I am a medical doctor, with specialty training in the field of Physical Medicine and Rehabilitation. My practice is unique in that I integrate a variety of disciplines to create a more effective approach to health which resolves medical problems at the source rather than managing symptoms. My specialty training provided me with a foundation in assessing the body from a neurological and musculo-skeletal perspective, with an emphasis on evaluating the whole person and their ability to function in their daily activities. However, I found that the formal medical training I received was insufficient to meet the needs of many of my patients, and therefore continued to study extensively with osteopathic physicians and manual therapists, who were leaders in their field both nationally and internationally. This expanded my ability to assess the body from a mechanical basis, and to evaluate all of the systems of the body in order to identify the part of the body that was the most restricted. In osteopathy and manual therapy, treatment is directed at this most restricted area. The understanding that this may be the cause of the person's complaints even if it is distant from the site of symptoms. Many of the systems of the body are assessed and treated individually, including: muscles, soft tissues, fascia (the thin layer covering muscles and organs), tissues around internal organs, joints, skeleton, neurologic, craniosacral (movement of the bones of the head and sacrum), circulatory, emotional, energy, cognitive (thought patterns) and spiritual (beliefs). However, the amount of treatment time needed was extensive, and the results were not always proportional to the time invested. I therefore continued to search for an approach that would allow quicker access to the source of my patient's complaints, and provide more complete correction of the problem.

The focus of the practice today is to address health and wellness from a holistic standpoint, rather than just trying to eliminate the symptoms which are bothering you. At times, the presenting complaint may linger, as the rest of the body heals, sometimes acting as a signal to keep you aware of your body's healing process. At other times, the presenting complaint may resolve very quickly.

My Practice Today: All patients who present to my practice undergo a complete medical evaluation, with an emphasis on the neuro-musculo-skeletal systems. This confirms or determines their diagnosis, and is used to establish a treatment plan and goals. Goals of treatment generally include resolution or improvement in the presenting complaints, and improvement/normalization of neuro-musculo-skeletal and postural integrity.

Conditions That Have Been Treated In My Practice (includes, but not limited to):

* Musculoskeletal Conditions, such as low back pain, neck pain, whiplash, disc disorders (commonly known as "slipped disc," herniated disc, sciatica, radiculopathy, nerve root compression, or pinched nerve), spinal stenosis, arthritis, joint pains, fibromyalgia, Myofascial Pain Syndrome: (commonly referred to as muscle spasms), sprains, muscle strains/pulled muscles, sports injuries, headaches, chronic pain disorders, TMJ (temporomandibular joint dysfunction), scoliosis.

* Neurological Conditions such as strokes, multiple sclerosis, cerebral palsy, Parkinson's disease.

* Other medical conditions, in conjunction with standard medical therapy, such as respiratory and circulatory conditions, chronic fatigue.

If you would like to discuss your medical condition with me feel free to call me at my office or send me email by logging into this site.


BACKGROUND MEDICAL INFORMATION

Myofascial Pain Syndrome (MPS): "Myo" is latin for muscle. "Fascia" is connective tissue which covers muscles, nerves, and internal organs. It is interconnected throughout the body, and is connected to the membranes surrounding the brain and spine. Trigger points are hyperirritable sites within muscles and fascia, often perceived as tender knots. Myofascial pain may occur with sudden overload of a muscle or with chronic repeated overuse. Sudden stretch of a muscle which has been hypershortened for a prolonged period of time, can cause reflex contraction of the muscle, perceived as "muscle spasm." Shortening of the muscle can restrict motion in the joints to which it is attached.

Active trigger points are painful on compression, often referring pain in characteristic patterns. The pain is dull and aching, often perceived as deep. There are often associated phenomena such as sweating, imbalance, dizziness, tinnitus, and distorted perception of the weight of objects lifted in the hand.

Latent trigger points are not painful, but may cause stiffness, weakness, and decreased joint range of motion. They can become active years after the original injury, with minor injuries such as overstretch, chilling, prolonged shortening of the muscle, viral illness or emotional stress. The amount of stress needed to activate a trigger point depends on the degree of conditioning of the muscle. Even without reactivation, the latent trigger points themselves may be responsible for the progressive restriction of mobility seen in the elderly.

