Manual Therapy

What is Manual Therapy?

The term “manual therapy” (or “manipulative therapy” as it is sometimes called) applies to a broad range of modalities and techniques. Essentially, however, it refers to the mobilization or manipulation of body parts to help them heal properly, relieve/manage pain and other symptoms, or improve range of motion and other functionality. Manual therapy techniques commonly recommended by our physical therapist include:

Joint manipulation – Manipulation of ailing or injured joints can correct small but significant alignment errors between different joint structures. These corrections can help joints move more normally, with less pain, while also improving your overall posture and weight distribution. We can refer you to an osteopath or chiropractor if you need this kind of treatment.
Joint mobilization – Some joints benefit from mobilization rather than manipulation. Getting these structures moving can help build up their strength and support, increase comfortable range of motion, and boost the flow of blood and healing nutrients to painful or damaged joints.
Soft tissue mobilization – That painful “stuck” feeling you’re experiencing may be due to internal scar tissue accumulations called adhesions. Adhesions sometimes form over injured tissues, limiting their motion and causing chronic pain. Muscles and connective tissue can also suffer from chronic tension and spasms, often referring pain to other parts of the body as trigger points. Our physical therapist can help you combat these issues through soft tissue mobilization techniques. Examples include trigger point therapy, deep tissue massage, and an instrument-assisted method called Graston Technique.

Good Candidates for Manual Therapy

Manual therapy can help people suffering from a wide range of conditions and issues. You may be an ideal candidate for a course of manual therapy if you need help with:

Acute or chronic back or neck pain
Headaches or migraines
Pain, tingling, numbness or weakness in an arm or leg
Shoulder, knee, ankle, or hip pain
An old injury which continues to cause pain and stiffness, even years later
Chronic soft tissue pain syndromes such as fibromyalgia
TMJ pain and stiffness

How Manual Therapy and Physical Therapy Work Together

Why might our physical therapist prescribe both physical therapy exercises and manual therapy for your condition? As powerful as each of these disciplines is in improving function and easing discomfort, they appear to offer special benefits when used in combination. For instance, a study of ankle sprain sufferers found that the ones who received a combination of manual therapy and physical therapy exercises had fewer functional problems and discomfort (both at 4 weeks and at 6 months) than those who only performed the physical therapy exercises.

Our physical therapist will perform a careful examination to see whether your particular health challenge will likely respond to certain kinds of manual therapy. If you’re showing signs of swelling, muscle spasms, chronic/acute pain, or restricted mobility, we will probably recommend at least one manual therapy technique to go along with your physical therapy exercises and other treatments. Our goal is always to help you move better, feel better, and maintain a higher overall standard of health and wellness.

Instrument Assisted Soft Tissue Mobilization (IASTM)

What is IASTM?

IASTM is a new and developing technique that uses a range of tools which enable clinicians to efficiently locate and treat individuals diagnosed with soft tissue dysfunction. The technique itself is said to be a modern evolution from Traditional Chinese Medicine called Gua Sha[1].However Gua Sha was not used to treat Musculoskeletal conditions but was traditionally applied along meridiens to move the bad chi out through the skin. IASTM is a is a procedure that is rapidly growing in popularity due to its effectiveness and efficiency while remaining non-invasive,with its own indications and limitations.

IASTM is performed with ergonomically designed instruments that detect and treat fascial restrictions, encourage rapid localization and effectively treat areas exhibiting soft tissue fibrosis, chronic inflammation, or degeneration. As in any Manual therapy treatment ,supplementation with exercises and additional modalities e.g. joint mobilization designed to correct biomechanical deficiencies by addressing musculoskeletal strength and muscle imbalances throughout the entire kinetic chain should be used in conjunction with IASTM.

How Does it Work?

Instruments effectively break down fascial restrictions and scar tissue. The ergonomic design of these instruments provides the clinician with the ability to locate restrictions and allows the clinician to treat the affected area with the appropriate amount of pressure.

The introduction of controlled microtrauma to affected soft tissue structure causes the stimulation of a local inflammatory response. Microtrauma initiates reabsorption of inappropriate fibrosis or excessive scar tissue and facilitates a cascade of healing activities resulting in remodeling of affected soft tissue structures. Adhesions within the soft tissue which may have developed as a result of surgery, immobilization, repeated strain or other mechanisms, are broken down allowing full functional restoration to occur.

Dry Needling

What is Dry Needling?

Dry Needling is a technique physical therapists use (where allowed by state law) for the treatment of pain and movement impairments. The technique uses a "dry"needle, one without medication or injection, inserted through the skin into areas of the muscle.

Other terms commonly used to describe dry needling, include trigger point dry needling, and intramuscular manual therapy.

Dry needling is not acupuncture, a practice based on traditional Chinese medicine and performed by acupuncturists. Dry needling is a part of modern Western medicine principles, and supported by research

What is a Trigger Point?

