Specialty Therapy Programs

Specialized services from TMJ to Custom Orthotics.

TMJ Treatment

Offering the best in TMJ treatment from eastern Nebraska to Western Iowa

Skyline Physical Therapy is one of the only places that specializes in TMJ disorder, commonly know as jaw pain. We serve the greater Omaha area as well as eastern Nebraska and western Iowa. Our research, techniques and specialization allows us to offer the best treatment available for TMJ disorder.

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.

Please Contact Us for more information and to find out what treatment options Skyline Physical Therapy can offer.

Manual Therapy

Manual therapy techniques consist of a board group of passive interventions in which Physical Therapists use their hands to administer skilled movements designed to modulate pain; increase joint range of motion (ROM); reduce or eliminate soft tissue swelling, inflammation, or restriction; induce relaxation; improve contractile tissue extensibility; and improve pulmonary function. These interventions involve a variety of techniques, such as the application of graded forces.

Physical Therapists use manual therapy techniques to improve physical function and health status (or reduce or prevent disability) resulting from impairments by identifying specific performance goals that allow patients/clients to achieve a higher functional level in self-care, home management, community, and work (job/school/play) integration or reintegration, or leisure tasks and activities.

Dan Peetz, P.T., O.C.S., M.T.C. was the first physical therapist in Nebraska to receive manual certification through the Institute of Physical Therapy. Dan has been a certified manual therapist since 1984.

Manual therapy techniques may include:

  • Connective tissue massage
  • Joint mobilization and manipulation
  • Manual lymphatic drainage
  • Manual Traction
  • Passive ROM
  • Soft tissue mobilization and manipulation
  • Therapeutic massage

The information above is from The American Physical Therapy Association's website. For further information, please visit www.apta.org

Functional Dry Needling

Functional Dry Needling is a skilled intervention performed by a physical therapist that uses a thin filiform needle to penetrate the skin and stimulate underlying myofascial trigger points, muscular and connective tissues for the management of neuromusculoskeletal pain and movement impairments.

With inserting a tiny monofilament needle in a muscle or muscles, shortened bands of muscles release and decrease trigger point activity. This can help resolve pain and muscle tension, and will promote healing.

*Needles are only one part of the treatment a physical therapist will provide with the overall goal being to restore function.

Graston Technique

The Graston Technique is a blueprint for treating and resolving soft tissue injuries, including repetitive stress diagnoses. Our therapist is specially trained in the Graston Technique, incorporation this technique into daily therapy rehabilitation.

The Graston Technique can be utilized for the care of acute and chronic:

  • TMD
  • Cervical Sprain/Strain (neck pain)
  • Low Back Pain
  • Plantar Fasciitis
  • Rotator Cuff Tendinitis (Shoulder Pain)
  • Achilles Pain
  • Fibromyalgia
  • Scar Tissue
  • Shin Splints
  • Trigger Points

How it Works

The technique primarily separates and breaks down collagen cross-links by splaying and stretching connective tissue and muscle fibers. The therapist uses stainless steel instruments that are designed to adapt to carious tissues, shapes and curves of the body. The instruments are designed to provide an adjunct to the clinician's hands and not replace them.

* Successful outcomes cannot be achieved with the instruments alone; they are one component of the overall therapy program.

Orthopedic Physical Therapy

Orthopedic physical therapy is the provision of care for those individuals of all ages with disorders or dysfunction of the musculoskeletal system. Orthopedic physical therapists are skilled in the diagnosis, management, and prevention of musculoskeletal disorders. They are experts in the assessment of movement and can help individuals move better, often with less pain, through skilled manual therapy, therapeutic exercise and patient education. Orthopedic physical therapy is often provided in an outpatient rehabilitation setting; however, orthopedic physical therapy extends into many other health care settings, including hospitals, homes, sports clinics, and industrial sites.

The following health conditions are often managed by orthopedic physical therapists:

  • Low back and neck pain
  • Rotator cuff injuries and other shoulder problems
  • Osteoarthritis
  • Plantar fasciitis
  • Post-operative rehabilitation from orthopedic surgical procedures
  • Muscle strains
  • Joint sprains/pain/swelling, including knee and ankle injuries
  • Chronic pain
  • Tennis/golfer's elbow
  • Carpal Tunnel Syndrome

Low Level Laser Therapy

Low level laser therapy is a form of phototherapy which involves the application of low power coherent light to injuries to stimulate healing. Low level laser therapy is used to increase the speed, quality and tensile strength of tissue repair, resolve inflammation, increase range of motion, and provide pain relief.

