- 1. Orthopaedic/Sports Rehabilitation
- a. ACL Prevention & Rehab
- b. Patellofemoral
- c. Meniscal/Articular Cartilage
- d. Degenerative Arthritis/Total Knee Replacement
- e. Rotator Cuff/Labral Tears/Instability
- f. Frozen Shoulder
- g. Total Shoulder Replacement
- h. Throwing Injuries
- i. Ankle & Foot Sprains/Fractures
- j. Plantar Fasciitis/Achilles Tendonitis
- k. Post Surgical Rehabilitation
- l. Tendinopathy
- 2. Elbow, Wrist & Hand Therapy
- a. Tennis/Golfers Elbow
- b. Sprains/Fractures
- c. Carpal Tunnel
- 3. Spine Rehabilitation
- a. Mechanical Back/Neck Pain
- b. Postural Syndromes
- c. Sacro-Iliac Syndromes
- d. Disc Herniation
- e. Sciatica
- f. Shoulder/Hand Syndromes
- g. Post Surgical Rehabilitation
- 4. Industrial Rehabilitation
- a. Acute & Subacute Injuries
- b. Post Surgical Rehabilitation
The Anterior Cruciate Ligament is the most common surgically repaired ligament in the body (https://www.ncbi.nlm.nih.gov/pubmed/24497504). Nevada Physical Therapy is the only physical therapy clinic in Reno that has re-written the protocol for this devastating injury, which has garnered recognition on a national platform by some of the top physical therapists and physicians in the country. We pride ourselves on actively trying to push the rehab conversation forward on this injury by creating the most up-to-date evidence-based protocol in the industry.
What makes our protocol unique? First, it is essential to understand the current limitations of conventional ACL rehab protocols. Did you know, 87% of return-to-sport criteria use only time from surgery and patient's self-report as the primary determination if an individual is ready to return to regular activity? We offer a multi-tiered return-to-sport assessment to create a complete picture of where an athlete (or weekend warrior!) is at before clearing them for sport. Only 60% of surgical recipients return to their previous level of play and failing to identify underlying risk factors may be a big reason why!
Second, core weakness is a well-established risk factor for re-injury. What is “core” and what is “weakness”? We implement an objective assessment of core strength using the Selective Functional Movement Assessment to identify dysfunctional non-painful movement and implement an objective progression model to correct these patterns. Additionally, we implement multi-joint compound movements, which have been proven in the literature to improve “core” strength. You will not be doing sit-ups here. We will teach you how to create an anti-fragile body through true core strength.
Finally, hamstring weakness is often an under-appreciated component in conventional rehab models. We incorporate functional posterior chain (hamstring, glutes, etc.) work from the kettlebell Romanian Deadlift to barbell pulls from the floor. It does not matter if you have never performed a deadlift in your life, we will teach you from the ground up how to incorporate this movement into your strength program and better prepare your knee for life after surgery.
Have you been diagnosed with Patellofemoral Syndrome? Or do you just have knee pain that hasn’t responded to treatment in the past? At Nevada Physical Therapy we often recognize “where you think pain is, it ain’t.” While this isn’t always the case, it usually is with the knee. More often than not, the dysfunction lies in the hip and ankle and even core. Inability to stabilize the core in single leg movements (running!) may create an overuse issue in the IT band and further, altered knee motion. We will design a program that not only addresses the specific joint requirements of the knee but we will assess your entire movement chain using systems including, but not limited to, the Postural Restoration Institute, the Selective Functional Movement Assessment, and others to treat the whole chain! An intervention that addresses a muscle and not a movement can fall short. Let us cure you of your IT Band syndrome, Runner’s Knee, Patella Tendonitis and any other host of knee pains by treating your entire chain, not just where it hurts. Come see what makes us different.
Meniscal Injury/Articular Cartilage
Did you know that chronic degenerative meniscal tears often do as well, if not better with physical therapy than when compared to surgery? (https://www.ncbi.nlm.nih.gov/pubmed/27440192) At Nevada Physical Therapy, we offer multiple training systems not found anywhere else in Reno, such as Blood Flow Restriction training (https://www.ncbi.nlm.nih.gov/pubmed/28966705), gravity-eliminated treadmill training, among others! If avoiding surgery is your goal, we will provide you with the most up-to-date evidence-based programming to maximize your gains. We recognize that our bodies are incredibly adaptive and that you are not your MRI findings!
