Manual Therapy

Manual Therapy is a physical treatment primarily used by massage therapists, physiotherapists, occupational therapists, chiropractors, osteopaths, and osteopathic physicians to treat musculoskeletal pain and disability.It is also encompasses the treatment of health ailments of various etiologies through ‘hands-on’ physical intervention and manipulation. This form of physical treatment usually refers to hands-on techniques and includes:

Spinal and Peripheral Manipulation Therapy:

Spinal manipulation is a therapeutic intervention performed on spinal articulations which are synovial joints

This involves the skillful movement of joints beyond their active limit of motion but within their anatomical abilities. It is a localized, high-speed, controlled thrust, and may cause an audible click or “popping” sensation that is usually painless. Joint manipulation can be performed on most joints of the body.

Joint and Soft tissue mobilization:

Soft tissues are the different kinds of cells that surround and support your organs and skeletal system. They include muscles, nerves, tendons, ligaments, joints, cartilage, and spinal discs.

The therapist gently coaxes motion through subtle but precise movements.

Myofascial release

Myofascial Release is a safe and very effective hands-on technique that involves applying gentle sustained pressure into the Myofascial connective tissue restrictions to eliminate pain and restore motion. This essential “time element” has to do with the viscous flow and the piezoelectric phenomenon: a low load (gentle pressure) applied slowly will allow a viscoelastic medium (fascia) to elongate.

Myofascial release is the mobilization of neural tissue and various connective tissue. Using various hands-on techniques, the therapist stretches the neural and connective tissues such as the fascia. Fascia is a connective tissue that connects bones, muscles and organs.

Craniosacral Techniques:

Craniosacral therapy is a holistic healing practice that uses very light touching to balance the craniosacral system in the body, which includes the bones, nerves, fluids, and connective tissues of the cranium and spinal area.

The use of delicate manual techniques of light touch to detect and correct imbalances, release problem areas and relieve undue pressure on the brain and spinal cords.

Low Level Laser Therapy (LLLT)

Low-level laser therapy (LLLT) refers to the use of a red-beam or near-infrared laser with a wave-length between 600 and 1000 nanometers and power from 5 to 500 milliwatts. Low-level lasers do not produce heat. In contrast, lasers used in surgery typically use 300 watts and burn the tissues they encounter. LLLT is also referred to as cold laser therapy, low-power laser therapy (LPLT), low-intensity laser, low-energy laser therapy, and monochromatic infrared light energy (MIRE) therapy. When administered to so-called "acupuncture points," the procedure may be called "laser acupuncture." The providers include physicians, chiropractors, physical therapists, and occupational therapists, but devices are also marketed for long-term use at home.

LLLT is used to increase the speed, quality and tensile strength of tissue repair, resolve inflammation, and give pain relief. The technical term often used to describe this form of therapy is “photobiostimulation.”

LLLT is indicated, but not limited to, in the following:

  • Post-op pain
  • Chronic pain
  • Joint dysfunctions
  • A soft-tissue injury
  • As a substitute for acupuncture

Interferential Current (IFC)

Interferential Current is a type of electrical stimulation that uses paired electrodes of 2 independent circuits carrying high-frequency (4,000 Hz) and medium-frequency (150 Hz) alternating currents. The superficial electrodes are aligned on the skin around the affected area. It is believed that IFS permeates the tissues more effectively and, with less unwanted stimulation of cutaneous nerves, is more comfortable than transcutaneous electrical stimulation (TENS). Interferential stimulation has been investigated as a technique to reduce pain, improve range of motion, and treat a variety of gastrointestinal disorders. There are no standardized protocols for the use of interferential therapy; the therapy may vary according to the frequency of stimulation, the pulse duration, treatment time, and electrode-placement technique.

Interferential Current is used to reduce pain, promote healing of soft tissue, decrease local swelling, and aid in the restoration of normal movement. By sending electrical impulses through electrodes in the tissue in the area of pain, it changes the firing of the nerves and their conduction of pain signals to the brain. IFC also increases local blood flow which can improve healing by reducing swelling and as a result helps to remove damaged tissue and bring nutrients necessary for healing to the injured area.

Most treatments last ten to fifteen mintues and patients descried as relaxing with a ‘pins and needles’ sensation. This feeling should be strong but not strong enough that it feels painful.

IFC should not be used on patients with pacemakers or cancer. It should also not be used over the uterus, pelvis, or lumbar spine of a woman who is pregnant.

Electromuscular Stimulation (EMS)

Electrical muscle stimulation, also known as neuromuscular electrical stimulation (NMES) or electromyostimulation, is the elicitation of muscle contraction using electric impulses.

Electromuscular Stimulation generates a weak electric impulse, which produces a strong muscle contraction similar to a normal voluntary contraction. With the use of EMS, the specific muscle involved can be controlled by the placement of the electrode. Therefore, the use of EMS allows a muscle to be activated, which may be otherwise difficult to activate through regular exercise.