Erchonia Medical is the leading research company on lasers and is the developer of the low level laser therapy technology. Low level laser therapy or commonly known as cold laser therapy is a major advancement in healing and is rewriting the medical journals on what is possible for chronic injuries, pain management, neurological impairments, and facilitating the healing process. Skyline Physical Therapy was one of the first clinics in the State of Nebraska to be awarded the use of the FDA approved Erchonia laser.

How does cold laser work?

The effects of low level laser therapy are photochemical, which is not thermal. Hot lasers in the medical world are used during surgery, while cold lasers are used for healing. The cold laser is set at 635 nm, which causes an interaction between cells and photons to take place. Photons from the laser affect the tissue at the cellular level. The cold laser enters the tissue, altering cell membrane permeability, and at the cellular level is absorbed in the mitochondria.

The mitochondria are the "powerhouse" of the cell and makes ATP which is needed for the life enhancement process of every cell which facilitates:

  • Rapid cell growth
  • Increased wound healing time
  • Increased metabolic activity
  • Reduced fibrous tissue formation
  • Anti-inflammatory action
  • Increased vascular activity
  • Stimulates nerve function

The Erchonia laser has been found to offer superior healing and pain relieving affects when compared to other electrotherapeutic modalities.

Low level laser therapy is used for the following conditions:

  • Soft tissue injuries: Sprains, strains, hematomas, tendinitis, tenosynovitis, capsulitis, and bursitis
  • Chronic neck and back pain
  • Myofascial trigger points
  • Reduction of inflammation
  • Wound management: Open wounds, pressure sores, postsurgical healing, ulcers, diabetic ulceration, and burns
  • Metatarsalgia
  • Trigeminal neuralgia
  • Brachial neuralgia
  • Plantar fasciitis
  • Frozen shoulder
  • Carpal tunnel syndrome

Pain Management

Pain is a distributed sensation that causes suffering or distress. The physical therapist uses pain tests and measures to determine the intensity, quality, and physical characteristics of any pain that is important to the patient. The physical therapist may determine a cause or a mechanism for the pain through these tests and measures. The tests and measures also may be used to determine whether referral to another health care professional is appropriate.

Data generated may include:

  • Activities that aggravate or relieve pain
  • Behavior or pain reactions observed during particular movement tasks
  • Muscle soreness classification and grade
  • Numerical ratings from standardized ratings instruments
  • Pain patterns over time
  • Pain reactions to cumulative stress or trauma
  • Response to pain
  • Response to noxious stimuli
  • Response during specific movement tasks and to provocation tests
  • Sensory and temporal qualities of pain
  • Somatic distribution of pain

Low level laser therapy is often utilized to treat pain.  Erchonia Medical is the leading research company on lasers and is the developer of the low level laser therapy technology. Low level laser therapy or commonly known as cold laser therapy is a major advancement in healing and is rewriting the medical journals on what is possible for chronic injuries, pain management, neurological impairments, and facilitating the healing process. Skyline Physical Therapy was one of the first clinics in the State of Nebraska to be awarded the use of the FDA approved Erchonia laser.

The information listed above is from The American Physical Therapy Association's website. For further information go to www.apta.org

Posture Tips

Ways to Have Great Posture as You Age

Open up 

Now that many of us spend our days hunched in front of a computer, "it's very important for us to be able to stretch and open up and improve our range of motion," says Jonathan F. Bean, MD, MS, MPH, an assistant professor in the department of physical medicine and rehabilitation at Harvard Medical School in Boston. 

To stay limber, try to get up for a couple minutes every half hour and stretch, walk, or stand.

Easy exercises

Try this exercise: Every morning and night, lie down on the floor and make slow "snow angels" with your arms for two or three minutes.
For an extra challenge, roll up a towel and put it on the floor underneath your spine. Many gyms have half foam rollers—a tube cut in half lengthwise—that you can use for even more of a stretch. 
But do these stretches slowly and stop if you feel anything worse than mild discomfort or pain, says Dr. Bean. "You want to work up to that, you want to make sure that you first get the flexibility."

Sit straight

When you do have to work at a desk, "sitting up with good, tall posture and your shoulders dropped is a good habit to get into," says Rebecca Seguin, PhD, an exercise physiologist and nutritionist in Seattle. 
This can take some getting used to; exercise disciplines that focus on body awareness, such as Pilates and yoga, can help you to stay sitting straight, Seguin says. Make sure your workstation is set up to promote proper posture.