If you do need surgery, these same services unique to Nevada Physical Therapy will be implemented to help you get better, faster. Meniscus repair failure rates have been shown to exceed 23% (https://www.ncbi.nlm.nih.gov/pubmed/28506133) of all repairs, so who you trust with your rehabilitation may make all the difference in a positive outcome and a failed operation! For over two decades, we are entrusted providers rehabilitating meniscus repairs in some of the most elite athletes in Reno, but you do not have to be an athlete to be treated like one! Whether your goals are to get back to recreational sports, gardening, or just climbing a ladder, we have you covered.
Degenerative Arthritis/Total Knee Replacement
It recently is shown that patients diagnosed with knee osteoarthritis who get physical therapy first avoid surgery 60-70% of the time! We will work with you with the most comprehensive approach possible to maximize your function and strength to try and avoid surgery. However, if you recently opted for a total knee replacement, getting therapy as soon as possible after your operation can help you maximize your surgical outcome!
When designing your program, we will focus not only setting a foundation for your new joint to succeed but we will treat your entire kinetic chain to help you get back on your feet, as well as improve your movement in its entirety. The treatment includes a comprehensive program design focused not only the knee but the ankle, hip musculature, and core. Additionally, we commit ourselves to corresponding with your physician regularly to ensure you receive the best possible care. Our goal is to give you the tools to help keep you moving for years to come!
Tennis and Golfer’s Elbow
Both Tennis and Golfer’s elbow often refer to painful, overuse syndromes at the inside or outside bony prominence of the elbow. These are usually frustrating episodes for many patients as they are commonly associated with their primary sport or work and further, can seem unresponsive to many interventions including cortisone injections and decompression straps. At Nevada Physical Therapy, we have dedicated months to develop a more thorough understanding of the biochemistry involved in tendon healing which allows us to create a model for treating these injuries based off evidence, not the popular gadgets. These conditions are often poorly understood and treated as inflammatory episodes by many clinicians which can lead to interventions that at best, do nothing and at worse, aggravate your condition. For example, perhaps you have heard that you need to create more “blood flow” to the area? The science does not support this as chronic tendon dysfunction (or tendinopathy) often has a primary finding or having too much blood flow, hallmarked by vessel and nerve infiltration. Choose a clinician that not only understands you but your condition! For more information on tendon injuries and tendon science, visit our tendinopathy page and feel free to contact us with any questions regarding your diagnosis. Refer to our Fall 2016 newsletter on tendinopathy. (http://www.nevpt.com/protocols/MD%20newsletter%20fall%2016-new.pdf)
Plantar Fasciitis/Achilles Tendonitis and Tendinopathy
Plantar fasciitis refers to the inflammation of the dense connective tissue covering the undersurface of your foot. It is often a chronic condition and can be debilitating to many patients! Nevada Physical Therapy recognizes treatments' focus on just this area alone can usually fall short and we commit ourselves to addressing the entire chain instead. While we may prescribe specific interventions for the footbed itself, it is often dysfunction in the ankle, knee, and hip that drive this painful condition.
Often related to Plantar Fasciitis is Achilles dysfunction, whether it be tendonitis (acute) or tendinopathy (chronic). The Achilles complex is a tendon comprised of two calf muscles, the gastrocnemius and soleus and Achilles Tendinopathy is responsible for 55-65% of all Achilles tendon disorders. At Nevada Physical Therapy, we have dedicated months to develop a more thorough understanding of the biochemistry involved in tendon healing which allows us to create a model for treating these injuries based off evidence, not the popular gadgets. These conditions are often poorly understood and treated as inflammatory episodes by many clinicians which can lead to interventions that at best, do nothing and at worse, aggravate your condition. For example, perhaps you have heard that you need to create more “blood flow” to the area? The science does not support this as chronic tendon dysfunction (or tendinopathy) often has a primary finding or having too much blood flow, hallmarked by vessel and nerve infiltration. Choose a clinician that not only understands you but your condition! For more information on tendon injuries and tendon science, visit our tendinopathy page and feel free to contact us with any questions regarding your diagnosis. (http://www.nevpt.com/protocols/MD%20newsletter%20fall%2016-new.pdf)
If you happened to sustain an Achilles tendon rupture, let us help you apply this tendon science to your new repair. We will generate a post-operative protocol that incorporates an appropriate loading progression to the repaired tendon to help improve your outcomes long term. Enhancing the mobility of the ankle complex, creating improved movement strategies for the entire lower extremity, and designing a program specific to your individual needs allows us to address not only your pain but your problem. Reno offers incredible outdoor recreation, and we will commit ourselves to getting you back outside.
