Techniques

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What is Strain Counterstrain?

An extremely gentle and  pain-free treatment that will get rid of muscle pain, tightness, spasm, joint stiffness, and other “hard to explain”  symptoms. The therapist uses his or her hands to guide the patient’s body and muscles into a position of comfort or ease that will decrease abnormal reflex spasms in your body.

Why does Strain Counterstrain work?

Strain Counterstrain works by correcting an overactive stretch reflex that exists in the painful muscle. This abnormal reflex causes the muscle to contract constantly, instead of just when it is needed. As a result waste products build up in the muscle and creates tender or “ trigger” points.

How was this developed?

In 1955 Dr. Lawrence Jones, DO discovered that positioning a patient for comfort could correct complex spinal disorders. The accidental discovery occurred after he helped a patient with severe low back pain try to find a comfortable sleeping position. After a brief period of experimentation, a position was identified in which the patient was completely comfortable. After a 20 minute trial in this position ( to see if this was a viable sleeping position) the patient was able to stand fully erect for the first time in 6 months. Shortly thereafter the patient made a full recovery.

What i can expect after Strain Counterstrain treatment?

You should have less pain and improved movement immediately following treatment. Even though the treatment is extremely gentle you can have soreness for 1-2 days following treatment due to the release of waste products from the trigger points.

Are there any restrictions following treatment?

It is recommended to drink ½ your body weight in ounces daily especially after treatment to flush out waste products/toxins released from the tender points ; avoid exercise involving resistance ( lifting weights, house cleaning, heavy yard work); prevent quick movements- instead be mindful to move in a slow deliberate manner; avoid chiropractic treatment for 3-4 days.

Why hasn’t my doctor heard of Strain Counterstrain

It is a relatively new technique in the field of manual medicine. The first research article to study Counterstrain’s effect on the stretch reflex was not published until 2006. (See : Stretch reflex and Hoffman Reflex Response to Osteopathic manipulative treatment in subjects with Achille Tendonitis, JAOA, Vol. 106, Sept. 2006.) Please feel free to share this information with your doctor.

What type of conditions does Strain Counterstrain help?

Many conditions can be treated with this gentle technique. The treatment has helped those with conditions that had previously failed physical therapy, chiropractic, massage, acupuncture, injections, and medications. The is a partial list of conditions that have been successfully treated with strain counterstrain: chronic pain, fibromyalgia, degenerative disc disease, bulging discs, headaches, heel spurs, low back pain, muscle strains, sports injuries, neck pain, myofascial pain, plantar fasciitis, rotator cuff injuries, carpal tunnel syndrome, tendonitis, tennis elbow, jaw pain, whiplash, some balance issues and vertigo, ankle sprains.

What is Dry Needling Technique?

This is a treatment which uses a solid filament needle which is inserted into the skin and muscle directly at a myofascial trigger point. Myofascial trigger points are the tender knots or muscle hardenings you feel in your muscles and when pressed on hard enough can produce pain or spread pain, numbness, tingling, burning to other areas of the body.

Is Dry Needling similar to acupuncture?

There are many similarities and differences between dry needling and acupuncture. Licensed physical therapists in a growing number of states can use dry needling under the scope of their practice. Dry needling also falls within the scope of acupuncture practice. Physical therapists at Burkhardt Physical Therapy Center are no licensed acupuncturists and do not practice acupuncture. In contrast to most schools of acupuncture, dry needling is strictly based on Western medicine principles and research. Dry needling is directed specifically at trigger points that create pain verses acupuncture/energy points.

How does Dry Needling work?

The exact mechanisms of dry needling are not known. There are mechanical and biochemical effects. Based on the pioneering studies by Dr. Jay Shah and colleagues at the National Institutes of Health, we know that inserting a needle into trigger points can cause favorable biochemical changes, which assist in reducing pain. It is essential to elicit so-called local twitch responses, which are spinal cord reflexes. Getting local twitch responses with dry needling is the first step in breaking the pain cycle.

What type of problems can be treated with Dry Needling?

Dry needling can be used for variety of muscle and joint problems. Muscles are thought to be a main contributing factor to many symptoms. Such conditions include, but are not limited to neck, back and shoulder pain, arm pain (tennis elbow, carpal tunnel, golfer’s elbow), headache to include migraines and tension type headaches, jaw pain, buttock pain and leg pain (sciatica, hamstrings strains, calf tightness and spasms). The treatment of muscles has the greatest effect on reducing pain mechanisms in the nervous system.

Is the procedure painful?

