Modalities: (are all types of hot and cold packs, US, laser, and electrical stimulation)
Hot Pack
- Hot packs are often used to help relax a muscle that is in spasm and help decrease pain felt in an area. Commonly used for more subacute or chronic injuries and conditions, hot packs (and heat modalities in general) increase blood flow to help encourage tissue healing. Using heat can help a muscle relax and increase comfort when experiencing discomfort. Moist heat is most beneficial.
Cold Pack
- Cold packs are often used to decrease inflammation and swelling in an area. They can be used throughout the length of an injury, but are very effective during acute injury or reinjury. Some of the science behind using cold packs or cold modalities in general is to slow down the activity of nerves, so your brain does not process the pain signals as quickly, thus reducing your pain. Cold packs are a great way to decrease pain and reduce swelling after injury.
Paraffin
- Another type of heating modality, paraffin is a type of wax that is normally used for hand injuries that involves dipping your hand into the wax repeatedly to insulate the heat generated by the paraffin. Paraffin is set to the temperature of ~126°F, which might sound high, but there is a reason for it! Paraffin has a lower specific heat than water does, which means it stores less energy than water, and a lower thermal conductivity. This means paraffin does not transfer heat as well as water does. This is not a very common form of treatment and won’t be found in every clinic, but if you had a hand injury, this may be something for you to look into!
Ultrasound
- Ultrasound is a type of heating modality that can be used to get to deeper tissue than a hotpack can reach. Ultrasound utilizes vibrating soundwaves that are produced by a crystal in the “head” of the applicator. These soundwaves are absorbed by the targeted tissues producing a heating effect. Ultrasound is customizable based on what your target tissue is, the size of target tissue, and where it’s located. Your clinician can then choose the size of the treatment head, the frequency, and the intensity to target your injured tissue.
Laser
- Laser therapy is a unique modality utilized in the physical therapy setting, involving a “low level laser” that penetrates deep into tissues to help reduce inflammation and swelling, as well as promote tissue healing. Laser therapy can be a useful alternative to ultrasound therapy, as they are both “penetrating” modalities that are used to get to deep tissues. The main difference between laser therapy and ultrasound therapy is that laser therapy has a photochemical effect, and ultrasound has a thermal effect. Laser doesn’t produce direct heat. You can compare the photochemical effect that laser has on cells to photosynthesis in plants!
Electrical Stimulation:
TENS (transcutaneous electrical neural stimulation)
- TENS can be used to help reduce pain levels by sending sensations through the stimulation pads that compete with pain sensations. TENS has 2 separate channels that can be used alone or together to create a “tingling” sensation felt under and around the stimulation pads attached to each channel. TENS does not have to be placed over the painful area in order to be effective! The TENS pads can be placed within adjacent areas if there is something that prevents the pads from going over the painful area, such as an open wound or surface metal.
NMES or “Russian Stimulation”
- NMES stands for neuromuscular electrical stimulation, which utilizes an electrical current to help create a muscle contraction. NMES is utilized when there is muscle weakness, perhaps after surgery or serious injury. Common situations for NMES use are an ACL repair or knee replacement, in which 2 pads from the NMES machine are placed over the muscle and the intensity of the current is turned up until there is a muscle contraction that is sustained for a set period of time.
Interferential Current (IFC)
- Interferential current utilizes two crossing channels of electrical stimulation that “interfere” with each other over a desired treatment site. This set-up allows for less pain and stimulation at the surface of the skin and more in a deeper target area. This type of stimulation is often used to draw blood flow to an area or temporarily reduce the pain there.
Massage Devices:
“The Stick” Roller
- A flexible stick with ceramic or plastic beads. This device allows you roll over the skin and massage the muscles beneath without creating too much friction. Some areas are easy to perform self treatment, but others you will need assistance.
Foam Roller
- These come in different diameters but most commonly about 6 inches wide. The lengths vary from about 12-36 inches, and the densities vary from soft to firm. This can be utilized by your therapist to assist in massage, or can be used by placing a body part on the roller and moving back and forth to massage the treatment area.
Percussion Therapy Devices (Hypervolt / Theragun)
- The hypervolt and theragun are types of massage guns that utilizes “percussion therapy” or a fast pulsation that helps relieve muscle stiffness and soreness, often resulting in decreased pain and increased range of motion. They can also help facilitate the healing process of an injury by improving circulation, can help with warmup prior to a workout and recovery after a workout or training session. The hypervolt comes with various attachments and 3 different speeds that can target different areas in different ways.