Labral Repairs/Instability/Throwing injuries
Nevada Physical Therapy has been the physical therapy provider for the University of Nevada, Reno Athletic Department for nearly 25 years. We have a lot of experience in pre and post-surgical intervention for shoulder instability and throwing injuries. We work closely with our orthopedic surgeons to generate a customized rehab protocol designed for your specific goals and needs. While not only working closely to monitor your healing repair we will address any risk factors that pre-disposed you to injury in the first place. Good scapular stability and spine mobility and motor control are hallmarks of having a functional shoulder. At Nevada Physical Therapy we incorporate multiple assessments using the Postural Restoration Institute and Selective Functional Movement Assessment to highlight any weakness within the core, shoulder blade and shoulder joint.
Tendinopathy is the diagnosis given to tendons when they begin to change their actual structure when viewed under a microscope, ultrasound, or magnetic resonance imaging. Think of the symmetrical alignment in a rope. The fibers are tightly packed, aligned, and there is little space or “fraying.” The description is what a healthy tendon looks like in a perfect world. Now take that same rope and start using and abusing it. It may begin to become disordered, the rope fibers may separate, and it may lose some of its structural integrity. The reality is, all of us have some tendinopathic changes, often in pockets within a normal tendon! The good news? We can create new collagen (healthy, aligned rope fibers in this analogy) with an appropriate program, which is a pretty incredible fact of the human body. With proper loading, we can lay new layers of collagen on top of disordered fibers in many cases.
Before we break down what makes our tendinopathy program unique, we need to define a few terms. First, loading can be broken down into two categories: cyclical and mechanical. Cyclical is anything bodyweight-oriented such as running, cycling, jumping, and swimming. Cyclical loading creates a catabolic (degenerative) cascade which can, after time, form disordered collagen fibers which allow an increase in the extracellular matrix (fluid between cells) and further, enables nerve and blood vessel ingrowth. Mechanical loading is the loading of a tendon with weights. This has been well documented to kick off an anabolic (restorative) cascade. It causes a release of growth factors and hormones which allow the formation of new collagen. If you are a bodyweight, cyclical athlete such as an endurance runner, triathlete, or swimmer of perhaps you have a grip dominant job such as steelworking, or tennis and golf it is imperative to counter the catabolic cascade with a mechanical loading protocol to match.
So what makes Nevada Physical Therapy unique among Reno providers? Not only have we dedicated an exceptional amount of tie to understanding the science of tendinopathy, but most poor clinical outcomes are thought to be related to inappropriate staging or diagnosing of where the tendon is in the tendinopathy cascade. There are several stages of degeneration, and each has a specific progression model to load the tendon appropriately (key word!) to allow for adaptation and healing. Have you ever had someone scrape your tendons with a soft tissue tool to “create more blood flow”? Not only does this show a poor understanding of tendon science but may propel the tendon further down the catabolic cascade (i.e., disordered tendon fibers, increased blood vessel proliferation, etc.)
Additionally, our protocol is based on the most up to date research available to maximize your outcomes. For example, for years eccentric loading has been considered the gold standard for loading protocols, but research shows even better results with heavy, slow resistance (HSR) program we implement. At Nevada Physical Therapy, we will apply an individualized plan based on the most current evidence and your specific presentation to give your body every opportunity to succeed.
Rotator Cuff Disease
Do you have a rotator cuff tear? Did you know a study in 2013, up to 75% of people with a full tear in their rotator cuff was able to rehab their shoulder without surgery? Did you also know that failure rate after surgery can range anywhere from 25-90%?!? At Nevada Physical Therapy we have the most up to date protocols for both operative and non-operative management of rotator cuff tears. We understand a protocol is just a guideline and we all are unique with a different story of how we got here. We are sensitive to appreciating predictors of failure of rotator cuff management including diabetes, age, and the biggest one: low expectations about physical therapy. We are up to the challenge to prove the general public wrong. Our Physical Therapists combine evidence-based research of rotator cuff treatment along with identifying dysfunctional non-painful movement patterns in the body. We do this to try to highlight any other contributing factors that created the wear and tear on your shoulder in the first place. Poor posture such as a forward head from sitting all day is highly correlated with shoulder pain. Nevada Physical Therapy is dedicated to working closely with you and your physician to generate the best long-term plan for your shoulder so you can get back to working on your golf handicap, playing catch with your kids, and finishing up that next DIY project at home.
Frozen shoulder or adhesive capsulitis can be a very disabling condition. It can occur following trauma or surgery, but many times it comes on from out of nowhere. The condition can last anywhere from 1-2 years. Nevada Physical Therapy combines the approach of manual and exercise therapy to help get your shoulder moving well again. Manual joint mobilizations help maneuver the shoulder joint in the directions that you can’t do on your own. Education on your condition and how to manage it on your own are of utmost importance.
