When we see patients and get their history, if they have had any therapy before they have been given exercise or stretches and they have usually not complied.

The reasons are the same: either they did not help, took too much time, or made them feel worse.

Time is of the essence for all of us, and we only have so much. No one is going to add something to their already busy day unless it helps them and it’s to the point.

That is why we have designed a program with only Pain Specific Stretches for our patients.

If my patient has a muscle spasm or pain, then I want them to know a pain specific stretch that targets the pain; that they can do and have relief within a minute or two.

This technique is a hands-on manual therapy that is used for soft tissue injuries and nerve impingements.  By releasing the spasm in the muscle, pain is reduced and movement is increased.

When a muscle is in spasm, it thickens in the space that it occupies.  There is not any extra space in the body waiting by in case it is needed.  Two things cannot occupy the same space so there is now compression, typically by the muscle on the nerve. It can also push the nerve against a bone causing another type of impingement. This can cause a severe and unrelenting pain.

An example of this type of muscle-nerve-bone combination is thoracic outlet syndrome.  When the scalene muscles in the neck spasm they can impinge the nerves going to the arm.  Directly under the clavicle is the first rib.  One of the scalene muscles attaches to the first rib.  When it stays in a contracted state it pulls the attachment up and forward, reducing the space between the rib and clavicle which the nerves pass through.  There are of course other causes for Thoracic Outlet Syndrome, but many times neuromuscular release of the scalene muscles will resolve the problem.

Another type of muscle-nerve problem can occur when the piriformis muscle (a deep lateral hip rotator) spasms and compresses the sciatic nerve.  Release of this spasm will relieve the sciatic nerve pain.  This can be an unrelenting pain and one that we easily resolve.  Also, when this is causing nerve root compression in the spine, the problem can still be resolved by lumbar decompression through soft tissue release. See piriformis syndrome / sciatica.

Myofascial Release is a very effective hands-on manual therapy that involves applying gentle sustained pressure into the myofascial connective tissue restrictions to eliminate pain and restore movement.

Fascia is not linear; it is three dimensional.  Fascia has two parts.  The first part is the elastin and that releases fairly quickly.  The second part is the collagen and it is the most important part and it does not start to release until after 2 to 3 minutes of sustained pressure.  When this release occurs the release will move in the direction of the restriction.

Fascia cannot be released by equipment such as a ball or a roller or machines; they can only soften an area.  For the release to take place there must be sustained pressure that moves with the release in the direction of the release.  The direction can be to go deeper, forward, back or even in a circular motion. The direction must be followed for the benefit to occur.

A patient presented with arm pain and numbness as well as shoulder pain.  During evaluation it was noted that the fascia was severely restricted in the chest region and the patient was told that we would need to release that area.  She stated that she had been having problems breathing and that her chest felt like it had a fifty pound weight.  All tests were negative and nothing had previously helped this problem.

After myofascial release she was able to take deep breaths and had no chest pain and the weight on her chest was gone (fascia can exert up to 2000 pounds of pressure when restricted).  Continuing with the myofascial release technique we were able to eliminate all the pain and numbness in her shoulder and arm.

Also see the fascia article.

This is an exact and distinctive therapy that reduces inflammation, increases blood flow without increasing blood pressure, and decreases swelling which promotes rapid healing.

MLD is a gentle technique that utilizes the superficial lymphatic vessels that are located just under the skin.  The lymph vessels are like fine silk threads and the correct technique only moves the skin that the vessels are attached to, causing the valves to open and an increased amount of lymph fluid to be pulled into the vessel for removal. Even a slight downward pressure on the vessels keeps them from pulling the fluid in, so this technique is gentle and can be used even when there is great pain in an area.

As the fluid is removed and oxygen and nutrients are brought to the area, pain quickly reduces and healing is rapid.