Most patients do not feel the insertion of the needle. The local twitch response elicits a very brief (less than a second) painful response. Some patients describe this as a little electrical shock; others feel it more like a cramping sensation. Again, the therapeutic response occurs with the local twitch responses and this is a good and desirable reaction. You may be sore for a few hours or a few days after a treatment.

Are the needles sterile?

Yes, we only use sterile disposable needles.

What side effects can I expect after the treatment?

Immediately you will have improved movement and decreased tightness in your muscles. Also you may have muscle soreness over the area treated and sometimes into the areas of referred pain. Typically, the soreness lasts between a few hours and two days. Ice, heat, and stretching will help.

What should I do after having the procedure done?

Our recommendations vary depending on the amount of soreness you have and on the individual response to the treatment. As always drink plenty of water after treatment. Apply heat or ice over the area which ever feels the bests. Perform gentle stretches, and modify activities.

How long does it take for the procedure to work?

This will very depending on how long you have had pain and how severe the pain is. If your symptoms are acute (new) it may only take 1-3 visits, but if your symptoms are chronic (over 3 months) it will take several visits for optimal results. Again, we are trying to cause mechanical and biochemical changes without any medications. Therefore, we are looking for a cumulative response to achieve a result that will disrupt the pain cycle. It is like peeling the layers of an onion.

Why is my doctor not familiar with dry needling?

In the US, dry needling is a relatively new method for treating myofascial pain and not everyone is aware of this effective treatment. Feel free to inform your doctor about this treatment option. It is upon all of us to educate others about new innovative ways to treat pain.

Where does dry needling fit in the entire rehabilitation program?

Generally speaking, dry needling is a treatment that will decrease pain, improve mobility, and therefore improve your function and daily activities. At Burkhardt Physical Therapy Center we use less invasive treatments such as Jones Strain Counterstrain and hands on Myofascial Release techniques first and then incorporate dry needling technique when needed, unless a patient specifically referred for dry needling technique and in certain cases after evaluation dry needling will be started right away.

Once I am feeling better, how often do I need to come back to maintain progress?

The muscles and joints are under constant pressure from gravity, stress, work, etc. A regular exercise program combined with good posture can prevent many problems. If the pain comes back, “tune-ups” are recommended to treat and prevent serious injuries.

What is Kinesio Taping?

The Kinesio Taping Method has taken the Rehabilitation and Sports Medicine world by storm.  Since development by Dr. Kenzo Kase nearly 20 years ago in in Japan, Kinesio Taping has become the standard therapeutic taping in the U.S.  The method of taping uses a uniquely designed and patented tape for treatment of muscular disorders and lymphedema reduction.

Since the introduction of Kinesio Taping into the US, medical practitioners from PTs, ATCs, OTs, DCs, MTs, to MDs have recognized and embraced this effective, safe, and easy-to-use modality.  The method and tape allow the individual to wear and receive the therapeutic benefits on a 24 hours/day basis, and can be worn for several days per application.  Currently, Kinesio Taping is practiced in hospitals, clinics, universities, high schools, and by professional sports teams.

The Kinesio Taping Method involves taping over and around muscles in order to either: assist and give muscle support, or to prevent over contraction of the muscles.  The first technique gives the practitioner the opportunity to actually give support with full range of motion that enables the individual to participate in physical activity with functional assistance.  The second technique helps fight against overuse/contraction and helps provide 24 hour/day facilitation of lymphatic fluid.  This technique is most commonly used in the acute state of rehabilitation. Lastly, there are many types of correctional techniques such as myofascial, lymph, and tracking (e.g. patella).  Kinesio Tex Tape can be used in conjunction with other therapies including cryotherapy, hydrotherapy, massage therapy, and electric stim.

How Does This Stuff Work?

Kinesio Taping alleviates pain and facilitates lymphatic drainage by lifting the skin.  The taped portion forms convolutions in the skin this increasing interstitial space.  The result is that pressure and irritation are taken off the neural/sensory receptors.  Then slowly, pressure is taken off the lymphatic system allowing it to drain more freely.

Over a bruise, Kinesio Tex Tape demonstrates the ability to increase circulation and facilitate lymphatic flow.  These results are seen within 12 hours of application.  This application was fan shaped Kinesio Tex Tape placed directly over the bruise.

1. Where did the work “Kinesio” come from?The name comes from the science of Kinesiology, because the taping method and tape allow the body and muscles to move while it assists in rehabilitation.

