At C.H.O.O.S.E. Physical Therapy we specialize in the treatment of all types of orthopedic and sports injuries, including prehabilitation (injury prevention). Below is a short list of some of the more common diagnoses that we frequently treat at C.H.O.O.S.E. Physical Therapy.
The disc in the spine acts as a shock absorber and spacer between the bony segments. The disc is composed of two areas; Outer region referred to as the annulus fibrosis and the inner region which is more gel-like and called the nucleus pulposus. Most people by the time they reach their 40’s have some findings of “Disc Degeneration” which does not mean you have to experience pain and functional loss associated with this diagnosis. There are Four different stages of herniations from least to most severe; Degeneration, Prolapse, Extrusion and Sequestration.
Here at C.H.O.O.S.E. we can help not only alleviate pain associated with this type of injury but also education on valuable techniques to improve your daily function. We specialize in Manual Therapy techniques which have proven effectiveness for such conditions and further backed up with lumbar stabilization(Core strengthening), body mechanics training and activity modification recommendations if warranted.
Whiplash often occurs in motor vehicle accidents, but can also happen with sports injuries, physical abuse, and falls. Whiplash is typically considered a “sprain and strain” injury. This is typically deemed an over stretching to the ligaments and muscles leading to pain. However, during these types of injuries due to the sheer forceful nature of the incident, there is often a compressive aspect in the extremes of one’s limit to motion. This combination of stress at the extreme of motion and forceful nature can cause trauma to bony structures such as the bones in the back/front of the spine and to the gelatinous discal matter that protects the bones and nerves.
Getting early access to physical therapy is highly recommended and beneficial for regaining your quality of life. Establishing a treatment strategy promptly will help with accelerating healing injured tissues, decreasing pain levels, regaining/enhancing strength, increasing range of motion and will help with preventing future flare ups. Contact us so we can help you develop an effective plan.
You athlete with pain at the inner part of your elbow along with a loss in throwing velocity and control? Little League Elbow is a common elbow condition seen in young throwing athletes due to overuse, which creates stress and tension at the medial elbow apophyseal growth plate. Throwing a full body activity, it is important to evaluate multiple joints such as the shoulder, thoracic, spine and lower extremity. Many youth throwing athletes have range of motion and strength deficits at the back, shoulder, elbow, and lower extremity. At C.H.O.O.S.E. Physical Therapy, we have a board-certified physical therapist and a physical therapist with experience with University of Miami’s Baseball team. As a part of your treatment plan, we can perform a throwing analysis along with implementing evidence-based practice to create a structured throwing program.
Up to 40 % of Americans experience Vertigo at least one time in their life. Two types of Vertigo; Central and Peripheral. Central is associated with issues in the brain and peripheral is linked to inner ear problems. Dizziness and Vertigo are both considered balance problems; however, the symptoms are distinct. Dizziness is a feeling of being unbalanced, while vertigo is a perception that you are moving, or your surroundings are spinning/rocking and or tilting. There are over 20 conditions that can cause these symptoms to occur such as Benign Paroxysmal Positional Vertigo (BPPV). BPPV is the most common cause of vertigo.
Here at C.H.O.O.S.E physical therapy we can help navigate the cause of vertigo/dizziness and rule out possibility of cervical spine involvement as well. One form of treatment for BPPV is Canalith Repositioning Therapy. We can often help manage BPPV in one to two sessions. Contact us for more information.
Do you have numbness, tingling, pain or weakness in your hand? Area involved can be thumb, index, middle and of the ring fingers and adjacent palmer areas. 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 duration of symptoms. 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 know as Double Crush Syndrome or Triple Crush syndrome.
