Category Archives: Orthopedics & Neurological Rehabilitation

Manual Therapy Treatment for Concussions

Following a concussion, symptoms such as headaches, light sensitivity, dizziness, cognitive difficulty, emotional irritability, depression, and sleep disturbances can often linger. Waiting for the symptoms to improve is a frustrating experience that can impact all areas of an individual’s life. Physical therapists skilled in manual therapy including Craniosacral Therapy, Visceral Manipulation, and Neural Manipulation have observed improvement in many clients’ symptoms post-concussion. These specific manual therapies are gentle therapies that follow the osteopathic principles that structure and function are interrelated. Craniosacral therapy improves the motion restrictions in the craniosacral system which consists of the meninges, bones, and cerebrospinal fluid from the head to the coccyx (base of the spine). Visceral manipulation is a manual therapy developed by a European osteopathic physician Barral that uses gentle, but specific manual forces to improve the mobility of the organs and the connective tissues. Barral Neural Manipulation works to improve the fascial mobility that surrounds all of our nerves allowing the freedom of motion needed for optimal function.

A recent study published by Gail Wetzler and colleagues confirms manual therapy can improve concussion recovery. In the study of 11 male retired professional football players, these specific manual therapies resulted in statistically significant improvements in pain intensity, ROM, memory, cognition, and sleep. For specific changes observed, here is a link to the research study.

Gail Wetzler PT was here at Restore Motion this weekend teaching the therapists who already have trained in these manual techniques how to better use these skills to treat individuals with post- concussive symptoms.


Written by: Stephanie Bloom, PT


“For information on what to do if you or your loved one sustains a concussion, please refer to

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Safe Pain Management: Choose Physical Therapy


Avoid Addictive Opioids.  Choose Physical Therapy for Safe Pain Management.

No one wants to live in pain.  But no one should put their health at risk in an effort to be pain free.

Since 1999, Americans have increasingly been prescribed opioids—painkillers like Vicodin, OxyContin, Opana, and methodone, and combination drugs like Percocet.  According to the Centers for Disease Control and Prevention (CDC), sales of prescription opioids have quadrupled in the United States, even though “there has not been an overall change in the amount of pain that Americans report.”

In some situations, dosed appropriately, prescription opioids are an appropriate part of medical treatment.  However, opioid risks include depression, overdose, and addiction, plus withdrawal symptoms when stopping use.  And people addicted to prescription opioids are 40 times more likely to become addicted to heroin.   As of 2014, the CDC estimates that 52 people die each day in the United States as a result of prescription opioid overdose.

In addition, Americans are creatively saving and sharing prescription opioids at alarming rates. These saved and/or shared drugs are now getting in the hands of our children.  Our children are not traditionally popping pills but masking the drugs in various ways.  Drug-laced lollipops are the latest in the drug culture.  This has been reported by high school students in our area. The lollipops are apparently laced with strong levels of painkillers.  This new drug delivery method should raise concern and awareness about the dangers of prescription opioids. Consumers and prescribers are encouraged to choose safer alternatives to prescription opioids.

The Centers for Disease Control and Prevention (CDC) is urging health care providers to reduce the use of opioids in favor of safe alternatives like physical therapy.

Don’t just mask the pain. Treat it.

Choose physical therapy to manage your pain without the risks and side effects of opioids.


Written by: Reshma Rathod, PT

Bone Up (get the facts) on Bones

Most of us know very little about our bones- they are hidden and not painful until we break one!

So let’s start with some anatomical facts and bone up (get the facts) on bones:

  • At birth we have 300 immature bones; some of these join up; adults have 206 bones.
  • The human hand has 27 bones; the face has 14.
  • The longest bone in the body is the femur (thigh bone) which is about 1/4 of your height.
  • Did you know that humans and giraffes have the same number of bones in their necks?

