Types of Physical Therapy

Here at Skyline, we're equipped to handle the vast array of problems that can occur.

TMJ Dysfunction (jaw pain)

Temporomandibular joint dysfunction or TMJ disorder occurs in the site where the lower jaw meets the temporal bone located right in front of the ear. There are two temporomandibular joints, one on each side of the face.

The TMJ is a very complicated joint. It opens and closes like a hinge, slides forward and backward and side to side. During chewing, it sustains an enormous amount of pressure. The TMJ contains a piece of specialized cartilage called a disc that keeps the skull and lower jawbone from rubbing against each other. TMJ disorder is most common in women in their early 20's and between the ages of 40 and 50. In rare cases, it is seen in children. TMJ disorder includes problems with the joints, the muscles surrounding them, or both.

The cause of TMJ disorder is a combination of muscle tension and anatomical problems with the joint. Sometimes, there is a psychological component as well. Specific causes include muscle pain and tightness, internal joint arrangement, arthritis, ankylosis, and hypermobility.  Another cause is abnormal cervical positioning, as well as trauma to the jaw and poor posture.

The therapist at Skyline Physical Therapy work your dentist from time to time with a splint which is utilized either during the day or during the night or both is incorporated in the treatment of this condition.

Recent research has shown that the use of the Erchonia low level laser is beneficial in treatment of temporomandibular dysfunction.

Please contact Skyline Physical Therapy for further information and treatment.

Back Pain

If you have low back pain, you are not alone. At any given time, about 25% of people in the United States report having low back pain within the past 3 months. In most cases, low back pain is mild and disappears on its own. For some people, back pain can return or hang on, leading to a decrease in quality of life or even to disability.

There are 3 different types of low back pain:

  • Acute - pain lasting less than 3 months
  • Reccurent - acute symptoms come back
  • Chronic - pain lasting longer than 3 months

* Most people who have an episode of acute pain will have at least one recurrence.

Often, low back pain occurs due to overuse, strain, or injury. It could be caused by too much bending, twisting, lifting--or even too much sitting. But just as often, the actual cause of low back pain isn't known, and symptoms usually resolve on their own.

Although low back pain is rarely serious or life threatening, there are several conditions that may contribute to low back pain, such as: degenerative disk disease, lumbar spinal stenosis, fractures, herniated disk, osteoarthritis, osteoporosis and tumors of the spine.

For most cases of low back pain, imaging tests such as x-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI) are not helpful for diagnosing the cause. However, if your physical therapist suspects that your low back pain might be caused by a serious health condition, the therapist will refer you to other health care professionals for evaluation.

Your physical therapist can help you improve or restore mobility and reduce low back pain--in many cases, without expensive surgery or the side effects of medications.

If you are having low back pain right now:

Stay active, and do as much of your normal routine as possible (bed rest for longer than a day can actually slow down your recovery.) If your pain lasts more than a few days or gets worse, schedule an appointment to see your physical therapist.

Not all low back pain is the same, so your treatment should be tailored to for your specific symptoms and condition. Once the examination is complete, your physical therapist will evaluate the results, identify the factors that have contributed to your specific back problem, and design an individualized treatment plan for your specific back problem.

Treatments may include:

  • Manual therapy, including spinal manipulation, to improve the mobility of joints and soft tissues.
  • Specific strengthening and flexibility exercises.
  • Education about how you can take better care of your back.
  • Training for proper lifting, bending, and sitting; for doing chores both at work and in the home; and for proper sleeping positions.
  • Assistance in creating a safe and effective physical activity program to improve your overall health.
  • Use of ice or heat treatments or electrical stimulation to help relieve pain.
  • Dry Needling

As experts in restoring and improving mobility and movement in people's lives, physical therapists play an important role not only in treating persistent or recurrent low back pain, but also in preventing it and reducing your risk of having it come back.

