Medical Machines

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

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

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.

Physical Therapy

More than just Physical Therapy At North Tahoe Physical Therapy, we offer a unique combination of Myofascial Release, Hands-on soft tissue mobilization, skeletal mobilizations, Pilates- based exercises, Education and Self Management. Our therapists are highly trained, experienced professionals. We provide a strong interaction between you, your doctor and your physical therapist.  North Tahoe Physical Therapy uses a 1-on-1 approach to Physical therapy with exceptional customer service. We treat you as a whole person, not just your injury. Each client obtains a thorough explanation of their condition. Your physician receives timely reports regarding your progress. We empower you to become active partners in your recovery and health maintenance. Our personalized approach results in your wellness and satisfaction. Click here for client testimonials. The cornerstone of our approach is Myofascial Release. Find out more about Myofascial Release

Our Treatment Philosophy Our treatment philosophy is based on the pelvis, the base of the spine.  We believe the pelvis is the foundation of the body.  This foundation must be level for the head and neck to sit properly and for the legs to hit the ground evenly.  When a client comes to us with “low back pain”, we begin by assessing the pelvis for symmetry.  If the pelvis is rotated or if the trunk is shortened on one side, the surrounding soft tissues will attempt to stabilize the system.  This may lead to muscle spasms, pain, or tension of the nerves and the discs which sit atop the pelvis. Additionally, the spine may rotate and side bend in response to the un-level base below.  Consequently, the head which sits atop the spine will be un-level. Our bodies are smart.  If our spine is rotated, we naturally adjust our head to have our eyes level. This may lead to issues of muscle spasms, muscle tension, TMJ/jaw disorders and headaches. So, for a person who comes to NTPT complaining of TMJ, headache or neck pain, our treatment starts at the pelvis. Like a house if the foundation is not level, the roof will crack and the windows won’t easily slide open or close. Therefore, it only makes sense to balance the pelvis, which is the foundation of the body. Self empowerment A maintenance program of Home exercises, education about how to avoid aggravating your condition, and awareness of how you can help yourself are important components of your care. North Tahoe Physical therapy, we empower you to be an active participant in your health and wellness. You may spend 1-3 hours a week with our team of therapists at North Tahoe Physical Therapy. There are 168 hours in a week. What are you doing the other 165 hours? Get well • Orthopedics • Sports Injury Care • Back and Neck care • Incontinence/Pelvic Floor Dysfunction • TMJ/Migraines/Headaches Stay Well • Myofascial Release therapy • Massage • Personal training • Medically Supervised gym • PILATES • Classes and workshops Address the Symptoms, look elsewhere for the Cause At North Tahoe Physical Therapy, we treat the cause of your problems. Our evaluation is a full body assessment. We look for Pelvic imbalances, fascial pulls, and postural abnormalities. We then determine how these deficits may have created your symptoms. For example, neck or jaw problems may arise from an unlevel pelvis. Knee issues may be due to a pelvis imbalance. If we only treated the symptomatic jaw without leveling the pelvis, the issues will return because the problem has not been corrected. By treating the cause, we are able to address and decrease the symptoms.

Myofascial Release

An Amazing Breakthrough in Pain Relief

Myofascial Release is a relatively new addition to the techniques of the physical therapist. Because it is somewhat different from traditional physical therapy, many people are unaware of what it is and how it works.

Myofascial Release (MFR) works on releasing the restrictions in the connective tissue called fascia. Fascia runs head to toe in a continuous sheath and surrounds every muscle, organ, nerve, cell, and blood vessel of our body. Restrictions can occur in the fascial system from trauma, surgery, poor posture and stress. When these restrictions occur, they can pull with forces of greater than 2000 pounds per square inch. Such tension acts like a “straight Jacket” and can lead to decreased range of motion, pain, headaches, poor posture and lack of mobility.

For many years, therapists have ignored the importance of the fascial system. This omission is now being recognized as the missing link to effective and lasting results in physical therapy.   The effects are profound throughout the body because the fascial system is ingrained in all of our bodily tissues.

When fascia scars and hardens in one area (following injury, inflammation, disease, surgery, etc.), it may create tension on adjacent pain-sensitive structures as well as on structures in far-away areas.  Often, medical professionals find that their clients have bizarre pain symptoms that appear to be unrelated to their original injury or to their primary complaint.  For, many, these symptoms can now often be understood as arising in the fascial system. Because this fascia of the body is all interconnected, a restriction in one region can theoretically put a “drag” on the fascia in any other direction.

During MFR treatments, a client may be treated in areas unrelated to their condition.  The physical therapist has a thorough understanding of the fascial system and will release the fascia in areas that she knows have a strong “drag” on the area of injury.  This is, therefore, a whole body approach to treatment.  A good example is the chronic low back pain patient: although the low back is primarily involved, the patient may also have a significant discomfort in the neck.  This is due to the gradual tightening of the muscles and especially of the fascia, as this tightness has crept its way up the back, eventually creating neck and head pain.  Experience shows that optimal resolution of the low back pain requires release of the fascia of both the head and neck; if the neck tightness is not also released it will continue to apply a “drag” in the downward direction until fascial restriction and pain has again returned to the low back.