When a nerve is “pinched” in more than one location. Nerves arise from your spinal cord in your neck and weave in an out of muscles in your arms, from your upper back and travel around your rib cage, and in your low back and travel down your legs. Pressure on a nerve came be from swelling, disc, bone, facet (joint stiffness), elevated ribs, abnormal posture or pressure in the arm and or leg from muscle or fascia tightness. Double crush theory is supported by research: A nerve compressed at one site become susceptible to damage at another site. A high percentage of patients with carpal tunnel syndrome (median nerve compression at the wrist) and ulnar entrapment (ulnar nerve compression at the elbow) also presented with cervical radiculopathy (compression of the nerve at the cervical spine). For a good outcome with physical therapy all areas of compression must be evaluated and treated.
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!
Ever feel a click or pop while eating, or how about the feeling your jaw locking? Temporomandibular Joint is the most used joint in the body, and Temporomandibular Joint Dysfunction is a common orthopedic condition treated by physical therapists. Physical Therapists are about to perform manual techniques to reduce pain, joint stiffness, and audible clicking along with implementing effective exercises to target muscle coordination and recruitment. At C.H.O.O.S.E. Physical Therapy, we offer a unique Class IV Laser, which promotes recovery and reduced pain levels while making an impact at the cellular level.
Front of the knee pain while running, jumping, sitting for prolonged periods of time, or going up and down steps? Patellofemoral Pain Syndrome is a common knee condition that accounts for up to 7.3% of the general population, within a wide variety of age groups. While many think Patellofemoral Pain Syndrome is just specifically a knee condition, there are multiple components that can be playing a factor. 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 what activity you enjoy most!
A tear of the meniscus often occurs by rotating the knee while weight bearing. You may feel pain, catching, locking, clicking, and/or weakness of the knee. Your knee may feel blocked making it difficult to fully extend your knee. Twisting on the knee and squatting will be painful. Many meniscal tears can be treated conservatively and not require surgery. Physical therapy can help to restore your range of motion and functional strength, decrease your pain and swelling, improve your balance and gait (how you walk), and help you safely return to activities of daily living and sports.
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. 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.
Trochanteric bursitis is inflammation of the bursa (a sac of fluid at the joint that protects the
tendons from rubbing at the bone) at the hip. Numerous causes of trochanteric bursitis exist. Some of these include: Injury to the hip: falling onto the hip, hitting the hip into an object, lying for prolonged periods of time on the hip
Activities that cause overuse: (running upstairs, climbing, prolonged standing or walking), incorrect posture or alignment ( caused by arthritis, scoliosis, leg length differences), hip bone spurs, and/or previous surgery around the hip. If you are experiencing hip bursitis you will have pain on the outside of your hip and thigh or into the buttock. The pain may worsen with lying on the affected hip, getting up from a low chair or squat, walking upstairs, or pressing on the outside of the hip.
Physical therapy can assist with treatment of hip bursitis by using joint mobilization to correct any lumbopelvic malalignments and improve hip joint mobility, soft tissue mobilization to decrease tightness in the muscles that could contribute to irritation of the bursa, exercises to help maintain the strength and flexibility of the hip muscles, and modalities to assist with decreasing pain and inflammation.
Narrowing of the spinal canal causing pressure on the spinal cord or nerves as they exit the spinal canal. Symptoms include neck or back pain, numbness and/or tingling that involves arms or legs. Postural changes are often noted with the inability to stand up straight or walk without increased symptoms in the low back or legs with lumbar stenosis (low back). Or pain and difficulty looking up with cervical stenosis 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. Emphasis on pain science education so that the patient can modify behavior to avoid increasing symptoms, and to enable recovery.
Pain on the outside of your elbow with your golf swing? Pain on the outside of your elbow with desk work and typing activities? Golfer’s Elbow / Lateral Epicondylitis is a common elbow condition treated at C.H.O.O.S.E. Physical Therapy, with a patient-centered focus to allow you to return to your goals. Our experienced and board-certified physical therapists at C.H.O.O.S.E. place an emphasis on evidence-based practice to provide the most effective treatment plans to decrease pain while also increasing range of motion, joint mobility, grip strength, and independence with functional activities.
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.