Hypervolt Vyper
- Made by the same company that makes the Hypervolt theragun, this is a vibrating foam roller that utilizes the same percussion therapy as the theragun to help relieve stiffness and soreness in muscles. Foam rollers in general work by overloading the muscle with a pressure signal which in turn helps the muscle relax. Adding the vibration facilitates further relaxation and comfort.
Graston
- Graston is a form of Instrument assisted soft tissue mobilization that involves the use of a metal tool to help accelerate tissue remodeling through light strokes on the skin. There are a variety of different shapes of tools to help target specific areas on the body for various soft tissues. They all have the same goal of facilitating a faster recovery and to decrease pain levels!
Traction
- Traction involves a light “pulling” on either the cervical spine or lumbar spine to create space for a variety of different injuries. Traction can be done either manually or mechanically. Mechanical traction can be modulated for more or less pull, as well as can be used for longer times than a therapist could be able to provide manually. Traction can be used for radiculopathy, hypomobility, stenosis, and more!
Types of Taping:
Athletic Taping
- Often found in sports settings, athletic taping involves the use of a stiff tape over a joint that has sustained an injury to increase stability of that area. The area of injury is placed into a stable, safe position and then wrapped in a way that provides additional stability. Common areas that can utilize athletic tape are the ankle and wrist usually following a sprain or strain type of injury. Both athletic trainers and physical therapists can apply athletic tape effectively after taking specific taping education classes!
Leukotape or McConnell Taping
- Leukotape is a form of very stiff and high tensile strength tape that can be used for a variety of reasons, such as; a muscular or joint injury, relieving pressure and providing stability. Popularized for patellar (knee cap) taping to improve the alignment of how the patella tracks, this strong tape has multiple uses and can often last for multiple days.
Kinesiotaping
- Another type of taping Kinesiotape, or “K-tape”, offers a person stability while maintaining the ability to move and fire muscles. Sometimes used following manual therapy performed by a physical therapist, K-tape can help extend the benefits of the manual therapy by helping to facilitate proper positioning without restricting movement. K-tape is malleable and can be used over any joint surface, ranging from the back, to a wrist, or even to a shoulder. If you think kinesiotape will benefit you in your recovery, ask your therapist if they offer this type of taping treatment!
Products That Can Be Purchased for Home Use:
- TENS units
- Hypervolt
- Hot Packs or Cold Packs
- Paraffin
- Kinesiotape
- “The Stick” Massager
- Foam Roller or Vibrating Roller
- Home Traction Units
- Graston Instruments or similar tools like Hawkgrips
All of the items listed above can be purchased through specific websites. Before purchasing an item, check with your physical therapist to make sure that it will benefit you in your recovery rather than harm you, as well as making sure you understand how to use the items safely!
Continue reading*From APTA’s “Beyond Opioids*
The most likely reason for a person to come to physical therapy is simple- Pain. There are different ways we can go about treating pain, with a popular approach being pain medications, specifically, opiates. Unfortunately there are a myriad of things that can go wrong with the use of opiates to control pain. Between the years of 2006 and 2012 America’s largest drug companies have saturated the country with 76 billion oxycodone and hydrocodone pills causing the nation’s deadliest drug epidemic to spin out of control.
- Painkiller prescriptions reached “Epidemic Levels” as of 2011.
- As of 2010, 12 million people age 12 and older reported using painkillers “non-medically”.
- In 2014, more than 750,000 people were receiving substance-abuse treatment for prescription opioids.
- In 2016, more than 3 out of 5 overdoses involved an opioid, with more than 42,000 people passing away due to opioid overdose, with more than 17,000 of those being due to prescription opioids.
You can read more about these statistics in a recent Washington Post article, link below.
Specifically for New Jersey, the rate of drug overdoses increased by nearly 30% from 2016 to 2017. In addition, provides in the state of New Jersey wrote 44.2 prescriptions for every 100 people. In order to take steps against opioid abuse, Governer Phil Murphy signed three pieces of legislation in hopes of decreasing opioid use. The bills that were signed are summarized as follows:
- A3292 – Prescription opioids in the state of New Jersey will now require a red warning label mentioning the risk of opioid medications.