During our lifetime, our bones are in a continual cycle of breaking down and rebuilding. Bone strength represents the integration of bone density and bone quality. Most women will reach their 90% of their bone mass by the age of 18 and their peak bone mass by the age of 30 which emphasizes the importance of bone growth in childhood and adolescence through active and healthy lifestyles. As we age, and especially with hormonal changes associated post-menopause, the living bone tissue reabsorbs at a higher rate than rebuilding.

Bone thinning is classified as osteopenia or osteoporosis. Osteopenia, the less severe of bone weakening, is defined as having between -1 and -2.5 standard deviation of bone mineral density. Osteoporosis, the more severe of bone weakening, is diagnosed as having bone mineral density greater than -2.5 from the standard deviation. The stronger bones we have, the less likely we will fracture in a traumatic incident.

Physical activity can modify bone strength. When gravitation or muscle pull produces strain on the skeleton that is greater than optimal strain, bone formation occurs. In conjunction to other types of interventions, bone loss can be slowed and sometimes reversed. The improvements from exercise are likely from increased bone density and lessened endocrotial bone loss, not an increase in bone size. Women who engaged in a combination of exercise types had an average 3.2% less bone loss at the spine and 1.03% less bone loss at the hip than those who did not exercise.

Consider the following to protect your bones:

  • Assessment of footwear and/or orthotics and adjustments if necessary.
  • Review food intake with a doctor/nutritionist to check if you have the essentials for strong bones.
  • Assessment of the load, type and intensity of your exercise program.
  • Medical check-up to rule out other potential causes (like thyroid disease or medications that may cause bone loss).
  • Don’t smoke and keep alcohol and caffeine intake to a minimum (these substances may lower bone density).


Written by: Reshma Rathod, PT

Not So Sweet

Does this sound healthy? Bagel and orange juice for breakfast, turkey sandwich, apple and chips for lunch, that afternoon latte and pasta for dinner. Have you ever thought about how many carbohydrates you eat everyday? The example daily menu tallied up to a grand total of 279 carbohydrates. Optimal daily recommended carb intake depends on many variables such as age, gender, body composition, activity level, and metabolic health, but moderate carbohydrate intake falls between 100-150 carbohydrates/day. However, people who are physically active and have more muscle mass can tolerate more carbs than those who are sedentary. You’re probably asking why you should care about carbohydrates. After all, haven’t we been told to watch the calories and the fat for decades? Those carbohydrates are sugar. Excess sugar consumption has been proven to directly contribute to weight gain. When you eat sugar, your pancreas releases insulin which brings the glucose (from the carbs) into the cells. This glucose is stored as glycogen in our muscle and liver, but if these glycogen stores are already full, the glycogen is stored as fat. In 2012, the British Medical Journal published a study that combed through the literature regarding how body weight and sugar intake were related and indexed over 15,000 potential studies.[1] Sixty-eight studies made the cut of passing the rigid standards and statistical reliability and they all came to the same conclusion: sugar makes people gain weight.

Sugar also elevates dopamine levels which control the brain’s reward and pleasure centers similar those to drugs such as cocaine, morphine and nicotine. Long-term exposure to sugar lead to a reduction of dopamine levels, causing increased sugar consumption to achieve the same level of reward.

So how are we to get out excessive sugar intake under control? In a study published by international research journal PLOS ONE, found withdrawal from chronic sugar exposure can “result in an imbalance in dopamine levels and can be as difficult as going ‘cold turkey’” from a drug. Hopefully we will not have to resort to drugs to break us from the tight grip sugar has on our taste buds. This summer, opt for water instead of juice and soda, or some string cheese instead of the apple and see if you can see a difference in the way you feel by breaking the sugar habit.


[1] Te Morenga, Mallard S., Mann, J., “Dietary sugars and body weight: systematic review and meta-analyses of randomized controlled trials and cohort studies,” British Medical Journal (January 2012): 345:e7492.


