Medical Machines

January 28, 2009 by Rebecca Deal  
Filed under Massage & Wellness, Physical Therapy

Modern physical therapy often involves the use of modalities. Modalities are anti-inflammatory machines designed to reduce swelling around an injured body part.   During the acute phase of an injury (generally lasts 1-6 days), inflammatory byproducts enter the traumatized area to remove debris and limit bleeding.   The inflammatory phase is characterized by heat, swelling, pain, redness, and loss of function.  The more quickly this phase is resolved, the lower the probability of joint destruction, excessive pain, swelling, weakness, immobilization, and loss of function.  Using anti-inflammatory modalities can accelerate patient progress toward more active participation in rehabilitation and expedite therapy goals for an early return to function.

Electrical Stimulation

Electrical stimulation has a wide variety of clinical applications in physical therapy.  Electrical stimulation is based on the principles of charged particles flowing to reduce inflammation and control pain.  Clinical units generally use two different types of currents to electrically stimulate muscles.  An interferential current is a waveform produced by the interference of two different medium frequency alternating currents from separate channels.  An interferential current is set up with four electrodes in an “X” pattern over a large body part.  A premodulated current uses one channel to deliver a continuous waveform with a medium frequency and a fluctuating current amplitude.  Premodulated electrical stimulation is delivered with two electrodes evenly spaced over a small, inflamed area.  Electrical stimulation treatments are often combined with temperature modalities (hot packs, cold packs) at the end of a physical therapy session for fifteen minutes to control swelling after activity.

Transcutaneous Electrical Neuromuscular Stimulation (TENS) is a popular electrical stimulation modality for controlling pain.  According to the gate control theory of pain, activation of A-beta nerve fibers can inhibit the transmission of the pain signal from the spinal cord to the brain.  Electrical stimulation, when set with appropriate parameters, can selectively activate the A-beta nerve fibers and block the brain from receiving the pain signal from the body.  TENS units deliver a low voltage current and the patient feels a strong, but comfortable tingling sensation.  Patient-friendly TENS units are available for home use at affordable prices.  A physical therapist can give you product recommendations and detailed instructions on how to set the TENS unit for maximum pain relief.  Contact the therapy team at North Tahoe Physical Therapy for pricing and information.


Ultrasound is a medical machine that uses sound waves to penetrate into tissue for both thermal and non-thermal healing effects.  Ultrasound functions under the principles of piezoelectricity: the ability to change shape in response to an electrical current.  An electrical current is applied to the crystal in the ultrasound “wand” called a transducer.  The piezoelectric crystal responds to the current by expanding and contracting, creating an ultrasound wave.  This wave is able to penetrate through skin using a conducting gel to tissue depths of 1-3mm to bring blood to the injured site and stimulate healing.  Macrophages are cells that work to localize the inflammatory process and recruit repair cells.  The ultrasound machine increases macrophage activity to consolidate inflammation and accelerate the cellular repair response.

Ultrasound treatment can be performed using either a continuous or pulsed setting for duration of eight minutes. Continuous wave ultrasound is used to produce heat and warm the tissues.  Pulsed wave ultrasound recruits macrophages is recommended for anti-inflammatory effects.  During the ultrasound treatment, the patient may feel a minimal sensation from the ultrasound wave.  The patient may perceive warmth from the ultrasound conductive gel.  Ultrasound can be done for a single session or repeated in consecutive treatments to produce the desired anti-inflammatory effects.


Iontophoresis is transdermal anti-inflammatory drug delivery using a low voltage direct current to move charged ions across the skin barrier. Ions are transported through skin pores to deliver Dexamethasone (a corticosteroid recommended for the treatment of inflammatory conditions) in the manufacturer recommended 40mA.minutes dosage.  This machine is set up with the medicated, active electrode over the inflamed tissue and a ground electrode at a distant site.  The patient perceives a light tingle under the medicated patch for the duration of the treatment.   Iontophoresis can be done one time, for several sessions consecutively, or in combination with other modalities to produce an overall anti-inflammatory effect.

Modern physical therapy now has several anti-inflammatory modalities from which to choose during the acute phase of healing.  Other medical professionals (MDs, chiropractors, and acupuncturists) may introduce you to similar tools in treatment designed to control inflammation.  Now that you understand the concept of inflammation and how each modality works to reduce swelling and decrease symptoms you can help your medical team make an educated decision about what combination of medical machines will work best for your body under each condition.

