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.

ATR Thoracic Spine Stretch for Golfers

Chris Stulginsky of Ayrsley Town Rehab in Charlotte, NC demonstrates a quick & effective stretch for the thoracic (middle) spine to improve mobility for golfers.

Chris is certified by Titleist Performance Institute and can help you take your golf game to the next level!

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.


Want to improve your golf swing? See a physical therapist!

With the days getting longer many take it as an opportunity to hit a bucket of golf balls after work, or to try to get out early one day to “squeeze in 9 or 18”.

As many golfers start playing more frequently, it is almost inevitable that they become frustrated with flaws in their game. Often one hears golfers saying, “I blocked the ball there” or “I was quick with my hands on that one”. Typically the frustrated reaction to a poor shot or round is, “I need some more time on the range”, “I need to get with my pro”, or “I need to look at a driver”. While practicing more, modifying your equipment and working with your pro can help, if your body won’t move enough to make  the adjustment or correction, other venues will probably continue to result in frustration. Additionally, this could result in injury or lead to a dysfunctional learned motor pattern that could have detrimental effects to one’s enjoyment of the game.

Your body is, after all, the only piece of equipment you never stop using on the golf course.

While the golfer may see a block, hook, early extension or reverse spine, a physical therapist certified by the Titleist Performance Institute (TPI) sees lead hip tightness, a lack of trail side shoulder stability or decreased thoracic spine mobility when they watch a swing.

Understanding how these dysfunctional motor patterns impact how golfer uses and performs with his or her golf club is imperative for improvement. Many people cannot perform basic functional movements, let alone produce a consistent golf swing on a foundation of a dysfunctional movement. Adding a physical therapist to your golf support team can help you assess and change the limitations of the body, making the lesson with your pro, or time on the range with your new wedge more efficient and beneficial.

With Adam Scott’s recent victory at The Masters, golf fitness has been on the national stage. Scott’s frequent appearances on the The Golf Channel’s, “Golf Fitness Academy presented by TPI” and his work with his Titleist Performance Institute team have helped him take his game to the next level.

Locally, Charlotte Country Club has started a “TPI Prep School”.  Director of Instruction, Rich Albright and Director of Custom Fitting, Allen Avakian have teamed up with TPI certified physical therapist, Chris Stulginsky in offering “Prep School” to the members.

“We wanted to connect body mechanics with the golf swing.  Each player’s body reacts differently to the body’s movement requirements for an effective golf swing.  When the body limits the movements within the golf swing, it is hard to hit the golf ball consistently”, said Rich Albright, Director of Instruction. “We saw each student gain efficiency in their ability to swing the golf club.

Both professionals also saw the personal benefits as it translates to their golf game as well,  Avakian pointed out, “personally, the program has helped to increase range of motion as well as ease of motion. My sense is that this increased mobility along with better stability will help in maintaining rhythm and tempo.” Albright added that, “[the program], had a direct impact on my back and my ability to rotate better during the swing.”

So many think that the program or physical therapy itself can be working with resistance band or stretching to improve flexibility. In fact they work a great deal on stability so one can build increase potential energy when they swing or on the motor control of functional opposites to make for a more consistent swing. With the properly trained eye, one can easily expand their program, and simultaneously make it more efficient and effective.

The program at Charlotte Country club has been a success leading the club to add another session says Avakian, “the feedback is leading us to start another session in the month of May.”

How to: Simple Home Screen for Nerve Tension

Often, when people have back pain, they also have tingling and numbness down their legs. This could be coming from the back but it could also be amplified if you have nerve tension which is the tightness of your nerves down the legs. You can do a simple at home screening as shown above to determine if you have nerve tension.  If someone does indeed have nerve tension, this can only be helped by proper physical therapy and corrective exercise.



Patient’s Report 35% Pain Relief with New Laser Treatment in Charlotte Physical Therapy Clinic

In May of 2009 Ayrsley Town Rehabilitation debuted the ML830 Laser in their clinic, over the last five months, patient have reported, on average of a 35% reduction in pain with the laser and the implementation of preferred provider protocols.

