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This method, created by the life-long work of Shirley Sahrmann at Washington University School of Medicine in St. Louis, is a key to the diagnosis and treatment of many common musculoskeletal injuries. This systematic approach is based on the concept of how repeated and habitual movements and sustained postures alter and eventually damage tissues. This eventually leads to a change in a person’s movement patterns. These faulty movement patterns are accompanied by compromised strength and flexibility and develop into negative changes in soft tissues and bony structures.

Functional Dry Needling is a mechanical-device assisted manual therapy technique utilizing a solid filiform needle for the purpose of deactivating trigger points, “loosening” shortened muscle, improving ROM and function and decreasing pain.  It is used in conjunction with active therapeutic exercise and other modalities and manual techniques.  Other likely areas of impact include the immune, inflammatory, vascular and neurological systems.  Common conditions dry needling can be useful for include:

• Spondylosis (spinal degeneration)
• Sciatica
• Piriformis syndrome
• Chronic hamstring strains
• Cervico-genic Headaches
• Rotator Cuff injuries / Impingement
• Tennis/Golfer’s elbow
• Patellofemoral Syndrome
• Shin Splints
• Groin Strain
• Achilles tendinopathy
• Carpal Tunnel and Thoracic Outlet syndromes

Physical Therapist Ron Hruska, from Lincoln, Nebraska developed this extremely in-depth approach to correcting postural and movement imbalances that affect both the upper and lower extremities, trunk and spine. “The Postural Restoration Institute (PRI) was established to explore and explain the science of postural adaptations, asymmetrical patterns, and multiple joint movement sequences that result in pain.”

Many of these patterns are created and become habitual at a young age, and result in both restricted joint range of motion and soft tissue/muscle dysfunction. Adaptation for these limitations then creates abnormal neuromuscular patterns and hyperactivity of muscles which are being placed in improper positions. This compensating activity and hyperactivity also includes many of the muscles involved in breathing, further limiting mobility through the trunk and pelvis.

Gua Sha is a Chinese manual therapy technique. “Gua” means to scrape or rub, and “Sha” stands for reddish, elevated, millet-like skin rash (aka petechiae). Sha is the term used to describe Blood stasis in the subcutaneous tissue before and after it is raised as petechiae.Gua Sha is a traditional Chinese technique dating back over two thousand years that intentionally raises a Sha rash to promote healing in the soft tissues and to improve blood flow. Gua Sha is also effective at releasing microscopic soft tissue adhesions in the muscles and connective tissues.

Polestar is a worldwide provider of rehabilitation-based Pilates education and was founded in 1992 by Brent Anderson PhD, PT, OCS and Elizabeth Larkam MA. The purpose was to train rehabilitation specialists who were interested in integrating Pilates evolved work into their current practices. The concept is to provide rehabilitation to patients with Pilates-evolved techniques while including manual therapy, movement science and body awareness. Pilates can be used across a wide variety of patient populations including high-level athletes, weekend warriors and the elderly.

G.D. Maitland from Auckland, New Zealand developed a comprehensive manual therapy approach to painful joints which Rebound utilizes. His passive mobilization techniques for every joint in the body include very gentle methods designed to calm down irritable joints and tissues as well as more vigorous manipulation for specific joint lesions.

This treatment approach focuses on addressing peripheral vestibular system deficits that are contributing to dizziness and balance problems. The vestibular system is a complex mechanism in our inner ear that serves as our primary equilibrium system. Deficits can occur in this area and can create a number of different symptoms, including dizziness, unsteadiness, and vertigo.

This treatment technique has been utilized in physical therapy and osteopathic medicine for many years to treat musculoskeletal problems. Muscle Energy is an active technique in which the patient engages specific muscles while the joints are placed in exact positions. It is believed that many joint dysfunctions and pain syndromes are created by overactive muscles which exert abnormal stress to the joints. Gentle active muscle contractions are thus used to “inhibit” or relax the overactive muscles and help restore normal range of motion and function.

Muscle Energy techniques can also be used to realign joints to promote more efficient motion.

Physical therapist John Iams from San Diego, California has developed this method for treatment of a wide variety of painful syndromes. In describing his method and the 35 year journey to develop the technique John writes:

"Could there be a missing piece to the puzzle of pain currently not being examined by even the most competent practitioners? The answer is a resounding, YES! Over the decades clinicians have examined and treated most components of the musculoskeletal system including techniques to release muscle, fascia, joint and neural tissues. Why not techniques to release abnormal reflexes in those tissues? Reflexes are an integral part of our complex nervous system that is hard-wired at birth. Two primal reflexes that seem to have the greatest potential for problems of pain and motion restriction are the startle reflex and withdrawal reflex. Although these and other reflexes have been gifted to us for survival, they may represent a previously unrecognized source of pain. I’ve discovered how these two reflexes can be found in virtually all musculoskeletal pain patients. I’ve termed this finding the Pain Reflex. I have described my findings as Trigger Regions, defined as an area of hypersensitivity, found when sliding one’s fingers over predictable areas. These areas have been found to fit certain patterns. It appears that once an injury occurs, healing either progresses to full resolution or not. An injury may be nothing more than sustained stress or repetitive injury accumulated over time. Evaluation of a patient begins with the One Minute Nocioceptive Exam during which the body is scanned with rather light palpation for the presence of withdrawal and startle reflexes. During this exam, finding the Pain Reflex response will be a surprise to the patient as the areas of hypersensitivity are frequently very distant from their perception of pain. Usually one side of the body is more affected than the other. Treatment involves a Primal Reflex Release Technique (PRRT) designed to downregulate (relax) the two reflexes. Upon reexamination of the hypersensitive areas after applying the techniques, there is frequently a remarkable change in tenderness and pain. This translates into instantly improved spontaneity of range of motion and speed of motion, and the results are usually lasting”.

As John describes above, the PRRT method is remarkable when chosen with the right patient. Perhaps most importantly, it is rapid to produce results and responders are easily detected, usually within three visits.

Cupping is an ancient Chinese practice in which a glass cup is applied to the skin through pressure changes inside the cup. This is performed by briefly heating the air inside the cup with the use of a flame, then quickly applying it to the skin. As the air inside the cup cools, a suctioning effect takes place pulling the skin and superficial muscle layer into the cup. Generally, several cups at a time are used and left in place for up to 20 minutes. During this process the skin will become temporarily red due to the congestion of blood flow inside. Cupping can be used to aide the treatment of back, neck, shoulder and other musculoskeletal pains by creating long lasting relaxation of the tissues and by reducing inflammation.