SPECIALTIES

I offer fall recovery training which means we practice on the edge of nearly falling and you practice righting yourself. I also offer fall prevention training when we try to trick your brain into sensing your environment in different ways in order to get more feedback going to your brain to prevent falls in the first place and give you greater control of your body. I feel that these methods lead to the most successful outcomes to improve balance and decrease fall incidence.

True bulging disc pain is rare but can be miserable when it occurs. This is due to the fact that a bulging disc can press on the nerve that exits from your spinal cord and travels very near the disc that usually sits between two of your vertebrae. It can happen in your neck or in your low back (rarely, it can happen in your mid-back). When it occurs in the low back, it is often after having bent forward, reached out for a load and twisted at your spine, your disc will bulge out from it’s fibrous casing that surrounds it. Or sometimes a disc can herniate (bulge) after traumatic compressive forces have been sustained. Sometimes, it is due to the repeated wear and tear of heavy labor or even gardening. No matter the origin, if you have a bulging disc you may be miserable or you may not feel anything at all. For the most part, bulging discs are a normal part of life. People with absolutely no low back pain have been shown to have bulging discs on MRI studies. And, sometimes, studies have shown that the protruding portion retracts back in. The good news for those in pain from a bulging disc is that Physical Therapy can usually alleviate the symptoms! Often, mechanical lumbar or cervical traction, promoting engagement of your body’s “natural corset” musculature, addressing muscles that have shortened over time and use and a handful of other techniques can relieve the severe nerve pain caused by a bulging disc.

Often CTS is a complicated presentation of many myofascial restrictions that lead to nerve entrapment, often not only at the carpal tunnel but up above in your arm affecting your brachial plexus (the nerve network from your neck to your shoulder before all the individual nerves of your neck split off). It can stem from poor posture, wearing heavy weighted objects over your shoulder or the presence of a cervical (extra) rib. A complete assessment will determine where the problem is originating and is usually multiple areas of tightened tissue.

Chronic pain is a diagnosis I love to treat mostly so I can experience the satisfaction of victory over a long battle where pain has been winning for too long!! Personal experience as well as many continuing education courses have made me well-versed in how to manage chronic pain symptoms. The longer a patient has had the symptoms, the more satisfaction I get from having success in relieving them. Chronic pain and CRPS both involve your nervous system acting in a heightened, irritable state. In the case of chronic pain and fibromyalgia, often there are nerve entrapments from myofascial restriction contributing to the pain. CRPS stems from a combination of problems after injury or surgery and involves many systems. Swelling, changes in skin color, sweating, temperature and hypersensitivity to touch-even blowing air or a sheet over the area is intolerable-are all possible symptoms of this condition. Immune system dysfunction, poor nerve health, and even your genetics can play a role in this condition. Nourishing movement, breathing techniques and manual techniques can help!

This condition results in a splitting of the tissue running down your midline in the abdominal area, then your belly pooches out through the separation. Most commonly, this occurs during or after pregnancy but also can occur with weight gain in men or women. This condition is often helped by helping your body regain control over your core muscles through neuromuscular re-education.

A problem of too much hypermobility (looseness of all the body’s connective tissues) causing overly flexible joints. Someone suffering from EDS needs a good stabilization program for their spine and all extremities. Frequently, their muscles hold too much tension which becomes myofascial restriction due to the fact that their joints need the muscles to support them, every upright minute of every day.

If every step you take is painful, you are going to limit those steps! Then, if this is the way you get your exercise, other areas of your body start to ache. Weight gain often ensues. Ick! Don’t let this happen to you! Get in to see me for an evaluation and we can take a look at what is going on…weak muscles? tight or short muscles? restrictions around or within your sciatic nerve sheath (the layer of connective tissue that contains fluid to bathe and nourish your nerves)? restrictions in tendons from overuse? joints that have limited mobility? Another puzzle I love to put together!

Another “near and dear” topic for me - I have had chronic hip and groin pain for almost twenty years - until now!! It took many months and many different myofascial and joint mobilization techniques, but I’ve got a hip that is finally able to tolerate moderate activity and prolonged sitting without complaint! If you are suffering from hip pain, come see me! There is so much that can be done with manual therapy and techniques to work on at home that can alleviate your pain and restore your range of motion!