2. What does Kinesio Taping and Tape do?Kinesio Taping Method is applied over muscles to reduce pain & inflammation, relax overused tired muscles, and to support muscles in movement on a 24 hour per day basis.  It is not a restrictive type of taping, and allows for full range of motion.  I contrast, traditional sports’ taping is wrapped around a joint strictly for stabilization and support during a sporting event.  Kinesio Tape is used for anything from headaches to foot problems and everything in-between.  Examples include: carpal tunnel syndrome, lower back strain/pain (subluxations, herniated disc), knee conditions, shoulder conditions, and sports injuries, etc.

3. Why is Kinesio Tape so much more accepted than other tapes?It has a number of benefits that are not achievable with other tapes:

  • 100% High Grade Cotton-for comfort and breathing
  • 140% Elastic-same flexibility as human skin and muscles
  • Heat activated adhesive-although very light, mild and hypo-allergenic
  • Latex Free
  • Air Circulation Waves-to channel out sweat and water and enhance skin breathing
  • Durable-average usage 3-4 days per application
  • More Economical-usually 8-10 applications per roll
4. Is it the tape or the technique that gives such great results?
Without a doubt, the technique is the most unique, however, the full benefits were not possible until Kinesio Tape was developed.  The taping method requires a tape that is patient and skin friendly, possesses optimum elastic qualities, the same thickness as the skin, and is durable enough to stay on multiple days even through sweat and showers.5. How is the tape applied?Without getting too technical, the tape is applied over the affected area with the muscles in a stretched position.  Then the tape is applied from one end of the muscle to the other with very little to no stretch of the tape.  The tape is applied from the ORIGIN to INSERTION of the muscle for SUPPORT and from INSERTION to ORIGIN for REHAB.

6. What are the concerns or difficulties with Kinesio Taping (Trouble Shooting)?

  • Skin needs to be free of oil, sweat, and lotion prior to application
  • After application rub down tape to activate heat sensitive glue
  • Avoid extreme stretching of the tape during application to avoid skin irritation
  • Apply approximately 1 hour prior to activity or shower to allow glue to adhere properly
  • Skin irritation is extremely rare, but special care should be taken with hypersensitive skin patients
7. What is the difference between the colors?There is no physical properties difference between colors.  In Japan they utilize colors as a form of color therapy. Blue having a more cooling effect and red having a more warming effect.  Colors, in my opinion are the best form of advertising.  Highly visible to the eye and no matter what the situation presets always asked what is that tape doing on you?  ​

Kinesio Tape Information

Purpose of taping
Kinesio tape is designed to gently create forces on the surface of the skin which elevate the tissue, relieving the pressures beneath the skin surface, thereby promoting increased circulation to the tissues and structures beneath the area taped.  To assess the effectiveness of the taping procedure, you will be asked to help with the following:
Wearing of the tape
Kinesio Tape is to be worn by the patient for up to 5-7 days as tolerated.  The tape’s cotton fabric will absorb water, however, the acrylic glue adhesive next to the skin is waterproof.  It is perforated with numerous holes to allow air circulation to the skin surface making the tape comfortable to wear.
The tape is ok to wear in the shower but, please do not rub the tape with a towel or washcloth.  Blot the affected areas taped.  Rubbing will cause rolling of the edges of the tape.  The cotton fabric will dry in approximately 20 minutes.  Do not use a hair dryer to dry the fabric as this may in some people, harden the acrylic glue making removal of the tape uncomfortable.
When putting on clothing, try not to rub against the tape excessively as this tends to roll the edges of the tape.  If a section of the tape should begin to peel, simply trim the affected portion with a scissors.  Once the tape is removed it no longer possesses its adhesive qualities and will not stick to the skin.
Observations
Please note whether there are changes in your pain levels while wearing the tape.  If so, attempt to determine on a 0 to 10 scale the amount of change.
If an itching sensation develops beneath the tape, remove the tape immediately.  A small percentage of the population is sensitive to a salt build up caused by perspiration being trapped in the tape’s glue.  If permitted to continue, skin reddening and irritation may result.
Please remove the tape approximately 24 hours before your next therapy visit.  This will allow you to assess any further changes in pain levels that may occur.  Inform your therapist accordingly.  This will assist both you and the therapist in determining the direction of your therapy program.  To remove tape, pull in the direction of hair growth.  Use a trailing finger under the tape, separating the skin from the tape.  If difficulty in removal persist, soak the tape in water or use oil between the skin and tape upon removal.

Kinesio Taping Videos

The Benefits of Total Motion Release

  • Teaches Patients to Fix Themselves
  • Takes less visits than traditional therapy
  • Improve Patient Compliance – able to achieve results at home in sessions of 10 minutes or less.
  • Is a life long skill that can be used for any ache or pain be it chronic or acute.
  • Works on variety of conditions such as pre & post joint surgeries, herniated discs, arthritis or just ‘old age.’
  • Helps with those who suffer from pain with prolonged standing, sitting or walking
  • Improves function & performance of daily activities and athletic performances.
  • Did we mentioned – the Patient learns to fix themselves faster than most therapists can. That’s pretty cool!

