Office Hours: Mon.-Fri. - 8:00 am-5:00 pm Saturday - 8:00 am-12:00 pm At Comprehensive Physical Therapy Center, our clinicians have expertise in treating all non-surgical and/or post surgical orthopedic/sports medicine related injuries/conditions for patients of all ages and level of condition, including: 1. Temporomandibular Disorders 2. Cervicogenic Headaches 3. Cervical, Thoracic, and Lumbar Spinal Disorders 4. Shoulder, Elbow, and Hand Disorders 5. Hip, Knee, and Ankle/Foot Disorders 6. Medically Deconditioned Patients 7. Vestibular Rehabilitation: Dizziness and Vertigo 8. Balance Training and Fall Prevention 9. Custom Orthotic Fit/Fabrication (Fastech) 10. Biofeedback/Stress Management 11. Women’s Health 12. Sports Related Injuries 13. Ergonomic and Workplace Assessment 14. Functional Capacity Evaluations 15. Arthritis Management 1. Temporomandibular Disorders (TMD) Temporomandibular disorders (TMD) occur as a result of problems with the jaw, jaw joint and surrounding facial muscles that control chewing and moving the jaw. TMD is usually treated as a team approach, with physical therapy being an integral part of the comprehensive plan. Physical therapy will address any biomechanical dysfunctions from the temporomandibular joint itself, the cervical spine (neck) and corresponding facial/masticatory, cervical, and periscapular muscles that can contribute to TMD. Another important consideration in the cause of TMD can also include the role of psychosocial stressors that have also been shown to exacerbate TMD symptoms. At Comprehensive Physical Therapy Center we offer Stress Reduction and Biofeedback services by a liscenced professional that can be scheduled in conjuction with regular physical therapy appointments. TOP 2. Cervicogenic Headaches Cervicogenic headaches are classified as head pain that can originate in the back/base of the skull and radiates throughout the head in a specific pattern depending on the origin of pain, for example behind the eye. These headaches are typically manifested by dysfunction in the deep cervical (neck) and periscapular muscles. Upper cervical spine joint dysfunction has also been linked to these headaches. A person’s resting posture and/or work related posture/ergonomics can play a big role in the manifestation of these symptoms. In the older population, arthritic changes to the cervical spine can also contribute. TOP 3. Cervical, Thoracic, Lumbar Spinal Disorders Disorders of the spine can be classified as either secondary to an acute trauma/event or as a chronic disorder. At Comprehensive Physical Therapy Center, we treat both. Examples of acute spinal injury can come from impact sports, falls, “whiplash” from car accidents. Acute injury can affect all structures in the spine from the vertebrae and corresponding joints, spinal muscles and ligaments, spinal nerves and discs (herniations). Chronic spinal disorders can also affect the same structures of the spine, but typically build up over time. Arthritic or degenerative changes to the spine that develop over time can predispose people to spinal disorders. These changes do not necessarily have to be painful, rather extraneous variables including our level of fitness/body morphology, lifestyle, posture, other biomechanical faults can all lead to stress on these arthritic spinal areas causing pain. At CPTC, we can treat all arthritic changes to the spine, but more importantly, we look to identify the stressors that inflame these arthritic changes. We are also trained to treat all post-surgical spinal conditions following appropriate tissue healing parameters and the referring physician’s rehabilitation guidelines. Finally, another common symptom we treat is “sciatica,” which is referring to the pain sensation and or numbness/tingling that can radiate from the back and into one or both lower extremities and possibly into the feet/toes. It is important to realize that sciatica is NOT a diagnosis, but rather a symptom of something that is CAUSING it. Disorders of the lumbar spine, sacro-iliac joints, and pelvic/hip muscles can all create these symptoms. It is our job to identify your source of sciatic pain. TOP 4. Shoulder, Elbow, and Hand Disorders We treat all disorders of the shoulder, elbow, and hand that have to do with the corresponding bones, muscles, ligaments, tendons, and specific structures unique to each body area. Commonly seen shoulder disorders include:   a. shoulder impingement, primary and secondary   b. shoulder bursitis   c. rotator cuff tendinopathy, partial