Massage Therapist Certification

December 16, 2008 by admin  
Filed under Physical Therapy

Often I see some massage therapist’s with a nationally certified credential behind their name. What does this mean and is it important to look for when searching for a therapist?

Nationally Certified in Therapeutic Massage and Bodywork, NCTMB as seen written behind a massage therapist name, sets high standards for massage and bodywork practitioners. It protects consumers and employers by ensuring that certified practitioners have the necessary skills and knowledge to perform their job – and that they are committed to upholding NCBTMB’s Standards of Practice and Code of Ethics. NCMTMB is an independent, private, organization established to set high standards of ethical and professional practice through a recognized credible credentialing program.

A nationally certified massage therapist represents the highest professional credential in the field. This therapist has completed a minimum of 500 hours of instruction, demonstrates mastery of core skills, abilities and knowledge, and has passed a standardized exam. This credential will help gain the therapists’ recognition and visibility, and will also increase employment opportunities.

So, is it important when searching for a good massage? Yes, I feel that it is a good thing when doing research for a therapist, yet it’s completely up to that individual. I personally have received great treatments from non-nationally certified therapists. Yet, it does show continued advancement in the profession.

-Brian A. Hrindo, LMT, NCTMB

Physical Therapy Hows & Whys

October 22, 2008 by Jane O'Brien  
Filed under Physical Therapy

Is Physical Therapy a good way to get started on an exercise program if you have been inactive for a long period of time or is a personal trainer a better option?

It is always best to consult with your doctor before beginning an exercise after prolonged inactivity. Your doctor will perform a complete physical and determine if you will be at risk or if you are safe to begin an exercise program. If the MD gives you the “Go Ahead”, physical therapy is your best option for proceeding.

The PT will evaluate your body before developing an exercise program. Tests may include an assessment of muscle strength in your arms, legs and core. He or she will assess your flexibility, your ligamentous stability, your range of motion in your joints, your endurance level, and your current fitness level. The PT will measure our blood pressure and your heart rate at rest and determine an appropriate activity level for your exercise program. He or she can tailor the program towards your specific fitness goals, for example, weight loss, improved endurance, strength gains, toning or others you may have in mind. If you wish, the PT can also measure your body fat level and develop a plan to reduce that level.

One benefit of beginning a fitness program with a PT is that you are being medically monitored. As you proceed with your fitness program, the PT will assess your heart rate and blood pressure before, during and after activity. Your exercises will be adjusted accordingly. If you have any previous injuries, alert the PT so that area can be protected in your program to prevent a flare up. Additionally, the PT can add exercise to your program to rehabilitate the injured area.

One last advantage of a fitness program which is performed under the direction of a Physical Therapist is the price. A medically guided program may be covered under your health insurance. This means that you may only need to pay for your copayment or coinsurance. If, however, you do not have insurance, many Physical Therapists provide personal training to their clients. The cost may be slightly higher than the fee a personal trainer may charge (about $10-$20 on average). But, the Physical Therapist is a medical professional who has either a Masters or a Doctor of Physical Therapy degree and is trained in the biomechanics of the body, muscle structure and function, injuries and rehab, anatomy and physiology, orthopedics, and strengthening and conditioning.
North Tahoe Physical Therapy works with many clients for reconditioning programs both through insurance and on a cash payment basis. We also offer personal training and Pilates exercise programs.

-Jane O’Brien, MSPT

Hip Replacement Care

September 14, 2008 by admin  
Filed under Physical Therapy

My relative is getting ready to come home from the hospital after a total hip replacement surgery. What do I need to know to set up my home and make them most comfortable during their recovery?

After a standard posterior approach total hip replacement, most surgeons instruct the patient (and all involved caregivers) in three major hip precautions. Familiarizing yourself with these three rules will allow you to promote a speedy and safe recovery for your family member:

1. Avoid hip flexion more than 90°- Lifting the leg out in front beyond 90° puts excessive stress on the posterior joint capsule of the hip as it attempts to heal. Exercises that require excessive hip flexion such as marching and straight leg kicks are not recommended after a total hip replacement surgery until the medical professional instructs the patient in the proper form.

2. Avoid hip adduction- If a line were drawn down the middle of your body from head to toe, the affected hip cannot cross over this midline. This rule is particularly difficult to abide by when rolling over in bed. Using a pillow between the patient’s knees can prevent them from crossing the midline.

