My post-doctoral fellowship training is in orthopedic manual therapy, or the hands-on piece of PT. Combined with my background as a massage therapist, this gives me a lot of tools to help with pain and mobility deficits. Scroll down to learn more about the kinds of advanced, hands-on care provided, including:
Peripheral joint mobilization
Spinal mobilization
Peripheral joint manipulation
Spinal manipulation
Soft tissue mobilization (massage)
Instrument-assisted soft tissue mobilization (IASTM), a.k.a. Graston, gua sha, or "muscle scraping"
Dry needling
Scar mobilization
Fascial manipulation (FM) and myofascial release (MFR)
Mobilization with movement (MWM)
Muscle-assisted mobilization (MAM) and muscle energy techniques (MET)
Neural mobilization
Cupping
Hips, knees, ankles, feet, shoulders, elbows, wrists, hands, jaw
Joint mobilization involves manual force applied to bones near their articulation point, creating a specific movement at the joint. The direction and amount of force applied is specific to the shape of the joint and the goal of the mobilization. For example, a gentle distraction force may be applied for pain relief, while a firmer glide in the direction of movement can help improve range of motion. The techniques are adjusted further based on the patient's response and whether the condition is acute or chronic.
Cervical (neck), thoracic (mid back), lumbar (low back), and sacroiliac (SI) joints
Spinal mobilizations are similar to peripheral joint mobilizations, but they are specific to the joints of the spine. Each vertebra in your spine has both an intervertebral disk joint and two facet joints where it meets the vertebrae above and below. In the thoracic spine, there are extra joints where the vertebrae meet the ribs. My training allows me to distinguish which joint requires attention and direct gentle, specific techniques to create movement where its needed, while taking stress away from areas that are sensitive (e.g. hypermobile joints, spinal fusions, areas of inflammation).
Shoulders, elbows, wrists, hands, knees ankles, feet
A manipulation is a manual technique that involves a high-velocity, low-amplitude (i.e. quick but small) force applied to a joint in order to restore mobility. Before performing a manipulation, I will closely examine the joint to be sure it is structurally sound and that a manipulation is safe for you. After obtaining your consent, the technique will be performed, then followed with neuromuscular reeducation to teach your body how to use the new movement we gained.
Cervical (neck), thoracic (mid back), lumbar (low back), and sacroiliac (SI) joints
Part of my fellowship training was becoming certified as a Spinal Manipulative Therapist. A manipulation is a manual technique that involves a high-velocity, low-amplitude (i.e. quick but small) force applied to a joint in order to restore mobility. Before performing a manipulation, I will closely examine your spine to be sure that a manipulation is safe for you. Then I will use specific positioning techniques to ensure that the movement caused by the manipulation is targeted at the stiff joint, keeping forces away from sensitive structures such as nerves, blood vessels, and joints that shouldn't be manipulated (e.g. fusions, hypermobile segments). After explaining the technique and obtaining your consent (no surprises, ever!), the manipulation will be performed, then followed with neuromuscular reeducation to teach your body how to use the new movement we gained.
With over 20 years of experience in massage, I realize that this is sometimes still the best way to get the results you need! Massage will be incorporated as appropriate into physical therapy treatment, though it is important to understand that this is only one aspect of a multifaceted treatment approach. If you are looking for a full massage session, I will be happy to refer you to a great local massage therapist.
a.k.a. Graston, gua sha, or "muscle scraping"
One effective method of addressing fascial adhesions and scar tissue is through the use of instruments, such as the one pictured here. These tools have a beveled edge that engages with anomalies in the tissue, helping to "break up" scar tissue and adhesions and restore mobility.
Trigger point dry needling is a technique used to produce a strong inhibitory response, allowing a tight area in a muscle to relax. The neuromuscular response is similar to that elicited in trigger point massage, but it is more direct, stronger, and faster. Many people experience significant relief from pain and gains in mobility from this technique. Though I am conservative with the use of electrical stimulation, in certain cases I may apply electrodes to the needle to produce a contraction in a muscle that isn't doing its job. Importantly, dry needling is NOT acupuncture. While I have extensive training in anatomy that allows me to place the needles safely, I am not trained in Chinese Medicine. My approach is a western one, addressing the myofascial system only.
It's never too late!
After a surgery or an injury that breaks the skin, the body repairs itself by laying down scar tissue. This is a wonderful thing, but the patch the body puts down is not well organized or isolated to the target tissue. Sometimes scar tissue causes its own problems, making the skin adhere to muscles or bones, or creating disruption in the fascia and lymphatic system. This can lead to discomfort, stiffness, and even pain. The good news is that there are manual techniques that help separate the scar from other layers of tissue, stimulate the body to reorganize the scar tissue itself, and restore normal mobility of the skin and fascia. With scar tissue it's never too late; I have worked with people who had surgery decades ago and still made remarkable progress with these techniques!
and Myofascial Release (MFR)
Fascial Manipulation is a specific way of addressing the body's connective tissue, using sustained friction to mechanically reduce density and adhesions in order to restore the normal physiology of the fascia. This technique was developed by Luigi Stecco, an Italian physiotherapist, and backed scientifically with copious research by physicians Carla and Antonio Stecco, among others.
FM is only one way to address fascia, albeit a very effective one. I may utilize FM, other forms of myofascial release, or a combination of these, depending on your specific needs and tolerance to the work.
Want to learn more? Stay tuned... I'll soon be adding more information about fascia and how FM works to my FAQ section on the "Physical Therapy" page.
MAMs and METs are manual neuromuscular techniques that require your active participation. In MAMs, I will position your joint at the end of its available range, then ask you to resist against a very specific force designed to activate the muscle whose job it is to bring the joint further into that motion. In METs, we are targeting the muscle itself, using a contraction against resistance to either help the muscle or its antagonist (muscle that does the opposite action) to relax and lengthen.
Joint mobilizations are helpful on their own, but they become very powerful when combined with the movement they are meant to restore. With MWM, I may utilize props, straps, my hands, and/or positioning to apply an appropriate force to the joint while creating active or passive movement to compliment it and enhance effectiveness.
a.k.a. nerve glides, sliders, tensioners
The nerves in your body are surrounded by muscle, fascia, and other tissues as they travel from your spinal cord to your extremities. Healthy nerves should be able to move smoothly through this interface and tolerate varying degrees of compression and stretch. However, when a nerve is irritated, it becomes sensitive and loses its tolerance for any stress. When applied appropriately, neural mobilization can help restore mobility of the nerve through the other tissues and desensitize an irritated nerve. Manual neural mobilization will be followed by nerve glides that you will do at home. Sometimes this must be done very carefully; if your condition has gotten worse from doing nerve glides in the past, they may have been done too aggressively or too soon. We'll work together to find the perfect progressions for your nervous system as it becomes ready to move again.
Have you seen the red, circular welts on athletes in the Olympics? Those are from cupping. This technique draws blood toward the surface as it lifts and stretches the tissue, using suction applied with a vacuum pump. In Chinese Medicine, it is believed to remove toxins from the body. I use cupping as another myofascial technique, most often incorporating movement of the cups to improve mobility and glide in the superficial layers of fascia between the skin and muscle. I may even ask you to do active movements while the cup is on, to encourage functional mobility and glide of the tissues.