• Low Back Pain
• Sciatica
• Neck and Shoulder Pain
• Hip and Knee Pain
• Ankle and Foot Disorders
• Arthritis
• Tendonitis
• Bursitis
• Carpal Tunnel
• Headaches
• Work-Related Injuries
• Sports Injuries
• Orthopaedics
• Fibromyalgia/Chronic Pain
• Balance/Fall Prevention
• Pre- and Post-Surgical Rehabilitation
• TMJ Dysfunction
• Vestibular Rehab
• Functional Capacity Exams
• Concussion management
• ImPACT testing

Aquatic therapy (therapy performed in a pool), is quickly becoming well known for its amazing effects on decreasing pain, speeding recovery, preventing injury and improving function. Aquatic therapy consists of treatment that is performed in water which usually includes exercise and sometimes even manual therapy, if necessary. It is a beneficial form of physical therapy that is useful for a variety of medical conditions. Aquatic therapy uses the physical properties of water to assist in patient healing and exercise performance by reducing the weight bearing on joints and providing an overall warm, soothing environment. The fastest way to recover from pain/injury is to begin the rehab process, but often times pain levels prevent patients from beginning rehab.  The pain commonly associated with rehab can be decreased/eliminated in water, thus allowing rehab to begin, first in water then progress to land.

Mishock PT & Associates is one of the few places in the region which provides lymphedema therapy. Lymphedema is a condition in which lymph fluid accumulates in the arms, legs, and/or trunk usually as a result from another, underlying medical condition.

One cause of chronic swelling could be lymphedema. This is a condition where swelling occurs in the extremities due to a compromised or damaged lymph system. Lymph is the fluid that bathes the cells with needed nutrients, oxygen, and white blood cells provided by the circulatory system. Lymph is very important to the health of cells and tissues, and helps the body fight infection. Lymph vessels remove waste products from the cells encouraging healthy circulation.

When an injury occurs, the body’s normal response is to swell. The body’s response is to send an increased amount of blood carrying nutrients, oxygen, and white blood cells to the involved area. Under healthy circumstances the body can handle a 20% increase in lymph fluid. This is why swelling does not linger for more than a few days following a minor injury. However, when the lymph system is damaged, even the slightest increase in fluid is difficult to clear. This fluid continues to build up causing increased swelling to the injured area as well as the affected extremity. The lymph system can be damaged through surgery, radiation, or trauma. This damage prevents the flow of lymph back into the circulatory system.

Lymph flows in only one direction, toward the heart. All lymph fluid is passed through the lymph nodes that act as filters, and eventually this fluid makes its way back into the blood. Unlike the circulatory system the lymph system does not have a pump to push the fluid along. The lymph vessels rely on external pressure from the movement of surrounding muscles to carry the lymph through the system where the excess fluid can be reabsorbed back into the circulatory system.

Lymphedema is best treated in physical therapy with three primary interventions:

1.) Manual lymph drainage to encourage the lymph nodes and vessels to take up the excess fluid and move it into the correct drainage area.

2.) Compression therapy to provide the proper gradient pressure to the involved limb.

3.) Therapeutic exercise for joint flexibility and muscle contraction necessary for optimal lymphatic mechanics

*Please note, if you are suffering from chronic swelling, it is important to see your family physician first to determine whether or not your circulatory system is involved.

Contact Us Today!

Mishock PT’s Gilbertsville location offers treatment for Lymphedema. Call 610-327-2600 for more information. Megan Repko, MPT, specializes in the treatment of Lymphedema patients. She looks forward to helping you today!

ART is a patented, state-of-the-art soft tissue system/movement based massage technique that treats problems with muscles, tendons, ligaments, fascia and nerves. Headaches, back pain, carpal tunnel syndrome, shin splints, shoulder pain, sciatica, plantar fasciitis, knee problems, and tennis elbow are just a few of the many conditions that can be resolved quickly and permanently with ART. These conditions all have one important aspect in common: they are often a result of overused muscles.

What is an ART treatment like?

