Independence From Pain Through Physical Therapy

Physical therapy can be your answer to independence from joint and muscular pain. Chris Stulginsky from Ayrsley Town Rehab explains how treating the underlying cause of pain is the only way to be truly pain free. No more just treating the symptom, solve the problem that’s causing the pain!
Ayrsley Town Rehabilitation (ATR) provides performance-enhancing, preventative and rehabilitative programs and services that maximize functionality and promote well-being in patients of all ages and abilities.

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Knee Pain Doesn’t Always Mean Surgery

As discussed in the video, chronic knee pain doesn’t always mean surgery. Our patient, Rosa Underwood’s* experience demonstrates how physical therapy helped resolve her chronic knee pain, even though she had been advised that surgery was her only option.

Patient Spotlight: Rosa Underwood*

The Issue: I had severe knee pain, constant arthritis pain in my right knee that was affecting my quality of life. The limited mobility affected my ability to shop, play with my grandchildren, garden, enjoy myself in general. I was fearful of being stigmatized professionally because of my limping and the possibility of not working due to needing knee surgery. I was miserable.

How was your physical therapy treatment? The physical therapy felt immediately empowering! I felt that I had an active role in getting better and the better I understood how muscles functioned the more I realized I was not helpless, that a lot of my pain was due to extra stress being put on my knee because of how I moved at many joints and that my knee was not going to crack in half.

The moment things changed: Chris found that I was compensating by clenching my jaw, he treated that and my knee pain decreased significantly. I thought, “What just happened?” My knee pain was decreased significantly, and I was able to garden that weekend kneeling with very little pain, I have not been able to do that in months.

The difference over the past few weeks is incredible… I am walking longer, my attitude is hopeful, I don’t describe my pain as severe…I play with my grandchildren and enjoy myself again. I have not worn a knee brace or wrapped my knee since. My doctor is pleased with my progress and so am I! The ATR team is truly outstanding!

The Therapist’s take: Rosa had significant movement restrictions in her knee, ankle, and hip which piled on top an existing arthritic condition. Her Gluteal muscles were not firing much, and her knee was not able to get straight. It is a common compensation pattern, inhibited gluts put more pressure on the muscles that surround the knee. We tested her glut, it was strong, but she was clenching her jaw. Retesting with a relaxed jaw decreased the glut strength drastically. Palpation revealed increased tenderness at her right masseter, and quick, patient-directed release resulted in the gluteal muscles firing again so they tested strong with a relaxed jaw. With the gluts back on line, it took pressure off of the knee and the patient’s squat test improved dramatically. This is a great example of how the pain is rarely problem, it is the symptom of dysfunction. This is why we examine and treat function, treating structure alone without addressing function rarely leads to long term success.

*Use of quotations and names are with permission of patient

Fall Prevention: The long term impact of a little slip.

Fall Prevention Can be Easy but it is Up to You to Take the First Step.

It is not uncommon to hear anyone over the age of 50 to say, “I am not moving around as well as I used to”. Many accept that as just a part of life. The problem is that this complacency can have very real consequences to everyone. It can require increased care for a parent, it can result in a move from home, and it can cost a lot of money.

According to the Center For Disease Control, 1 in 3 adults over the age of 65 fall each year, 20 to 30% of which suffer what are classified as moderate to severe injuries. As a result of 2.4 non-fatal falls which leads a to an estimated 660,000 hospital admissions per year.

Benjamin Franklin noted long ago, that “an ounce of prevention is worth a pound of cure” so it is important to take note of the following:


Many fail to remember or ignore this fact, but you can often do so with very little work and, in many cases, little to no out of pocket cost. Dr. Betty Perkins-Carpenter, who is on the President’s council of Physical Fitness and Sport acknowledges that, “It is not always possible to prevent the illnesses that change our live, but it is possible to prevent or minimize most of the falls that plague our senior citizens.”

Many know the basics, and things such as pulling up throw rugs modify lighting with auto timers for the evening are often done. However, both family members and some medical professionals often think they are helping when they are actually, and unknowingly INCREASING the risk of falls.

When someone is losing their balance, the first thought is to get a cane, a quad cane, walker or other assistive device.  In many places this is sole responsibility of the physical therapy team. In fact, at Johns Hopkins, the surgical patients are not allowed to leave the hospital until they were properly outfitted with a device and properly instructed in its safe and proper use.

