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Musculoskeletal conditions

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Arm pain

Arm pain may result from any acute or chronic injury to skin, muscles, joints, or bones or nerves in the arms. These injuries may be secondary to sports, performing manual labor duties, repetitive overuse, trauma, and improper exercise technique.
The symptoms that can accompany arm pain will depend on the cause.

Possible symptoms for arm pain:

• arm discoloration
• stiffness in the arm
• swelling in the arm
• swollen lymph nodes under the arm
• tingling in the arm
• neuropathic pain: numbness, tingling, burning, shock like pain
• sharp pain in the arm
• arm muscle weakness
• pain with gripping / grasping
• Changes in temperature

Common causes of arm pain:

• Skin injury
• Pinched or damaged nerves in arm or neck.
• Brachial plexus injury
• Bulging or herniated disc in the neck
• Arm sprains
• Elbow tendonitis
• Wrist Tendonitis
• Rotator cuff injury
• Broken bones in the arm
• Autoimmune conditions: Rheumatoid arthritis, lupus, psoriasis, gout or pseudogout.
• Torn tendon in the arm or bicep
• Ruptured bicep tendon
• Growth plate inflammation
• Golfer’s elbow
• Tennis elbow
• Little League Elbow

Goals of low back physical therapy treatment:

• Improve range of motion.
• Strengthen the muscles and tendons.
• Reduced referred pain to arm from neck, brachial plexus or shoulder.

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Back Pain

Back pain can be a result of an acute or chronic injury that can result in degeneration or inflammation in the lower back. There are many causes of back pain, but the most common include muscle strains, disc or facet joint irritation, as well as sacroiliac dysfunction. The symptoms from these are often very similar, however proper diagnosis is critical in providing the appropriate physical therapy for back pain essential.

Symptoms of back pain:

• pain or discomfort in the upper back or lower back
• stiffness, sharp pain, soreness along the spine
• muscle spasms in the back
• postural changes
• back pain can result in symptoms in other parts of the body or even radiate into the extremities such as arms or legs.

Causes of back pain:

• Muscle strain
• Bone injury: Fracture
• Broken bones
• Scoliosis
• Herniated or bulging disc
• Spinal stenosis
• Degenerative disc disease or osteoarthritis
• Spondylolisthesis (slipped vertebrae)
• Muscle weakness
• Poor posture
• Facet Joint Syndrome

Goals of low back physical therapy treatment:

• Improve range of motion through back stretches
• Strengthen the back muscles to offer pain relief
• Use massage therapy and other modalities to loosen the muscles
• Reduce referred or radicular pain into extremities.

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Foot/Ankle Pain

Foot pain is common and may be to either an acute injury or progressive degeneration of joint or inflammation of tendons and muscles in the foot or ankle.

Ankle sprain is most common source of ankle pain. This usually occurs when the foot exceeds its normal range of motion and as a result, the ligaments in the ankle joint stretch or tear. This is often seen in people working on their feet for most of the day or in athletes. Most people experience lateral (outer) ankle sprain more commonly than medial sprains.

Many times, if the pain is mild in your feet than you can eliminate this pain by choosing more comfortable, well-cushioned shoes, stretching before exercising, keeping up with foot hygiene, and maintaining a healthy weight.

When foot or ankle pain is moderate or severe, then have your doctor evaluate your pain and determine if therapy may be an option for your pain.

Types of pain amendable to physical therapy:

1. Plantar Fasciitis: stabbing pain in heel and bottom of foot affecting your walking.
2. Ankle Sprains: functions to regain range of motion, reducing pain, strengthening muscles.

Symptoms of Foot/ankle pain:

• Pain in moving ankle or foot.
• Pain in arch of the foot
• Pain in toes
• Heel pain
• Swollen ankle or feet
• Weakened feet
• Trouble standing
• Difficulty with walking.

Common causes of Foot/Ankle pain:

• Ankle sprain
• Toe sprain
• Bone spur
• Plantar fasciitis
• Achilles tendinitis or rupture.
• Avulsion fracture
• Foot or toe fractures.
• Tendinitis
• Bursitis
• Flat foot
• Haglund’s deformity
• Osteoarthritis
• Autoimmune arthritis: Rheumatoid arthritis, psoriasis, Lupus, pseudogout, gout.
• Infection Osteomyelitis
• Raynaud’s disease
• Neuropathy
• Radiculopathy (pain referred from back to foot)

Goals of Foot/Ankle physical therapy treatment:

• Improve range of motion.
• Improve walking
• Strengthen the muscles and tendons.
• Reduced referred pain to the foot/ankle from back.

