population.
Spinal Stabilization When our neck or back hurts, we move differently – in Physical Therapy we call it compensatory movement patterns. Studies have shown us on all of our major joints that this process leads to loss of strength and even atrophy (wasting or loss of muscle tissue). The spine is not immune to this process and this loss of strength leads to poor control of gravitational and movement forces that can lead to more pain and “instability”. Spinal stabilization, sometimes referred to as core stabilization, typically takes on a different meaning to a Physical Therapist than a personal trainer. A Physical Therapist should look at not simply just strengthening your “core” muscles but creating increased neuromuscular control and either reinforcing or reestablishing essential muscular force couples in the spine for increased biomechanical efficiency and ultimately “stabilization” of the spine. By achieving this stability we are looking to decrease pain by decreasing the abnormal mechanical forces on the joints, discs, and nerves of spine. Often it takes a multi-level approach to gain control of this pain and dysfunction process (see spine program) depending on the length of time you've been hurting or the extent of pathology (disease process/damage) to the tissues. A good spinal stabilization program should include not only exercises, but education on postural and lifting mechanics and nutrition along with use of physical agents to control pain and promote healing.
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Manual therapy is a hands-on treatment provided by a physical therapist for a patient with a musculo-skeletal or neurological problem. Manual therapy is the skilled passive movement of a joint or soft tissue structure to restore function to that structure. It includes joint mobilization, manipulation, soft tissue mobilization, myofascial release techniques, strain-counterstrain techniques, muscle energy techniques, stretching and many other techniques used in combination to treat neuromuscular and orthopedic dysfunctions.
Joint mobilization/manipulation: the movement of the joints or bones in a controlled manner. This technique is to help loosen joints and re-establish functional movement patterns.
Soft tissue mobilization/myofascial release (MFR): the restoration of muscle play, breaking fascial restrictions between muscles, and decreasing excessive tone that is associated with muscle tightness.
Strain-counterstrain: Strain counterstrain is a passive procedure that places the body in a position of greatest comfort thereby relieving pain and dysfunction by reducing the inappropriate feedback between the brain and the effected body part. This technique applies a mild overstretch in the direction opposite to that which causes the discomfort. The communication with the brain is “reset” to allow for proper feedback.
Muscle Energy Technique (MET): Muscle Energy Technique focuses on joint range-of-motion limitation, and uses light to moderate force muscular contractions precisely controlled to affect a specific joint and restore normal joint motion. The physical therapist will position the patient in a manner such that the specific joint will be affected. The patient is asked to initiate a muscle contraction to assist in the procedure.
At Curnyn Physical Therapy manual therapy is used in conjunction with other forms of therapy, such as therapeutic exercise, neuromuscular re-education, and modalities to achieve optimal results for our patients.
Ultrasound therapy in a physical therapy clinic is different than ultrasound or sonograms in radiology. Although both utilize sound waves at a higher frequency than the human ear can detect, depending on the frequency of the sound waves we can achieve different treatment results. In radiology a very high frequency is selected which tends to reflect off different tissues differently and a machine generates an image. In physical therapy we select a frequency of sound wave that penetrates deeper into the tissues resulting in an increased tissue temperature (deep heat). Most people don't feel the heat since the sound waves bypass the temperature receptors in the skin, but the therapeutic benefits are taking place none the less. The advantage of ultrasound is the sound waves' ability to penetrate up to 2” deep compared to 1/2 to 2/3” with superficial hot packs. These deeper benefits are especially useful for tissue and joints of the spine that are too deep to be reached by hot packs. Ultrasound also has selective benefits at the (specialized portion of the muscle) tendon bone interface as in a tendinitis.
Iontophoresis is an effective, well-tolerated, and simple method for delivering medication across the skin using electricity. This is particularly beneficial when treating an isolated area rather than subjecting the whole body to the medication. A direct current is applied to an electrode containing an ionized medication (meaning that it has an electric charge to it, either positive or negative) and utilizing the principle that “like charges repel like charges”, the electric current acts as a force to “push” the medication across the skin barrier to the affected area. The medication is usually a steroid with fewer risks or side effects than a typical steroidal dose pack. This type of treatment has been used successfully to treat tennis and golfer’s elbow, jumper’s knee, achilles tendonitis, rotator cuff injuries, plantar fasciitis and other inflammatory conditions.
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