Total Motion Release is being used in every setting of physical therapy:

  • Orthopedics & Sports Medicine
  • Pediatrics
  • Home Health
  •  Neuro – Stroke & Brain Trauma
  • Sub-Acute & Skilled Nursing
  •  Acute Care
  •  Aquatics

The Total Motion Release concept is simple:

  1. Find motions that are out of balance left side versus right side in the 5 largest joints of the body.
  2. Treat or Exercise toward the easier side to achieve fast & effective results
  3. Use the Rules to Wellness to determine what to do no matter what happens to the patient.
  4. Then learn how to progress into more and more dimensions of motion so as to unlock more and more restrictions that have built up over the years.
  5. Learning the Total Motion Release Process is an exact and step by step process that allows the therapist to teach everything he/she learned easily to their patient.

Total Motion Release systematically takes students and patients through each progression of the program until the desired results are achieved. The remaining 5% of patients who do not respond may need more hands-on care. The hands-on care we use still treats the patient using the same concept. Those who don’t respond to treatment we know in a few visits, not weeks, if they need to be referred out for other care.

Can 6 exercises really make that big of a difference?

The idea that 6 exercises can have an effect on a large percentage of aches & pains and the entire skill of fixing pain can be turned over to the patient can seem very unfathomable. I tell students, you should be skeptical. In order for this to ‘become part of you’ you have to see success using it again and again. It isn’t just 6 exercises, however 6 exercises builds a foundation that you and your patients can build off of. After the 6 you will learn to take each of them into 6 directions of motion, different body positions and alternates for when things aren’t working.

The Total Motion Release Program gives the patient the ability to fix themselves in a short period of time. It uses simple motions that a toddler can understand and provides a medically designed progression so the patient can improve to the level they desire. It not only is effective one on one, but can be applied to large groups.

Interesting patterns…

  • Migraine headache sufferers – the eye in which they experience the throbbing headache in is often times the side they have shoulder restriction.
  • People who grind their teeth at night and are unable to open their mouth very wide are relieved both in tightness and in their ability to open their mouth simply by them gently compressing their teeth for two minutes.
  • Plantar fasciitis may not resolve until the upper rib cage or upper thoracic is released.
  • A person who is “unable” to stand up straight or backward bend can usually extend on one side easier than they can on the other side. Same goes for bending forward. A person who cannot bend forward, can bend forward if the bending is more one-sided.
  • A person who is balanced in their tissues can spin around like a child and have very little, if any, dizziness. The more dizziness a person experiences with this activity the more restrictions that will be found throughout the body (if you are going to try this – do it on yourself and not your patients.)
  • Tail bone and pelvic pain is not completely eliminated (long term) if the thoracic area and rib cage is not made more flexible.
  • Testing an individual for which eye they can see better out of is also the side of the shoulder/arm that is more flexible.
  • An acute back pain sufferer never (except on a few occasions) comes in stuck in extension. They are always slouched forward or to the side, and almost always the traditional form of therapy will try to get them standing up straighter rather than slouching over further. Have you ever tried to exaggerate what the body is doing – it is wonderful to see what effect this has on a person’s pain. Try it!
  • Tightness of lets say the hand also shows up in similar movements of the shoulder. For example, a restricted motion at the wrist – cocking the hand out to the side can present as a restriction at the shoulder of not being able to raise it up and back, as if being a driver and reaching behind the passenger side car seat.
  • If one finds rotation restrictions at the shoulders most likely the patient will also have rotation restrictions at the hips.
  • When a person goes to squat down to pick something up, they invariably weight bear and squat down more on one side than the other.
  • If a person is asked to move their jaw to side to side, the side they can move to further (8 times out of 10) has a tighter shoulder and arm of that side.
  • Foot pain or issues of numbness and tingling also correspond to hand numbness or tightness on some occasions. Many people with plantar fasciitis also sufferer from tennis elbow, carpal tunnel, etc in one or both of their upper extremities
  • Restriction of the trunk can show up as a variety of ailments from musculoskeletal to visceral. Free up trunk range of motion and patients will tell you that all sorts of things have changed for them.
  • Every person has a good side and a bad side for every movement. Next time you get out of a chair focus on which side you place more weight on. Chances are you do this every time you go to stand and sit down. I have found this asymmetry to be one of the root causes to many pain complaints.
  • A pelvic shift and tailbone rotation causes a three dimensional issue in the entire spine and the patient usually has a variety of complaints they are seeing you for.
  • People even have a good and bad side for which ear they can hear out of better and which eye they can see out of better.