Electromuscular Stimulation is often used post-surgically when the muscles need to be re-educated. It is also used to activate the smaller muscles in the spine, which help to achieve core stability. The goals are to provide muscle re-education and increase client awareness of muscle activation. Therefore clients who are having difficulty initiating/recruiting specific muscle activity may benefit from Electromuscular Stimulation.

Treatments usually last ten to fifteen minutes, and it will feel like a strong tingling feeling that is slightly uncomfortable but not painful. It should be strong enough to visibly see muscle contractions.

Ultrasound

High-frequency sound waves.Ultra-sound waves can be bounced off tissues by using special devices. The echoes are then converted into a picture called a sonogram. Ultrasound imaging allows an inside view of soft tissues and body.

Ultrasound is a therapeutic modality used by physiotherapists. A round-headed wand is put in direct contact with the patient’s skin. Ultrasound gel is used to assist in the transmission of the ultrasonic waves into the tissue

The waves are generated by a piezoelectric effect caused by the vibration of crystals within the head of the wand. The sound waves that pass through the skin cause a vibration of the local tissues. This vibration or cavitation can cause a deep heating locally, although, usually no sensation of heat will be felt by the patient. In situations where a heating effect is not desirable, such as a fresh injury with acute inflammation, the ultrasound can be pulsed rather than continuously transmitted.

A typical ultrasound treatment will take from three to five minutes. In cases where scar tissue breakdown is the goal, this treatment time can be much longer. Some conditions treated with ultrasound include:

  • Swelling
  • Bursitis
  • Tendinitis
  • Muscle Spasm

Ultrasound can produce many effects other than just the potential healing effect. It has been shown to cause increases in tissue relaxation, local blood flow, range of motion and scar tissue breakdown. The effect of the increase in local blood flow can be used to help reduce local swelling and chronic inflammation.The intensity or power density of the ultrasound can be adjusted depending on the desired effect. A great power density is often used in cases where scar tissue breakdown is the goal.

Acupuncture

Acupuncture is one of the main forms of treatment in traditional Chinese medicine. It involves the use of sharp, thin needles that are inserted in the body at very specific points. This process is believed to adjust and alter the body's energy flow into healthier patterns, and is used to treat a wide variety of illnesses and health conditions.

Acupuncture is a method of encouraging the body to promote natural healing and to improve functioning by inserting needles and applying heat or electrical stimulation at very precise acupuncture points.

Needling into the acupuncture points stimulates the nervous system to release chemicals in the muscles, spinal cord, and brain. These chemicals will either change the experience of pain, or they will trigger the release of other chemicals and hormones which influence the body’s own internal regulating system.

Use of acupuncture in the treatment of muscular and neurological disorders such as:

  • Sciatica
  • Neck pain
  • Headaches
  • Osteoarthritis
  • Tennis Elbow
  • Frozen shoulder
  • Low back pain
  • Various forms of tendonitis

Shockwave

Shockwave Therapy consists of a series of high energy percussions to the area being treated. The shockwave spreads outwards (radially) from the applicator head into the tissue to a depth of about 3.5cm. The shockwave is physical in nature, not electrical.

It is hypothesized that radial shockwave creates a controlled local tissue injury. In essence the micro-trauma created by RSWT creates an inflammatory response and leads to a cascade of healing to occur. This is believed to increase tissue growth factors within locally injured tissue which leads to neovascularization (new blood flow), speeding up the healing process.

RSWT is primarily used to treat chronic connective tissue injuries such as:

  • Jumpers Knee
  • Trigger Points
  • Plantar Fasciitis
  • Achilles Tendinosis
  • Tennis/Golfer’s Elbow
  • Calcific Rotator Cuff Tendinosis

Therapeutic Exercise

Anyone can benefit from therapeutic exercise. Exercise builds strength, improves balance and coordination, improves sleep, increases flexibility, stimulates the cardiovascular system, tones muscles, and relieves musculoskeletal stiffness, fatigue and pain. The physical therapist will customize a program to meet the patient’s individual needs.

Therapeutic exercise can be the most effective elements of a physiotherapy-based rehabilitation. A Physiotherapist will essentially prescribed certain exercises for an individual to perform during appointments and when they are away from the clinical setting. The exercises recommended by a Physiotherapist attempt to do one or more of the following:

  • Improve muscle strength and joint stability
  • Improve functional mobility and balance
  • Mobilize joints
  • Release contracted muscles, tendons and fascia
  • Enhance performance

The power of therapeutic exercise in a rehabilitation program is that individuals can complete the exercises on their own time. The physiotherapist, guide patients through the correct movements so that they can properly perform the exercises and continue them even when their clinical treatment is complete. It is important to consult a physiotherapist before beginning. Their advanced understanding of the human body allows them to tailor a program to a specific individual, their abilities and their injury.

Video Analysis

Patients are video-taped for analysis of biomechanics, techniques, movement disfunctions and injury compensation.

  • Golf swing Analysis
  • Throwing Analysis
  • Running/Gait analysis

Performance Training

Physiotherapists will design sports-specific exercise regimen to speed recovery and strengthen joints and muscles with a particular sport/activity-related outcome.