3. Avoid internal rotation- Do not allow the patient to turn the toes on their affected leg inward. Again, placing a pillow between their feet can prevent the patient from being able to internally rotate their hip.

Depending on the surgeon, physical therapy can begin soon after the patient awakes from the surgery. Specific questions should be directed to the doctor or physical therapist directing the patient care. As the caregiver, remember you are an important part of the rehab team and helping to communicate with the medical professionals can best promote a safe and speedy recovery for your loved one.

-Rebecca L. Deal, MSPT

10 Steps to an Ergonomic Office

Where do you spend the majority of the time during your typical work day? If your answer is sitting in an office chair staring at a computer, it is time to evaluate your work station with regards to your health. Setting up a desk that minimizes prolonged postural stresses can prevent work-related episodes of low back pain. To set up your own ergonomically designed work station, follow these 10 simple steps:

Sitting Posture- When sitting in your chair, it is important to maintain three spinal curves: an inward curve in your low back, an outward curve in the mid-back, and another inward curve in the neck. Shoulder should remain relaxed but kept back in a retracted position. Your head should be kept level with the chin tucked in for the ideal desk posture.

Seat Settings- Adjust your office chair for optimal posture and comfort. For computer work slightly recline the back of the chair. Although some office chairs have lumbar settings, a separate lumbar support pillow is best. A small towel rolled and put in the small of your back works great to maintain the inward lumbar curve. When sitting against the back of the chair, there should be approximately two inches between the edge of the seat and the back of the knees.

Bending in the Chair- To bend over to reach an object out of a low drawer or pick up an object from the floor it is imperative to maintain the inward curve in your low back. Scoot to the edge of the seat and extend one leg out in front of you. Place one hand on the desk surface to assist with balance and bend from the hips. Using your hips as the hinge for this bending motion helps protect the low back.

Turning in the Chair- No Twisting!! When it is necessary to reach into the cabinet behind you or respond to a co-worker in the cubical next to you, it is important to avoid twisting motions that put excessive forces on the spine. Instead, move your body as a single unit in the direction you intend to go with the hips and feet pointed in the same direction.

Foot Rest- Optimal leg position is a 90° angle at the hips and knees. A 90° angle is best obtained using an appropriate height foot rest. Prevent “slouching” by sliding the office chair under the desk as far as possible while making sure to have adequate leg room.

Wrists over Keyboard- Chronic incorrect wrist positioning while typing can lead to the common office injury of carpal tunnel syndrome. To avoid carpal tunnel syndrome, use a wrist rest to position the wrists straight. Keep both of the elbows bent approximately 90° and supported by the desk surface. Adjusting the keyboard to maintain the straightened wrist position can help prevent the excessive wrist extension which leads to carpal tunnel injuries.

Monitor Position- The computer monitor should be angled to be level with the eyes in order to maintain proper head and neck posture. When attempting to type written material, use a document holder to position items at eye level.

Reaching across the Desk- Arrange the work area to eliminate tasks of repetitive reaching. Keep frequently used items close while storing rarely used supplies in a lower drawer. Repetitive lifting can irritate rotator cuff muscles and should be avoided without proper conditioning.

Talking on the Phone- When conducting business on the phone, do not support the receiver between your neck and shoulder. It is best to use a head-set or speaker-phone features to maintain proper neck alignment while talking on the phone for long business conversations.

Take Frequent Rest Breaks for Exercise- To take the strain off your back and prevent fatigue, change positions often. Alternate job tasks that require different postures when possible. The goal for all office workers is to take a break for one minute every hour to stretch and mobilize all the major joints of the body.

So if you’re up for the challenge of setting up your own ergonomically correct work station, print this list out, tape it to the bottom of your monitor and take the time to save your spine from the work-related aches and pains. For additional work station consultation advice or further questions, contact the physical therapy team at North Tahoe Physical Therapy.

-Rebecca L. Deal, MSPT

RICE to Control Swelling

How do I best control swelling after a knee surgery?

Physical therapists often use the acronym RICE to educate patients in the principles of controlling the inflammatory response to injury or surgical trauma:

R: rest- Resting the leg after surgery allows the traumatized tissue structures to relax. Surgical procedures involving a bony repair require eight weeks of non-weight bearing status to allow the bone to heal. After a ligament repair, gentle weight-bearing exercises are allowed under the supervision of a physical therapist. Although an individualized home program is encouraged, excessive exercise is not advised.