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Hip Pain

Hip pain is a common complaint and can be a result of many different degenerative or mechanical reasons. Although the hip is a resilient joint that can sustain repeated motion and usage, hip pain often has disabling effects because nearly all body motion involves the hip joint.

Often hip pain on the lateral aspect of the hip, the buttock, or thigh it can be due to injuries involving tendons, ligaments, and muscles in the hip region.

Femoroacetabular Impingement (FAI) is a painful hip condition that can occur as a precursor to the development of hip arthritis. The underlying pathology of FAI is usually related to the impingement of bony incongruences at the pelvis and thigh bone. Often the pain is usually located in the front of the hip with pronged sitting or athletic maneuvers. FAI is most commonly experienced by younger people participating in recreational or competitive athletics or dance, but can also be experienced in the middle-aged population.

Common Symptoms of hip pain:

• Groin pain
• Pain inside or outside the hip joint
• Pain in the thigh area
• Pain in the buttocks area
• Reduced range of motion
• Gait disturbance
• Pain with prolonged sitting
• Pain while laying on your side

Goals of hip physical therapy treatment:

• Improve range of motion.
• Strengthen the muscles and tendons.
• Reduced referred pain to the hip from back.

Causes of hip pain:

• Juvenile rheumatoid arthritis
• Osteoarthritis
• Psoriatic arthritis
• Rheumatoid arthritis
• Septic arthritis
• Tendinitis
• Trochanteric bursitis
• Hip dislocation
• Post-operative pain
• Hip fracture
• Labral tear in the hip
• Bursitis
• Inguinal hernia
• Lower back pain referred into the hips secondary to pinched nerves
• Femoroacetabular Impingement (FAI)
• Sports hernia
• Gluteal muscle tear

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Knee Pain

Knee pain is on the most common compliant we treat with critical impact on quality of life. Knee pain can hinder your ability to walk and perform everyday functions. Common daily activities such as sitting, standing, climbing stairs, exercising, getting in and out of cars can be limited if your experiencing knee pain.

The type of knee pain experienced dependent on the mechanical source along the joint or may be referred to the knee from a secondary source, thus proper description and identification is crucial in providing you the best care possible.

Locations of knee pain:

• Patellofemoral stress syndrome – pain in the kneecap may be related to inflamed tendon in front or side of the knee or poor movement of the kneecap.
• Medial knee pain- may be related to any injury or strain of the medial meniscus or medial collateral ligament.
• Lateral knee pain- may be related to Iliotibial band (ITB) or injury to other lateral structures.
• Posterior knee pain- may be related to hamstring injury or osteoarthritic changes.

Symptoms of knee pain:

• Stiffness or limited range of motion.
• Color changes, such as redness around the knee joint
• Pain with movement.
• Pain to touch or pressure.
• Weakness in hamstrings or quadricep muscles.
• Soft kneecaps
• Warm knees

Goals of Knee physical therapy treatment:

• Improve range of motion.
• Strengthen the muscles and tendons.
• Reduced referred pain to the knee from back.

Causes for knee pain:

• Patellofemoral stress syndrome
• Osteoarthritis
• Tendinitis
• Bursitis
• Injury resulting in: Dislocations, fracture, muscular injures, ligament tears (ACL, MCL, PCL)
• Baker’s cyst
• Chondromalacia patella
• Meniscus tear
• Autoimmune conditions: Lupus, Rheumatoid arthritis, Gout, Pseudogout, Psoriasis.
• Post operative pain
• Bone tumors
• Infection
• Lower back pain referred into the knee secondary to pinched nerves

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Shoulder Pain

Shoulder pain is a common source of distress that may be related to any acute or chronic injury that can limit one’s capacity to work and activities of daily living. The anatomical shoulder area is comprised of multiple joints, muscles and tendons making it the most mobile joint in the body.

The rotator cuff is the most frequent area of injury resulting in pain. In the setting of a rotator cuff injury, arm movement can be very painful. Pain at night, particularly when rolling onto the affected shoulder is a hallmark of rotator cuff pathology.