Every ART session is a combination of examination and treatment. The ART provider uses his or her hands to evaluate the texture, tightness, and movement of muscles, fascia, tendons, ligaments, and nerves. Abnormal tissues are treated by combining precisely directed tension with very specific patient movements. These treatment protocols – over 500 specific moves – are unique to ART and enable the therapists to identify and correct problems affecting specific soft tissues of each individual patient. It is a specialized approach to soft tissue mobilization/manual therapy to improve dysfunction.

ART sessions allow the therapists to identify and correct the specific problems that are affecting each individual patient. Art is not a cookie-cutter approach. ART is performed differently.

There is a new technique used at Mishock Physical Therapy & Associates, called the Fascial Manipulation. This remarkable procedure allows us to detect and treat areas of dysfunctional muscle or fascia that may be leading to acute or chronic muscle pain and dysfunction. Fascia is a thin strong soft tissue that forms a continuous covering over muscles, nerves, and organs.

Fascial Manipulation is a technique that was developed in Italy over 35 years ago by an Italian physical therapist, Luigi Stecco. He developed a system of assessment and treatment of these muscle or fascial restrictions. Anatomical studies have now supported his claims, demonstrating that in each muscle there are motor points (areas where the nerve meets the muscle). It is believed that during injury these points become densified (hardened) adversely affecting the muscle nerve receptors resulting in abnormal tension in the fascial system. This in turn causes aberrant stress in that region of the body leading to pain and dysfunction. Often the pain may be at a distant site from where the muscle problem is. For example, chronic low back pain may be due to dysfunction tissue in the middle back, hips, or even the ankle.

Fascial Manipulation begins with a complete history and functional evaluation to determine what fascial plane or planes appear to be most involved. This is followed by palpating (touching) the motor points that relate to the painful movements, looking for densification, tenderness, and a referred pain pattern (pain that radiates to a distant area).

Treatment involves the clinician’s hands using pressure and movement on these dysfunctional motor points and fascia. In the beginning we use light pressure and movement attempting to go deeper, as tolerated by the patient. Each point is worked on for 2 – 5 minutes and then we move onto the next dysfunction point. The aim is to restore gliding between the fascia and release the dysfunctional motor unit. The Fascial Manipulation technique is followed by traditional physical therapy such as: stretching, strengthening, aquatic therapy, patient education, and modalities (ice, heat, ultrasound, electric stimulation) with the goal of treating the cause of the problem and preventing it from returning.

The Fascial Manipulation Technique is currently being used by many professional sports teams, chronic pain clinics, and work injury providers. Furthermore, there are a number of research studies demonstrating the technique’s anatomical and clinical efficacy.

More common diagnoses that respond well to Myofascial Manipulation Technique:

The Graston Technique® incorporates a patented form of instrument-assisted soft tissue mobilization that enables clinicians to effectively detect and treat scar tissue and restrictions that affect normal function.

It is an innovative technique to mobilize the soft tissues by using metal tools in a specific way, which enables clinicians to effectively break down scar tissue (in muscle) and fascial (covering of muscle) restrictions. The Graston Technique utilizes specially designed stainless steel instruments to specifically detect and effectively treat areas exhibiting soft tissue fibrosis or chronic inflammation.

The Technique:

• Separates and breaks down collagen cross-links, and splays and stretches connective tissue and muscle fibers
• Increases skin temperature
• Facilitates reflex changes in the chronic muscle holding pattern
• Alters spinal reflux activity (facilitated segment)
• Increases the rate and amount of blood flow to and from the area
• Increases cellular activity in the region, including fibroblasts and mast cells
• Increases histamine response secondary to mast cell activity

Kinesio Taping came to notoriety shortly after the 2008 Olympics where numerous athletes were photographed wearing the colored tapes. The Kinesio Taping concept was developed by Dr. Kenzo Kase, DC in 1973 in Japan and was introduced to the US in 1995. Mishock Physical Therapy has many clinicians who are Certified Kinesio Taping Practitioners (CKTP).