Often remarkable improvement is noted immediately during or after a treatment.  Sometimes pain in new areas will be experienced.  There is sometimes a feeling of light-headedness or nausea, and at times a patient experiences a temporary emotional change.  Occasionally, a client may report a temporary increase in their discomfort followed by tremendous relief.  All of these are normal reactions of the body to the profound, but positive, changes that have occurred by releasing fascial restrictions. In general, acute cases will resolve with a few treatments.  The longer the problem has been present, generally the longer it will take to resolve the problem.

It is felt that release of tight tissue is accompanied by release of trapped metabolic waste products in the surrounding tissue and blood stream.  It is highly recommend that clients “flush their system” by drinking a lot of fluid during the course of their treatments, so that reactions like nausea and light-headedness will remain minimal.

Myofascial release can greatly help reduce headaches, neck and back pain, shoulder pain, pelvic and hip pain. Besides pain, MFR can help lengthen muscles to gain increased power. It is useful for restoring poor range of motion. Clients with poor posture can also gain amazing results from this technique. Lastly, MFR feels great and leaves a client with restored energy. It is a wonderful form of body work to receive instead of a traditional massage due to the lasting effects which are created. Many clients have regular Myofascial sessions to prevent dysfunctions. Others may come in for minor Tune-ups.

About Us

Our Mission Our highly skilled team at North Tahoe Physical Therapy is focused on helping you to achieve your optimal state of health through exceptional therapy, education and personalized treatment programs designed to return you to the lifestyle that you desire. Our Staff Jane O’Brien, MSPT Advanced Myofascial Release Practitioner Women’s Health Therapist Jane is the owner and director of North Tahoe Physical Therapy. She received her Master of Science Degree from Boston University in 1992. She has over 15 years experience in treatment of orthopedics, women’s health, and pain. Jane has extensively trained in manual therapies such as Myofascial release, Craniosacral therapy, and spinal and joint mobilizations, dynamic stabilization exercises and strength and conditioning. Since 2000, Jane has been an instructor for John Barnes’ Myofascial Release Seminars. While living in Sedona, Jane trained and worked with Barnes at his clinic.  She presents several workshops annually on the Myofascial Release technique. Jane is currently in pursuit of the Certificate of Achievement in Pelvic Physical Therapy (CAPP). This honor is granted to physical therapists that have completed the required training and testing through the American Physical Therapy Association (APTA) Section on Women’s Health. The CAPP demonstrates dedication and advanced training in the field of Women’s Health. She expects to complete her studies and receive the CAPP in Spring 2009. Memberships: APTA-American Physical Therapy Association, Section on Women’s Health AAUW- American Association of University Women Hobbies: Belly dancing, skiing, hiking, rollerblading, Brian Hrindo, MT Brian graduated from Bowling Green State University in northwestern Ohio with a Bachelor of Education in Kinesiology, where he studied Early Childhood Development and Effective Movement in Athletes. He has been practicing as a Massage Therapist since graduating from the Utah College of Massage Therapy. Brian specializes in injury massage, Russian Sports Massage, Craniosacral Therapy, and Deep Tissue Massage. He has trained under John F. Barnes, international lecturer and authority on Myofascial Release, and has become a highly skilled Myofascial Release practitioner. In his spare time, Brian enjoys relaxing on his boat on Lake Tahoe, skiing, mountain biking, and rafting the rivers of the Wild West. Rebecca L. Deal, MPT Rebecca received her Master of Science degree from California State University, Long Beach in 2005. She holds a bachelor’s degree in Exercise Science and a minor in Nutrition from the University of California, Davis. She believes in helping people by educating and empowering them to take responsibility for their health.In her spare time, she enjoys snowboarding, snowshoeing, and hiking the Tahoe trails with her dog.

Our Location 889 Alder Ave., Suite 105 Incline Village, NV 89451 775-831-6600 office 775-831-6697 fax We are located on the ground floor of the Lakeside Medical and Professional Building, across the street from the hospital. Our History North Tahoe Physical Therapy was established in the 1980’s in Incline Village, NV. by Claudia Dill, PT. Ten years later, Thom Werner, PT, bought North Tahoe Physical Therapy and operated the clinic for 14 years. In 2003, Jane O’Brien, MSPT, became the 3rd owner of North Tahoe Physical Therapy. Jane O’Brien, MSPT, director and owner of North Tahoe Physical Therapy, says, “Many people think of physical therapy as exercise and hot packs. We want to change that perception. We believe that a hands-on, intuitive approach combined with movement is the key to healing and restoration of function. Our staff has dedicated many years learning to use our hands as tools for healing.”

Getting in Shape for Skiing

What are the most important elements to getting in shape for ski season?

