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The future of musculoskeletal care is here,
and it's patient-centered and outcome-based.
Successful treatment outcomes rely on an accurate diagnosis, it all starts with a functional evaluation process. As a sports medicine specialist, we develop a detailed diagnosis that is structure and dysfunction specific. First determining what structure is involved (muscle, tendon, ligament, disc, nerve, bone, joint capsule, labrum, meniscus). Then determining the dysfunction, or what's gone wrong with that specific structure (adhesion, weakness, degeneration, tear, fracture, inflammation, entrapment).
Assessing functional movements such as a squat, lunge or hip extension with the help of selective tissue tension tests, directs us to the involved structure. Motion palpation of the joints and compressive palpation of the soft tissues provide the added detail necessary for a dysfunction specific diagnosis.
We then select the treatment that has proven effective in resolving the dysfunction and apply it to the involved structure. Our treatment approach involves three essential components: highly skilled manual treatment of both joint & soft tissues, rehabilitation and self-care. Our patients can expect several of the following procedures to be used during a treatment session as dictated by their particular condition.
OUR TREATMENT PROCEDURES
Load Management Strategies
A doctors first treatment is to teach the patient to avoid what harms them. Identifying and removing (whenever possible) or effectively managing exacerbating activities, thereby reducing load is the first step in restoring the load vs. capacity balance.
The ultimate source of injury is from overloading your body enough to cause damage. We maybe able to fix the injury, but if the load isn't managed the problem will return. Load management strategies are used throughout the course of our treatment to allow you to remain active, yet not compromise your recovery. Load management includes the effective use of bracing, taping, cervical pillows, lumbar supports, lumbar night rolls and orthotic fabrication. Patients are also instructed in how to move properly (see hip hinge), micro breaks, ergonomics and return to training guide lines.
Spinal Joint Manipulation
The objective of manipulative therapy is to improve mobility in joints that are restricted. Meniscoid entrapment is the theory that best describes how joint restriction occurs. Spinal joints are lined with irregularly shaped slips of cartilage that can become trapped between the two joint surfaces. It is this entrapment that prevents the joint from gliding properly. A spinal joint that is unable to glide will cause one or more of the following problems:
1. Restricted joint motion
2. Pain and inflammation
3. Produce muscle spasm or inhibition (weakness)
4. Causes the body to compensate
5. Encourage joint and disc degeneration (arthritis)
Joint restriction occurs when joints are overloaded. Overload can be caused by poor posture, muscle imbalance, scar tissue, trauma or faulty movement patterns.
Spinal manipulation is preformed by applying a gentle force across a joint that separates the joint surfaces. The direction, speed, depth and angle that is used is the result of years of training and experience. This is most often done with a short quick thrust (manipulation) and sometimes all that's required are slow oscillating movements (mobilization). Gaping the joint releases the entrapped meniscoid, restoring normal position and motion to the involved joint.
Manipulation produces a "popping" sound from the shifting of gases within the joint capsule, and the patient can usually sense a slight movement of the joint. When preformed by a highly skilled doctor of chiropractic the procedure is safe, gentle and proven effective.
Extremity Joint Manipulation
The objective of manipulative therapy is to improve mobility in joints that are restricted. The foot, ankle and hip are the extremity joints most commonly affected with joint restriction. Extremity manipulation is performed in the same way it's applied to the spine. It's most often done with a short quick thrust (manipulation) and sometimes with slow oscillating movements (mobilization). Like spinal manipulation it's safe, gentle and proven effective.
Active Release Techniques
Active Release Techniques® (ART) is an effective procedure used to eliminate adhesion (scar tissue) in muscle, tendon, ligament, fascia and nerve, collectively referred to as soft tissues.
When soft tissue is torn the healing process involves the creation of adhesion, also known as scar tissue. This is necessary to connect and bind the torn tissue. Unfortunately, the healing adhesion often sticks to surrounding structures (think of it as glue) overworking healthy tissue, entrapping nerves and limiting motion, strength and speed.
Adhesion can also result from poor posture or repetitive motions. Both cause the soft tissues to increase in tension, decreasing the blood supply and releasing free radicals. Free radicals attract the cells that produce adhesion. This means that maintaining poor posture or sustained posture (sitting in front of a computer for hours), and repetitive motion (using the computer keyboard or mouse) can all result in the formation of adhesion. In fact this is the most common pathway.