to full thickness tear   d. shoulder instability/multi-directional instability   e. adhesive capsulitis   f. labral tears   g. muscle strains   h. proximal bicipital tendinopathy   i. acromioclavicular (AC) joint injuries   j. sternoclavicular joint injuries   k. sternocostal joint injuries   l. Thoracic Outlet Syndrome Commonly seen elbow disorders include:   a. medial epicondylitis or “golfer’s elbow”   b. lateral epicondylitis or “tennis elbow”   c. ligament strains; example: ulnar collateral ligament (UCL) strain   d. muscle sprains   e. distal bicipital tendinopathy   f. triceps tendonitis   g. peripheral nerve injuries to either ulnar, radial, or median nerves   h. cubital tunnel syndrome   i. radial tunnel syndrome   j. stress fracture OCD/Panner’s Disease   k. olecranon bursitis   l. loose body chondromalacia Commonly seen Forearm/Wrist/Hand disorders we treat include:   a. flexor-pronator muscle strains   b. muscle strains   c. ligament sprains   d. tendinopathies   e. carpal tunnel syndrome (CTS)   f. De Quervain’s tenosynovitis   g. Carpal, metacarpal, phalangeal fractures; example Scaphoid fracture   h. Radial and/or ulnar fractures; example Colle’s fracture   i. Osteo and rheumatoid arthritic changes to hand/fingers We are also trained to treat all post-surgical spinal conditions following appropriate tissue healing parameters and the referring physician’s rehabilitation guidelines. TOP 5. Hip, Knee, and Ankle/Foot Disorders We treat all disorders of the hip, knee, and ankle/foot that have to do with the corresponding bones, muscles, ligaments, tendons, and specific structures unique to each body area. Commonly seen hip disorders include:   a. muscle strains   b. ligament sprains/labral tears   c. tendonitis; for example hip flexor tenditis   d. osteoarthritis of the hip   e. post operative total hip arthroplasty, hip resurfacing Commonly seen knee disorders include:   a. muscle strains   b. ligament sprains; for example medial collateral ligament (MCL), lateral collateral ligament (LCL), anterior cruciate ligament (ACL), posterior cruciate ligament (PCL)   c. tendonitis; example patellar tendinitis   d. meniscal injuries   e. patellofemoral syndrome/chondromalacia of the patella   f. distal ilio-tibial band (ITB) syndrome   g. osteoarthritis of the knee   h. post-operative total knee arthoplasty, hemi arthoplasty Commonly seen lower leg/ankle/foot disorders include:   a. medial tibial stress syndrome or “shin splints”   b. compartment syndrome   c. muscle strains   d. ligament sprains   e. tendonitis; example Achilles, Posterior Tibial, Peroneal tendons   f. plantarfasciitis   g. hallux rigidus   h. metatarsalgia/Morton’s neuroma   i. stress fracture We are also trained to treat all post-surgical spinal conditions following appropriate tissue healing parameters and the referring physician’s rehabilitation guidelines. TOP 6. Medically Deconditioned Patients Medically deconditioned is a phrase that describes a patient who suffers from a lack of muscle strength and endurance, reduce cardiorespiratory endurance, poor balance, lack of energy/fatigue. This can be a result of inactivity, age, or medical co-morbidities. Following appropriate physician based guidelines, we can help rehabilitate each patient with the goal towards improving their quality of life. TOP 7. Vestibular Rehabilitation: Dizziness and Vertigo The vestibular system consists of 3 semicircular canals that are sensitive to head rotations, and 2 otolith organs that are sensitive to linear head movements. The system resides within the inner ear, along with the cochlea (auditory organ) and performs the following functions:   a. Gaze stabilization when moving your head.   b. Postural correction/adjustments to prevent a fall (balance)   c. Orientation relative to gravity. Normal balance requires the integration of visual, vestibular, and somatosensory (use of muscles and joints) information. When one of the systems does not function well, you may experience blurred vision with head movements, disequilibrium, an abnormal sense of movement or orientation, poor balance, dizziness and/or vertigo, and motion sensitivity. At Comprehensive Physical Therapy, a licensed Physical Therapist trained in vestibular rehabilitation will complete an initial evaluation to determine if physical therapy is appropriate. The therapist will evaluate your vestibular system by assessing your sensitivity to head movements, postural orientation, and static/dynamic balance. The physical therapist will then work with you to develop an individualized program to decrease your dizziness and improve your balance. Your vestibular rehabilitation program may include:   a. Balance retraining exercises   b. Sensory organization techniques   c. Gaze stabilization strategies to decrease blurred vision/dizziness.   