Common activities resulting in shoulder pain: manual labor, sports, and even simple repetitive movement. While surgery is sometimes required to treat certain conditions, shoulder physical therapy can be a highly effective way to treat shoulder pain.

In devising the proper treatment plan, one has to first properly diagnose the source and mechanism of shoulder pain.

Common causes of shoulder pain:

• Tendon inflammation/degeneration or tear in the shoulder
• Rotator cuff tear
• Bursitis
• Tendinitis
• Osteoarthritis
• Instability in the shoulder
• Shoulder injury: resulting in tendon or muscle tear or bone injury
• Impingement
• Frozen shoulder
• Labral tear
• Shoulder dislocation

Goals of shoulder physical therapy treatment:

• Improve range of motion.
• Strengthen the muscles and tendons.
• Reduced referred pain to the shoulder from neck.

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Scoliosis

Scoliosis is atypical curvature of the spine affecting trunk alignment and posture. Scoliosis causes the spine to move to the side and turn. This condition can occur at any age but is more commonly detected during adolescence. In the elderly is as results of chronic degenerative changes.

Adolescent idiopathic scoliosis (AIS) is the most common type of scoliosis diagnosed in children aged 10 – 18 years. There is no clear cause in this age group, but family history may play a role.

Adult scoliosis may be either degenerative in origin or secondary to individuals with AIS with now have fixed, mature bone structures.

At first, AIS may be pain free, however as the curvature worsens than pain ensures as a results of stress to the surrounding muscles and joints. Pain symptoms are more common in adult scoliosis. Changes in the spine alter a person’s alignment and movement patterns and create muscle imbalance.

Common findings in a person with scoliosis include:

• Uneven shoulder height
• Uneven hip height
• An uneven waistline
• An uneven alignment of ribs
• An awareness that the 2 sides of the body don’t line up
• Pain in the areas surrounding the spine including the shoulder, pelvis, and hip
Treatment modalities for scoliosis is dependent on severity and debility:
• Physical therapy
• Bracing
• Surgery

Goals of physical therapy for scoliosis.

The treatment for scoliosis can include physical therapy, bracing, and surgery depending on the severity of scoliosis. Physical therapy can provide care

Goals of physical therapy for Scoliosis:

• Range of motion and flexibility exercises to prevent limitations in joints or muscles.
• Strength training for muscles surrounding the spine and other parts of the body.
• Manual therapy including hands-on treatment to restore motion to the joints and the muscle tissue and to reduce pain
• Functional Movement training to optimize spinal alignment and movement patterns.
• Education for continued home program for scoliosis.

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Leg Pain

Leg pain can result from any acute or chronic injury to skin, muscles, joints, or bones or nerves in the legs. present itself as a sharp, stabbing sensation or simply a dull ache. Sprains and strains are common causes of leg pain in athletes and people that rely on standing for work due to overuse. Muscular injuries in the legs are common and are amenable to physical therapy.

Pain in the quadriceps, groin, and hamstrings are especially common in athletes who rely on quickness in their sport such as sprinters, soccer players, football players, rugby players, lacrosse players, and basketball players.

Symptoms of leg pain:

• Pain when stretching or flexing thigh muscles
• Broken blood vessels on leg
• Bruising on the leg
• Leg swelling
• Weakness
• Muscle spasms
• neuropathic pain: numbness, tingling, burning, shock like pain
• Changes in temperature in legs

Goals of leg pain physical therapy treatment:

• Improve range of motion.
• Improve walking
• Strengthen the muscles and tendons.
• Reduced referred pain to leg from lower back.

Common Causes of leg pain:

• Atherosclerosis
• Leg ulcer related to infection or blood flow compromise
• Peripheral Vascular Disease
• Deep Vein Thrombosis (blood clots in legs)
• Sports injuries
• Sciatica
• Bulging or herniated disc in the back.
• Knee injuries.
• Bone fractures.
• Arthritis in the leg
• Osgood-Schlatter disease
• Legg-Calve-Perthes disease
• Tendinitis
• Surgical procedure
• Nerve damage in the leg
• Muscle cramps (charley horse)
• Acute leg injury
• Varicose veins
• Dehydration
• Overuse of leg muscles
• Torn leg muscle
• Inflamed leg tendon
• Shin splints
• Autoimmune conditions: Rheumatoid arthritis, lupus, psoriasis, gout or pseudogout.

