manual therapy

Soft tissue mobilization
Restoration of muscle play, breaking fascial restrictions between muscles and decreasing hypertonus (muscle spasm) that is associated with muscle tightness. Specific directional manual force is used in the direction of fascial restriction. Functional STM combines active lengthening of the muscle tissue with manual work at the same time.

Joint mobilization
The skilled, passive movement of the articular joint surfaces performed by a physical therapist to decrease pain and/or increase joint mobility.

Manual traction
The application of manual forces to draw adjacent body parts away from each other with the goal of distraction to increase a joint space and in the spine increase the intervertebral space. We provide a very specific and controlled distraction force to a joint or the spine in order to alleviate pain or compression. This treatment can help with “pinched” or compressed nerves or even compression in an arthritic hip or knee joint for example. Patients with spinal stenosis may benefit from this treatment as well.

Trigger point dry needling

In Travell and Simon's Myofacial Pain and Dysfunction: The Trigger Point Manual, Dr. Janet Travell defines a trigger point as a 'hyperirritable spot in skeletal muscle that is associated with a hypersensitive, palpable nodule in a taut band. The spot is tender when pressed, and can give rise to characteristic referred pain, motor dysfunction, and autonomic phenomena.' Most people recognize trigger points as “knots” in their muscle. They are very common throughout the body from overuse, postural faults, acute injury, and metabolic imbalances. A healthy muscle usually feels very little discomfort upon insertion of the needle; however, if the muscle is sensitive and shortened or contains active trigger points, the subject may feel a sensation much like a muscle cramp or deep pressure, often referred to as a 'twitch response.' A reproduction of their pain can be a helpful diagnostic indicator of the cause of the symptoms. Patients soon learn to recognize and even welcome this sensation as it results in deactivating the trigger point, reducing pain and restoring normal length and function of the involved muscle. Typically, positive results are apparent within 2-4 treatment sessions but can vary depending on the cause and duration of the symptoms, overall health of the patient, and experience level of the practitioner. While we appreciate the art of acupuncture and the benefits it can provides to clients, we want to make a clear distinction, as the treatments are very different in premise and practice. Dry needling has its roots in Western medicine and focuses on releasing specific, painful, taut bands or "knots" deep in a muscle belly while acupuncture follows a more eastern, holistic approach of needling into more superficial meridian points to normalize the flow of a client's chi.

General Orthopedic/Post surgical care

Joint replacement/Revisions

  • Shoulder--reverse and standard total joint replacement
  • Hip--Total replacements (anterior and posterior approaches), minimally invasive and resurfacing procedures
  • Knee --Both partial and complete replacements

Arthroscopic/Endoscopic joint procedures 

  • Rotator cuff repair
  • Acromioclavicular (AC) joint revisions
  • Bursectomies (shoulder, hip, knee)
  • SLAP repair
  • Biceps tenodesis
  • Elbow/wrist/hand tendon release
  • Carpal tunnel release
  • Trigger finger release
  • Impingement/Labral tears of the hip
  • Chondroplasty of hip and knee
  • Meniscus/ligament repairs of the knee (ACL, PCL, MCL, LCL)
  • Tarsal tunnel release
  • Achilles tendon repair/debridement
  • Bunionectomy

Fracture repairs

  • Open repairs with metal implants
  • Closed repairs with casting and splinting

Spinal Surgeries 

  • Fusions
  • Discectomy
  • Laminectomy


Lymphedema is the abnormal accumulation of fluid in an area of the body. It is typically in the arms or legs but can also occur in the abdomen and genitals. The lymphatic system picks up extracellular/interstitial fluid (becoming lymphatic fluid) and drains it back into the blood circulation where it can be eventually eliminated. When this system cannot drain properly, fluid builds up in the tissues causing swelling.

