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Orthopedic Manual Therapy is a specialized area of physical therapy for the management of neuro-musculoskeletal conditions, based on clinical reasoning, using highly specific treatment approaches including manual techniques and therapeutic exercises. Orthopedic Manual Therapy also encompasses, and is driven by, the available scientific and clinical evidence and the biopsychosocial framework of each individual patient.
Manual therapists are physical therapists who have completed stringent post-graduation specialization programs in the field of neuro-musculoskeletal disorders indicated by the credentials behind their name; OMT or COMT. Manual therapy is a specialized clinical approach utilizing skilled, specific hands-on techniques, including, but not limited to, manipulation/mobilization of joint, nerves and soft tissue. The techniques require accurately determined and specifically directed manual force to the impaired structures in order to improve mobility in areas that are restricted.
These techniques are mastered by certified manual therapists to diagnose and treat nerve, soft tissue and joint structures for the purpose of modulating pain; increasing range of motion (ROM); reducing or eliminating soft tissue inflammation; inducing relaxation; improving contractile and non-contractile tissue repair, extensibility, and stability; facilitating movement; and improving function.
Dry needling is a technique physical therapists use to treat pain. The technique uses a “dry” needle, one without medication or injection, inserted through the skin into hypersensitive areas in the muscle known as trigger points. Dry needling is not acupuncture, a practice based on traditional Chinese medicine and performed by acupuncturists. In the ancient art of acupuncture, meridians or energy flow is stimulated mostly at distal sites. Dry needling is part of modern Western medicine principles, where the affected tissue is targeted directly in an effort to make a local mechanical change and stimulate a central release of pain inhibiting processes. It can make a profound change in pain and is supported by research (Cummings et.al, 2001).
When you are looking for someone with true knowledge in orthopedic physical therapy, you want someone Board Certified as an Orthopedic Clinical Specialist (OCS). These specialists have advanced training, and must have completed at least 2,000 hours working specifically with orthopedic conditions. The specialist certification program was established to provide formal recognition for physical therapists with advanced clinical knowledge, experience, and skills in this special area of practice and to assist consumers and the health care community in identifying these physical therapists. The credentials of Orthopedic Clinical Specialist (OCS) are designated to those individuals who have successfully become board certified clinical specialists in the areas of orthopedics.
Dizziness, vertigo, visual disturbance, and/or imbalance are a cluster of impairments known as vestibular disorders; collectively they can diminish quality of life and impact all aspects of daily living. People with vestibular disorders often experience problems such as nausea and/or vomiting, reduced ability to focus or concentrate, and fatigue. This dysfunction can have a major impact on quality of life because the symptoms frequently cause people to adopt a sedentary lifestyle in order to avoid bringing on, or worsening, dizziness and imbalance contributing to emotional problems such as anxiety and depression. The long-term negative sequela is decreased muscle strength and flexibility, increased joint stiffness, and reduced stamina. Evidence has shown that vestibular rehabilitation can be effective in improving symptoms related to many vestibular (inner ear/balance) disorders.
One form of vestibular dysfunction is BPPV—Benign Paroxysmal Positional Vertigo. BPPV occurs as a result of displaced otoconia, small crystals of calcium carbonate, which are normally attached to the membrane in the inner ear. Trauma, infection, or even simple aging, can cause these crystals to detach from the utricle and collect within the semicircular canals of the ear. Simple head movements cause the misplaced crystals to move and overstimulate sensitive nerve hairs in the canals sending false signals to the brain causing dizziness and nausea. The goal of the vestibular rehabilitation is a repositioning procedure returning these crystals to the correct place stopping these false signals and the debilitating symptoms they can cause. This repositioning is accomplished through the Epley maneuver, a series of head position changes that moves the crystals from the canal back to the utricle. Once in the utricle, the crystals re-adhere to their sticky matrix on the membrane and can eventually dissolve.
Incontinence of Bowel or Bladder:
Urinary incontinence (UI) affects a large portion of the population and often goes untreated because people are uncomfortable talking about it, and many doctors do not ask about it. UI can start at any age, but often begins after one gives birth. As humans age, our muscles, ligaments and connective tissue can weaken and deteriorate. Muscles of the pelvic floor are no different; when these muscles weaken to the point of no longer holding organs and waste properly in place within our bodies, the result is pelvic floor dysfunction which may include incontinence. UI is also prevalent in men following prostate surgeries, which are on the rise as baby boomers enter the golden years.
Many people struggle with bowel incontinence which inhibits your life even more than UI as it is harder to hide. This can come about from any pelvic floor dysfunction but is often seen in women 30-40 years after giving birth in particular if forceps were used to assist in the birthing process.
PT can assist you in retraining these muscles whether you have urinary or bowel incontinence.
Pelvic Pain and Painful Intercourse:
Men and women both may be forced to deal with pelvic pain as a result of surgical scars, old endometrial adhesions, or asymmetry/malalignment of the pelvis. Asymmetry of the pelvis can result from orthopedic weaknesses, muscle restrictions, or from old sports injuries. All of this could lead to pain while sitting, standing or during sexual activity.
Scar Release and Visceral Mobilization:
Old scars from abdominal surgeries often lead to pain and restrictions of other soft tissue including muscles and organs (viscera). Old scars especially done years ago before surgical techniques were improved are often very large. They may become stuck to underlying tissue and result in pain. Even the lack of visible scars today such as with a vaginal hysterectomy or robotic prostate surgery still leave adhesions underneath your skin where the actual cutting or removal of tissue took place. This can lead to a pulling sensation or discomfort in the region. Helping release these scars and adhesions that are stuck to your muscles or viscera can help reduce or eliminate your pain.
Constipation is one of the most common diagnoses of the ER and in the doctor’s office. Many people benefit from PT used to help mobilize the colon and surrounding tissues involved. IBS, colitis and other inflammatory diseases also benefit from this same treatment. Believe it or not, many times when someone struggles to pass stool, the body has forgotten how to use the muscles that work to evacuate the bowel. You may actually be tightening pelvic floor muscles instead of relaxing the ones that need to open in order to defecate. Our diet, activity level and fluid intake all influence our bowels and can contribute to constipation. We will educate you on motility techniques, general mobility, and diet to assist you in solving this most uncomfortable issue.
Think BIG, Move BIG: Parkinson’s Treatment (LSVT BIG)
Are you affected by a movement disorder such as Parkinson’s disease? The NRAM Wellness Institute is now pleased to offer Parkinson’s treatment (LSVT BIG), an intensive, amplitude-based therapy for treatment of movement disorders. This specific program is researched based, and focuses on the re-education of the sensorimotor system and neural plasticity for improved function and independence in daily activities.
The program is specifically designed to address the movement of those affected by Parkinson’s disease, but may also be beneficial to those who are recovering from a stroke or have other movement disorders including multiple sclerosis, tremors, or tic disorders. It is delivered in a standardized and evidence-based protocol that is adapted to individual abilities.
LSVT BIG is provided only by a certified and licensed clinician, and has demonstrated success in improving walking, balance, trunk rotation and mobility in daily activities following treatment.