Physical therapists can teach you how to use the following strategies to prevent back pain:

  • Participate in regular strengthening and sketching exercises to keep your back, stomach, and leg muscles strong and flexible.
  • Maintain a regular physical fitness regimen - staying active can help to prevent injuries.
  • Keep good posture - don't slouch!
  • Use good body positioning at work, home, or during leisure activities.
  • Keep the load close to your body during lifting.
  • Ask for help before lifting heavy objects.

All physical therapists are prepared through education and experience to treat people who have low back pain.

You may want to consider:

  • A physical therapist who is experienced in treating people with orthopedic, or musculoskeletal problems.
  • A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopedic physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.

The information above was modified from Move Forward. For further information visit their website at www.moveforwardpt.com

Neck Pain

The cervical spine is a marvelous and complex structure. It is capable of supporting a head weighing 15 or more pounds while moving in several directions. No other region of the spine has such freedom of movement. This combination however, complexity and mobility, make the neck susceptible to pain and injury.

This complex structure includes 7 small vertebrae, intervertebral discs to absorb shock, joints, the spinal cord, 8 nerve roots, vascular elements, 32 muscles, and ligaments.

Neck mobility is matchless. It is capable of moving the head in many directions: 90 degrees of flexion (forward motion), 90 degrees of extension (backward motion), 180 degrees of rotation (side to side), and almost 120 degrees of tilt to either shoulder.

The causes of neck pain are as varied as the list is long.

Consider a few examples:

  • Injury and Accidents
  • Growing Older
  • Everyday Life

Poor posture, obesity, and weak abdominal muscles disrupt the spine's balance often causing the neck to bend forward to compensate. Stress and emotional tension can cause muscles to tighten and contract resulting in pain and stiffness.

Obtaining a proper diagnosis is paramount to determine the best course of treatment. A  physical therapist will take the patient's medical history. The oral segment of the examination often includes many questions such as "when did the pain start?" - "what activities preceded the pain?" - "previous treatment" - "does the pain radiate or travel into other body parts?" - "what makes the pain less or greater?" and so on. A physical examination includes observing the patient's posture, range of motion, and physical condition. Any movement generating pain is carefully noted. The therapist will palpate or feel the curvature of the spine, vertebral alignment, and detect muscle spasm.


Pain of any type that occurs in any part if the head is called a headache. There are many different types of headaches, with just as many causes.

The International Headache Society describes several different categories:

  • Tension-type Headaches
  • Migraine Headaches
  • Cluster Headaches
  • Secondary Headaches
  • Cranial Neuralgias-Facial Pain-Other

Most headaches are harmless and usually resolve on their own. Severe headaches that are recurring can affect your ability to perform daily activities and can reduce your quality of life.

There is effective treatment for almost every type of headache. The challenge lies in determining the specific type of headache occurring and it's cause. Physical therapists can help determine the type of headache and are experts in managing the pain.

Tension-type headaches are the most common type of headaches in adults. They may be causes by neck or jaw problems, poor posture, fatigue, or stress. A tension-type headache usually begins at the back of the head and spreads to the top of the head and the eyes. You may feel an increase in facial pain, tightness and tugging along the hair line or cheek near the jaw bone.

A Physical therapist can help by performing a thorough examination that includes your health history. The therapist will as several questions to determine the most likely cause of your headaches. The therapist will work with you to correct the problems that are causing your headaches and will help you to learn to prevent them through simple changes in your posture and lifestyle.

The information provided above is from the American Physical Therapy Association. For further information visit www.apta.org

Post Surgical Rehabiliation

Total Hip

Total Knee

ACL repair

Total Shoulder

Rotator Cuff Repair (RTC)


The term for fibromyalgia is used to describe several related disorders. Various alternative terms for these disorders have been used, including generalized fibromyalgia, primary fibromyalgia syndrome, secondary fibromyalgia syndrome, localized fibromyalgia, and myofascial pain syndrome, each having different connotations. Previously, these disorders were collectively called fibrositis or fibromyositis syndrome. Because inflammation is not present, the -itis suffix was dropped.