d. Habituation exercises to decrease motion sensitivity.   e. Canalith Repositioning maneuver: If you are diagnosed as having BPPV   f. An individualized home exercise program to maximize your rehabilitation potential. You may be a candidate for vestibular rehabilitation if you suffer from:   a. Vestibular Neuritis: Viral infection of the vestibular nerve.   b. Labyrinthitis: Infection/ inflammation of the labyrinth of the inner ear.   c. Benign Paroxysmal Positional Vertigo (BPPV): caused by calcium carbonate crystals moving within the inner ear.   d. Bilateral vestibular loss (BVL): due to use of ototoxic medications or autoimmune disease.   e. Meniere’s Disease: abnormality in the fluids of the inner ear causing dizziness and ringing in your ear.   f. Unilateral Vestibular Hypofunction (UVH): One side of the vestibular system (inner ear) is not working properly, due to an inner ear infection, aging, or prior injury.   g. Stroke: Depending on the severity and area affected, you may benefit from balance retraining and gaze stabilization exercises. TOP 8. Balance Training and Fall Prevention Each year in the United States 30% of community dwelling people over the age of 65 years will experience a fall and 12% of those will have a serious injury (*1). The risk for a fall increases to 45% in people over the age of 75 (*1,2). Falls can result in devastating consequences including fractures of the hip, pelvis, spine, forearm, leg, ankle, arm, and wrist. Injuries resulting from a fall can severely limit your mobility and impact your quality of life. Your risk of falling depends heavily on your ability to balance. Balance requires the integration of visual, vestibular (inner ear), and somatosensory (muscle strength, joint integrity, and sensation) information. As you get older you may have decreased function of one or many of the sensory systems that control balance. When one of the systems is impaired, you have a greater chance of losing your balance and having a fall. At Comprehensive Physical Therapy a trained physical therapist will perform a thoughtful and thorough evaluation of your balance which will include an assessment of your strength, flexibility, joint mobility, endurance, and sensation. A Physical Therapist will assess your risk of falling and develop an individualized program for you to follow to improve your balance and decrease your risk of falling. Your program may include a combination of dynamic and static balance training in addition to lower extremity strengthening and conditioning. Excellent candidates for our balance and fall prevention program include those with a Dr.’s referral who suffer from:   a. Diabetic peripheral neuropathy involving decreased sensation in the legs and feet   b. Muscular weakness and de-conditioning   c. Inner ear disorders including vestibular neuritis, labyrinthitis, benign paroxysmal positional vertigo (bppv), Meniere’s disease, bilateral and unilateral vestibular (inner ear) loss, and stroke.   d. Parkinson’s disease   e. Impaired vision *1 Hornbrook, M.C., Wingfield, DJ., Hollis,J.F., Greenlick, M.R., and Ory, M.G., Preventing falls among community-dwelling older persons: results from a randomized trial. The Gerontologist, Vol 34, Issue 1 16-23, 1994. *2 Hausdorff, JM, Rios, DA., Edelberg, HK. Gait variability and fall risk in community-living older adults: a 1-year prospective study. Arch Phys Med Rehabil, 2001, Aug;82(8):1050-6. TOP 9. Custom Orthotic Fit/Fabrication (Fastech) Foot orthotics are a device or insert which fits into shoes and help decrease stress on body tissue by correcting anatomical alignment while standing, walking, and running. Oftentimes, foot orthotics can help in treating plantarfasciitis, shin splints, Achilles tendonitis, etc. Orthotics can be used for different reasons, for different people. For “flat-footed” (over pronated) people, they can control excessive foot motion to decrease stress on the body. For “rigid, high arched” (supinated) people, they can provide increased cushion and shock absorption. There are a variety of systems that can be used to fabricate foot orthotics at Comprehensive Physical Therapy Center. With each system, we take measurements in a non-weight bearing