Myofascial release therapy does more than relieve your myofascial pain and discomfort. There are a lot of people suffering from myofascial pain syndrome. Some say the pain is so bad they want to die. Certainly, the unbearable pain that is felt can be devastating.

Myofascial pain syndrome is a chronic type of pain that target the muscles, tendons and ligaments. This problem is so hard to identify because it doesn’t show up on x-rays and MRIs. This syndrome is usually diagnosed through physical assessment performed by a physician.

If you are one of these people who are diagnosed as having the syndrome, you may wish try an innovative mode of treatment known as myofascial release therapy. A certified therapist will be the one to perform this type of procedure.

It can sometimes be somewhat painful to undergo but it is considered safe and quite effective. And the outcome is well worth it.

Facts About Myofascial Release Therapy

Myofascial release therapy is a highly specialized fascia stretching technique intended for myofascial pain syndrome. This is done by a qualified therapist to relieve you from all the tension, pain and discomfort.

To better understand what myofascial release therapy is and why it works so well, you must first know something about myofascial pain syndrome. This condition typically affects the fascia which is a thin layer of connective tissue that covers all the muscles in the body. Myofascial syndrome occurs when pain and inflammation is present in the muscle fascia.

When you perform stretching exercises on your muscles, your fascia are also stretched. Every time you overstretch or strain yourself, your fascia shortens and tightens resulting in muscle spasm which is really painful.

This stressful event results in symptoms that revolve around the injured fascia and muscle tightness. Muscle tension can also put pressure on the nerves and muscles that can lead to agonizing pain and discomfort.

Details About Myofascial Release Therapy

The point of myofascial release is to stretch and relax the fascia. The stretching technique is performed by the therapist. He is being guided by your body’s feedback towards the firm compression on the muscles.

The therapist estimates how much pressure is used, what direction the pressure will be placed and the duration of the pressure. Portions of the muscles are stretched one at a time.

Most of the time, people with myofascial syndrome are unable to verbalize where the sore spots are located. The trained and licensed therapist will be the one to locate the trigger points through the use of gentle palpation. After locating the hardened muscles, the therapist will loosen them one by one.

With the use of his fingers, palms or knuckles, the therapist will gently stretch the first muscle that is chosen from the area of tightness. The muscle is stretched in different patterns depending on the extent of the pain that is felt on the trigger point.

When the tissue starts to relax, the therapist will increase the pressure and force that is applied. This method is repeated until the whole muscle is fully relaxed. After that, the therapist will proceed to the next muscle. Trigger points may easily disappear with the use of myofascial release therapy.

A lot of myofascial pain syndrome sufferers have been relieved from pain and discomfort following this therapy. Intended to release the muscle tension that is found all over the body, myofascial release therapy is not an ordinary massage treatment.

Craini Sacral Technique (CST) was pioneered and developed by osteopathic physician John E. Upledger following extensive scientific studies from 1975 to 1983 at Michigan State University, where he served as a clinical researcher and Professor of Biomechanics.

CST is a gentle, hands-on method of evaluating and enhancing the functioning of a physiological body system called the craniosacral system – comprised of the membranes and cerebrospinal fluid that surround and protect the brain and spinal cord.

Using a soft touch generally no greater than 5 grams, or about the weight of a nickel, practitioners release restrictions in the craniosacral system to improve the functioning of the central nervous system.

By complementing the body’s natural healing processes, CST is increasingly used as a preventive health measure for its ability to bolster resistance to disease, and is effective for a wide range of medical problems associated with pain and dysfunction, including:

  • Migraine Headaches
  • Chronic Neck and Back Pain
  • Motor-Coordination Impairments
  • Colic
  • Autism
  • Central Nervous System Disorders
  • Orthopedic Problems
  • Traumatic Brain and Spinal Cord Injuries
  • Scoliosis
  • Infantile Disorders
  • Learning Disabilities
  • Chronic Fatigue
  • Emotional Difficulties
  • Stress and Tension-Related Problems
  • Fibromyalgia and other Connective-Tissue Disorders
  • Temporomandibular Joint Syndrome (TMJ)
  • Neurovascular or Immune Disorders
  • Post-Traumatic Stress Disorder
  • Post-Surgical Dysfunction

Muscle Energy Therapy, or MET, consists of  osteopathic techniques used by therapists to help relax the muscles and stretch  the joints. In their book “Trigger  Points and Muscle Chains in Osteopathy,” Philipp Richter and Eric Hebge write  that these techniques are popular because they are not dangerous and often  successful, even if not performed correctly.