Often devices are purchased at a pharmacy or given by a medical professional other than a physical therapist with the assumption that use is intuitive; it is not.

The incorrect device or a correct, but not properly sized device can actually increase your risk of falls.

As easy as it looks, there are nuances to choosing, sizing, and prescribing an assistive device, not to mention proper usage and, in some cases, the amount of practice that is required to use it correctly and safely. This education is included in the extensive post graduate course work in physical therapy school. In fact the billing code for gait training it unique to physical therapists and physical therapy.

The advantage, when you utilize a physical therapist the service is covered by medical insurance and does not require a doctor’s referral.


Many know that physical therapists are experts in conservative, non-pharmaceutical pain relief; they are also experts in how the body moves and, more importantly, how the body compensates.

In addition to being able to examine and inform you of why you back may hurt as a result of the way your foot touches the ground when you walk, they can examine your balance centers, watch how you walk and move, identify what needs work and come up with a treatment plan to improve your balance and decrease your risk of falls.


Falls account for 25% of all hospital admission, 40% of all nursing home admissions. 40% of those who are admitted to the hospital never return to independent living.

In the year 2000 falls accounted for a 19 billion dollar cost to Medicare and by 2020 that number is projected to exceed $54.9 billion. When you take into further consideration that these numbers are only for the treatment and do not include the cost of assisted living or long term care they skyrocket.

Balance is the interaction of your body with gravity. The body depends on three primary balance centers: what you see with your eyes, what you detect with your inner ear and what you feel with your body. If you lose one or one is diminished, balance is more difficult. This could, to a point explain, why more falls occur at night when it is tough to see. It is incorrect to assume that balance deteriorates because of age; in fact it occurs more do to disuse. As people get older, they move less, as a result their balance centers do not benefit from the daily interaction with gravity and the become less sensitive.

A simple 5 minute balance test that evaluates your standing (static) balance and walking (dynamic) balance can quickly set a benchmark. The plan will work on the areas of weakness and in a few weeks a re-test will be administered to monitor improvement.

With a very easy physical therapy program, these three balance centers can easily improve and tests bear that out.

No matter how complex one may think a medical issue is, it is generally agreed on that, “prevention is the best medicine”. Something that can change so much, can easily be prevented with little effort or cost. All you have to do is take the first step.

Summer Foot Pain is Preventable

As the weather gets nicer many change their footwear and increase activity. This often results in foot and ankle pain. With simple preventative exercises, individuals can reduce chances of experiencing this pain & get treatment if it does get worse.

PRLog (Press Release) – Apr. 24, 2012 – With the days getting longer and the weather getting warmer, summer is right around the corner. As a result, many will be spending more time outside exercising, doing yard work and enjoying,  “shorts and flip flop weather”.

“Who doesn’t love this time of year?” says Chris Stulginsky, physical therapist and owner of Ayrsley Town Rehabilitation.  “It’s a great time to get outside with your family and friends to enjoy the weather; however foot and ankle pain often follows.”

There are many ways to work to prevent these types of injuries with very little effort. “Alternating footwear, and performing stretches, like a standing gastrocnemius stretch and standing soleus stretch, are very important.”

Many of these problems are preventable, but despite one’s best effort, they still may start developing pain in the foot and ankle.

“When the pain is interfering with your life, it is very important that these types of maneuvers are performed correctly. They may seem easy on the paper your doctor has given you or on the internet; however, I would say, almost everyone we see needs some level of correction,” stated Stulginsky.

The body’s desire to do things efficiently is a positive in many ways, but in a case where pain has set in it often results in compensation and improper technique. “Many times we find our patients are not performing their exercises correctly and are reinforcing the very issues that are cause a great deal of their pain. Additionally, dysfunction in the hip and knee often change the way the foot hits the ground and also contributes to the pain,” says Stulginsky.

Many disorders, such as plantar fasciitis, tarsal tunnel, tendonitis and heel pain, all present very similarly and are typically treated with footwear modification and potentially with injections. One commonly over-looked component is the nerve in that area, which needs to be treated with a specific and targeted treatment plan.