Just receive your surgery and looking to start working towards your goals at physical therapy? It is go time! The Anterior Cruciate Ligament (ACL) is one of the most common knee injuries, which can limit an individual’s ability to perform every day and recreational activities that brings one joy. When seeking treatment, it is important to an effective and individualized plan of care that is focused on the patient. At C.H.O.O.S.E. Physical Therapy, we have an experienced staff which has two board certified physical therapists, a therapist with collegiate sports experience and has completed an orthopedic residency, along with physical therapists with extensive experience and advanced manual therapy certifications. The research on ACL rehabilitation is constantly growing, and it is important to have a physical therapist who places an emphasis on evidence-based practice to ensure a safe and successful recovery for your goals!
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 which is due to the plantar fascia’s origin, the calcaneal tubercle, where heel spurs are most commonly present. Symptoms can vary; however, the most common are 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!
A bunion, known as hallux valgus, is commonly described as a bump on the inner surface of the first toe. While pain is most often experienced with a bunion, it can cause difficulty with walking, running, standing, and performing the activities you enjoy most. The presence of a bunion can create limitations with your first toe ROM, first joint mobility, ankle and foot strength, and muscle flexibility of the lower extremity. At C.H.O.O.S.E. Physical Therapy, we have physical therapists who can perform a variety of treatment techniques which range from soft tissue and joint mobilization, stretching, and patient-specific strengthening. In-addition, at C.H.O.O.S.E. Physical Therapy we offer specialized services such as custom orthotic fitting, in-depth gait analysis, and advanced taping techniques to relief your pain and optimize your function!
Ready to start your journey for back to baseball? Tommy John is a common surgery performed on throwers, where the ulnar collateral ligament (UCL) is reconstructed to provide stability to the medial elbow. Over the past decade, Tommy John surgery has become more and more prevalent. Ensuring that a comprehensive rehabilitation is in place is a main ingredient for success and for your turn to the diamond. At C.H.O.O.S.E. Physical Therapy, we have a physical therapist on staff who has previous experience in Division I and II settings, specifically with University of Miami’s Baseball Team. It is important to have a physical therapist to progress you along the stages of rehabilitation while hitting your range of motion and strength goals with evidence-based practice. Here at C.H.O.O.S.E. Physical therapy, we offer Blood Flow Restriction (BFR) Training along with creating structured throwing programs backed by research used at the MLB and Collegiate level.
What does tennis elbow feel like? Tennis elbow can begin as an ache on the outside of your elbow. The ache could worsen and turn into a severe burning pain. The pain may progress from your elbow into your forearm and the back of your hand and be worse when you grip, twist or lift with that arm. Your grip may weaken. You may have pain and difficulty with activities such as brushing your teeth, turning a key or doorknob, opening a jar, carrying a purse or bag of groceries.
Tennis elbow is inflammation of the tendons that attach the muscles that extend your wrist and fingers to your elbow. This tendinitis is usually caused by repetitive wrist and arm motions or overuse. It is important to rest your elbow by stopping the activity that caused the problem. Recovery could take 6 months to a year, sometimes longer. Physical therapy can speed the healing with mobilization of the joints and soft tissues, stretching, splinting, and use of modalities such as ultrasound, laser, ice, and electrical stimulation. Your physical therapist may also be able to assess the activity that caused the problem and suggest modifications (i.e. form with tennis stroke, workspace modifications/computer ergonomics).
Experiencing numbness in your hands while raising your hand, or while sitting? Thoracic Outlet Syndrome is a diagnosis that sometimes can be overlooked. With those dealing with Thoracic Outlet Syndrome, there can be underlying issues such as an elevated first rib, pec tightness, postural abnormalities, and lack of neural mobility. It is important to get an in-depth and comprehensive evaluation to address other components that may be playing a role. At C.H.O.O.S.E. Physical Therapy, we have an experienced staff with credentialed manual therapy degrees to provide pain-relief along with symptom management. Our physical therapists place a large role on evidence-based practice, providing you with the most up-to-date and effective treatment techniques to allow you to reach your goals.