- A4744 – Benefits for eligible recipients receiving certain types of medication assisted treatment under Medicaid to be given without imposition of any prior authorization.
- SJR35 – Designates October 6th as “Knock Out Opioid Abuse Day” in order to raise awareness about opioid use and addiction
- For more information, click on the link here to the Office of the Governor regarding the legislation: https://www.nj.gov/governor/news/news/562019/approved/20190716a.shtml
However, there is good news! The CDC (Center for Disease Control) has found that non-pharmacological (non-medication) treatments, such as physical therapy, have been found to be just as effective as pharmacological treatments when dealing with chronic pain. Physical therapy is a multidimensional profession utilizing the best treatments available based on the strongest research studies to relieve pain and restore function as fast as possible. This is often a combination of treatments such as:
- Massage
- Modalities (electrical stimulation, ultrasound, laser, heat, and cold)
- Manipulations (often thought of as only a chiropractic treatment)
- Dry needling and cupping (often thought of as only acupuncture treatments)
- Exercise
Physical therapy is a collaborative process which involves communication with various health professionals, so that physical therapists can provide you with the most effective treatment possible
The APTA put out a video that has a great illustration regarding the opioid epidemic with some additional information. If you are interested, you can click the link below!
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What is Physical Therapy?
Physical therapy utilizes an individualized treatment plan to provide you with the best care and results, focusing on returning to life and activity without dysfunction or pain.
Physical therapy is in a variety of medical settings including; fitness centers, private practices, skilled nursing facilities, hospitals, schools, and more.
Physical therapy is an integral part of care for diagnoses ranging from an ankle sprain to recovery from a brain injury or stroke. Physical therapy is a collaboration between you, your physical therapist, primary care doctor, cardiologist, rheumatologist, or any other specialist involved in your care; health and wellness is a team effort!
Why choose Physical Therapy?
Physical therapists are clinical doctors and are qualified to screen you for neuromusculoskeletal pathology. Your PT is qualified to determine if physical therapy is appropriate for you or if you need to be referred to a different doctor or specialist for your symptoms. Your clinician will help develop a plan of care appropriate for you whether that is in PT, or elsewhere.
Physical therapists are rehabilitation and movement specialists – there are not many other healthcare professionals who understand how and why people move the way they do like physical therapists!
Services
There are a variety of services that a physical therapist can provide. Physical therapy is a balanced, thorough approach to your pain. Physical therapist’s use the best techniques supported by consistent research to improve your pain and dysfunction. When necessary, Physical therapists provide manipulations, soft tissue mobilization, cupping, and dry needling to manage pain. These techniques are often viewed as exclusive to chiropractic care, massage therapy, and acupuncture, respectively. When paired with mindful specific exercise, these techniques among others will help you return to your best life.
The following are some treatment techniques utilized by physical therapists. Inquire to see if a certain treatment is appropriate for you. Some services that physical therapists can provide are, but are not limited to:
- Graston
- Dry needling
- Kinesiotaping/athletic taping
- Functional Movement Screen
- Modalities such as TENS, ultrasound, traction
- Treatment types such as CIMT, Mckenzie, etc.
- and many more!
These services aren’t required to be offered at every clinic and not every physical therapist will pursue the extra certifications to provide these services. Always inquire about what techniques a therapist is trained to perform. It is important to research what a clinic offers before deciding on where to begin your plan of care.
How to Find Your Therapist
Direct Access
You can see your Physical Therapist first! Often times patients find physical therapy after given a prescription from a medical doctor. In almost every state patients are able to directly access physical therapists without having to receive a prescription or referral from a medical doctor. To see if direct access is available in your area, check out the APTA website.
Therapist/patient ratio
It is important that you have one on one time with your physical therapist. The amount of individual time a therapist is able to spend with a patient can vary from clinic to clinic. Look for a clinic where the therapists organize their schedule to see each patient one on one for an hour at evaluation and two patients in an hour thereafter. This allows each patient to have one on one time with their therapist to reassess, update treatment plans, and receive focused hands on care. Consider inquiring about therapist to patient ratio by asking how many patients are scheduled with each therapist per hour. Higher quality clinics will only see 1-2 patients an hour per licensed physical therapist.
