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The discs in the spine act as a shock absorber and a spacer between vertebra. The disc is composed of two areas: an outer region, referred to as the annulus fibrosis, and the inner, more gel-like region, called the nucleus pulposus. The outer region resists tensile forces, such as stretching, and the inner region absorbs compressive forces. Most people, by the time they reach their 40’s, have some findings of “Disc Degeneration,” but this does not mean that one has to experience pain and/or a functional loss associated with this diagnosis. There are four stages of herniations from least to most severe: degeneration, prolapse, extrusion and sequestration. Sitting and bending forward usually increase the pain associated with lumbar disc injuries, with poor posture particularly increasing intradiscal pressure. 

Here at C.H.O.O.S.E. we can help not only with pain alleviation associated with this type of injury but also with education on techniques to improve your daily function. We specialize in Manual Therapy Techniques, which have proven to be effective for such a condition, as well as further lumbar stabilization, deep core strengthening, body mechanics training, and activity modifications to protect the spine. Further, traction is a modality that we use for decompression and healing alongside self-treatment exercises to realign the spine. 

“Little League Elbow” is a common overuse injury affecting young throwing athletes, caused by stress on the medial elbow’s apophyseal growth plate. Repeated stress, often from improper mechanics, can widen the growth plate due to traction forces, potentially leading to an avulsion fracture. Since throwing is a full-body movement, it’s essential to assess multiple areas, including the shoulder, thoracic spine, and lower extremities. Many young athletes have range of motion and strength deficits in the core, shoulder, elbow, and legs, which can alter throwing mechanics, increasing the stress on the elbow and exacerbating the risk of injury. Common symptoms include pain on the inner elbow, decreased throwing velocity and control, and possibly numbness or tingling in the 4th and 5th fingers or forearm flexors, suggesting potential ulnar nerve involvement. 

At C.H.O.O.S.E. Physical Therapy, our team includes a board-certified orthopedic physical therapist with experience working with athletes from the Philadelphia Phillies and local softball travel teams. One of our therapists recently completed a rotation with the rehabilitation team for the Baltimore Orioles, giving us valuable insight into treating and preventing these injuries. We focus on teaching proper mechanics, developing appropriate training programs, and implementing guidelines to reduce overuse injuries. As part of our comprehensive treatment plan, we offer throwing analysis and evidence-based practices to create a personalized throwing program.

Contact us to schedule an appointment and discuss how we can help improve your child’s condition and prevent future injuries.

Do you have numbness, tingling, pain, or weakness in your hand? You may be experiencing carpal tunnel syndrome (CTS). Potential areas involved can include the fingers and adjacent palmer areas, and causes can be one specific movement or repetitive motions. These symptoms can be constant or come and go with varied positions of your wrist. Weakness and muscle loss can occur with CTS, especially with pinching, and the “pad" of the thumb may appear flat or smaller, known as atrophy. This is caused by pressure on the median nerve at the wrist as it passes through a “tunnel” that has bone on one side and a thick fascia on the other. Physical therapy, including mobilization of the joints and soft tissue, stretching, and tool-assisted myofascial release can make a significant difference regardless of symptom duration. A change in symptoms should be present in approximately 6 visits. It is also very important that you undergo a FULL evaluation including your neck, ribs, shoulder, elbow, wrist and hand to rule out any other areas that can be causing or contributing to these symptoms, known as Double Crush Syndrome or Triple Crush syndrome.

Lymphedema is a dysfunction and/or blockage of the body’s lymph nodes, which leads to excess accumulation of protein-rich fluid. Patients with lymphedema normally experience an increase in swelling located at the area of dysfunction along with skin discoloration, skin hardening, and the inability to perform essential everyday activities that they love. Lymphatic physical therapy consists of Manual Lymphatic Drainage (MLD), which is only able to be performed by a licensed physical therapist with a certification from an accredited establishment. At C.H.O.O.S.E. Physical Therapy, we have a Certified Manual Lymphatic Drainage Physical Therapist, who is credentialed through ILWT. Manual Lymphatic Drainage places an emphasis on activating lymph nodes and facilitating lymphatic drainage into properly functioning lymph nodes to decrease protein-rich fluid accumulation and swelling to allow one to perform the activities they enjoy the most! 

Do you experience pain at the front of the knee while running, jumping, sitting for prolonged periods of time, or going up and down steps? Patellofemoral Pain Syndrome is a common knee condition that impacts up to 7.3% of the general population within a wide variety of age groups. While many think Patellofemoral Pain Syndrome is specifically a knee condition, there are multiple components that can be involved. Experienced orthopedic physical therapists place a focus on evidence-based practice to provide the most effective manual techniques and exercises that are best suited for you. At C.H.O.O.S.E. Physical Therapy, we offer Blood Flow Restriction (BFR) Training to help accelerate strength gains to help you return to your every-day routine!

Hamstring strains are one of the most common hip and lower extremity injuries. Hamstring strains normally occur at the proximal region, near the gluteal fold while performing running activities, sprinting activities, and while overstepping during walking. The patient may experience a cramping and pulling sensation located near the gluteal muscle and the inability to perform their walking routine due to a sharp and stabbing pain. 

Narrowing of the spinal canal can cause pressure on the spinal cord or nerves as they exit the spinal canal. Symptoms include neck or back pain and numbness and/or tingling that involves the arms or legs. Postural changes are often noted, such as the inability to stand up straight or walk without increased symptoms in the low back or legs (as seen with lumbar stenosis). Cervical stenosis may involve pain and difficulty looking up, with symptoms in the arms. Patients can usually decrease symptoms by bending forward or sitting down. Treating spinal stenosis involves mobilization of the spine to improve mobility, postural exercises, and a strengthening program. There will be emphasis on pain science education so that the patient can modify behavior to avoid increasing symptoms and enable recovery.  

Cervical instability occurs when you have loose ligaments in your upper cervical spine. Those with cervical instability may experience headaches, vertigo, and nausea. They often complain of their head feeling heavy "like a bowling ball" and have difficulty holding their head up for extended periods of time. They will often have tightness of their neck muscles with pain in the neck near their skull and referred to the shoulders and head.

There are numerous causes of instability, some of which could be trauma (i.e. car accident), genetic disorders (i.e. Ehlers-Danlos syndrome), or rheumatoid arthritis.  Physical therapy can provide manual treatment and modalities to help decrease headaches, nausea and muscle tightness, and instruction in exercises to help stabilize the cervical spine and to decrease vertigo.

Experiencing a sharp and stabbing pain at the ball of your foot? Heel spurs occur when there are calcium deposits that develop into boney overgrowths at the heel of the foot. Patients may experience similar symptoms to plantar fasciitis due to the plantar fascia’s origin, the calcaneal tubercle, where heel spurs are most commonly present. Symptoms can vary; however, the most common involve limited ability to bare weight, painful ambulation, decrease in standing tolerance, and inability to perform essential and recreational activities. At C.H.O.O.S.E. Physical Therapy, we place an emphasis on creating a patient-centered treatment plan along with implementing evidence-based practice. With heel spurs, a variety of treatment options are available, such as advanced manual techniques, structured stretching programs, intrinsic foot strengthening, and modalities such as iontophoresis and a Class IV Level Laser. Our physical therapist, Cera Heitkamp, can create custom molded orthotics to prove you pain relief and the ability to perform your daily routine!