  • Primary Lymphedema is when swelling is caused by a malformation in the structure of the lymphatic system. Swelling may present at birth or it may occur later in life when the lymphatic system can no longer manage the demands placed on it.
  • Secondary Lymphedema occurs due to an injury to the lymphatic vessels leading to decreased efficiency and effectiveness of the lymphatic system. Often this happens due to cancer or cancer treatments such as lymph node removal, radiation, and chemotherapy. It may also occur after trauma. Secondary lymphedema may present quickly after an injury to the system or many years later.
  • Arm swelling may not be the first sign noticed by the patient with arm lymphedema. His or her jewelry may become tighter, or clothes may feel smaller/tighter on the affected arm. The arm may ache or it may feel heavy or tight.
  • Lymphedema in the legs may occur due to cancers of the prostate or gynecological cancers (ovarian, cervical, vulvar, etc). Swelling will often occur on the side effected most by treatment, which may include lymph node removal, radiation, or both. Some patients may experience abdominal and genital swelling, as well.
  • Swelling in the legs may also occur due to chronic venous insufficiency. This swelling is typically in both legs though it may be worse on one side. There also may be a darkening or discoloration (hemosiderin staining) in the lower legs. Swelling in a leg can also occur after DVT (blood clot)- this is called post-thrombotic syndrome.
Symptoms IN LEGS may include:
  • Chronic swelling in ankles/feet
  • Needing to change shoe size &/or style of shoes to fit swollen feet
  • Sock tops “dig into” legs
  • “Cankles”
  • “Weeping”
  • Dry, flaky, scaly skin
  • Dark brown “staining” in the lower legs
  • Venous stasis ulcers
  • Cellulitis
  • History of DVT
Symptoms IN ARMS may include:
  • Heaviness
  • Swelling
  • Pain/discomfort at rest or with movement
  • Clothing/jewelry fits tighter on affected arm
Lymphedema is a progressive condition but when addressed early it can be managed very effectively. Even moderate to severe swelling can be reduced and managed. Lack of treatment leads to a greater risk of cellulitis, thickening of the skin tissue (fibrosis), elephantiasis, worsening of swelling, skin breakdown (drying, cracking, flaking, “weeping”) and non-healing wounds/ulcers/sores. Treatment consists of Manual Lymphatic Drainage, Compression (multi-layer compression bandaging and/or compression garments), Meticulous Skin Care, and Decongestive Exercises. A Certified Lymphedema Therapist (CLT) can effectively treat the swelling and facilitate the patient’s transition into managing their Lymphedema. The Certified Lymphedema Therapist will develop a plan that best addresses the needs of the individual patient.

Scar tissue mobilization

Scar tissue is an important part of post-surgical healing, but scars can become problematic when they adhere to underlying tissues such as tendons, ligaments, fascia and skin. This can cause contractures, which prevent normal movement, and pain. It also can affect a person’s ability to function or attain good postural alignment. After surgery, collagen cells cluster around the incision site to promote the formation of scar tissue. Fortunately, scar tissue restriction is not permanent and can be manipulated to look and move like normal tissue through a process called “remodeling”.

  • Any orthopedic surgical scar (See post surgical care tab)
  • Mastectomy and lumpectomy scars
  • Cesarean section scars
  • Prostatectomy
  • Abdominoplasty
  • Episiotomy
  • Laparoscopic/laparotomy scars

Visceral Mobilization (VM)

This technique, developed by world-renowned French Osteopath and Physical Therapist Jean-Pierre Barral, assists functional and structural imbalances throughout the body including musculoskeletal, vascular, nervous, urogenital, respiratory, digestive and lymphatic dysfunction. It evaluates and treats the dynamics of motion and suspension in relation to organs, membranes, fascia and ligaments. It is a therapy consisting of gentle, specifically placed manual forces that encourage normal mobility, tone and inherent tissue motion of the viscera, their connective tissue and other areas of the body where physiologic motion has been impaired.