Written by: Heather West, PT
Edited by: Reshma Rathod, PT

Seasonal Allergies

It’s the peak of allergy season, since plants are awakening and releasing massive amounts of pollen into the air.  Pollen is the biggest trigger of allergies.  Trees, grasses, and weeds release these tiny grains into the air to fertilize other plants.  The immune system mistakenly sees the pollen as a danger and releases antibodies that attack the allergens.  That leads to the release of chemicals called histamines into the blood.  Histamines trigger the runny nose and itchy eyes.

Steps you can take to combat season allergies include:

  • Identify and avoid your allergens
  • Take antihistamines suggested by your health care provider
  • Keep your windows closed, remove your shoes outside and bathe pets frequently to stop the spread of allergens inside the house
  • Check the pollen count
  • Don’t keep too many indoor plants because the soil serves as a place for mold to grow
  • Pollen levels peak during morning hours and during hot, dry and windy days, so stay inside if possible
  • Avoid spaces with mold, including basements, garages, and barns
  • Wash your hair, take a shower, and change your clothes after you’ve been outside.


Writte by: Kristen Bissell
Edited by: Reshma Rathod, PT

What a Pain in the Neck

Neck pain is a common reason for doctor visits. It is so common that the topic made it to the Washington Post recently in an article titled “What you need to know about that pain in your neck.”

Here are some facts about neck pain:

  • A common cause of neck pain is poor posture during work, rest or leisure.
  • Lifting or carrying heavy objects can strain muscles connecting your arm/shoulder and neck.
  • Even light weight (or un-weighted) repetitive motions can cause neck pain.
  • Excessive tension or stress frequently causes us to hold our jaw, neck and shoulders in a way that leads to pain and headaches.
  • The joints of the neck allow a great deal of motion. That is why necks are vulnerable to injury with trauma.

What you need to know before you go to the doctor:

  • Majority of neck pain episodes resolve in 2-3 weeks without imaging studies.
  • The older we are the more likely neck pathology will be seen on imaging studies even on those people without neck pain.
  • Over the counter analgesics (Acetaminophen, Ibuprofen, Naproxen Sodium) are more effective in treating neck pain than muscle relaxants.
  • Sleeping with too many pillows or a pillow that is too firm can cause neck pain.

What you can do:

  • Use heat or cold pack to soothe muscle aches. Use the type that feels best to you.
  • Decrease unnecessary weight in your handbag, book-bag or briefcase.
  • Remind yourself to relax your neck, jaw and shoulder muscles while trying to maintain good posture.
  • Consider Physical Therapy to help improve muscle and joint balance via exercises for your neck and shoulder girdle.
  • If pain has not resolved in time, or if your pain was caused by trauma, see your physician or urgent care clinic.


Written by: Miriam Graham, PT, DPT
Edited by: Claire Agrawal, PT, DPT

Photo Credit:×600.jpg

Link to Washington Post article:

New ACL Surgery May Improve the Lives of Many

ACL Knee Surgery Picture Blog, May, 2016The anterior cruciate ligament (ACL) of the knee is one of four ligaments between the femur and the tibia that helps keep the bones together and stable during movement. Injury to this ligament can lead to knee pain, a feeling of your knee buckling or giving out from under you, and decreased knee range of motion. Spraining or tearing of the ACL is one of the most common knee injuries in humans. Depending on the severity of the injury and the person’s age, physical therapy may be the first treatment option to stabilize the knee. If symptoms do not improve with conservative management, surgery is often considered next.

Currently, the standard surgical technique is called ACL reconstruction and involves removal of the torn ends of the ligament and replacement with a tissue graft. A tissue graft is tissue from another part of the body (usually hamstring tendons) or a cadaver. The tissue graft acts as scaffolding for a new ligament to grown on. Recovery is lengthy and patients are at a higher risk of developing arthritis 15-20 years post surgery (Boston Children’s Hospital).

A new surgery, called “bridge-enhanced ACL repair, or BEAR,” has been developed by Dr. Martha Murray and her team at Boston Children’s Hospital. The technique places stitches and a sponge injected with the patient’s own blood between the ends of the torn ACL to stimulate healing of the original ligament instead of replacing it. Over six-to-eight weeks, the ends of the torn ACL grow into the sponge and reconnect.