Having suffered quite a bit of hand, wrist and elbow pain myself over the years due to various injuries has “learned me a lot” in how to care for pain in this area. At a young age I broke the two bones in my lower arm right in half, yes, there was a ninety degree bend where there shouldn’t be. The bones didn’t break through the skin since I was a gymnast and my muscles in my lower arm were super strong and held the bones in. I have had pain all my life in my elbow and wrist as well as some numbness in my pinky and ring finger-all nearly resolved after working on my arm the last few months. I was suffering from both golfer’s elbow and tennis elbow as well as tendinitis in the tendons responsible for cupping my palms or moving my palms to face down. Pain in this area can be stubborn and persistent even without a long history of chronic pain in the arm. Usually, there are multiple areas “further up the chain” that need to be addressed as well as getting the inflammation out of the local tissues before full resolution of your symptoms is attainable. Treatment often involves Trigger Point release as well as whatever myofascial release techniques work for your affected tissue.

I was very fortunate to learn techniques that are very effective for headache and the most prevalent cause of dizziness/vertigo early on in my career! I have found in my years treating dizziness and vertigo that most often those symptoms arise from an issue at the upper part of your neck and once effective treatment is directed there, those symptoms resolve. Neck exercises don’t properly address the joint and muscle dysfunction that is occurring in this region so are ineffective. Once manual techniques are used, the dysfunction resolves and then exercises and self-treatment techniques can be very effective to manage the symptoms prevent their return.

Knees are a favorite of mine. A knee joint is a, comparatively speaking, simple one. The intricacies of how the knee cap interfaces with the long leg bone below it often can be the cause of pain, particularly if the pain comes on with descending stairs or walking declines. Knee problems are often the result of hip weakness so will never fully resolve without not just hip strengthening exercises but full-on muscle re-education is usually required. Our brains will only use strong muscles and continue to ignore the weak ones, using the path of least work/calories required. Our brains are masterful at compensation. Close attention needs to be paid to how hip movement is occurring. If there is compensation going on, then an unfavorable movement pattern will be reinforced by performing the hip strengthening exercises-you will only strengthen the compensating muscles rather than the weakened muscles. Strengthening the correct muscles in the hip will optimize the position of the long leg bone, the femur, which the knee cap rests on. The forces placed upon the muscles and the long tendon along the outside of your leg will also be more optimal, allowing that tissue to recover. Healthy, flexible tissue along the outside of the leg will put an end to the pulling that occurs on the outside of your knee cap that is present when there is too much tension. It’s a delicate balance that can be restored with appropriate intervention.

Incontinence is super-common though not often discussed. It has been shown that 40-50% of adult women experience it and, in those over 65, the incidence can be up to 75%! There is much that I can instruct a patient with incontinence to do to mitigate or eliminate these symptoms, often without internal biofeedback!

My own battle with 10 years of insomnia taught me a lot! I have recently developed effective techniques to resolve the cause of sleep deprivation and brain fatigue and restore rejuvenating sleep.

Jaw, with or without facial, pain can be a miserable condition to endure. There are specialized techniques of joint mobilization, soft tissue mobilization as well as helpful exercises and activity modifications to perform in order to overcome it. TMJ conditions are nearly always found simultaneously with problems with the upper cervical spine (upper neck or sub-occipital region). Sometimes, for successful resolution of your TMJ symptoms, treatment to the neck needs to be performed as well and sometimes vice-versa as well.

Most people consider joint pain a normal aging process. And to some degree it may be. But when it crosses the line into affecting your function, there's much that can be done, no matter how old you are! Resolving joint and soft tissue restriction can often bring about pain free joint movement at any age! As our tissue becomes shortened with poor posture, weakened due to inactivity or restricted after years of dysfunctional movement patterns, more force is placed on your joints instead of absorbed by healthy, optimally functioning muscles. Over time, joint degeneration occurs. Physical Therapy cannot do much for what's already degenerated but bringing about healthy, functional muscles to support your affected joints can lessen or eliminate the inflammatory component that causes pain with movement or weight bearing.

Teasing out the exact origins of your low back pain is a puzzle I love to solve! Typically, there are many factors causing your back and/or leg symptoms. Sometimes, there is radiating pain from your spine, other times, it may be referred pain, or even, a numbness/tingling sensation in your hip or leg from myofascial (muscles and connective tissue) restriction or an irritated/entrapped nerve. There are true sciatic symptoms and there are muscle strain symptoms. All present as low back and/or hip/lower extremity pain but your symptoms can originate from many structures. Sometimes, low back pain can be affected by weak core musculature but not always. Through a process of selective tissue testing and movement/mobility assessment I am able to determine the origins leading to pain. Getting to the root cause forms the basis for my “saying good riddance to low back/leg pain” treatment plan.