This taping concept utilizes a non-latex, elastic, cotton fiber tape with no medicinal properties. It can be used for acute (new) to chronic injures, throughout all stages of rehabilitation, and to prevent re-injury. It is safe to use in any population, including children and the elderly, with only minimal contraindications. The tape does not limit motion; in fact it works with the body to help assist in normal range-of-motion. The tape can be worn for 3-5 days in order to enhance performance.

The technique can be used to create positive responses to skin, fascia, muscle, joints, ligaments, tendons, and circulatory/lymphatic systems. Through the application, with varying amounts of tension in the tape and direction of pull, it can microscopically lift the skin to create increased lymphatic drainage, decreased inflammation, and more space for receptors that lie under the skin/fascia. Creating more space can allow for excessive swelling to decrease or decreasing pressure on the receptor in the muscle that perceives pain. The concept can also be used to re-educate the muscles to function properly from over or underuse, and can assist with corrections to better align joints, ligaments, and tendons and return the body to homeostasis.

Kinesio Tape differs from athletic taping in that it is not restrictive to the involved muscles and joints. Athletic tape will provide support to help prevent additional injury, but also inhibits free movement and “breathing” of the skin. Additionally athletic tape offers no ability to relieve pain in the affected area.

There is current research stating that the benefits of this therapeutic Kinesio Tex Tape can affect the skin, lymphatic and circulatory system, fascia, muscles, ligaments, tendons, and joints. It is used in conjunction with other physical therapy treatments and modalities including manual/myofascial techniques. Kinesio Taping can also prolong any therapeutic benefits that are achieved during a manual treatment session.

Chiropractic care implements a wide variety of hands-on techniques including: diversified adjusting, active release technique, strain-counter-strain, myofascial release, activator, spinal manipulation, Cox flexion/distraction, and trigger point therapy. A more detailed explanation of a few of those techniques is listed for your convenience:

Active Release Technique (ART): ART is a patented, state-of-the-art soft tissue system/movement-based massage technique that treats problems with muscles, tendons, ligaments, fascia, and nerves. Headaches, back pain, carpal tunnel syndrome, shin splints, shoulder pain, sciatica, plantar fasciitis, knee problems, and tennis elbow are just a few of the many conditions that can be resolved quickly and permanently with ART. These conditions all have one important thing in common: they are often a result of overused muscles.

Spinal Manipulation/ Mobilization: Manipulation/mobilization is the precise controlled movement of a joint through its range-of-motion using one’s hands. It is often associated with a “cracking” sound. It has been a treatment technique used with success for thousands of years. Manipulation/mobilization is performed by chiropractors, physical therapists, and osteopathic physicians. There are hundreds of studies supporting the efficacy of manipulation/mobilization for acute/chronic spinal pain, migraine, and cervicogenic (neck related) headaches.

Myofascial Release: Myofascial Release is an effective hands-on technique that involves applying gentle sustained pressure into the Myofascial (muscle) 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 muscle and fascia to elongate

Trigger Point Therapy: Trigger points are described as hyperirritable/painful spots in muscle that are associated with palpable nodules in taut bands of muscle fibers. The clinician uses compression/massaging of a trigger point which releases the muscle nodule thereby allowing pain relief and relaxation of the muscle.

Strain-Counterstrain/ Positional Release Technique: This is a very gentle technique in which the clinician gently contacts the painful trigger point/muscle and positions the body part in a relaxed position. This is held for 90 seconds and repeated on other dysfunctional muscles. This technique is often used with severe acute pain when the patient cannot tolerate other forms of treatment, such as with an acute whiplash injury.

Fascial Manipulation: There is a new technique used at Mishock Physical Therapy & Associates, called the Fascial Manipulation. This remarkable procedure allows us to detect and treat areas of dysfunctional muscle or fascia that may be leading to acute or chronic muscle pain and dysfunction. Fascia is a thin strong soft tissue that forms a continuous covering over muscles, nerves, and organs.