Generalized fibromyalgia which is about seven times more common in women than in men occurs throughout the body with pain and stiffness being widespread. Primary fibromyalgia syndrome is the most common variation of generalized fibromyalgia; it usually occurs in young or middle-aged women who have not associated or contributing underlying factors. Secondary fibromyalgia syndrome is a type of generalized fibromyalgia and refers to fibromyalgia symptoms in a person who has another underlying disorder that is causing fibromyalgia symptoms, such as hypothyroidism. Other disorders, such as systemic lupus erythematosus or rheumatoid arthritis, maybe associated with fibromyalgia but not the underlying cause. In localized fibromyalgia, pain and stiffness occur in a particular area or at a fused site such as the jaw, neck, and/or shoulder muscles. Localized fibromyalgia is somewhat more likely to occur in men, possibly because they are more likely to engage in physical muscular activities in occupational and sports situations. Sometimes, localized fibromyalgia generally spreads to become generalized fibromyalgia. Myofascial pain syndrome is a type of localized or regional fibromyalgia which may be seen in various sites. In the temporomandibular type, the chewing muscles on the side of the face are commonly involved and may become painful and tender.

Fibromyalgia is not dangerous or life-threatening, but nonetheless, persistent symptoms can be very disruptive.

The cause of fibromyalgia is unknown, but it is thought to be a type of autoimmune disorder. Fibromyalgia is worsened by physical or mental stress; poor sleep; repetitive strain; injury or trauma; or chronic exposure to dampness and cold. Physical therapy has been shown to provide relief for fibromyalgia primarily through educating patients in its management. Generally an exercise program of regular physical activity and stretching is setup. Proper sleep and decreasing stress are also very important. The therapists at Skyline Physical Therapy are quite knowledgeable in fibromyalgia and have extensive experience in treating patients with this chronic condition. For further information, please contact Skyline Physical Therapy.

Foot and Ankle Injuries

The most commonly reported injuries in the foot/ankle region are ankle sprains. A sprained ankle simply means that the ligaments (the strong bands of tissue that connect the bones of the foot) are stretched beyond their normal limits, resulting in inflammation, tearing, or rupture of the tissue.

Sprained ankles run the gamut from minor to serious. If you're in pain for more than a day or two, or if the pain is intense, you should see a physical therapist or physician. If physical therapy is required, the sprained ankle may be immobilized for a short period to prevent further damage and to give the tissue a chance to heal. After that, therapy progresses quickly with exercises designed to restore stability and strength to the muscles. It is also crucial that the patient's sense of balance be restored or enhanced through exercise.

Physical therapists may choose from an array of options in treating you, including exercises for flexibility, stability, balance, strength, coordination, and restoration of range of motion, as well as massage, electrical stimulation, ultrasound, heat or cold. These tools allow the physical therapist to create a program of rehabilitation that is custom-designed for your particular problem. In addition, the physical therapist may consult with other health care practitioners to provide special, braces, supports, casts, or shoe inserts.

To avoid or overcome a foot or ankle problem you may need to modify your current level of physical activity, whether it involves work, recreation, or both. Once your physical therapy goals are met, your physical therapist will help you continue therapy on your own with a home program designed to fit your needs. The goal of physical therapy is to return you to normal activity as quickly as possible, with the knowledge you need to prevent re-injury.

Plantar Fasciitis

Plantar fasciitis is a localized degenerative condition that affects approximately two million Americans each year, as much as 10% of the population over a lifetime. (PHYSICIAN SPORTS MED), 2004 Nov.

This condition is a common cause of heel pain in many adults. Pain is usually caused by collagen degeneration at the origin of the plantar fascia plus acute inflammation with an increased connective tissue matrix are usually seen. Repetitive micro tears of the plantar fascia is the cause of degeneration and the body's ability to repair itself is hindered.

A classic sign of the disorder can occur with "worst pain" during the first few steps of the morning. Individuals with low arches or flat feet (pes planus) or high arches (pes cavus) have an increased risk for developing plantar fasciitis.