A trigger point is a taut band of skeletal muscle located within a larger muscle group. Trigger points can be tender to the touch, and touching a trigger point may cause pain to other parts of the body.

What Kind of Needles Are Used?

Dry needling involves a thin filiform needle that penetrates the skin and stimulates underlying myofascial trigger points and muscular and connective tissues. The needle allows a physical therapist to target tissues that are not manually palpable.

Physical therapists wear gloves and appropriate personal protective equipment (PPE) when dry needling, consistent with Standard Precautions, Guide to Infection Prevention for Outpatient Settings, and OSHA standards. The sterile needles are disposed of in a medical sharps collector.

Why Dry Needling?

In cases when dry needling is used by physical therapists, it is typically 1 technique that's part of a larger treatment plan.

Physical therapists use dry needling with the goal of releasing or inactivating trigger points to relieve pain or improve range of motion. Preliminary research 2 supports that dry needling improves pain control, reduces muscle tension, and normalizes dysfunctions of the motor end plates, the sites at which nerve impulses are transmitted to muscles. This can help speed up the patient's return to active rehabilitation.

As part of their entry level education, physical therapists are well educated in anatomy and therapeutic treatment of the body. Physical therapists who perform dry needling supplement that knowledge by obtaining specific postgraduate education and training. When contacting a physical therapist for dry needling treatment, be sure to ask about their specific experience and education.

Therapeutic Massage

What is Therapeutic Massage?

Therapeutic massage incorporates a variety of advanced modalities that enhance the body’s natural restorative functioning. Light to firm touch is used to release tension, relax muscles, increase blood and lymph circulation, and impart a sense of calm. Therapeutic massage can be used as a collaborative, supportive addition to conventional medical treatment of illness and injury, alleviating pain and stress, aiding soft tissue healing, and revitalizing the body. Also, regular massage can enhance health, providing relaxation, release of muscle tightness, relief from anxiety and tensions, and balancing aspects of body/mind/spirit.

Different Techniques

Swedish Massage: Flowing, kneading, and passive joint movement techniques. Promotes release of tensions and general relaxation. Stimulates nerve endings in the skin and connective tissue, increasing blood and lymph circulation.
Deep Tissue Massage: Work done deep within the muscles and connective tissue. Slow strokes and deep finger pressure work to release contracted areas of muscles and surrounding tissue.
Reflexology: Pressure point holds stimulate reflex channels. Effective for areas of tension or pain. Hands, feet, and ear pressure points are massaged to promote general well being.
Neuromuscular Massage: Advance massage techniques effectively treat chronic pain and injuries. Improves muscular and postural imbalances.
Craniosacral Therapy: Light touch holds work within the natural flows of the body. Results in deep relaxation and encouragement of the body’s alignment and natural healing ability.
Lymph Drainage Therapy: Light pressure facilitates increased movement of lymph fluid. Complements treatment of auto-immune disorders, cancer treatments, surgery, and contributes to wellness through improved immune response.
Reiki: Light touch, accesses Universal Life Energy. Can speed healing, reduce pain, and decrease symptoms.
Hot Stone Massage Therapy: This 90 minute session uses a variety of large and small smooth heated stones to melt away tension and stress, resulting in deep relaxation.

Why do we perform massage?

Stress, Anxiety, Depression: promotes relaxation response, enhances coping mechanisms in patients undergoing treatment for cancer, reduces symptoms of anxiety, depression and stress disorders
Pain control: fibromyalgia, arthritis, sciatica, headaches, childbirth
Chronic lung disease: increases respiratory function and decreases anxiety
Edema: manual techniques to reduce lymphedema and other soft tissue and joint swelling
Injuries: overuse and repetitive strain injuries, workplace and athletic trauma, whiplash

Electrical Stimulation

What is Electrical Stimulation?

Electrical stimulation is a type of physical therapy modality used to accomplish various tasks in physical therapy. If you have an injury or illness that causes pain or limited functional mobility, your PT may use electrical stimulation, or E-stim, as one part of your rehabilitation program.

Electric stimulation works by mimicking the natural way by which the body exercises its muscles. The electrodes attached to the skin deliver impulses that make the muscles contract. It is beneficial in increasing the patient’s range of motion and improves the circulation of the body. It is used in treating conditions like sprains, arthritis, back pain scoliosis and sciatica.

Electric stimulation can be muscular, general and transcutaneous electrical nerve stimulation (TENS). The muscular type of electric stimulation seeks to strengthen the muscles by reducing muscle spasms. Also known as EMS, this stimulates the skeletal muscle using electric impulses to cause muscle contraction.

Why E-Stim Is Used?