Post-surgical patients whether from orthopedic interventions, oncologic, or otherwise frequently suffer from swelling / lymphedema. It can also occur after injury, from heart or vascular disease, infections or even eczema or arthritis or can present as lipidema, an abnormal amount of fat in the leg(s). There are a variety of techniques that help to reduce this swelling and, because of that, encourages and speeds up healing if lymphedema comes on after orthopedic surgery. I have recently learned some new techniques that I have found very effective!

Looking at the way that the body moves and making modifications to relieve the pain associated with the body’s usual, but, sometimes, detrimental movement patterns can be an effective way to reduce strain on sensitive, inflamed tissues. Typically, when all of our muscles are working correctly and with the proper timing, our tissues provide pain-free movement. But when there has been an insult to the tissue, from bringing it to the ”pain threshold/micro- or macro-trauma point” through overuse or overload, a painful cascade begins. Pain with certain movements causes the brain to overlook the muscles that are causing the pain, which leads to what we call muscle inhibition, then creating movement dysfunction. Often these tissues begin to hurt from our everyday activities rather than having injured the tissue suddenly. Low force over either frequent repetition, like if your rotator cuff muscles in your shoulder stop engaging when you raise up your arm, or low force over a long period of time, like holding poor posture while sitting all day. If it hurts to do a movement or hold a poor posture for a long time, the brain says, “Don't do it”. But us humans aren't always good listeners to what the brain is telling us and then we worsen the situation, creating more injury, by moving through the pain or maintaining that cruddy posture for hours. PTs trained in Movement Impairment Syndromes can sometimes interrupt the pain cycle by simply changing up the way you move. Sometimes the tissues are more involved and need myofascial release of some sort or active stretching in order to produce pain-free movement of an area.

Please reference my first email newsletter/blog on my website under the “NEWS” tab at the top for more information on this important topic. It deserves some extra explanation! If you want to sign up for my newsletter, you can do so below.

This mid- to upper-back region can become painful in, and of, itself but also plays a HUGE role in not only shoulder mechanics but also in neck and lower back pain. The joints of your thoracic spine (mid-back) are very susceptible to becoming restricted over time usually due to excessive sitting...desk jobs, TV watching, driving, etc but can also occur with a lot of repetitive loading with manual labor and sporting activities. We do not realize over time that our joints are stiffening until it becomes painful, either at the joints themselves or in related areas by way of the myofascia not moving optimally. Ribcage immobility is also a factor in upper back mobility so that is assessed and treated as well at Therapeutic Connection, if needed.

From the National MS Society:

“Rehabilitation is an essential component of comprehensive care for persons with multiple sclerosis (MS). MS is an unpredictable, fluctuating disease that progresses over time.

Therefore, the rehabilitation team must be knowledgeable about the range of symptoms that can occur and be responsive to their variability from one person to another.

Unlike most other neurological disorders, including spinal cord injury, traumatic brain injury, and stroke, there is no “fixed deficit” in MS; symptom profile, disease activity and MRI burden are all variable.

Therapists must be prepared to treat each MS patient individually, with flexibility, throughout the disease course. “ I have taken advanced study in nervous system treatment techniques as well as treating from “a whole body including the mind” perspective.

Chronic neck pain treatment is near and dear to my heart. I have suffered numerous concussions and whiplashes throughout my years here on this beautiful planet and I spent a healthcare journey of several months learning how to overcome chronic neck pain symptoms. My Doctor told me that with how much arthritis I have in my neck it looked like the neck of an 80-year-old and this was 10 years ago. I would love to help others who suffer from the chronic neck pain. Acute neck pain is usually a quick fix if there weren’t underlying issues leading to the last straw that sent you into symptoms. For example, if your neck just starts hurting without provocation, there are likely underlying issues that will need to be resolved lengthening the healing process.

Many people suffer from osteoarthritis, and many people think that there is nothing that can be done to help their osteoarthritis. Even those that have been to physical therapy before, may find benefit and coming for therapy at therapeutic connection. Most therapists don't look at the underlying causes both in the tissue, The joint and your movement patterns. I take all these things into account in order to help your joints feel their best. They're also maybe an issue with your nervous system causing the pain but it's never been ruled out and it will feel just like your joint is hurting.

This diagnosis can span the gamut of symptoms and origins. Physical trauma, surgery, sudden or gradual onset of painful internal and/or external symptoms, no matter what the source, it can create feelings of hopelessness. It can feel unrelenting and like it will never go away. Or, perhaps, your provider recognized warning signs and sends you to Physical Therapy before there are symptoms. But often it does improve or even resolves.