There is potential for the BEAR technique to allow quicker recovery of strength after ACL surgery and possibly reduce the long-term risk of arthritis in the injured knee. At this time the surgery is experimental and being performed through clinical trails to determine long term risks and benefits. To learn more about the clinical trials, click here.




Written by: Kristen Bissell
Edited by: Claire Agrawal, PT, DPT

Clinical Trial link:

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What is Diastasis Rectus Abdominis?

Most people know that the abdominal muscles can be toned and displayed as a “six-pack.”  Fewer people know that the same muscles can also separate from each-other, right down the midline, forming a diastasis rectus abdominis (DRA). diastasis-recti

Diastasis means separation. Rectus abdominis refers to muscles that make up part of the abdominal layer closest to the skin. They are the vertically oriented muscles in the picture above, comprised of a right and left side. The two strips of muscle are connected to each-other by connective tissue (fascia). In the formation of a diastasis rectus abdominis, the connective tissue stretches and the muscles elongate.

Q: What are the Risks Associated with Having a Diastasis Rectus Abdominis?

A: Increased risk of injury to your back from decreased core support.

Muscles function best at optimal length. If the rectus abdominis muscles are asked to work in an over-stretched position as in a DRA, they will not contract as efficiently. The result is less core support of your spine and pelvis. Decreased core strength or core muscle imbalance is associated with risk of injury, especially to your back.

In addition to the risk of injury, some people simply dislike the appearance of a protruding abdomen.

How can a Diastasis Rectus Abdominis Form?

  • Improper lifting techniques and chronic straining (with lifting or to move bowels)
  • Pregnancy
  • Significant weight gain
  • Weakened abdominal muscles or connective tissue disruption from surgery
  • Idiopathic, born with it

What can be done about a Diastasis Rectus Abdominis?

Treatment options include physical therapy, wearing an abdominal brace, or surgery.

Physical therapy treatment for DRA may include the following:

  • Identification of movements and postures that exacerbate the DRA and education on how to avoid or modify these factors. This includes education on proper lifting/carrying/lowering body-mechanics.
  • Exercise prescription focused on helping the rectus abdominis muscles activate as well as balancing the strength and coordination of deep core muscles (e.g. pelvic floor muscles, transverse abdominis, multifidi, and diaphragm).
  • Resolution of myofascial trigger points in the core musculature
  • Abdominal taping or bracing to bring the rectus muscles back aid optimal length for function

Appropriate treatment will depend on the severity of the separation and how long it has been that way.                           Consult your medical team to determine if you have a diastasis rectus abdominis and what is the best approach to treat it.


Written by: Claire Agrawal, PT, DPT


Photo credits: Diastasis Rectus Abdominis:

Ehlers-Danlos Syndrome (EDS) – Pain Management with Your Physical Therapist


*    Ehlers-Danlos Syndrome, or EDS is a hereditary disorder affecting the body’s ability to produce collagen. Collagen is the most abundant structure in the body and is a component of bone, cartilage, tendons, ligaments, and organs.
*    There are six types of EDS. The three most common types are:
o Hypermobility type of EDS
o Classic type of EDS
o Vascular type of EDS
*    Signs and Symptoms vary by type and may include: hyper-extensible joints, muscles, and skin; chronic joint pain; easy bruising; chronic fatigue; gastrointestinal mobility disturbances; and autonomic dysfunction (such as hypotension and difficulty with body temperature regulation).
*    It is important to see your doctor for a diagnosis of EDS, as man other conditions share the same signs and symptoms.
*    Once diagnosed, you may be referred to a team of health professionals besides your primary doctor. This team may include a sleep specialist and a physical therapist.
*    People with EDS may avoid physical activity due to pain associated with previous trials of exercises. Doing so, however, leads to muscle weakness and further exacerbates joint instability and pain. Your physical therapist can help you with pain management, finding safe ranges to work your muscles, and fun ways to stay active.