The nerve is one component that can affect all of these areas. It commonly presents symptoms in one area but and is radiating from problems in other areas.  “Just like muscles and tendons, nerves get tight as well,” says Jackson Bellis, DPT who is the newest addition to ATR’s clinical team. “We have found that using nerve mobilizations with our patients is gentle, effective and can have fast results.”

Recently, Roger Goforth presented to the ATR team with a diagnosis of tarsal tunnel. “I was in excruciating pain. Things I took for granted all my life such as showering, walking barefoot and getting dressed were difficult.”

The tarsal tunnel runs along the inside of the ankle and provides sensation to the entire bottom surface of the foot. This area typically gets squeezed between the tissue behind the ankle bone on the inside of the leg.

“With the use of gentle neural mobilizations and a technique we call a tarsal trace we have significantly diminished Mr. Goforth’s pain,” says Bellis.

When performed by a skilled clinician, neural mobilizations are effective because both the nerve and the surrounding tissue get relief from issues causing inflammation.  The neural tissue becomes hypersensitive, and as a result, it is harder for the nervous system to perform and recover.

Goforth is a believer. “After 3 treatments I was able to walk and stand barefoot with very little pain for the first time in a year. The results have been nothing short of amazing.”

Charlotte Area Clinic Making Strides in Knee Pain Treatment

Knee Pain affects 18-20% of US population and many are frustrated with treatment and feel that surgery is the only option. Recent treatment breakthroughs at a local physical therapy clinic are helping patients who feel they have run out of options.

PRLog (Press Release) – May 11, 2012 – Knee Pain is a very common condition that is reported by 18-20% of the U.S. population. It affects the way one walks, works and lives. It can make hobbies and leisure activities such as going for a walk with your husband or wife, playing with your kids, and fitness activities very difficult.

Any pain or dysfunction at the knee can result in back, hip or foot and ankle pain. There are many common causes to knee pain, most of which are as a result of overuse or improper mechanics.

“During our evaluations, we often find that pain is the symptom of dysfunction elsewhere. Treating it without looking at the entire kinetic chain may offer some short term relief, but it does not address the cause of the problem and often leads to a more chronic condition,” says Chris Stulginsky, PT who is the owner of Ayrsley Town Rehabilitation.

Cortez Curtis has had pain in the front of his knee for three years. “I have been to 4 different doctors. They all took x-rays and told me I needed to exercise and lose weight. I was frustrated because I was never told what specifically to do and exercise made my knee worse.”

The knee pain located in the front of the knee was indicative of a problem elsewhere. “During the initial evaluation, Cortez was not getting much hip extension at all. Decreased hip extension typically results in increased bending of the knee, rotating the hip to the outside or positioning the foot and ankle outward while walking. In Cortez’s case he had compensated with external rotation at the hip, the knee followed suit and we had our issue.”

For the most part the primary motion of the knee is bending or straightening, which is called flexion and extension respectively; however, there is mild rotation at the knee joint which often goes unnoticed and can easily cause a great deal of dysfunction and pain throughout the joint.  The popliteus is a muscle that crosses from the outside of the knee to the inside of the knee at a 40 to 45 degree downward angle and is primarily responsible for this movement. The muscle also attaches to the lateral meniscus and often mimics meniscal derangement.

“Many knee exams are performed in sitting or while lying down. Traditional knee tests were negative. After watching Cortez walk just a few feet I had some clarity on what was going on, and confirmed it with further examination”, added Stulginsky.“When he started pressing on my knee, he was right on it,” says Curtis, who explained that for 3 years he has had difficulty playing with his kids, putting his feet on the ground when getting out of bed, and making it through his shift without intense discomfort.

Stulginsky says, “After seeing this presentation a number of times in the last few years, we have developed a protocol for this issue, which includes a simple, 2 step, self-care program. Everyone is built a little differently, it is not the same exact thing for every individual, but the themes are similar.

“I felt an instant difference,” said Curtis. “After two treatments, my pain is down 75%. Playing with my kids is easier, shifts at work are better.”

This dysfunction can cause a great deal of pain in many people, including competitive runners and weekend warriors. Stulginsky states that if this is the primary cause, it can be addressed relatively quickly in a very conservative, non-invasive fashion without medication or injections.

Mr. Curtis concludes, “I am happy that someone can finally tell me what was going on with my knee, and I have a solution that is fast, effective and easy enough that I can do it on my own.”