Total Joint Replacements
Nevada Physical Therapy is Reno’s premier facility for outpatient rehabilitation of joint replacements. With our founding fathers (literally) paving the way by generating the original post-operative PT total joint protocols nearly 30 years ago. The experience of our physical therapists, combined with advances in surgical procedures, Nevada Physical Therapy hands down has the most advanced and up to date treatment plans for rehabilitating your total joint. We treat total shoulder replacements, total knee replacements, and total hip replacements on a daily basis. We have the experience that you want to have confidence in getting the best long-term outcome after your joint replacement.
Current evidence shows that 95% percent of people over the age of 50 have degenerative changes in their cervical spine on MRI and x-ray imaging while being asymptomatic! These findings lead us to believe maybe some of the changes and abnormal results on imaging may be normal, or have nothing to do with your pain presentation. So then, why does my neck hurt and what can I do about it? Is surgery my best and only option? Not necessarily. Let’s talk about what is happening below that big heavy head this tiny neck has to hold up.
Did you know that your right diaphragm is larger and stronger than your left? Why are we talking about the diaphragm in a cervical spine section? Because, when this asymmetry of diaphragm contractions on the right becomes too powerful it creates a change in demand on the neck. When we become stressed (as we all do often enough), our diaphragm breathing becomes altered, and we rely on our neck muscles as accessory breathing muscles. If our neck is busy trying to pull in air, it is distracted from holding our heavy head up in an optimal position. In this state, your neck may not be able to work as efficiently when you’re trying to check your blind spot driving in traffic on the freeway or while the desk jockey works on a deadline.
It is important that you find a clinician in Reno that looks at you as a whole and not just one or two levels of your cervical spine. Diaphragm dysfunction being a big part of that holistic approach for example. Another example is looking at whether you have a “mobility” issue or a “stability” issue? While neck stretches and mobility exercises have their place, has a PT ever checked your motion while lying down versus standing?? Why does this even matter? What we see all too often is that when our necks are tasked with holding our heads up against gravity, they often become dysfunctional (tight, painful, loss of motion, etc.). If a patient has full range of motion laying down, then it can be safe to say it is not a cervical issue but a motor control/postural issue! If your shoulder girdles are not doing their job, it may show up in the neck for example. Treating patients entirely as a structural issue often leads to missing the entire picture of the patient as a unique whole.
Nevada Physical Therapy takes a unique approach to treating the cervical spine. We appreciate the asymmetry within our body and incorporate this philosophy into our treatment programming. Combined with hands-on manual therapy, restoration of diaphragm breathing patterns and targeted postural strengthening exercises Nevada Physical Therapy has a specialized program for all of your neck pain needs. From whiplash following a motor vehicle accident, degenerative disc disease, or post-operative therapy following cervical disc or cervical fusion surgery, we have you covered.
Low back pain is one of the most common human afflictions, with an estimated 85% of people experiencing it at some point in their lives. Nonspecific back pain is the most common presentation we see clinically and refers to low back pain that does not have a specific mechanism of injury. The injury could be due to overuse, pain after an unusual change in activity such as traveling or shoveling the driveway after the first snowfall of the year! While this pain often resolves on its own in a month or two, it can be debilitating and may return if the underlying dysfunction is unaddressed. At Nevada Physical Therapy, our job is to interrupt the pain cycle, accelerate the healing process and design a program to minimize the risk factors for re-injury. In a world where an abundance of information is available at the touch of a button, it is our job to help you navigate these often scary findings and create an individualized plan for how you explicitly present in the clinic.
More and more evidence is coming to light we are not our MRI findings. For example, 30% of 20 year olds and 84% of 80 year olds have one or more “herniated discs” on MRI. The point? These are symptomatic individuals with absolutely no pain. In fact, after the age of 50, it is more unusual to not have a herniated disc on imaging, so it begs the question: if more patients have a herniated disc than do not and have no symptoms to speak of, what is normal?? The structural findings are seen throughout almost all lumbar imaging studies and the good news? Physical therapy is nearly always the best management of low back pain. Patients who seek PT first save almost $4000 compared to those referred to imaging after being diagnosed with low back pain.
Reno offers many options on who you can choose to manage your low back pain and health in general, so we cannot overemphasize how important is to find a clinician who understands your goals and will not treat you as just an MRI diagnosis. Whether your goals are to hit the first chair after a big snowfall or wrench on your old ’66 in the driveway all afternoon, we will help you get back to it faster and build a program to keep this pain away.