A Chiropractor, as defined by www.webmed.com, is someone who uses his or her hands to manipulate the spine into alignment. Chiropractic therapy may be used on its own or with other treatments (like physical therapy). Chiropractic seeks to restore joint function, eliminate pain, and prevent further injury.

Mishock Physical Therapy & Associates has 3 basic Prevention Programs: Balance & Fall Prevention, ACL Tear Prevention/Sports Performance Improvement, and Dynamic Stretching.

Balance & Fall

Each year 2 million seniors are treated in the E.R. for fall-related injuries. Falls = injury, decreased independent function, premature admission to nursing homes, and even early death. If you have a tendency to fall or believe you may be in danger of falling for any reason, please don’t hesitate to contact any of our offices and ask to schedule your evaluation.

ACL Tear Prevention/ Sports Performance Improvement

Are you an athlete (or do you know an athlete) looking to improve sports performance or prevent an injury? Mishock Physical Therapy can help you INCREASE SPEED, AGILITY, & ENDURANCE while helping to prevent major injury. Knee and lower extremity injuries are not only painful and disappointing, but also expensive! Your goal and our goal is to keep you in the game! Call us today to learn more about this program. Improve explosive power for soccer, baseball, football, lacrosse, tennis, track & field, field hockey, and more.

Dynamic Stretching

The type of stretching that an athlete does prior to an athletic endeavor is important to improving performance and preventing injury. Static stretching (the traditional 30 second hold variety) has long been the standard activity performed prior to athletic events. However, more current research has demonstrated that dynamic stretching may be the better way to prepare the athlete for competition.

Static stretching prior to an activity may actually have adverse effects, such as calming the athlete, decreasing blood flow, and reducing overall strength output. Furthermore, there is a neuromuscular inhibitory response to static stretching. The stretched muscle becomes less responsive and stays weakened for up to 30-60 minutes after stretching, which is not how an athlete wants to begin competition. The muscle is then actually weaker and may be more vulnerable to injury.

Conversely, research has shown that dynamic stretching, a rhythmic, smooth, continuous series of movements that stretches many joints of the body in functional patterns, can increase power, flexibility, and range-of-motion. Unlike static stretching, dynamic stretching does not cause the inhibitory response to the nervous system. Beyond this, dynamic stretching will increase heart and respiratory rates, allowing the athlete to be better prepared for activity. Dynamic stretching also primes the body for more intense activity to come.

A study comparing hamstring strength production during a leg curl exercise performed after both static and dynamic stretching revealed significant differences in strength output. Results showed that static stretching produced a significant reduction in hamstring strength for a time period lasting up to one hour post-stretching. Dynamic stretching, however, resulted in significantly higher muscle temperature and increased muscle flexibility. This study supports the use of dynamic flexibility prior to a competition or training session and suggests that static stretching should be used as a post-workout cool down (Journal of Strength and Conditioning Research, 2005).

THE RIGHT WARM-UP should accomplish two things: loosen muscles and tendons to increase the range of motion of various joints and, literally, warm up the body. When muscles are at rest, there is less blood flow to muscles and tendons and they stiffen. A well-designed warm-up starts by increasing body heat and blood flow. Warm muscles and dilated blood vessels pull oxygen from the bloodstream more efficiently and use stored muscle fuel more effectively.

Even golfers, notoriously nonchalant about warming up, would benefit from exerting themselves a bit before teeing off. A recent survey of 304 recreational golfers found that two-thirds seldom or never bother to warm up prior to golf. In one 2004 study, golfers who did dynamic warm- up exercises and practice swings increased their club-head speed and were projected to have dropped their handicap by seven strokes over seven weeks. And new research out of Bloomsburg University in Pennsylvania, suggests that those who warm up are nine times less likely to be injured.

The optimal way to warm-up (and stretch) prior to an athletic event is to start with a few minutes of low intensity aerobic exercise (walking or jogging) around the court or field. Follow this by performing dynamic stretches. Thirty seconds to one minute of the following: walking lunges, body weight squats, high knee hugs, lateral lunge walks, straight leg marching, quad walks, and arm circles. Static stretching can be simply moved to end of the workout. Don’t trash it altogether because the inhibitory effect on the nervous system can be beneficial to elongate tight muscles, reduce soreness, and speed recovery.