History
Muscle Energy Therapy may have been first  developed to help treat muscle spasms and shortenings. However, the osteopath  community often credits Fred Mitchell, Sr., who was  influenced by osteopaths T.  J. Ruddy and Carl Kettler with the development of the techniques in the late  1940s for treating joint dysfunction.  Through the years, the techniques have  been refined as studies come out on the neurophysiological properties of  myofascial structures.

Defining Muscle Energy Therapy
Muscle Energy Therapy is when a osteopath or other related therapist asks a patient to tense a muscle from a controlled position against the accurate resistance of a therapist. The purpose of MET is to treat limited mobility in joints as well as stretch hypertonic muscles and fasciae. MET may also help to stimulate blood circulation in the area and change muscle tone with neuromuscular mechanisms. This can help to tone and strengthen muscles and joints, as well as help to alleviate pain.

Requirements
Muscle Energy Therapy requires patients to tense muscles while breathing in and out, as well as moving a joint in a certain direction. This therapy cannot be used on comatose or uncooperative patients. The book “Stretching Therapy: For Sport and Manual Therapies,” states that therapists must also be much stronger than a patient for it work, or ask a patient to exert only partial effort. One and a half minutes is considered standard for each exercise. Pain can be experienced if it goes on any longer. Joints need to return to a neutral position very slowly so that muscle spindles are not reactivated.

Contraindications
Patients need to be accurately diagnosed in order for MET to be effective. Therapists need to understand what triggers the pain, limits joint movement along with the cause of imbalance or incorrect motion pattern. Communication and coordination should be clear and concise between patient and therapist. Bones and muscles that are not healed should never undergo METon

Definition
Joint mobilization is a treatment technique used to manage musculoskeletal dysfunction. Most manipulative and mobilization techniques are performed by physical therapists, and fall under the category of manual therapy.

In most cases, at the end of a long bone there is a joint or articulation. The long bone is attached or joined to another bone by a joint. For example, the femur is attached to the tibia at the knee joint. The knee joint is made up of the surface of the tibia, femur, ligaments, and capsule. Thus, the knee joint is stable and yet mobile. When an individual is sitting in a chair and freely kicks his leg out (knee extension), the tibia moves, while the femur is stationary. However, at the surface of the articulating bones (tibia and femur), there is other movement. This movement is known as slide or glide; some have termed it “joint play.” When an individual kicks his leg out, the lower leg or tibia is not only moving forward, but also gliding across the end of the femur. Mobilization is the treatment technique that involves the clinician applying a force to mimic the gliding that occurs between bones. It is a passive movement, the goal of which is to produce a slide or glide. Mobilizations are usually completed at slow speed, sometimes with oscillations, and even with a “hold” or stretch. Manipulations are more aggressive, high velocity techniques, or thrusts. They occur very fast, and at the end of available joint play.

Purpose 
Mobilizations are used to restore joint play that has been lost due to injury or disease. In order for an individual to kick his leg out, there must be sufficient joint play, or freedom for the tibia to move on the femur. Thus, mobilizations are used when range of motion or mobility is lacking. Furthermore, gentle oscillations within the available joint play range is a technique used to decrease pain. Manipulations are quick movements that occur beyond the available joint play range. The purpose of manipulations, or joint thrusts, is to increase the available range if it is not full. Secondly, manipulations are done to break adhesions that disrupt joint movement.

Results
If done appropriately, mobilizations can help reduce pain and restore joint play, which is critical for normal mobility, range of motion, and function.

All massages are $65 per hour;  $100.00 per 90 minutes; & $130.00 per 2-hours
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  • Promotes relaxation
  • Decreases stress and anxiety
  • Soothes strains and pains throughout the body
  • Reduces muscle tension throughout the body
  • Reduces intensity and frequency of headaches, neck, and back pain
  • Increases circulation throughout the body which can lower blood pressure
  •  Improves lymphatic drainage which removes toxins, waste products, and bacteria from the tissue
  • Improves energy level
  • Improves sleep and reduces insomnia
  • Improves self-esteem and feeling of self-worth