PRLog (Press Release) – Sep. 30, 2009 – In May, Ayrsley Town Rehabilitation (ATR), a physical therapy clinic in southwest Charlotte, introduced the ML 830 Laser in their clinic. According to the results of the company’s internal study, patients treated with the ML830 Laser have reported a 35% reduction of pain after a 10 minute treatment.  “It has gotten to the point, where I am no longer surprised by the results,” said Christopher Stulginsky, PT who is not only the managing partner of ATR but also the regions only certified premier provider according to the distributor’s website.  “We have had success with people of all ages and with multiple body sites and conditions. Most of our success has been with carpal tunnel, arthritis pain, post surgical rehab, with people who have been in car accidents, and those who have back pain.” Stulginsky has also had success with adolescent sports injuries as well. “They always seem to like the idea of being treated with something that Olympic and NFL athletes use.”

For more information about this and other treatment programs at Ayrsley Town Rehabilitation please contact them at 980.939.1580.

Additionally, the 830 Laser can be used over orthopedic hardware, pacemakers and over adolescent growth plates without side effect, which is not necessarily the case with traditional ultrasound and electric stimulation.  “The laser, which is the first on the market approved by the FDA, uses light to assist the local lymphatic response, it does not use heat or electricity, which can be contraindicated in certain scenarios,” said Stulginsky, who continued, “people need to know this information, they need to know what they have available to them. It is the only way to navigate healthcare today, to be armed with knowledge and explore their options.”

Many patients have been successfully treated at ATR since they opened their doors last October. Amelia is one of them and certainly agrees with Stulginsky’s assessment. She is a grandmother of one and recently had surgery for a torn rotator cuff, “I was going to have to wait for a while before I could get my surgery. I thought there was no point in going physical therapy, and that I couldn’t without a referral.  One day I was just in so much pain, a client recommended Chris to me, and I realized he could see me without a referral; he started working with me and helped the healthy muscles stay strong and help manage my pain with the laser.  I had not slept well it quite some time, but after one laser treatment I slept through the night. I am way ahead of schedule after my operation; I attribute that to Chris, seeing him before surgery and the use of the laser,” said Amelia.

Keith is a full time barber and  works at a local restaurant on the weekend, he has gone to ATR for treatment. “All day I am cutting hair, I can feel it in my forearm and wrist. I need for my hands to work. That laser thing is amazing. I feel relief within the first few minutes.”  Keith was also in a car accident many years ago, and after a busy weekend at the restaurant, he feels his old injury.  “Just the other day, after working on the weekend, I could barely stand up to cut hair, Chris was able to get me in and help lower my pain so that I could get through the day”

Annie is a chronic pain patient with severe osteoarthritis, multiple bulging discs, radiculopathy, entrapped nerves at L4 and L5 with trochanteric bursitis and peripheral neuropathy. She has tried many different treatments including medication, acupuncture and steroid injections.  “After my first treatment I cried in the bathroom the next morning because for the first time in many years I was not experiencing that horrible grinding pain.”

For more information about this and other treatment programs at Ayrsley Town Rehabilitation please contact them at 989.939. 1580.


Ayrsley Town Rehabilitation (ATR) was opened by Christopher Stulginsky and Alex Gomez in October of 2008 in The Town of Ayrsley, a New Forum community in southwest Charlotte.

Christopher Stulginsky, PT is the managing partner and treating physical therapist at ATR. Christopher is a 2003 graduate of the masters in physical therapy program at The Rangos School of Health Sciences at Duquesne University in Pittsburgh, PA. After graduation he spent 4 years as a travel physical therapist working throughout the United States. His travel background afforded him the opportunity to learn various techniques and about different technologies that were being used around the country. Additionally, Christopher has worked in multiple settings and multiple institutions including: The Johns Hopkins Hospital in Baltimore, MD; Friday Harbor Physical Therapy in Friday Harbor, WA; Mercy Hospital, West Suburban Sports and Rehab Clinic and Westlake Hospital’s Outpatient Back and Spine clinic in Chicago, IL.