The first thing that comes to mind for getting in “ski shape” is strengthening. I believe everyone would agree that strengthening of the lower extremity or leg muscles is top on the list. The legs are doing most of the work during a ski or snowboard run, so, focus strength training here. The muscles to emphasize are the quads (front of the thighs) the hamstrings (back of the thighs), the calf muscles, and the glutes. It is very important for one to gain strength of the proximal leg muscles, those closest to the trunk, typically called the hips. The stronger one is in the hip region, the less strain will occur across the knee joint.
A great exercise for the whole lower extremity is the squat. This uses the buttocks, the quads, the calves and the hamstrings. Also great are lunges and leg presses. These exercises directly correlate to the motions used in telemark skiing and downhill skiing. Bicycling is a wonderful outdoor activity for lower extremities. Lastly, calf raises (going up and down on tip toes) is great for balance and calf strength.

Besides strength, flexibility is highly important for all activities. A tight muscle is more likely to tear or be strained because there is no slack in the system. Stretches create length in the muscle and allow for freedom of motion.

While everyone agrees that training the lower extremity muscles is highly important, I also want to emphasize the importance of training the trunk or core muscles. The trunk is the “power center” of the body. These muscles include, among others, the abdominals, the iliopsoas, the glutes, hamstrings, and the spinal extensors. A strong core helps with speed, balance, strength, and power, quickly changing directions, improvement of skill level and prevention of injury. A training program needs to consist of trunk flexibility and strength conditioning. Having a strong and flexible core allows one to twist, turn and stabilize the body during the downhill journey. According to Douglas Brooks, MS, who wrote Effective Strength Training, the trunk is the base or foundation of the body. A body is only as strong as its weakest link. A body needs a strong base from which to direct its energy. If the core is weak, it leads to poor performance or worse, injury.

Join our email list to get our special report on the 3 Keys to a Fantastic Ski Season.  Just leave your name and email address in the space on the right side of this page.

Massage and Soreness

I just had a massage yesterday, why am I so sore today?

Chances are it was the bodywork you experienced the day before, and it’s perfectly okay. Yes, soreness can be an after-effect of the treatment and it is common to experience it. Soreness or tenderness can result from the pressure used to release the restrictions in your body’s tissue, and also can be a result of under-hydration either before or after the treatment. If the body is not being properly hydrated after the session to flush out the toxins, such as lactic acid, they may be re-deposited into the muscular system causing tenderness. A great approach would to be properly hydrated prior to your treatment by drinking 2-3 glasses in the hours before your appointment. Water is necessary for the liver to filter out the toxins and chemicals from our body, food, and medications.

A professional massage is more than an ordinary back rub. The reason that massage therapy is so effective is that it physically breaks up the restrictions in the muscle tissue causing pain. It is very much like doing a workout. If the muscles are not used to it, they often respond with some soreness. This should only last a day or two, if it does last longer, speak with your therapist about adjusting the treatment. However, just as with exercise, when your body adjusts to having this type of workout your physical response will also be less intense. As a therapist, I want to know how the body is feeling after the soreness does subside.

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

Position For a Good Night’s Sleep

For A Good Night’s sleep… According to one Physical Therapists perspective

Have you ever awoken from a long night of sleep feeling sore, stiff, or in pain? Sleep is supposed to be the body’s way of recovering, resting and rejuvenating the body. Many people find that the 6-8 hours they spend sleeping is anything but restful.

As a physical therapist, I inquire of my client’s sleep position. I find that they are often sleeping in the wrong position. I rarely advocate sleeping on one’s stomach due to the extreme neck rotation combined with extension required in order to achieve this position. This small change in sleep position from the stomach to the side or back can relieve a tremendous amount of neck pain. If you must rest on your stomach to fall asleep, put a pillow under the chest to lift the trunk and allow for the neck to drop into flexion and rotation. One should also remove the pillow from under the head.

Pillows can be used to support the spine during sleep. Side sleepers can place a pillow between the knees to keep the hips from rolling forward and to keep the pelvis level. Back sleepers can place a pillow under the knees. This will allow the back to rest flat against the bed. A rolled towel can be placed inside of the pillow case to support the neck arch just as a contoured pillow would do. Lastly, one can buy pillows designed for side sleepers or for back sleepers in bedding stores. The firmness of these pillows differs to provide the proper amount of support for the cervical spine.

The mattress is an important component of a proper nights sleep. Imagine if you had to stand for 6 hours on a pair of shoes such as flip flops which do not support your arches. Later that day, you may have foot, leg or low back pain. If you had to sit on a chair for work all day that was leaning to one side and too tall for you, your body would ache after the work day. Now, think of sleeping on an old bed that is sinking in the middle or perhaps it is too soft. This bed cannot support the curves of your spine. Your muscles must work all night to give you that support. If you have not replaced your mattress in 4 or 5 years, it may be time to consider a change. Also, remember to flip the mattress as directed by the manufacturer to promote proper wear of the mattress. Firmness of a mattress is dependent upon taste to a degree. A mattress that is too firm may cause a backache while one that is too soft will not provide support. It is up to the sleeper to determine the density that will both create comfort and support.

-Jane O’Brien, 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?

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

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