I: ice- Cold modalities affect blood vessels through the process of vasoconstriction to decrease joint effusion. Choices include an ice pack, an ice water circulating cooler, or an ice cube massage. An ice bag works best over large, general areas and should be administered 15-20 minutes, 2-3x/day. Ice cooler units circulate cold water for a 15 minute treatment. An ice massage takes only 5-7 minutes and works best over bony prominences.

C: compression- Using an Ace bandage or a surgical sleeve to provide constant pressure around the knee joint prevents inflammatory by-products from collecting in the knee joint or draining into the lower leg during weight-bearing activities. The Ace wrap should be applied from top to bottom encompassing the entire knee joint.

E: elevation- Positioning several pillows under the heel prompts the inflammatory fluid to return to the bloodstream and flush back towards the heart to reenter the circulatory system. The key to elevation is to ensure the leg is above the level of the heart (lay flat on back with leg up). Combining the four RICE principles and resting the leg while compressing the joint with an ice bag in an elevated position for 20 minutes after exercise is the ideal situation to control swelling after a knee surgery.

-Rebecca L. Deal, MSPT

Rotator Cuff Surgery and Repair

July 10, 2008 by Rebecca Deal  
Filed under Physical Therapy

How long does it take a rotator cuff tendon to heal after a surgical repair?

A surgical rotator cuff repair requires a tendon reattachment into a bony anchor in the shoulder. The bone site of tendon reinsertion requires eight weeks to heal. Physical therapy, although specifics depend on the surgeon’s rehab protocol, usually begins three-five days after the surgery and continues for up to twelve weeks in three distinct phases until all prior shoulder function returns.

During phase one, the first eight weeks of physical therapy, while the bone is still healing, rehab is focused on symptom control and the return of symmetrical range of motion (ROM). Educating the patient to ice, encouraging the use of an arm support to rest the irritated tendons, and introducing the Codman pendulum exercises are all common strategies for controlling shoulder symptoms. ROM activities are limited in phase one to passive stretching (the patient must keep the muscles relaxed while the therapist stretches the rotator cuff muscles).

After the surgical repair site has healed and the patient has full ROM, emphasis shifts in phase two to shoulder strengthening. Strength work focuses on both rotator cuff muscles and the interscapular muscles to promote the return of normal shoulder biomechanics. Rotator cuff strengthening begins with isometric contractions and progresses to eventual strengthening with weight or Theraband resistance.

Phase three involves proprioceptive training for the upper extremity to ensure proper reaction time and future injury prevention. During week twelve of physical therapy the patient performs final assessment to determine if they can safely return to all activities of daily living before formal discharge from physical therapy. Once discharged, the patient is encouraged to maintain shoulder flexibility and strength with an independent exercise program.

-Rebecca L. Deal, MSPT

Heat vs Ice for Injuries

When should I use heat or ice for a specific condition?

There are two issue to consider when deciding between heat and cold therapy after an injury. First, consider the timing of the injury. If the injury is in the acute phase (1-2 days) and still showing signs of inflammation, ice is the most beneficial treatment. After swelling has resolved and the injury passes into the sub-acute and chronic phases of healing, switching to heat treatments is advised.

Second, the affected area and placement of the heat/cold modality must be analyzed. Crowded joint spaces, ligaments and tendon attachment sites that are susceptible to swelling and increased joint fluid with conditions like rotator cuff tendinitis or a torn knee meniscus require ice. Cold modalities work to decrease inflammation allowing more joint space and removing the fluid restrictions to range of motion. Muscles respond well to heat. Heat sources to sore muscles act to decrease muscle tension and eliminate muscle spasms.

Sometimes an injury scenario presents itself and the timing and placement issues conflict, leaving you again confuse between ice and heat modalities. What do you do for an acute muscle condition or chronic joint pain? The timing issue takes precedent over the placement so acute muscle pain needs ice, while chronic joint pain requires heat. If it is just too difficult to decide ice versus heat, consider a contrast heat/cold schedule. A contrast schedule alternates between heat and cold modalities in succession to both eliminate inflammation and provide symptom relief.

-Rebecca L. Deal, MSPT at North Tahoe Physical Therapy

Do I need diagnostic tests and results before I start PT?

June 13, 2008 by Jane O'Brien  
Filed under Physical Therapy

Do I need to have an X-ray or MRI and get the results before I start Physical Therapy?