Pelvic Floor Treatment

Pelvic floor dysfunction refers to a wide range of problems (incontinence, constipation, pain) that occur when the muscles of the pelvic floor are weak, tight, or there is an impairment of the sacroiliac joint, low back, coccyx and/or hip joint. The tissues surrounding the pelvic organs may have increased or decreased sensitivity and/or irritation resulting in pelvic pain. Many times, the underlying cause of pelvic pain is difficult to determine.

Bladder disorders

  • Urinary frequency- more than 12 voids in a 24 hour period
  • Urinary urgency, hesitancy, retention and/or incomplete emptying
  • Nocturia (urinary frequency at night) more than 1 void during sleeping hours
  • Pain in the urethra, bladder, and/or pelvis
  • Difficulty initiating urination
  • Weak urine stream and/or a stream that stops and starts
  • Interstitial Cystitis (IC): Also known as painful bladder syndrome (PBS). Recurring pain or discomfort in the bladder and the surrounding pelvic region. Signs and symptoms may include urinary urgency, frequency, nocturia (nighttime frequency) and retention; dyspareunia (painful intercourse); pain in the low back, suprapubic area, and/or abdomen; and pain before, during, or after urination.
  • Urinary Incontinence: Any involuntary loss of urine. This can be due to muscle weakness or muscle spasm/tightness.
    • Urge incontinence: Urine loss due to a strong desire to urinate (urgency), with only a quick warning.
    • Stress incontinence: Urine loss due to an increase in abdominal pressure, such as coughing, sneezing, lifting, laughing and running.
    • Mixed incontinence: Combination of urge and stress incontinence.
  • Urinary retention: Difficulty or inability to urinate. This could be caused by various medical conditions of the prostate, kidneys or urethra. Additionally, some medications may cause urinary retention. Retention may be a symptom of pelvic floor dysfunction when pelvic floor muscles are in spasm or guarding and a patient is unable to relax the muscles, which is necessary for emptying of the bladder.

Bowel disorders 

  • Constipation
  • Fecal Incontinence
  • Bowel frequency, urgency, retention, and/or incomplete emptying
  • Hemorrhoid pain
  • Rectal prolapse (Rectocele)
  • Difficulty controlling flatulence/gas
  • Diarrhea Bloating
  • Rectal and/or abdominal pain, pressure, or spasm
  • Pelvic pain
  • Levator Ani Syndrome

Pelvic Organ Prolapse

  • Cystocele: Herniation or protrusion of the bladder into the vagina most often due to pelvic floor muscle weakness. May result in incomplete emptying of the bladder and consequently urinary leakage.
  • Enterocele: Herniation or protrusion of the small intestine between rectum and vagina
  • Uterine Prolapse: Herniation or protrusion of the uterus into the vagina
  • Rectocele: Rectal prolapse

Pelvic Pain

  • Prostatitis
  • Proctalgia Fugax
  • Coccydynia
  • Anismus
  • Endometriosis
  • Pelvic Congestion
  • Pelvic Inflammatory disease (PID)
  • Dyspareunia
  • Vaginismus
  • Vulvar vestibulitis
  • Vulvodynia
  • Lichen Planus
  • Lichen Schlerosus

Post-Surgical Care

  • Hysterectomy
  • Hernia repair
  • Laparoscopy/laparotomy
  • Cesarean section
  • Appendectomy
  • Prostatectomy
  • Episiotomy.

Services for children
Is your child over 5 years of age and still wearing pull-ups? Is your child on medication to regulate his/her bowel/bladder? If any of the problems listed below sound familiar, then we can help! We meet with each child and their parent/s or guardian initially to get a thorough knowledge of history and current problems. We then do a physical examination, looking at the muscles of the abdomen, legs, back and others we feel applicable to the specific problem. Finally, we consult with the parent and child to develop an individualized treatment plan. Treatment is one-on-one, hands on, in a comfortable and private treatment room with the parent or guardian present.