Pain due to pressure on trigger points during sleep can disrupt sleep. Research suggests that sleep disturbance may contribute to the pain and stiffness associated with myofascial pain. Correction of the sleep disturbance may enhance the response to treatment with manual techniques.

Emotional factors can also exacerbate myofascial pain. Stress may cause increased muscle tension, causing overload to already symptomatic muscles. Chronic pain is a well known cause of depression. Conversely, depression may also lower the pain threshold, intensify pain, and impair response to specific myofascial treatments.

Treatments: Myofascial release techniques are designed to achieve muscle relaxation and elongation, eliminating the trigger point. Stretching exercises are techniques in which the muscle is taken to the restrictive barrier, and force is applied in order to break through this barrier. This process is often inhibited by neurologic reflexes within the neuromuscular system, designed to prevent overstretch of a muscle. Alternative techniques include shortening the muscle (often only very subtly), taking it away from the restrictive barrier. This bypasses the inhibitory neurological reflexes, allowing the muscle to relax and elongate. Treatments can be more effective when all of the systems of the body are considered, including: muscles, soft tissues, fascia (the thin layer covering muscles and organs), tissues around internal organs, joints, skeleton, neurologic, craniosacral (movement of the bones of the head and sacrum), circulatory, emotional, energy, cognitive (thought patterns) and spiritual (beliefs).

Muscle conditioning can prevent activation of trigger points. Therefore, engagement in low-impact aerobic exercises on a regular basis is often helpful. Strengthening exercises can also be beneficial. However, trigger points often cause reflex weakness of local muscles, which cannot be overcome by exercises. Resolution of the abnormal reflex may restore normal muscle strength without the need for specific strengthening exercises.

Relaxation techniques may reduce the effects of stress or anxiety on myofascial pain. Progressive relaxation techniques teach you how to relax each of the muscle groups throughout the body. You are also taught how to identify areas of muscle tension, and to perceive when this tension increases during the day. Biofeedback enhances the perception of muscle tension and relaxation through the use of a machine which electronically reads the amount of muscle tension present in a given muscle.

Traditional treatments often include use of Acetaminophen (Tylenol) or Ibuprofen (Advil, Motrin) for pain relief. Often there is a vicious cycle where the initial muscle injury produces pain, resulting in muscle spasm, which causes further pain. Relieving the pain with medications may interrupt this cycle. Muscle relaxants, particularly Flexeril, and anti-depressant medications (such as Elavil) may actually normalize the sleeping pattern. Since sleep disturbance may be a factor in myofascial pain, the restoration of normal sleep may decrease the symptoms and enhance response to other treatments.

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Arthritis:
Arthritis means inflammation of a joint. Arthritic diseases affecting the entire body systemically include rheumatoid arthritis or lupus. The most common form of arthritis, however, is degenerative arthritis. This is not a "systemic" disease, but rather the result of "wear and tear" on commonly used joints in the body. If there is inflammation in the joints, this will respond to treatment with nonsteroidal antiinflammatory medications (such as Ibuprofen, Naprosyn, Clinoril, Voltaren, Celebrex, Vioxx to name just a few). Often the pain is not due to true inflammation within the joint, but rather to surrounding myofascial pain or to joint restriction. In such a situation, the pain will not resolve completely with medications alone, but may also require treatment with manual therapy techniques. The manual therapy techniques allow the surrounding muscles to relax, and joint mobility to normalize. This often results in decreased pain and increased function, even when the x-ray continues to show "arthritic" changes. Studies have also shown that there is often poor correlation between the degree or presence of arthritic changes on x-rays and a person's symptoms. Most treatment techniques available today are management techniques which try to minimize disease progression, relieve symptoms, and maximize function.

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Posture:
The human body is very efficient, and does not expend energy unnecessarily. Therefore it will maintain alignment of the spine in the position which requires the least amount of ongoing muscle activity. If there are joint or soft tissue restrictions with in the spinal column, this alignment may not appear ideal. Often the person will be told to stand up straight. However, since it requires active muscle contraction to maintain this straight posture, the person will not be able to sustain it without active concentration. Correction of the joint and soft tissue restrictions may enhance posture, even at an advanced age.