Diagnostic tests are always helpful when assessing a client’s dysfunction, but they are not necessary prior to starting Physical Therapy. During the initial examination, the physical therapist (PT) will take the patient’s history to assess the nature of the problem. She will perform an examination of the client consisting of inspection of the body for posture and deformity, palpation of the tissues involved checking for tension, pain and inflammation. She will look at active and passive movements of the dysfunctional area. Additional clinical tests will be performed by the PT to help determine a diagnosis. The results of this comprehensive evaluation will indicate the nature of the client’s problem and lead to the development of a treatment plan.

Diagnostic tests can be used to validate the clinical exam results. They can provide clarity to any uncertainties regarding the dysfunction that the exam could not pick up. Many times, clients begin therapy without having had diagnostic tests and find that therapy alleviates their symptoms. If the problem is corrected, there is no need to have diagnostic tests after the fact. If the problems continue, X-rays or MRI may be ordered to determine how to redirect their treatment. The common thought is not to delay the healing measures by waiting to receive tests but to start therapy early, shorten the healing time and add diagnostic tests later if needed.

-Jane O’Brien, MSPT

Pelvic Floor Dysfunction and Physical Therapy

June 12, 2008 by Jane O'Brien  
Filed under Physical Therapy, Women's Health

North Tahoe Physical Therapy June 11, 2008

The term pelvic floor refers to the sling of muscles, ligaments, and fascia which spans from the front of the pelvis at the pubic bone to the posterior pelvis at the tail bone. The purpose of the musculature is to support the pelvic organs (uterus, colon, and bladder), allow for control of the outlets (urethra and rectum) and provide tone for sensation for the sexual functions. It is important for this area to have proper muscle tone. Excess tone of the muscles can cause difficulty sitting, pain during intercourse, hip and low back pain or retention. Diminished tone may lead to incontinence, organ prolapse and possibly decreased sexual response.
Commonly, people associate pelvic floor dysfunction with incontinence. However, there are a myriad of diagnoses that fall under this category such as overactive bladder, pelvic pain, prolapsed uterus, painful periods (dysmenorrhea), interstitial cystitis, coccyx pain, painful intercourse, and many others. Symptoms may limit a man or woman’s ability to perform daily activities, cause a change in exercise habits and create embarrassment. Problems in this area are often not discussed with medical professionals and therefore, go untreated.

Many physical therapists have specialized training that can benefit men and women with issues of the pelvic floor. These therapists utilize every aspect of their physical therapy training to evaluate patients and to provide intervention to overcome these dysfunctions. Treatments may consist of a combination of many techniques. Exercises such as “Kegels,” which are geared for this area, greatly enhance muscle function when performed properly. Relaxation techniques may be utilized to assist with decreasing tone and pain. Manual techniques, such as Myofascial Release and soft tissue massage are often used to relieve tension. Biofeedback is used to increase awareness of proper muscle recruitment or to quiet overactive muscles. Electrical stimulation may be used to recruit and train pelvic floor musculature or to relieve pain. Joint mobilizations are often utilized to restore pelvic alignment and motion. In addition, patient education can assist with prevention of dysfunction.

Physical therapy for the pelvic floor dysfunction is relatively new and not widely known by many medical professionals in the USA. There are only a handful of Physical Therapists who are trained in Pelvic Floor therapy in Northern Nevada. But, Pelvic Floor Dysfunction is common. Just consider the number of commercials from the pharmaceutical industry promoting drugs aimed at treatment of these issues. Numerous surgeries are advocated as an answer for many pelvic floor issues. Many are unsuccessful. Physical Therapy can provide tremendous relief for Healthcare consumers who want to take control of their symptoms and overcome them without the use of longterm drugs or surgeries.

When choosing a physical therapist for treatment of a pelvic floor dysfunction, it is important to inquire of their training, experience and outcomes with this area to ascertain if they are qualified to treat this area. The Section on Women’s Health of the American Physical Therapy Association offers training and mentoring leading to a certificate program called the Certificate of Achievement in Pelvic Physical Therapy (CAPP). Approximately 150 PT’s have received the CAPP to date. To find a Physical Therapist who is trained to work with Pelvic Floor Dysfunction, one can contact the Section on Women’s Health of the American Physical Therapy Association. The web site is The website provides articles and resources for consumers to learn more. One can also log onto for further information and treatment options.
Jane O’Brien, MSPT is a physical therapist at North Tahoe Physical Therapy who provides services for the pelvic floor, orthopedics and pain. She is a candidate for the CAPP expecting to complete her certificate in summer 2008.

-Jane O’Brien, MSPT

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