  • Urinary incontinence (Loss of urine)
  • Urinary urgency (Constant/strong need to urinate)
  • Urinary frequency (Urinating over 8 times in a 24-hour period)
  • Urinary retention (not fully emptying the bladder)
  • Fecal urgency, frequency, and/or retention
  • Bowel incontinence, pain with defecation, inability to empty bowels
  • Excessive gas, abdominal bloating
  • Constipation, diarrhea with/without soiling or staining

Pre- and Post-natal care

Our motto is "back pain during pregnancy is common, but not normal." 80% of expectant women experience low back pain at some time during their pregnancy. It is a misconception that low back pain is a "normal" part of pregnancy and that you have to wait until after delivery for relief. Back pain may manifest in the lumbar spine, sacroiliac joints, or lumbosacral joint. Commonly, the pubic symphysis (pubic bone) is also affected. Many factors contribute to back pain during pregnancy, including the effects of the hormone Relaxin which causes relaxation of the supporting structures of the spine and pelvis.

Pre-natal care:

  • Low back pain
  • Mid back/rib pain
  • Carpal tunnel syndrome
  • Post-natal abdominal strengthening for diastasis recti (abdominal separation)
  • Post-natal Cesarean scar tissue mobilization
  • Education in safe lifting and strengthening techniques
  • Pelvic floor rehabilitation for urinary/fecal incontinence, pelvic pain

Post-natal care: 

  • Low back, mid-back and/or neck pain
  • Diastasis recti (Separation of abdominal muscles from midline)
  • Scarring
  • C-Section, episiotomy, or perineal tear
  • Pelvic floor weakness
  • Pelvic organ prolapse
  • Urinary or fecal incontinence
  • Pelvic pain
  • Dyspareunia

Custom Orthotics

We are musculoskeletal experts trained in examination and assessment of foot and ankle biomechanics to accurately diagnosis dysfunction and then create a custom fit orthotic to address those needs. Many consumers purchase off the shelf orthotics that are not made specifically for them or their individual problem and are often not effective. We make only custom orthotics designed for your feet. Assessment includes:

  • Gait analysis
  • Evaluation of foot biomechanics
  • Shoe recommendations
  • Plaster casting for a custom fit with hundreds of customizable options

Strength and Balance

Patients who’ve had a recent illness or hospitalization, multiple falls, been diagnosed with a neurological disorder, or experienced a stroke are all excellent candidates for a general strengthening/conditioning and balance program. We emphasize regaining motor control while challenging the vestibular and proprioceptive systems to improve a patient’s balance and skill in different scenarios.

Conservative Spinal Care

Disc pathology

  • Herniated/”bulging” disc
  • Degenerative disc disease

Spinal Stenosis/Arthritic changes

  • Foraminal and central canal stenosis
  • Degenerative joint disease
  • Osteoporosis/Osteoarthritis

Sacroiliitis/Sacroiliac joint dysfunction

Spinal Stiffness (hypomobility)

  • Decreased range of motion
  • Low back stiffness
  • “Crick in the neck”
  • Work/posture related neck tightness

Pre-operative spine care
“Pre-habilitation” to strengthen the joints and muscles for surgery - A study in the Journal of Clinical Rehabilitation found that patients who completed an exercise program prior to back surgery had improved function prior to surgery and met milestones and left the hospital sooner following surgery compared to those who didn’t.


Spinal Instability (Hypermobility)

If your doctor says you need surgery, you may want to explore other options

Studies are finding that conservative management is just as effective as surgical intervention and with significantly lower cost and less risk of complications, less need for injections and follow up visits to the doctor. Below are different articles exploring the benefits of therapy over surgery for different joint issues:

Spinal stenosis

Acute low back pain

Degenerative disc disease:

Rotator cuff tear

Rotator cuff tear

Total hip replacement

Knee arthritis and meniscus tear

ACL tears

Physical therapy results in lower healthcare costs