Sacroiliac joint dysfunction can cause pain across your back below your waistline. Sometimes the sacroiliac (SI) joint can also give you buttock/pelvis pain, hip pain, or groin pain.Occasionally pain, numbness, tingling, weakness and giving away of your leg can occur. Often it can disturb your sleep, your ability to tolerate sitting and cause increased pain with going from sitting to standing.
The primary purpose of the SI joint is to provide stability of the pelvis. It is a weight bearing
joint, supporting the weight of the upper body. SI joint instability can occur from trauma,
childbirth, degeneration, arthritis or other conditions.
Physical therapy can help improve mobility of the joints and soft tissue surrounding the SI joint, optimize the alignment of the SI joints and pelvic girdle, improve muscle strength to help stabilize the SI joint, improve posture, gait (ability to walk), and ability to transfer (sit to stand from a chair or toilet, in/out of bed or a car for example).When appropriate, Sl joint belts or modalities such as ultrasound, laser, heat, ice, electrical stimulation may be used to provide pain relief.
Have you ever moved your head quickly, had a momentary muscle spasm and then just couldn’t move you neck as far in one or more directions? Do you often feel the need to “pop” your neck or back? After you sit or sleep do you have pain or difficulty moving/ One of your facet joints could be “stuck”. This can happen at any part of your spine, and is often treated by physical therapists, osteopaths or chiropractors with mobilization and/or manipulation of the involved area. However, if this happens often it is a sign weakness in the spinal stabilizers. With “normal” movement joints move throughout the available range of motion and if you have good muscular strength and control, will return easily to neutral spine position, without this “catching” feeling. When weakness is present a joint can get “stuck” at the end range of motion and not return to neutral. Increasing strength of the spinal stabilizers takes very specific exercises or you will strengthen the wrong muscles, leading to even more frequent symptoms.
Experiencing clicking, catching, or clunking with overhead activities? The glenoid labrum is a structure within the shoulder that provides stability to the glenohumeral joint at rest and with movement. Whether you are post-operative or seeking conservative treatment, physical therapy is an essential component to your rehabilitation process. At C.H.O.O.S.E. Physical Therapy, we ensure that your rehabilitation process is focused on your individual goals with provided effective evidence-based practice to maximize your progress. We offer unique services to maximize your recovery which includes advanced manual techniques by our certified physical therapists, cupping, instrument assisted soft tissue mobilization (IASTM), taping techniques, and gravity-fit training.
Loss of range of motion in the shoulder, can be significant, moderate or mild. Pain is usually located on the outer part of the upper arm but as it progresses, can radiate down the arm. May experience pain with sleeping on your side and pain often precedes the loss of range. External rotation is usually lost first and most significantly. There is often underlying pathology for the shoulder and/or neck: including but not limited to tendonitis, rotator cuff tear, trauma, bursitis, nerve compression, cervical radiculopathy or Diabetes. If neural symptoms are involved, then aggressive stretching can make the symptoms pain and loss of range worse. In almost all the patients that we see, there is nerve involvement this must be treated at the same time as the shoulder. Patients respond well to joint, neural and soft tissue mobilization, class 4 laser, and other modalities to decrease pain.
What is Blood Flow Restriction Training (BFR)? Blood Flow Restriction Training has taken the field of physical therapy and strength & conditioning by storm, as it has gained popularity in both the professional athlete and military population. As opposed to traditional strength training where improvements in strength & muscle mass take 8 to 12 weeks, BFR helps promote greater strength gains in as early as 2 weeks! The research behind Blood Flow Restriction Training has proven to be effective in a wide variety of diagnoses and post-operative surgeries such as ACL reconstruction, meniscal repairs, rotator cuff repairs, and much more. In-order to perform BFR, it is important to have a physical therapist who is certified in Blood Flow Restriction Training. At C.H.O.O.S.E. Physical Therapy, Michael DeSimone is certified in Blood Flow Restriction Training through Owens Recovery Science, a leader in the field. Michael also has conducted research on BFR, and we are excited to announce he has been invited to the ATPA’s Combined Sectional Meeting to present!
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