position to make an assessment of how closely the joints of the foot align so not to cause tissue stress. Then, a mold of the foot is taken to get a weight-bearing impression. Following the molding procedure, the foot orthotics are then contoured so that we, “bring the ground up to meet the foot” in an unstressed position with good postural alignment. All measurements and production of the foot orthotics take place in the clinic so that we can modify the product as needed, thereby decreasing downtime and increasing patient comfort. These orthotics are classified as semi-rigid and will likely last 2+ years with appropriate care. They can fit in any running shoe and can be molded to fit into special athletic shoes (i.e. soccer cleats, etc.). Comprehensive Physical Therapy Center can also make ¾ length orthotics to fit in some dress shoes. Many insurance companies cover one pair of foot orthotics per year and our business office can check the details for you. TOP 10. Biofeedback/Stress Management Jeanne Gresko, MS, CRC, LPC, has a M.S. in Rehabilitation Counseling from West Virginia University and is both a Certified Rehabilitation Counselor and Licensed Professional Counselor. She has received training in Mind/Body Medicine from the National Institute for the Clinical application of Behavioral Medicine and has worked in the field of rehabilitative medicine for over 14 years. Jeanne also has been teaching stress management techniques for over 8 years. What is biofeedback? Like the thermometer you use to take your temperature, or a mirror you use to check your posture, biofeedback simply gives you information about your body. In our clinic, biofeedback is a tool used to help you learn about physiological responses to stress, such as muscle tension and the temperature of your hand. How can biofeedback help me? Just as you might learn to stand differently after seeing your posture in the mirror, biofeedback helps you to learn to reduce you muscle tension and change other responses to stressful situations in your life. It is a powerful technique to help you learn self-regulation. Using biofeedback learn how to: Relax deeply and reduce muscle tension Control tension throughout your day Reduce primary hypertension Take an active role in your healing In addition, learn strategies to manage your stress more effectively. Does biofeedback hurt? No, biofeedback merely involves placing sensors on your skin using tape or an adhesive patch. Before the sensors are attached, your skin will be prepared using alcohol on a gauze pad. Other biofeedback treatment Biofeedback may also be used to augment your physical therapy treatment in our clinic. If your therapist determines that you are over using certain muscles and under using others, biofeedback may be used to help learn to use your muscles more effectively. How long does it take to learn biofeedback? This depends on the individual and how much practice is done between weekly sessions in the clinic. Biofeedback requires an active role as a patient; similar to the way your physical therapist expects you to do stretching and other exercises important in improving the functioning of you muscles. Most patients need 4 -10 sessions to learn these techniques. Referrals You can receive biofeedback services following referrals by the physical therapist providing your treatment. In some cases, you therapist may discuss this service with you physician before the referral is made. Appointments Appointments can be made for this service through our office following referral by your therapist. Insurance Coverage Most insurance plans will cover this service. If you have any questions concerning coverage with you insurance plan, please call our office manager for assistance. Download this Biofeedback page as a pdf file. TOP 11. Women’s Health Women face unique health concerns across the lifespan that deserve special attention from a female therapist with women’s health education. Common health concerns among women that we are available to treat include pelvic/vaginal pain, pregnancy and postpartum musculoskeletal pain, incontinence, osteoporosis, rehabilitation following breast surgery, as well as wellness and fitness counseling. At CPTC you will find a licensed physical therapist trained in the external evaluation of the pelvic floor and treatment techniques applicable to a wide variety of patient populations. Our therapists appreciate the relationship of the pelvic floor muscles to the hip, pelvic girdle, sacroiliac, symphysis pubis, lumbosacral