A simple example would be a patient that had been struck by a golf ball with great force.  She had a severe hematoma the size of half a baseball on her deltoid and it was very painful to the touch.  After first being treated peripherally, then immediately over the injury, all the pain was gone.

A more complicated case would be a patient that had had a complex open reduction of the tibia after an auto accident.  They wanted a knee flexion of 130 degrees, but were only able to attain 80 degrees and with great pain.  After MLD to the area she quickly attained the 130 degrees and without pain, because the edema softened and then was being decreased.  Also the skin improved in health as scabs fells off, dryness decreased, the skin became supple and had a healthy sheen.

(Joint and soft tissue mobilization)

Our joint  and soft tissue mobilizations are based on Feldenkrais Movements.  It is our belief that the best way to open a door is to use the handle and not a battering ram.  This is very important because way too often we see patients after their problem (shoulder, knee etc.) has been forced to the point that the problem is now worse.

With Feldenkrais the movements are small, gentle and very powerful.  The concentration is on short, slow, repeated movements of the joint directly.  This method takes into account the movement of the whole body and how restricted movement in one area is affected by the correct or incorrect movement of a joint in another area.  Even when a patient cannot lift their arm because of the pain in their shoulder, they can easily perform the Feldenkrais Movements.

The change in the pain level and range of motion are immediate.  This surprisingly quick change is common with this method.  This technique can be used on all patients regardless of age, degree of injury or general health.

An example of this technique is a patient that presented with severe shoulder and arm pain with a range of motion restricted to less than 30 degrees in abduction.  This injury was 10 months old and getting worse.  After the Feldenkrais Movements in the first session, her abduction increased to 110 degrees without pain.  This is a good start and the patient was very happy.   After therapy was completed she had no pain and her range of motion was within normal limits.

This is a manual therapy that allows for release of deep muscle spasms and trigger points without pain and with the patient being in control of the depth and pace.

When a patient has severe pain and the technique is too intense or painful, the body will just work against the technique and protect the areas that it believes is going to be hurt.

In truth, the axiom ‘no pain no gain’ may be true in some cases, but not in therapy.  When the body perceives that there is imminent harm, it will go into a  protective mode and fight against the therapy which will increase the intensity of the problem.  We work with the body, not against it.

This does not mean that we do not go deep, actually we go deeper.  When you wait for each layer to release and then go to the next layer and wait for it to release, you can continue to a depth that would be impossible to reach by going directly there, or by overpowering the system.

An example is a patient that presented with severe pain in the hip and sciatic region.  They had previously had therapy that had been aggressive and inflamed the region for days.  By using DSL Edgework we were able to resolve the problem instead of aggravate the problem.  With ReCAPS System™ your pain will not be aggravated, and you will be listened to.

This is a multifaceted therapy.  CDP includes:  Manual Lymphatic Drainage (see treatments), compression bandaging, skin care and therapeutic exercises.

This treatment was designed to treat lymphedema.  It also has other benefits.  It can be used in the treatment of diabetic ulcers, soft tissue trauma and to treat swelling after a surgery.

A patient presented with a diabetic ulcer that had been ongoing and was resistant to healing.  She also had extensive edema in her lower leg where the ulcer was.

We treated her with comprehensive decongesting physio-therapy for about  three weeks.  Within three weeks the ulcer was almost healed, the edema was gone from her leg, and the health of the leg had improved so much that hair started to grow back.  (the only thing she was not happy with was shaving again!)

Another patient was referred to us that had been in a severe auto accident and had a large swelling on his hip.  Since the swelling had been there for nearly four months the consistency of the lymph had gone from liquid to gel and was now solidifying.  The patient was very discouraged.  With CDP we were able to break the swelling up and return it to a liquid state.  Then MLD and the correct compression bandaging helped the lymphatic system to absorb the lymph and resolved the problem.

It is important to note that the liquid is not water; it is lymph fluid that carries a lymphatic load.  It is ONLY through the lymphatic system that the load can be fully removed.  See swelling/edema.