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Neck Pain

Neck pain may be a result of an acute or chronic injury resulting in inflammation or degeneration of the cervical spine. Sudden jerking of the head that can occur in car accidents may result in neck pain, commonly referred to as “whiplash.”

You may experience neck pain after playing sports, car accidents, falls, poor prolonged posture, and improper exercise technique.

Causes of neck pain:

• Osteoarthritis and bone spurs
• Rheumatoid arthritis
• Osteoporosis
• Fibromyalgia
• Spondylosis
• Pinched nerve
• Degeneration of cervical spine discs
• Herniated or bulging discs
• Spinal stenosis

Goals of neck physical therapy treatment:

• Improve range of motion.
• Strengthen the neck muscles
• Use massage therapy and other modalities to loosen the muscles
• Reduced referred pain to upper extremities.

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Balance and Fall prevention

Falls are common in all age groups and especially problematic in the elderly. Falls can result in both musculoskeletal and neurological injuries. Balance and stability are important factors for aging adults to maintain a healthy lifestyle. Physical therapists are an essential part of a patient’s healthcare team, and can help to prevent falls, injuries, and identify those who are at risk for falling.

Common causes of balance difficulty and falls:

• Osteoarthritis seen in neck, back, hips or knees
• Neuropathy or nerve injury
• Vitamin deficiency such as B12 deficiency
• Pharmacologic (medications)
• Weakness in extremities
• Strokes
• Vertigo
• Blood pressure shifts
• Glucose shifts
• Improper footwear.
• Visual impairment

Goals of treatment for balance difficulty and falls:

• Therapeutic exercise to improve strength
• Balance-specific training to improve balance and vestibular function
• Home safety assessments and recommendations for proper in-house amenities.
• Patient education regarding footwear.
• Proper use of assistive device uses; such as canes or walkers.
• Communication with primary physicians and pharmacists regarding patient medication

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Multiple Sclerosis (MS)

Multiple sclerosis is a common neurodegenerative disorder affecting the central nervous system. This is one of the leading non traumatic disability in young adults. This condition results from the loss of the insulating covering (myelin) of nerves in the brain and/or spinal cord. This loss of nerve covering results affects the brain and spinal cord ability to transmit signals resulting in physical and cognitive disability. The exact cause is not clear, however it is related to either improper myelin formation or the immune system attacking the nerve covering (myelin).
Multiple sclerosis can be diagnosed at any age, however, is most diagnosed between the ages of 20-35 year of ages. The diagnosis is usually symptom based supported by specific MRI findings and cerebrospinal fluid markers.
Rehabilitation interventions should be considered early for optimizing functional capacity and maintaining independence. Studies have shown, in addition to pharmacologic disease modifying therapy, early rehab intervention optimizes functional capacity and reduces risk for loss of independence. Early rehabilitation has been proven to reduce disability, participation and quality of life despite disease progression.

Common symptoms of multiple sclerosis (MS)

• Difficulty with walking.
• Difficulty with coordination
• Numbness
• Weakness
• Vision changes
• Changes in bladder or urinary function
• Pain
• Fatigue
• Sensitivity to heat

Treatment for Multiple Sclerosis: although there is not a cure of MS there is broad range of treatment modalities that slow progression and disability form disease.

• Be sure to discuss with your neurologist your pharmacologic options for treatment. Treatment modalities have expanded in the past decade resulting in improved functional outcome and reduced disability.
• Currently there is more than 15 disease modifying therapies or medications that have shown success in fighting this disease. Be sure to discuss your options with your neurologist to optimize your management.

Goal of Physical therapy in multiple sclerosis: MS rehabilitation is individualized as patient can exhibit different deficits from this condition.

• Mobility training in learning how to use assistive devices
• Improve speech and comprehension.
• Improve visual changes
• Improve range of motion and minimize spasticity
• Improve strength
• Gait training

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Parkinson’s Disease

Parkinson’s disease is a slowly progressive neurodegenerative disorder that can occur in any age group ranging from 45-90 years of age. Most common occurrence onset tends to be between the ages of 55-65. This condition can affect speech, fine motor skills, gait and coordination. Cognitive and psychological impairment can also occur in the later stages of this disease. Parkinson's disease occur as results of reduced production of a molecule called “dopamine” that is needed for movement and emotions.

Although there is not a cure for Parkinson’s disease there are several different medications for symptomatic relief. In severe cases surgery may be considered with deep brain stimulation. High intensity physical therapy can help in staving off Parkinson’s disease progression.