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Swedish “Relaxation” Massage ($65.00/hr)
Swedish massage is the basic relaxation massage that is the most well known in the Western culture. It is based on the concepts of anatomy and physiology, which is the study of the form and function of the human body. Swedish massage is performed by a licensed massage therapist. During a Swedish massage the therapist performs various massage techniques (including effluerage, pettrisage, kneading, friction, and stretching) to loosen and warm up the muscle tissue thereby relieving tissue adhesions or “muscle knots”. The therapist will alter the amount of pressure applied to the tissues depending on the preference of the client. It is called Swedish massage therapy as it was introduced by a Swedish physiologist, Per Henrik Ling.Deep Tissue Massage ($65.00/hr)
Deep tissue massage is very similar to Swedish massage but focuses more on the deeper layers of the tissue and fascia. A deep tissue massage here at Burkhardt Physical Therapy Center generally  focuses more  on the common areas of the body that have a tendency to develop increased muscle tension and dysfunction.  A deep tissue massage also encompasses additional massage techniques including active range of motion by the client to achieve maximum results.

Pre-natal Massage ($65.00/hr)
Massage therapy is a wonderful addition to pre-natal care. It is a relaxing way to relieve some of the normal discomforts experienced during pregnancy such as headaches, backaches, neck stiffness, swelling, and leg cramps. The therapist positions the client comfortably in side-lying with soft supportive cushions to decrease back strain and positions her on her back with her back slightly elevated for maximal comfort.

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Myofascial Release (65.00/hr)
Myofascial release is a manual technique  used to release  barriers or restrictions in the  deeper layers of the connective tissue (fascia). This is accomplished by stretching the deep fascial layers using various techniques including the cross hand technique. Deep fascial releases can be performed  in all directions and all over the body depending where the restriction is located.

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Hot Stone Massage ($65.00/hr)
Hot stone massage is a form of massage in which the therapist uses smooth warmed stones to perform massage on the body. The therapist also positions the stones on the body to maximize relaxation and decrease muscle tension. Hot stone massage is especially beneficial to those with extremely tense muscles as the heat of the stones allows the therapist to manipulate the muscle tissue more effectively releasing tension and promoting relaxation. The heat also allows for improved circulation which delivers increased oxygen to the tissues, thereby decreasing pain symptoms.

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Foot reflexology  ($65.00/hr)
Reflexology is a type of massage that applies pressure to various points on the hands and feet with the goal of benefiting other parts of the body, and for overall improved health and wellness.

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Craniosacral therapy ($65.00/hr)
Craniosacral therapy is a very gentle hands on technique used to decrease pain and dysfunction through releasing restrictions in the tissues surrounding the central nervous system (brain and spinal cord). Craniosacral therapy was originally developed by John E. Upledger, Osteopathic Physician.

Vestibular Symptoms
Symptoms of vestibular dysfunction may be mild, lasting perhaps only seconds or minutes, or they may be severe, resulting in total disability.
Not all symptoms will be experienced by every person, and other symptoms are possible. Common symptoms of
vestibular disorders are:
• Imbalance or unsteadiness
• Vertigo
• Dizziness
• Blurred or bouncing vision
• Nausea
• Hearing changes
• Problems with coordination, thinking and memory

Causes
• Whiplash, concussions and other head trauma or injuries
• Sudden or significant pressure changes
• Degenerative changes to the vestibular system and brain
• Chronic or recurrent ear or sinus infections
• High doses or long term use of certain antibiotics

What is BPPV?
One of the most commonly diagnosed vestibular disorder is Benign Paroxysmal Positional Vertigo (BPPV). This is an inner ear problem that causes short periods of dizziness when your head is moved in certain positions. It occurs most commonly when lying down, turning over in bed and looking up. This dizzy sensation called vertigo usually only lasts a few seconds up to a minute, but often makes you feel like the room is spinning around you.  It may also make you feel lightheaded, off balance and nauseous.  The underlying cause of BPPV is crystals that are displaced in the inner ear canals.

 What is Vestibular Neuritis?
Another commonly diagnosed vestibular disorder is Vestibular Neuritis, also known as Labyrinthitis. This affects the part of the inner ear that helps to control our body’s balance. It can be caused by a bacteria or a virus that damages the vestibular nerve, which sends messages about movement and balance between the inner ear and the brain. The source of the virus can be an infection of the respiratory system or the gastrointestinal system.  Initially you may feel sick but it is possible that you may be unaware that you even had an infection. Vestibular Neuritis may be caused by decreased blood flow in the inner ear, exposure to toxic agents, or allergic substances, all of which can damage the vestibular nerve.

Diagnosis
The diagnosis of a vestibular disorder relies on a combination of tests and careful inspection of the history of the problem. A complete physical examination by an experienced, certified provider is essential to rule out other causes of dizziness, such as cardiovascular or central nervous system disorders.  If a person is then referred to a specialist, tests may be performed to measure hearing, eye movement and balance.