Strengthen your core

Pilates and yoga are great ways to build up the strength of your "core"—the muscles of your abdomen and pelvic area. 
These muscles form the foundation of good posture, and a strong core can have many other benefits, from improving your athletic performance to preventing urinary incontinence.

Support your spine

After menopause, women may have more weakening in the muscles around the spine than aging men do, Dr. Bean says. 
Exercises targeting the back extensors, neck flexors, pelvic muscles, and side muscles are crucial. Trainers at gyms can help; there are even special machines that target these muscles.
Endurance in the spine and trunk muscle groups is important too, according to Dr. Bean; "that's what allows us to stand up for long periods of time without our back hurting us."

Lift weights

The vertebral compression fractures that subtract from our height—and can lead to the "dowager's hump" in the upper back that's a hallmark of old age—are due to the bone-thinning disease osteoporosis. 
Women—and men—can prevent these changes with weight-bearing exercises, like walking, stair climbing, and weight lifting. 
"People who walk regularly through their whole lives tend to have better bone density than sedentary people," Seguin explains.

Vitamin D

Vitamin D is essential for bone health, and may help us maintain our muscles too. 
Try to get it from a healthy diet. A recent report from the Institute of Medicine, an independent, nonprofit organization, found that most of us get enough vitamin D from food and sunlight without taking supplements. 
The recommended dietary intake for vitamin D is 600 IU a day for women up to age 70 and 800 IU for women older than 70.

Eat healthy

We all know the bone benefits of calcium. It is recommended that women 19 to 50 years old get 1,000 milligrams of calcium daily. For older women, it's 1,200 milligrams. But again, it may be best to get calcium from food rather than supplements.

The recent Institute of Medicine report found that most people, except adolescent girls, get enough calcium from their diet. In addition, studies have shown that people taking calcium supplements have higher rates of heart attacks and kidney stones. 

Talk with your physician about whether or not you need to take supplemental calcium.

Identify the warning signs of back pain caused by poor ergonomics and posture

Back pain may be the result of poor ergonomics and posture if the back pain is worse at certain times of day or week (such as after a long day of sitting in an office chair in front of a computer, but not during the weekends); pain that starts in the neck and moves downwards into the upper back, lower back, and extremities; pain that goes away after switching positions; sudden back pain that is experienced with a new job, a new office chair, or a new car; and/or back pain that comes and goes for months.

Keep the body in alignment while sitting in an office chair and while standing

When standing, distribute body weight evenly to the front, back, and sides of the feet. While sitting in an office chair, take advantage of the chair's features. Sit up straight and align the ears, shoulders, and hips in one vertical line. Any prolonged sitting position, even a good one, can be tiring. Shifting forward to the edge of the seat with a straight back can alternate with sitting back against the support of the office chair to ease the work of back muscles.

Some people benefit from a naturally balanced posture that is achieved by sitting on a balance ball; in this posture the pelvis is rocked gently forward increasing the lumbar curve which naturally shifts the shoulders back (similar to sitting on the edge of a chair seat).

Also be aware of and avoid unbalanced postures such as crossing legs unevenly while sitting, leaning to one side, hunching the shoulders forward, or tilting the head.

Get up and move

As muscles tire, slouching, slumping, and other poor postures become more likely; this in turn puts extra pressure on the neck and back. In order to maintain a relaxed yet supported posture, change positions frequently. One way is to take a break from sitting in an office chair every half hour for two minutes in order to stretch, stand, or walk.

Use posture-friendly props and ergonomic office chairs when sitting

Supportive ergonomic "props" can help to take the strain and load off of the spine. Ergonomic office chairs or chairs with an adjustable back support can be used at work.

  •  Footrests, portable lumbar back supports, or even a towel or small pillow can be used while sitting in an office chair, on soft furniture and while driving.
  •  Using purses, bags, and backpacks that are designed to minimize back strain can also influence good posture.
  •  Proper corrective eyewear, positioning computer screens to your natural, resting eye position can also help to avoid leaning or straining the neck with the head tilted forward.

Increase awareness of posture and ergonomics in everyday settings

Becoming aware of posture and ergonomics at work, at home, and at play is a vital step towards instilling good posture and ergonomic techniques. This includes making conscious connections between episodes of back pain and specific situations where poor posture or ergonomics may be the root cause of the pain.

Use exercise to help prevent injury and promote good posture

Regular exercise such as walking, swimming, or bicycling will help the body stay aerobically conditioned, while specific strengthening exercises will help the muscles surrounding the back to stay strong. These benefits of exercise promote good posture, which will, in turn, further help to condition muscles and prevent injury.