In my thorough physical therapy examination, I am constantly on the lookout for entrapment of nerves, pressure on nerves from muscles, discs, arthritic changes. Often, these can be resolved, sometimes rather easily. Sometimes it requires myofascial release, sometimes traction, sometimes what's called clinical neurodynamics. Myofascial restriction can cause numbness and tingling by way of nerve entrapment of the nerve endings within the fascial layers and muscles. Numbness/tingling/radiating pain can also originate from the nerve having been affected by adhesions within the nerve sheath (the covering around all of our nerves). In other instances, it may originate from an enlarged muscle usually due to hypertonicity (a muscle that is too tight or excessively contracting) that is passing adjacent to the nerve and putting too much pressure onto the nerve. Numbness/tingling/radiating pain can also be coming from chemical irritants in the nerve’s vicinity (from inflammatory agents) or from not having enough elasticity to go around and through all the tissue as it makes takes it’s course through your body.

Healing after surgery is critical during the first 6-8 weeks since that is when the majority of the tissue healing occurs. This can also be a time when the affected area and related areas around your surgery can be VERY swollen. Swelling can slow the healing process! I enjoy seeing the relief on patient’s faces after treating them with lymphedema (swelling) techniques! Lymphatic drainage manual techniques and exercises can significantly reduce the swelling and the discomfort it causes. Equally as important is getting your range of motion restored in the early stages while your healing tissue is the most pliable. Benefit from my experience in knowing how much and when to push you to get the most range of motion possible since every surgical outcome is unique. I also offer a deep understanding of how to isolate out and re-educate specific muscles in order to return to optimal strength.

RA is a chronic inflammatory and autoimmune disease that mostly affects the joints while fibromyalgia is a disease which causes severe pain and tenderness in the soft tissue/muscles and joints. Often, both are consistent with severe myofascial restriction and can be helped with various forms of myofascial release. There is no one technique that works for everyone that has significant myofascial restriction. That is why I have spent years studying a variety of methods in order to be able to help a wide range of conditions that cause myofascial restriction.

RSI usually occurs at the hands/wrist or shoulders and elbows from repetitive motions performed over and over again. Taking frequent breaks can help prevent strain but there are more specific stretches and exercises that can be done depending on what tissue is being affected. With repetitive strain, there are always myofascial restrictions that sometimes exercise will not resolve. Myofascial release techniques, both in the clinic and at home are an important part of getting past RSI injuries quickly so you can be pain-free sooner!

Scar mobilization when performed during the correct phase of healing can do wonders to prohibit excessive scar tissue and organize the scar tissue that gets laid down post laceration or surgery.

Movement impairment syndromes are very common at your shoulder blade and are often directly related to myofascial restriction in the muscles holding your shoulder blade to your ribcage as well as pain in your shoulder. The dysfunctional movement patterns affect the rotator cuff and the alignment of your long arm bone, the humerus, as well as the collarbone (clavicle) as it interfaces with the shoulder blade. Usually, without a lot of myofascial release, shoulder issues rarely resolve. Equally as important in the proper mechanics of your shoulder motion are the problems that can be caused by restrictions within the shoulder joint capsule, the dense, fibrous connective tissue that forms a fluid filled sac surrounding most of your joints. These restrictions respond very well to joint mobilization if they are found to be part of your shoulder problem. Often involved as well are restrictions within the joints of your upper back which also affect your shoulder mechanics by way of affecting your shoulder blade movement. All of your supportive muscles for the shoulder blade originate from your upper spine. This is often overlooked but is a necessary component to relieving your shoulder pain and restoring normal shoulder mechanics.

A Sports Hernia is not a true hernia, instead, it is a severe strain or tear of your oblique muscle as it attaches to the pelvis, your oblique muscle itself or where your thigh muscles attach to the pelvis. This can be resolved using Physical Therapy techniques with an in-depth look at your core muscle engagement and other possible underlying strength deficits - deficits that may have led to a twist of your pelvis, that you had likely done plenty of times in the past without strain, suddenly overloading the area and causing injury.

Tendonitis is an acute injury caused by inflammation whereas tendinosis is a chronic state of inflammation that leads to degenerative changes within the tendon tissue. Both are treatable with Physical Therapy. Even if the tendinous tissue is torn, often, using muscle re-education can get you moving pain-free through using better mechanics with arm movement.

I treat patients suffering from work-related injury with the same care and concern that I offer every other patient that comes to me. I want to see them productively return to work as much as they want to get back to work! And if they haven’t had to stop working, I make it so their exercise program can fit their busy schedules to get them feeling recovered and healthy.