Physical Therapy for Your Specific Needs
Through additional coursework or residency programs, there are eight specializations that physical therapists can pursue through the American Board of Physical The
rapy. Specializations offer physical therapists a broader base of knowledge and increased skills specifically to a certain area of practice. These specializations are pursued completely by choice and are not required of physical therapists. These specializations are:
- Geriatrics
- Pediatrics
- Orthopedics
- Sports Therapy
- Cardiovascular and Pulmonary
- Women’s Health
- Clinical Electrophysiology
- Neurology
If you’re looking for a physical therapist that is a board-certified specialist in one of the eight areas, you can easily access this information at abpts.com and search for physical therapists based on a specialization in your area.
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Hiking Frozen Waterfalls
By Kristy Carrico
Hiking is one of my favorite pastimes! While on a New Year’s Day hike with my neighbor four years ago we committed to doing a hike every month. We have been as far south as the Pine Barrens, west into Pennsylvania, north into New York and so much in between. We take turns choosing the hike and haven’t missed a month yet. Her favorites are mountain tops and vistas while I love a great waterfall! What could be better on a sunny winter morning than a brisk walk to see frozen waterfalls?
The Hike
Last week we did one of my favorite winter hikes, Dingmans Falls in Delaware Township, PA. It’s in the Delaware Water Gap and takes a little over an hour to get there but the view is worth it. It’s a very popular place to visit in the summer but the visitor’s center and bathrooms are closed in the winter and the road is blocked off. There is a small parking area right off the road and you can walk up the driveway about a mile to the waterfalls. The actual hike is on a boardwalk, is handicap accessible, and is only about ½ mile round trip. Silverthread Falls is the first waterfall you come to. This tall and narrow falls was almost completely frozen and there were a few ice climbers there. Ice climbing is a popular sport that takes training and special equipment and these climbers had traveled over two hours to climb Silverthread. Ice climbing is not for me as I have a fear of heights and don’t really care to be wet and cold at the same time.
Continue on the boardwalk to the beautiful Dingmans Falls. This is a stunning 40 foot waterfall that pools into a 
pond like area. You can see different views of the falls by climbing the 221 stairs to the top. There is also a trail (2.4 miles) that continues to Child’s Park but it was not visible in the snow so we didn’t venture there. Dingmans Falls was still flowing abundantly but there was a safe area that was frozen that we ventured out on. Exhilarating!
This hike is beautiful in the winter, spring, and fall! PTCOE is planning to schedule some hikes this spring, summer, and fall and are hoping our friends will join us.
How To Get There
Take I-287N to I-80W to NJ-15N (exit 34B) to US-206N. Turn left at Tuttles Corner Dingmans Road and continue into Pennsylvania. Turn left on US-209 for .25 mile and the parking area/driveway will be on the right.
Lat: 41.13.50N Long: 74.53.32W
Other Waterfalls In The Area
George W. Childs Park
Raymondskill Falls
#hiking
#waterfalls
#dingmansfalls
#silverthreadfalls
#raymondskillfalls
#hikingwaterfalls
#iceclimbing
For so many of our patients, colder weather means hitting the slopes for the first time since last year. Winter sports are a fun way to maintain both cardiovascular and muscular endurance, but whether you’re a snowboarder, skier, ice skater, or snow tuber, preparation is key to preventing winter injuries. Here are some exercises to get you started:
** Always consult with a medical professional before starting any exercise program in order to determine your target heart rate and signs/ symptoms of any distress.
Squat Variations
Squats are somewhat of a total package for lower extremity strength, including your hamstrings, gluteal muscles, and quadriceps.
Wall Squats with PhysioBall
Start with a physioball behind your back against a wall. Slowly bend your knees, approaching a 90 degree angle. Be sure not to let your knees pass in front of your toes — if they do, step your feet out further. Once you bend down to a comfortable angle, stand straight up. Repeat.
Wall Sits
These are specifically great for improving isometric strength, which you use when maintaining a squatting position in both skiing and snowboarding. Start with your back on the wall with your hips and knees at 90 degree angles. First, hold for 15 seconds, then increase the time as tolerated until your quads fatigue.
Butt Burners
Also called a curtsey squat; is a single leg squat where your back leg ends up at approximately a 45 degree angle behind the front squatting leg. Again, be sure that your knee translate in front of your toes too far. Extending your hands in front of you will allow you to sit back into the squat better. When you stand back up, drive the back leg up towards your chest for an extra challenge.