Our PT Evaluation + The Right Exercise Program + Patient Education = Minimized Risk

• Attention Female Athletes: Prevent ACL Tears Today!
• Attention Seniors: Prevent Falls & Improve Your Balance Today!
• Attention Baseball Pitchers: Prevent Shoulder & Elbow Injury!
• Let It Snow! How to Prevent Injury While Shoveling Snow

ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) is the most-widely used and most scientifically validated computerized concussion evaluation system. ImPACT provides trained clinicians with neurocognitive assessment tools and services that have been medically accepted as state-of-the-art best practices — as part of determining safe return to play decisions. ImPACT addresses the need for an accurate, medically accepted assessment system that is used as part of an overall concussion management protocol.

ImPACT has the largest database of clinical research (190 peer reviewed and over 125 independent studies) on concussion management, validating ImPACT’s model. Further, ImPACT’s comprehensive normative data includes more than 75,000 (and growing) results, which provides reliability and validity of testing, even without a baseline.

ImPACT has received numerous accolades and endorsements from many of the world’s leading sports authorities, governing bodies, teams and athletes. Currently, more than 10,000 medical professionals have been trained by ImPACT on concussion management and the ImPACT Program. ImPACT is in use by many teams in MLB, NHL, NFL and WWE. More than 7,400+ high schools, 1,000+ colleges and universities, 900+ clinical centers, 430+ Credentialed ImPACT Consultants, 200+ professional teams and select military units use ImPACT. Cirque du Soleil, Irish and South African rugby teams, among many other organizations around the globe also use ImPACT.

Fall Risk – Assessment, Prevention & Treatment

In the next 17 seconds, an older adult will be treated in a hospital emergency department for injuries related to a fall. In the next 30 minutes, an older adult will die from injuries sustained in a fall. Falls are the leading cause of injury among adults aged 65 years and older in the United States.

Statistics from the Centers for Disease Control and Prevention (CDC – 2010):

• Among older adults, falls are the leading cause of both fatal and nonfatal injuries.
• One out of three older adults (aged 65 or older) falls each year
• Less than half of those who fell talk to their healthcare providers about it
• Over 95% of hip fractures are caused by falls
• Over 97% of wrist fractures are caused by falls
• In 2010, almost 22,000 older adults died from fall injuries
• Children ages 12 – 17 have the second highest incidence of falling
• In 2010, the direct medical costs of falls, adjusted for inflation, were $30 Billion

Statistical evidence clearly demonstrates the following actions reduce fall risk:

• Being screened for fall risk by a medical professional
• Getting adequate calcium and Vitamin D
• Performing weight bearing and balance exercises

Mishock Physical Therapy can help you prevent falls!

The XObalance is for patients experiencing gait abnormalities and/or foot and heel pain.

 Utilizes state of the art technology for a more thorough evaluation.

• Evidenced-based treatment protocols to decrease pain and improve function
• Improves balance to prevent falls
• Improves recreational and athletic performance

Providing:

• Computer assisted neuromuscular re-education
• Dynamic gait retraining

Mishock also provides Custom Bracing & Orthotics

LSVT BIG® is a standardized exercise prescription that adheres to principles of practice promoting strength, motor learning and changes in brain function. LSVT BIG is a research-based exercise approach. Initial research funded by NIH has also shown LSVT BIG to enhance amplitude whole body functional movements for up to three months (post intervention) that include:

•  faster walking with bigger steps

•  better balance

•  increased daily function

• Benign Paroxysmal Positional Vertigo (BPPV)

• Labyrinthitis

• Vestibular Neuritis

• Meniere’s Syndrome

• Perilymph Fistula

• Bilateral Vestibular Loss

• Cervicogenic Dizziness (Cervical Vertigo)

• Migraine Related Dizziness