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Fibromyalgia:
Fibromyalgia is a disorder characterized by widespread pain and aching for over three months, with no apparent cause. There is consistent localized tenderness in multiple typical locations. There is associated fatigue, morning stiffness, headaches, irritable bowel syndrome, and a subjective sense of swelling or numbness. Symptoms improve with physical activity, and worsen with weather, anxiety, stress and poor sleep.

If this description sounds similar to myofascial pain, then it may not surprise you to know that there is controversy within the medical profession as to whether these are two separate conditions, or just two extremes on a single continuum. Generally, the treatment provided is similar for the two conditions. Responses in fibromyalgia may not be as rapid due to the increased duration of symptoms prior to the initiation of treatment, and to its more diffuse involvement.

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Chronic Pain Syndrome:
Chronic Pain Syndrome is defined as pain lasting more than six months, often without a easily explained source of pain. Because joint restrictions and myofascial trigger points do not appear on x-rays, MRIs or CT scans, they are often overlooked. These conditions can be corrected even years after their onset. However, as time progresses, emotional factors, such as depression or stress, may complicate the situation. Techniques such as manual therapy techniques, biofeedback, progressive relaxation and supportive psychological counseling have been used to minimize symptoms.

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Whiplash:
Whiplash is an injury which occurs as a result of acceleration/deceleration of the body. Physical findings will include myofascial pain in the neck and back, often with limited flexibility in these regions as well.

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Temporomandibular Joint Dysfunction (TMJ):
TMJ is defined as pain in the joint between the jaw bone and the skull. Other symptoms include clicking, popping, snapping and occasionally, locking, of the jaw joint. Although there may be a primary problem within the jaw itself, there is often soft tissue tightness in the neck and upper chest. The soft tissue tightness affects flexibility of the neck and jaw, and is often the cause of, or at least a significant contributing factor to the jaw problem. Symptoms will often improve with treatment of the soft tissue (myofascial) abnormalities without having to use an intra-oral appliance or undergo surgery.

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Cervical Radiculopathy:
This is commonly known as "a pinched nerve" in the neck. Nerves extend from the neck into the arm in order to control the arm muscles. Other nerves begin in the arm and return to the spine, transmitting information about touch, pain and other sensory information. Complaints with cervical radiculopathy include weakness, numbness or tingling in one or both arms. These complaints can also occur with compression of the nerves anywhere along their path, which runs under the collar bone, through the "armpit" and down the arm between muscles. Soft tissue tightness, muscle spasm, or somatic dysfunction (restricted movement in a neck bone or the collar bone) are correctable causes of nerve compression. In addition, myofascial pain can mimic nerve compression in the neck, and responds well to treatments designed to relieve the muscle spasm.

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Lumbosacral Radiculopathy or "Sciatica":
A major nerve which extend from the back into the legs is called the sciatic nerve. This can be compressed in the back, buttocks or legs. Discs are located between the spine bones (vertebrae) and act as shock absorbers for the spine. If the disc is disrupted, torn or displaced, it can release chemicals which irritate the nerve, or may actually compress the nerve fibers themselves as they pass through the spinal canal. Typical complaints include back pain radiating into the leg, often with numbness and tingling. However, muscle spasm (particularly in the buttock, where it entraps the nerve) or vertebral somatic dysfunction (stiffness in the spine bones) can mimic nerve compression in the back. Traditional exercises included sit-ups, lying on the back with the knees bent, and raising the knees to the chest. However, it has been shown that these exercises all increase pressure on the disc and increase the risk of reinjury. Studies demonstrate that arching the back (passively) and maintaining a proper curve in the lower back help reduce pressure on the nerves (McKenzie(c) Exercises). There are also ways to strengthen the back muscles without doing sit-ups that help prevent recurrent disc injuries (Dynamic Stabilization Exercises). Traditional thinking also assumed that disc injuries were only present if the symptoms extended into the leg. It has since been shown that many patients complaining only of low back pain have minor disc injuries. Initiation of treatment at this point can prevent recurrent and more severe injuries.

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