Hip Strength
Sports like skiing and snowboarding require quite a bit of hip stability. These exercises will help you to strengthen your hips to avoid placing increased stress on your knees.
Clam Shells
Lay on your side with both knees bent. Keep your feet touching while lifting your top knee. Be to keep your pelvis still and not rotate your whole body. Repeat 10-15 times for 3 sets. For an extra challenge, tie a theraband slightly above your knee before beginning.
Crab Walks
Start by placing a theraband above your ankles and begin in a squat position with arms extended. Keeping your chest upright and in line with your lower body, take wide steps sideways, bringing your feet together between each step. Continue for 15-20 ft, then continue facing the same direction as you do the same movements back towards your starting point. Repeat 2-3 times.
Plank Variations
Core strength begins with torso stability and provides a foundation for both lower and upper extremity motions. For all three of these exercises, start on a yoga mat, and remember to keep your core and gluteal muscles tight throughout.
Forward Planks
Lay on your stomach with your forearms on the ground and your elbows located directly below your shoulders. Push up through the forearms until your chest and stomach rise off the ground and your body is in a straight line. Focus your gaze 6-12 inches in front of you to keep your neck in line. Hold until fatigue.
Side Planks
Lay on your side with your whole body straight; keep your lower elbow bent at 90 degrees, directly below the shoulder. Push up through your forearm, keeping the body in a straight line throughout. Focus your gaze directly in front of you to keep your neck in line. Hold until fatigue.
Side Planks with Leg Lift
Assume the same position as side planks. Once you feel stable here, begin to lift the upper leg 1-2 feet up in the air and slowly return it back towards the lower leg. Stay in this side plank position and repeat the leg movement several times. Continue until fatigue then switch sides.
Continue readingIt’s a new year and we all know what that means: it’s time to put down the Christmas cookies and get serious about our 2019 health goals. Eighty percent percent of people will ditch their resolution by February, so it is important to plan ahead. Here are some tips for maintaining your resolutions this year:
First Thing Is First – Your Health Should be Top Priority.
We recommend setting goals which focus on your health. This includes a healthy diet, getting eight hours of sleep per night, proper hydration, and getting 150 minutes of moderate-to-vigorous activity per week. These goals might seem lofty, so it is okay to start small and work your way up. Another thing to consider is reducing bad habits like smoking and alcohol intake. With this in mind, it is important to discuss your plans with a medical professional, like your primary care physician or a physical therapist, if this is your first time being active in a while. New Jersey is a direct access state, meaning you can be evaluated by a physical therapist without a prescription from your physician.
Set Specific, Measurable Goals
Setting a variety of goals to work towards has been proven to increase success rates. Try setting short term goals first, like getting to the gym 2-3 times the first week or drinking an extra glass of water per day. Once you have boosted your confidence by accomplishing small goals, work towards bigger ones, like completing your first 5K or hiking that mountain you have always wanted to. This will give you something to look forward to on the calendar and make your short-term goals more motivating.
Hold Yourself Accountable
Having someone waiting for you at the gym or at your favorite farmer’s market holds you more accountable for your goals. While you may be tempted to skip a morning workout alone, knowing that your friend is waiting for you will motivate you to get out the door. Group fitness classes are another fun way to be active with your friends, and many gyms have classes which are accessible both before and after work.
Much like meeting up with friends, having a trainer sets a time and date that can be solely dedicated to fitness. Certified personal trainers also have the knowledge base to get you in shape while minimizing your risk of injury.
Track your progress – and reward yourself for accomplishments!
Writing down your goals on a calendar or making to-do lists allows you to keep your eye on the prize. If you achieve all of your goals for the week, treat yourself to something like a smoothie or a new pair of running shorts.
Wearable technology, like FitBit, Apple Watch, and Garmin make tracking your progress easy. Not only are they pedometers which track your steps, but many also allow you to log runs, swims, and even yoga. If watches aren’t your style, there are great apps like Apple Health, MyFitnessPal, and RunKeeper which are all free and accessible on your SmartPhone’s App Store.
Whatever your health goals are for 2019, PTCOE is always here to answer questions and guide you in the right direction. Throughout the month of January we are even offering 50% off any personal training package to get you moving in the right direction!
Happy Resolutioning!
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