There are also specific exercises that will help maintain good posture. In particular, a balance of core muscle and back muscle strength is essential to help support the upper body and maintain good posture.

Wear supportive footwear when standing

Avoid regularly wearing high-heeled shoes, which can affect the body’s center of gravity and induce compensatory alignment of the entire body, thus negatively affecting back support and posture.

When standing for long periods of time, propping a leg up on a foot rest, wearing supportive shoe orthotics, or placing a rubber mat on the floor can improve comfort.

Remember good posture and ergonomics when in motion

Simply walking, lifting heavy materials, holding a telephone, and typing are all moving activities that require attention to ergonomics and posture. It is important to maintain good posture even while moving to avoid injury, walking tall with shoulders back for example.

Back injuries are especially common while twisting and/or lifting and often occur because of awkward movement and control of the upper body weight alone.

Create ergonomic physical environments and workspaces, such as sitting in an office chair at a computer

It does require a small investment of time to personalize the workspace, home, and car, but the payoff will be well worth it. Undue strain will be placed on the structures of the spine unless the office chair, desk, keyboard, and computer screen, etc. are correctly positioned.

It's much easier and less time consuming to correct everyday ergonomics and minimize back or neck pain than to add doctor visits and corrective therapies for debilitating pain conditions.

Avoid overprotecting posture

Remember that it is important to maintain an overall relaxed posture. Avoid restricting movements by clenching muscles or adopting an unnatural, stiff posture. For individuals who already have some back or neck pain, it's a natural tendency to limit movements to avoid provoking increased pain.

However, unless there is a fracture or other serious problem, the structures in the spine are designed for movement and any limitation in motion over a long period of time creates more pain and a downward cycle of less motion and more pain.


Individuals who participate in sports commonly have sports related injuries.  Why running incorrectly causes the most injuries, it is closely followed by skating, skiing, mountain biking, dancing, aerobics, tennis, basketball, gymnastics, football, and soccer.

The ten most common sports related injuries are:

  1. Muscles pulls and strains: Fiber stretch beyond capacity. Cramps, tightness, fatigue over exerting the muscles associated with dehydration and depleted minerals, such as sodium, potassium, calcium, magnesium, and phosphorous.
  2. Neck strain: Awkward positioning with sleep or over exertion and stretching of the neck muscles.
  3. Frozen shoulder (adhesive capsulitis): Condition associated with weakness of the rotator cuff muscles and the capsule of the shoulder adhering to itself.
  4. Low back pain: Awkward movement of the back or lifting a weight that is too heavy or improper lifting technique.
  5. Tennis elbow (lateral epicondylitis): Inflammation for the forearm muscles that bend the wrist back (extension) and roll the palm up (supination) is commonly seen in golfers, baseball pitchers, tennis players, weight lifters or any repetitive activity of the wrist and forearm.
  6. Runner's knee (patella femoral syndrome): Misalignment of the kneecap in the groove that is created by the leg bones. Muscle imbalances in the upper leg pull the kneecap out of alignment causing rubbing and wearing of the cartilage. Pain can be felt around the kneecap or the back of the knee.
  7. Shin splints: Strain of the lower leg muscles associated with running and jumping on hard surfaces or simply overuse. The shin muscles help raise the arch of the foot, and when the arch collapses, it strains the muscles and tendons in front of the lower leg. May occur in people that recently change shoes, surfaces they run or walk on, and exercise regimen.
  8. Ankle sprains: Most common type is inversion sprain where the foot rolls in and stresses the ligaments on the outside of the ankle. It can also be a compensation for other injuries of the foot, leg, hip or back.
  9. Heel cord (Achilles tendinitis): Stresses to the largest tendon in the body associated with jumping, such as volleyball and basketball usually exacerbated by poor mechanics of the foot and ankle (pronation) that pulls the Achilles tendon out of alignment.
  10. Foot arch pain (plantar fasciitis): Overstretch to the long elastic covering of the sole of the foot that holds up the arch. It occurs with people having high arches, improper support of their footwear, and increased activity creating increased impact on the foot. An example would be jumping.

Custom Orthotics

Custom-fitted orthotics are generally made by taking an impression of the individual's foot and then constructing an insert that is specifically designed to control biometrical risk factors.

Orthotics can help correct:

  • Flat feet/low arches (pes planus)
  • valgus heel (internal rotation)
  • plantar fasciitis
  • leg length discrepancies

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. Our staff at Skyline Physical Therapy are knowledgeable in custom orthotic fabrication.

We as a dedicated team of therapists welcome your individual scenarios, questions and concerns as we work together to assist in successfully treating your symptoms.