According to (AM FAM Physician), 2001 Feb 1. Symptoms usually resolve more quickly when the onset of treatment occurs shortly after the onset of symptoms.

This disorder can be successfully treated by the knowledgeable therapy team at Skyline Physical Therapy. The skilled  therapy team is able to tailor treatment to an individual's preferences and risk factors. Many treatment options exist, including ultrasound, manual therapy, iontophoresis, stretching, strengthening, orthotics, night splints, and anti-inflammatory agents.

Custom-Fitted Orthotics Custom orthotics are generally made by taking an impression of the individual's foot and then constructing an insert, specifically designed, to control biometrical risk factors. Flat feet/low arches (pes planus), valgus heel (internal rotation), plantar fasciitis, and leg length discrepancies are a few samples of what orthotics can correct. The support provided by an over-the-counter arch support is highly variable, and may be a consideration for an adolescent's treatment due to rapid foot growth (AM FAM Physician), 2001 Feb. 1.

The staff at Skyline Physical Therapy are knowledgeable in custom orthotic fabrication. A dedicated team of therapists welcome your individual scenarios, questions and concerns, as they work together to assist in successfully treating your symptoms.

Trochanteric Bursitis

Trochanteric bursitis is inflammation of the bursa (fluid-filled sac near a joint) at the outside (lateral) point of the hip known as the greater trochanter. When this bursa becomes irritated or inflamed, it causes pain in the hip. This is a common cause of hip pain.

Trochanteric bursitis typically causes the following symptoms:

  • Pain on the outside of the hip and thigh or in the buttock.
  • Pain when lying on the affected side.
  • Pain that gets worse during activities such as getting up from a deep chair or getting out of a car.
  • Pain with walking up stairs.

Trochanteric bursitis can result from one or more of the following events:

  • Injury to the point of the hip. This can include falling onto the hip, bumping the hip into an object, or lying on one side of the body for an extended period.
  • Play or work activities that cause overuse or injury to the joint areas. Such activities might include running up stairs, climbing, or standing for long periods of time.
  • Incorrect posture. This condition can be caused by scoliosis, arthritis of the lumbar (lower) spine, and other spine problems.
  • Stress on the soft tissues as a result of an abnormal or poorly positioned joint or bone (such as leg length differences or arthritis in a joint).
  • Other diseases or conditions. These may include rheumatoid arthritis, gout, psoriasis, thyroid disease or an unusual drug reaction. In rare cases, bursitis can result from infection.
  • Previous surgery around the hip or prosthetic implants in the hip.
  • Hip bone spurs or calcium deposits in the tendons that attach to the trochanter.

Bursitis is more common in women and in middle-aged or elderly people. Beyond the situations mentioned above, in many cases, the cause of trochanteric bursitis is unknown.

Treatment goals include reducing pain and inflammation, preserving mobility, and preventing disability and recurrence. Treatment recommendations may include a combination of rest, splints, heat, and cold application.

More advanced treatment options include:

  • Non-steroidal anti-inflammatory drugs, such as ibuprofen or naproxen
  • Corticosteroid injections given by your health care provider. Injections work quickly to decrease the inflammation and pain.
  • Physical therapy that includes range of motion exercises and splinting.

Most cases of bursitis improve without any treatment over a few weeks.

See your health care provider if you have any of the following signs or symptoms:

  • You experience pain that interferes with your normal day-to-day activities or have soreness that doesn't improve despite self-care measures.
  • You have recurrence of bursitis.
  • You have a fever or the area affected appears red, swollen or warm.

Because most cases of bursitis are caused by overuse, the best treatment is prevention. It is important to avoid or modify the activities that cause the problem. Underlying conditions such as leg length differences, improper posture, or poor technique in sports or work must be corrected. Apply these basic rules when performing activities: Take it slow at first and gradually build up your activity level, Use limited force and limited repetitions, Stop if unusual pain occurs.

The information listed above is from The Cleveland Clinic Foundation.