TENS is commonly used to help with chronic pain. The general type of electric stimulation is used for healing wounds and alleviating pain. For the convenience of the patient, a portable TENS unit can be prescribed by the doctor or a physical therapist for the patient to use at home.in the skin and connective tissue, increasing blood and lymph circulation.
Interferential current (IFC) is another form of TENS. It is used by physical therapists and chiropractors for the purpose of decreasing inflammation and swelling of affected tissues. This treatment has also shown positive effects in improving symptoms of asthma and in reducing back pain.
Galvanic stimulation is also another application of electric stimulation. This involves applying pulsed electric current on affected body tissues in stimulating muscle contraction. It differs with TENS and IFC in its use of direct current rather than alternating current. The positive pad acts to decrease circulation of the target area and reduce swelling. The negative pad increases the distribution of oxygen, blood and nutrients to the injured area thus increasing the speed of the healing process.
Neuromuscular Electrical Stimulation or NMES uses a device that sends electrical impulses to nerves. This input causes muscles to contract. The electrical stimulation can increase strength and range of motion, and offset the effects of disuse. It is often used to “re-train” or “re-educate” a muscle to function and to build strength after a surgery or period of disuse.

Taping

What is the Kinesio Taping Method?

The Kinesio Taping Method is felt to cause physiological effects on several body systems. The systems affected by the body are thought to include the circulatory/lymphatic, neural, muscular, and fascial systems, as well as the joints. Kinesio Taping is currently being used by therapists to change muscle tone, move lymphatic fluids, correct movement patterns, and improve posture. The Kinesio Taping Method is a unique method of applying Kinesio Tex Tape in a specific manner to create change in the aforementioned systems. Benefits of using the tape are that it is more economical over time than other modalities, it is easy to learn and apply, there are less types of tape, and it may be used over a longer period of time.

The Kinesio Taping Method differs from athletic strapping tape and the traditional McConnell Taping Method. Athletic strapping tape is used mostly to limit ranges of motion and to constrict muscle movement. The effect of this method is to create a bridge over the areas that are injured so that athletes can perform sport movements and have either prophylactic support or support to an injured part of the body. Athletic tape is typically removed after the end of an athletic event.

The McConnell Taping Method is a technique that tapes body parts to affect a specific biomechanical movement. McConnell Tape uses a very rigid, highly adhesive tape that is applied for no more that 18 hours and often for shorter periods of time due to patient discomfort.

The Kinesio Taping Method has been developed specifically to be used in conjunction with Kinesio Tape. The Kinesio Taping Association certifies practitioners of the Kinesio Taping Method. Kinesio Tape can be identified by the words "Kinesio Tex" printed on the back of the tape.

How Does it Work?

The following are the current theories of how properly applied Kinesio Tape works.On skin, the Kinesio Tape pulls the upper layers of skin, creating more space between the dermis and the muscle. The space created is believed to relieve pressure on the lymph channels in the area between the muscle and the dermis, creating more space for lymph flow and thus better lymph drainage through an affected area. This space also houses various nerve receptors that send specific information to the brain. When the space between the epidermis and the muscle is compressed, such as during an injury, these nerve receptors are compressed and send information to the brain regarding continuous touch, light touch, cold, pain, pressure, and heat. This information causes the brain to send out certain signals to the body on how to react to particular stimuli. Kinesio Tape alters the information that these receptors send to the brain and causes a less reactive response in the body, allowing the body to work in a more normal manner and removing some of the roadblocks that normally slow down the healing process.

Kinesio Tape also is felt to affect deeper tissues in the body. Increased space theoretically allows muscles greater contractility, which in turn pushes more fluid through the muscle, resulting in better muscle performance. The end results are believed to be reduced muscle fatigue, increase in range of motion, and better quality of muscle contraction.

Kinesio Tex Tape is used to improve joint alignment by affecting the muscles and fascia and can reduce poor function of a joint by influencing opposing muscle groups and joint mobility. Fascia and lymph have an intimate relationship with each other. Fascia is a material that divides and separates the muscles and internal organs and helps to provide support against gravity in some parts of the body. Lymph removes fluids and chemical substances in the muscles. Lymph channels pass though fascia between the bone and the muscle and superficially between the skin and the muscle. Lymph ducts range in size from smaller than a hair to 2 cm lymph nodes. Major lymph channels can be found in the groin, neck, and armpits. When the flow of lymph is restricted or increased, an accumulation of fluid occurs behind the congested area, resulting in swelling that decreases space between the muscle and skin, causing the body to react to a painful stimulus.

The working model gives rise to the basic theoretical concepts of the Kinesio Taping Method. There are six basic concepts of the Kinesio Taping technique called corrections. They are: mechanical, fascia (fascial), space, ligament/tendon, functional, and circulatory/ lymphatic. Mechanical corrections are used for improved stability and biomechanics. Fascia or fascial corrections create or direct movement of fascia. Space corrections are used for decreasing pressure over a target tissue. Tendon/ligament corrections decrease stress on a ligament or tendon. Functional corrections provide sensory stimulation to either assist or limit a motion. Circulatory/lymphatic corrections help move lymphatic fluid from more congested to less congested areas.

Kinesio Taping has also been shown to affect scars. Reductions of adhesions and pitting, softening, flattening, improved pliability, and reduction of contractures have been seen in some patients.