Dr. Viteritti is an experienced ART provider who has been trained to identify areas of adhesion by the way it feels. Palpation of the tissue reveals a tight area with altered texture and decreased movement.
Conceptually ART is very simple. However, effective application requires a very high level of skill and years of experience. It works like this:
1. The doctor identifies the area of adhesion by feeling it.
2. The muscle, tendon, ligament or nerve is shortened.
3. The doctor places a contact (fingers or thumb) on the adhesion creating tension.
4. The patient moves the body part, lengthening the structure. This generates tension that breaks down the adhesion restoring normal movement, tension, texture and function to the tissue. Restoring soft tissue function is what ultimately reduces pain and improves performance. For further information and video demonstrations of ART contact www.activereleasetechniques.com.
Instrument Assisted Soft Tissue Mobilization (IASTM)
Instruments are an essential tool used in the assessment and treatment of soft tissue disorders. They have proven to be exceptionally effective in breaking down adhesion (scar tissue) and fascial restrictions.
Much like a tuning fork, the instrument vibrates in the doctors hand when encountering adhesion allowing him to detect it and then treat it very precisely. Since the surface of the instrument does not compress as do the fat pads of the fingers, deeper restrictions can be detected and treated as well. Just as a stethoscope amplifies what the human ear can hear, the instruments increase what the human hand can feel.
The patient themselves can feel and hear a "crunching", as the instrument is past over the adhesion. With only a handful of effective treatments, the adhesion can be significantly reduced. The use of instruments in soft tissue treatment is a skillful art that demands both training and experience to become expert in its use.
Dr. Viteritti has been extensively trained and certified in several IASTM techniques including Graston®, FAKTR, Sound Assisted and Instrument Adhesion Release with a decade of experience in their use. He taught advanced procedures in soft tissue treatment in his role as a clinical instructor for Northeastern University Sports Medicine. For further information and video demonstrations of an example of IASTM contact www.grastontechnique.com.
Effective rehabilitation is much more than performing a few simple exercises from a sheet of paper. Strength exercises are used to restore normal muscle strength. When a muscle is weak, the first step is to identify why it's weak. Jumping right into performing strength exercises can be ineffective and inappropriate. After other problems have been identified and corrected, strength exercises are used to restore muscle balance, joint stability and strength. It is important that each muscle in the body is capable of doing the job it is intended to do.
Joints are generally surrounded by several muscles or groups of muscles. Muscles work together to move and stabilize the joint. Both of these functions, movement and stability, are critical for efficient and healthy motion. For example, lifting a suitcase with your right hand first requires the muscles of the left low back to contract. If your back muscles are weak, the joints, discs and soft tissues will be overloaded. This can cause an acute injury or if occurring repeatedly, lead to degeneration.
When strength exercises become necessary, they are prescribed using a specific protocol. First, individual muscle weakness is identified and strengthen with isolation exercises. Once balance is achieved, functional exercises are used to increase overall strength. When muscles are strong and well-balanced, joints are able to maintain their proper position. This minimizes chances of injury, particularly to cartilage and labrum structures.
Peripheral nerve entrapment's, such as carpal tunnel syndrome require careful examination by a doctor. First to determine the involved nerve, and then the precise location of the entrapment. Dr. Viteritti is certified in ART Long Track Nerve Entrapment's, enabling him to manually release nerve entrapment's.
Nerve flossing is an essential self-care maneuver that supplements the highly skilled manual treatment provided by Dr. Viteritti. The idea behind nerve flossing is for the patient to perform various movements that cause the nerve to slide back and forth. It's this back and forth movement or "flossing", that creates the tension that helps pull the nerve free from where it's stuck.
Nerve flossing is also helpful in preventing adhesion from once again sticking to the nerve, just as flossing your teeth cleans away plague buildup. A thorough evaluation and treatment of a nerve entrapment should always proceed a self-care program of nerve flossing.
Vital to our over all approach is patient education and self-care. Progressing a patient from passive-care (a doctor treating a patient), to active-care (a patient treating themselves) is one of the hall marks of exceptional clinical care. Self-care procedures are an integral component of our treatment programs because they encourage patients to be self-reliant whenever possible.
The only hope of successfully managing complex spinal conditions requires that patients play an active role in their own recovery. First helping to resolve their acute symptoms and then preventing its recurrence. The essential self-care procedures that we prescribe include the proper use of ice and heat therapy, stretches, exercises, joint mobilization, form rolling, nerve flossing and load management strategies.