Physical therapists at the PM&R Center treat patients with a wide range of disorders; including spine (neck, back, sacroiliac and coccygeal), shoulder, chest wall, knee, balance disorders, gait problems, geriatrics, pelvic floor and incontinence, temporomandibular joint, sports, performing arts, and post-mastectomy patients.

While all of our therapists have experience in these areas, a number of our therapists have expertise and advanced credentials in specific treatment areas.

Below is a summary of the role of physical therapy in various types of disorders. For a brief explanation of the modalities mentioned, see the "modalities" section on this web site.

Neck and Back Disorders, Scoliosis

Causes of pain and disability in the neck and back include problems with discs, nerves, joints, ligaments, or muscles. Physical therapy uses a combination of modalities, or means of treatment, to target each patientâs specific problem.

The McKenzie method is often helpful in addressing the component of the patient's problem that is caused by the discs of the spine. Traction may alleviate pain related to a pinched nerve (radiculopathy). Modalities and manual techniques address the soft tissues and limitations on joint mobility. Patient education in body mechanics, as well as specific stretches and positioning exercises, are of critical importance in both achieving a rapid resolution to the problem as well as in future prevention. Biofeedback may have a role in muscular relaxation. The PM&R Center offers a back school to educate small groups of patients with lumbar disc problems.

Coordination of care between therapist and physiatrist allows for more aggressive treatment when necessary including brace or corset, soft tissue injections, joint injections, and epidural or selective nerve root injections. We also provide postural and strengthening programs for adolescents with scoliosis, kyphosis, or other postural abnormalities.

Sacroiliac and Coccygeal Disorders

Patients can sustain traumatic injuries to the pelvic bones resulting in displacement of joints. Women often develop laxity of pelvic joints followed by displacement and pain during their third trimester of pregnancy and postpartum period.

A number of our therapists have expertise in assessing and treating pelvic joint disorders. These problems are unique and at times puzzling. A combination of mobilization, muscle energy techniques, modification of posture and body mechanics, and occasionally bracing, is generally effective in controlling symptoms.

Shoulder pain may emanate from any of the four joints that form the shoulder complex, or it may be stemming from a problem elsewhere, most commonly in the neck. Common sources of shoulder pain include rotator cuff injury, inflammation of the cuff or joints, and restricted joint mobility or instability (excessive mobility). Identifying and understanding the source of the pain is crucial to the finding the correct balance of potentially opposing treatments.

A physical therapist, in concert with a physiatrist, must determine the precise source of the patient's problem so that the therapy can be properly targeted. The physical therapist can reduce soft tissue pain, stabilize a joint with taping and positioning, strengthen musculature (properly and without causing harm), or mobilize the shoulder joint if it is contracted.

Many patients present with complaints of knee pain, knee stiffness, or instability of the knee joint. Although knee pain usually emanates from a problem in or about the knee, it may also be caused by a problem in the hip or lumbar spine. Knee disorders may involve the entire joint complex, any combination of the knee's three compartments, or surrounding muscles, tendons, or bursae (fluid-filled pouches). There may also be an injury to a ligament or meniscus, which is cartilage that is unique to the knee. Regardless of the underlying abnormality, weakness develops almost universally. After knee surgery, there is always some degree of weakness, stiffness, and inflammation.

The first and foremost task for a physical therapist, in conjunction with the treating physician, is to determine the specific source of the patient's problem. Treatment must include a proper balance of modalities for pain control, mobilization, strengthening, and generalized conditioning. Proper management includes addressing foot alignment, considering the hip joint, and varying the program based on the patient's lifestyle and athletic interests. Our staff has advanced training in peripheral joint mobilization, fabrication of shoe orthotics, McConnell taping techniques, and management of knee disorders, including postoperative rehabilitation.

Pain can arise from a number of musculoskeletal structures including ribs, muscles, and the joints between the ribs and the breast bone (costochondral joints). However, before initiating treatment directed at the chest wall, the therapist and physician must ascertain that chest pain is not being caused by conditions involving the heart, lungs, upper abdominal organs, cervical spine, or thoracic spine. It is also critical to determine that the patient does not have a chest wall fracture before performing any manual therapy. Therapists at the PM&R Center have postgraduate training in mobilization of ribs and other chest wall structures, and can assist and instruct patients in performing corrective stretching and strengthening exercises. Postural advice and modification of body mechanics are integral to dissipation of pain and prevention of further injury. On occasion, injections by members of the physiatry staff relieve resistant chest wall pain.