Charlotte Clinic Offers Affordable Payment Options for Treatment as Deductibles Reset in New Year

With the new year, comes a reset in insurance deductibles, with high cost deductibles, many avoid treatment, which makes situations worse. This Charlotte clinic offers options to patients for manage the costs of their health care needs.

 PRLog (Press Release) – Jan. 27, 2010 – As the calendar has flipped to 2010, individuals who have medical insurance once again encounter and, are understandably concerned about their high medical insurance deductibles.  Insurance deductibles vary from insurance plan to insurance plan and in most cases they are a number negotiated between insurance company and their employer. The deductible is the amount that the employee is responsible for before the insurance coverage begins.

With some plans the deductable is a total medical deductable, with some there is a total family deductable, and with other plans there is a separate deductable for different medical services.  It is understandable that after a busy and usually expensive holiday season, individuals put off medical treatment because of the deductable of their plan.

Ayrsley Town Rehabilitation feels that high cost deductibles should not interfere with those who want and need pain relief.  “There is no reason that just because the calendar has changed that treatment should stop or be avoided. Pain does not stop after the new year, why should treatment?” says Chris Stulginsky, PT who is the managing partner of Ayrsley Town Rehabilitation in the Steele Creek area of Charlotte, NC.

In order to help patients navigate a climate with high insurance deductibles or a situation where there is no insurance at all , Ayrsley Town Rehabilitation offers discounted private pay rates as well as discounted multiple treatment rates all of which can be applied to the patient’s deductable. “We have plans in place to make things affordable for patients, most people are hesitant to even contact a medical facility to ask about payment possibilities, we encourage everyone to call and ask, we can help find what  option is best for each individual,” said Stulginsky.

“It is something for both patients and providers to consider as we continue to give our patients the best total care that we can.”

For further details on this or many other affordable pain relief programs at Ayrsley Town Rehabilitation please contact Chris Stulginsky, PT at 980.939.1580.

Christopher Stulginsky, PT is a 2003 graduate of the physical therapy program at the Rangos School of health Sciences at Duquesne University in Pittsburgh, PA. He is a certified member of the Prehab Network and a Certified Provider in use of the ML 830 Laser, the first cold laser approved by the FDA for pain. He has worked at The Johns Hopkins Hospital in Baltimore, MD and in various Sports Medicine clinics around the country. Currently, he is the managing partner or Ayrsley Town Rehabilitation, a physical therapy clinic in Charlotte, NC.

Local Clinic Introduces New Aquatic Program

Ayrsley Town Rehabilitation offers first aquatic therapy pain relief and therapy program in the Steele Creek section of Charlotte, NC.

PRLog (Press Release) – Jun. 23, 2010 – Charlotte, NC:

(Steele Creek) – On June 1, 2010, Ayrsley Town Rehabilitation started offering aquatic physical therapy to the healthcare consumers of southwest Charlotte.

“Aquatic therapy is a great way to decrease pain,” states Chris Stulginsky, PT of Ayrsley Town Rehabilitation.

“It is the closest thing we can get to being weightless, it unweights the joints and allows people to do more and work on true solutions for their pain relief. Because they are able to move more easily, clients strengthen their muscles to take pressure off of the joints over time.”

Myrtle Williams, a client who participates in the aquatic program agrees.  “I can do more in the pool then I can on the land, it helps me move around better without the pain. I can exercise without soreness the next day.”

Stulginsky continues on, “The aquatic program assists us in providing comprehensive pain solutions. It is an added plus to our already established Back Pain, Fibromyalgia, Orthopaedic Rehab and Prehab for Pregnancy Programs. Though it varies from plan to plan, in most cases the therapy is covered by health insurance, including Medicare.”

Stulginsky adds, “The aquatic program is another component to assist us in addressing the pain and rehabilitation needs of the people of south Charlotte and the Lake Wylie corridor.”

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.”