joints and the thoracic and lumbar spine and are prepared to assess and treat your condition with a comprehensive approach. If you have more questions concerning women’s health physical therapy at CPTC please email cccptc@bellsouth.net. TOP 12. Sports Related Injuries Most injuries listed above can be caused on the field of sport. Our physical therapists all share a special interest in the rehabilitation of these injuries for patients whose goal is to return to a specific sport. Collectively, our therapists have first hand experience in the following sports: running (track and long distance), figure skating, baseball, basketball, and football. In addition, we have treated various local middle school, high school, and collegiate athletes of these and other sports. Some of our therapists have earned specific certified strength and conditioning credentialing (CSCS) through the National Strength and Conditioning Association (NSCA) which has provided them with more in depth expertise when it comes to the rehabilitation of an athletic population. TOP 13. Ergonomic and Workplace Assessment We see many people in the clinic each day who have repetitive overstrain issues from spending long hours on the computer. Repetitive overuse problems relating to use of the computer include (but are not limited to): neck and shoulder pain, rotator cuff strains, "tennis elbow", wrist tendinitis and carpal tunnel syndrome as, "Blackberry thumb". Additionally, we see people who have physical jobs that injure themselves because of faulty body mechanics in the workplace. A lot of these problems can be prevented by having the appropriate assessment to find out where the problems lie. We offer all new patients who come into the clinic with repetitive overstrain injuries an ergonomic assessment to help them determine where their faulty mechanics lie. By doing this, when we do rehabilitation on the injury, we can simultaneously help them prevent the problem from recurring. For those individuals with more active physical jobs who hurt themselves working, we offer the same ergonomic analysis and provide job-specific practice using correct body mechanics to also teach the individual the safe way to lift and function in general on their respective job. Oftentimes, we will conduct a, "mini back school" to reinforce the learning process. TOP 14. Functional Capacity Evaluations A functional capacity evaluation or, FCE for short, is a detailed examination and evaluation that measures the person's current level of function primarily in context of the demands of competitive employment. These measurements can be used to make return-to-work and activity decisions, disability determinations, or to generate a rehabilitation plan. The testing essentially measures the ability of an individual to perform functional or work-related tasks and predicts the potential to sustain these tasks over a defined period of time. TOP 15. Arthritis Management Osteoarthritis is a chronic condition characterized by the breakdown of the joint’s cartilage over time. Cartilage is the material at the end of your bones that absorbs shock at the joint, provides cushion and allows easy, pain free movement. With severe cartilage breakdown the bones at your joints can rub against each other, causing stiffness, pain and loss of movement. Once cartilage has broken down it cannot be restored, however proper medical management including medication as appropriate in combination with physical therapy can help you to minimize your pain and stiffness, restore range of motion and function, and slow the progression of the condition. A physical therapist can provide you with gentle stretching and range of motion exercises to normalize your mobility and minimize stiffness. We will also provide you with a safe strengthening program to effectively strengthen the muscles surrounding the effected joint. Strengthened muscles provide shock absorption and stability to the injured area, which will help decrease your pain and improve your function. A physical therapist can also show you safe ways to exercise to maintain your overall fitness as well as teach you how to use walking aids such as crutches, a walker, or cane, if necessary. Our staff is experienced with working with patients with arthritis and can provide you with the necessary education to manage this chronic condition. TOP Comprehensive Physical Therapy Center · 115 Timberhill Place · Chapel Hill, NC 27514 Phone: (919) 967-5959 · Fax: (919) 968-1478 · Email: cptc@bellsouth.net