Common features of Parkinson’s Disease:

• Slow and/or small movement
• rigidity
• Resting tremor
• postural instability,
• shuffling gait
• Monotone voice
• freezing in activity
• hypotension (low blood pressure)
• constipations
• arm or leg pain
• day time sleepiness
• sleep difficulty
• cognitive changes.
• Mood changes.
• Fatigue

Lee Silverman Voice treatment (LSVT) BIG and LOUD program in therapy are the most studied and proven treatment rehab methods for parkinson’s disease.

• LSVT BIG: is a program that helps with motor impairment of Parkinson’s’ disease focusing on amplitude or “bigness” and high-intensity exercise.
• protocol calls for 16 one-hour treatment sessions, four times per week for four weeks.
That is not always feasible, thus start with 10 to 15 minutes of daily exercise
LSVT LOUD: Helps patient maintain their voice quality and improve swallowing.

Goals of treatment for Parkinson's Patients:

• Improve strength and Balance
• Improve gait
• Improve Range of motion and functional mobility

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Neuropathy or Peripheral Neuropathy

This a condition results from damage to nerves of the peripheral nervous system. The peripheral nervous system supplies nerves to the face, chest, abdomen, upper and lower extremities. Individuals may have neuropathy specific to one nerve or may have a more generalized complaint affecting multiple extremities. This nerve damage may be sudden and rapidly progressive or chronic and slowly progressive depending on the inciting toxin.

Common symptom of neuropathy

• Nerve pain that may be described as a stinging or burning sensation.
• Pins and needles
• Tingling or itching
• Numbness
• Cramping
• Weakness
• Walking difficulty
• Recurrent falls

Common Causes of neuropathy:

• Diabetes
• Chronic alcohol use
• Vitamin deficiency such as B1, B12 or B6
• Trauma resulting in direct nerve injury
• Nerve compression exiting the spine
• After Chemotherapy
• Hereditary such as Charcot-Marie-Tooth disease
• Auto-immune such as Guillain-Barre Syndrome and Chronic inflammatory Demyelinating polyneuropathy (CIDP)

Goal of Physical therapy for neuropathy: This is individualized and focused on the patient’s presenting symptoms.

• Improve range of motion and minimize spasticity
• Improve strength
• Gait training
• Preventing falls
• Use of assistive devices to help with pain and walking
• Improve pain
• Patient education on causes.

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Stroke or Cerebrovascular accident (CVA)

A stroke occurs as a result of loss of blood flow to a part of the brain. When the brain is deprived of blood flow that results in suboptimal oxygen and nutrient delivery to brain cells and thus they start to die within a few minutes. Strokes can result in lasting brain damage, long-term disability, or even death.

Goal of stroke rehabilitation is to re-learn lost skill related to the brain injury to regain independence improve quality of life. The sooner we initiate therapy the greater the overall functional outcome.

Types of strokes:

1. Ischemic stroke: this comprises about 80% of all strokes and is as result of poor blood flow to brain tissue related to either a blood clot or narrowing or hardening of blood vessels.
2. Hemorrhagic stroke: this is a bleeding stroke related a blood vessel injury.

Common risk factors for stroke:

• Uncontrolled high blood pressure
• Smoking
• Heart disease
• Irregular heart rhythm such as atrial fibrillation
• History of diabetes
• Age, anyone greater than age of 60 is at increased risk.
• Family history and specific genetic mutations.
• High Cholesterol
• Obesity
• Excess Alcohol
• Illicit drug use.

Common Symptoms of Stroke:

• Sudden numbness or weakness of the face, arm, or leg (especially on one side of the body)
• Sudden speech difficulty with either word production or comprehension.
• Sudden loss of vision.
• Sudden difficulty walking or balance difficulty
• Sudden severe headache

Goal of Physical therapy in Stroke: Stroke rehabilitation is individualized as not every stroke presents with the same deficits.

• Improve strength, balance and walking
• Mobility training in learning how to use assistive devices
• Improve speech and comprehension.
• Improve visual changes
• Improve range of motion and minimize spasticity

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We strive to provide a comprehensive individualized patient centered care for a wide range of neurological and musculoskeletal pain disorders. We will seek to rehabilitate your condition utilizing the newest methodology and​techniques in therapy.

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