Treatment
Treatment can provide a complete cure for some, but in persistent cases, the symptoms can only be controlled, not eliminated entirely.  Treatment varies according to the diagnosis, and may consist of head maneuvers, diet changes, a special form of physical therapy called vestibular rehabilitation therapy, prescribed drugs or equipment or in some cases surgery.
Seeing a therapist who has experience with vestibular disorders is critical.  If left untreated, the result could be permanent vestibular damage.

What to expect at your appointment
• Thorough history and review of your individual case
• Balance assessment
• Ocular motor exam
• Comprehensive inner ear evaluation utilizing infrared goggles

What is vestibular rehabilitation?

Vestibular rehabilitation focuses on improving the function of the inner ear organs – your center for balance control and equilibrium.

Who would benefit from vestibular rehabilitation?

People with a variety of different diagnoses are recommended for vestibular rehabilitation.  It can be recommended after a person suffers a stroke, has brain trauma or a concussion, has poor balance and/or experiences many falls, has debilitated walking, or has had a specific inner ear disorder such as Meniere’s disease, Benign Paroxysmal Positional Vertigo (BPPV), or some sort of virus or infection affecting the inner ear.

What if I have had these symptoms in the past, and already had treatment, or was told there is nothing that can be done?

Well, that may or may not be true.  It is always best to talk with your doctor regarding your specific ailment.  With advances in research and new techniques to help people, you may want to revisit the prospect of attending vestibular rehabilitation.

What can be done for tinnitus (ringing in the ears)?

There are some new medications that have shown promising results.  Talk with your doctor.  Generally, vestibular rehabilitation does not specifically help tinnitus.

How often would I have to attend vestibular rehabilitation?

This varies depending on the reason for your vestibular condition.  In cases of persons with uncomplicated BPPV, usually 2 visits is sufficient.  In more complex cases where one side of your system is not working properly, 1-2 sessions a week, gradually every other week for up to 8 weeks is likely. After one sustains a concussion, the therapist may want to initially see you more often, and get a solid exercise base for home, and wean down to every other week for up to 3-6 months depending on the severity.

Who provides vestibular rehabilitation?

A physical therapist can usually take care of many disease processes related to this.  However, for specific or complicated conditions, it is best to see a physical therapist with advanced training and certification in vestibular rehabilitation.

What can I expect when I come for evaluation for Vestibular Rehabilitation?
Again, this depending on your specific diagnosis.  For those with BPPV, you can expect some sort of balance testing, eye and head movement tests, and finally evaluation with infrared goggles.  The goggles block your vision, but allow the therapist to evaluate your eye movements for nystagmus when you are placed in various positions.  This helps the therapist learn which canal to treat.

In cases of falls or imbalance, you can expect strength and balance tests, and coordination testing.

In cases of brain injury (concussion), your therapist may do all the previous mentioned testing, along with some memory and cognitive testing.

In all cases, your therapist should listen to you and your symptoms, and proceed carefully so as not to unduly worsen your symptoms.

You therapist will work with you and your schedule to meet your needs.

What can I expect in subsequent sessions of vestibular rehabilitation?
Your therapist will take the information gathered from testing you, and formulate a specific vestibular program with your goal in mind – whether to decrease dizziness, reduce falls, improve walking and community balance, or improve reaction times.  Your therapist will progress coordination, eye, strength and balance exercises until your abilities and scores fall within accepted norms, and you feel confident again.

​Energy Medicine is an approach that involves balancing and restoring your body’s natural energies for the purposes of increasing your vitality, strengthening your mental capacities, and optimizing your health. The techniques you will be experiencing and learning trace back to traditions such as yoga, tai chi, and acupuncture. The variety used here is thoroughly modern and does not require adherence to any particular set of beliefs or practices. The core concept is that your personal well-being and effectiveness are directly related to the state of your body’s energies.
The techniques used and taught to you are based on the premise that by promoting balance and flow in the body’s electromagnetic and subtle energies, health and well-being are enhanced. The techniques may involve the use of certain postures or movements or touching /holding, pressing on, tracing, or circling over the specific areas of the skin. These motions move, balance, and restore the body’s energy flow. A technique called “energy testing” may be used to assess how your energies are flowing through specific areas of your body and may help us identify the techniques that will be most beneficial for you.

Energy Medicine can help to:  relieve pain, reduce stress and anxiety, strengthen the immune system, improve digestion, manage weight, alleviate insomnia, sharpen your mind and thought processes, boost vitality and stamina, and teach you to keep yourself healthy and balanced.