The PM&R Center has therapists with expertise in treating problems which are unique to the patient who has had surgery for breast cancer with or without reconstruction. Post-mastectomy patients may have swelling of the upper extremity (lymphedema). This swelling may be treated successfully by lymphedema massage, custom made compression garments, and home pump devices. Patients may also have weakness, pain or a loss of flexibility postoperatively, all of which can be addressed through manual therapy and exercise.

There are multiple potential causes for gait instability and a resultant increased risk of falling. Aging, neurological disorders and orthopedic disorders can all contribute to an abnormal gait pattern. Specifically, abnormalities in cognition (thought processes), cerebellar function (coordination system), strength, sensation, joint flexibility, inner ear function, and vision can all contribute to an increased risk of falling. In addition, there are numerous environmental factors, including ice, uneven terrain and stairs in the home, which can put a patient at risk for falling.

The PM&R Center physical therapy staff is trained in determining the specific causes and risk factors for falling in each patient. At times, specialized balance testing equipment as well ENG (electronystagmography) help pinpoint the abnormalities. The therapists provide exercises and educate patients in techniques to cope with their specific risk factors for falling, in addition to addressing all environmental risk factors.

PFD is an abnormal resting state of the muscles of the pelvis that support the pelvic organs. The muscles are usually overactive, and the cause is usually trauma to the pelvis, abdomen, low back or hip, which includes falls, childbirth and surgery. Chronic inflammation, as is present in interstitial cystitis, can also result in PFD. PFD often causes urinary frequency and incontinence, as well as pelvic pain.

The PM&R Center has a therapist skilled in administering manual techniques and teaching exercises that strengthen, realign and relax pelvic structures. In addition, the therapist has expertise in the use of electromyographic biofeedback to help the patient learn to relax and/or strengthen the pelvic floor musculature. Biofeedback is accomplished using a sensor that is placed over the pelvic muscles and tells the patient when they are contracting the pelvic muscles. In this way, the patient can gain control over her muscle tone. A number of studies demonstrate that biofeedback is at least as effective as medication for the control of urinary dysfunction.

The temperomandibular joint (TMJ) is located just in front of the ear. When functioning normally, this complex joint allows for all movements of the jaw including opening, closing, and sidegliding. The TMJ contains a meniscus, which is a specialized cartilage structure which, when injured, can lead to abnormal or restricted joint movement, clicking, and locking. The joint is also subject to inflammation either from localized wear and tear, as part of a generalized inflammatory disorder, or from bruxism (grinding) related to tension. Trigger points (myofascial pain) often develop in surrounding muscles and may then contribute to the patient's pain.

While there is a role for oral orthotics (bite plates) to guide jaw motion, and on rare occasions, arthroscopic surgery, the mainstay of treatment is physical therapy. Therapists at the PM&R Center are trained to use manual techniques to restore mobility and reduce the muscular component of the patient's pain. The patient is guided in a number of self-treatment and prevention techniques after being educated regarding the nature of the disorder. At times there is a role for trigger point injections administered by the physiatry staff.

Our clinical staff of therapists and physicians combines its extensive training in sports rehabilitation with its broad range of personal experience in sports participation to manage patients with sports injuries.

Our treatment is catered to the goals and lifestyle of the injured individual, because decisions must be made as to how aggressively and rapidly to pursue diagnostic testing and treatment. The elite athlete who is approaching a very important event desires to be treated differently than a recreational athlete who may have other safe and satisfactory options for exercise. High level athletes place much greater demands on there musculoskeletal system, and therefore subtle abnormalities on physical examination can have great functional consequences. Likewise, the goals and rehabilitation program differ when the demands on flexibility, strength, stability, and endurance are greater. As with all of our patients, the athlete is always educated in strategies to prevent future injury.

Like other athletes, the performing artist is highly dedicated to an activity involving precise repetitive movements. Dance and musical instrumentation require strength, endurance, properly balanced musculature, and excellent fine control. Due to the positions assumed and specific muscles recruited, each activity is prone to unique injuries.

Members of the PM&R Center clinical staff have had extensive personal experience with dance and music, as well as with the management of related injuries. We often directly observe the performing artist patient perform his or her activity to best appreciate the nature of the injury. Our therapists have attended numerous courses on performing arts injuries and are trained to use their manual skills and knowledge of exercise to facilitate the return of the performer to his or her passion or hobby.