I am a medical doctor, with board certification 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 aims to resolve medical problems at the source as opposed to managing symptoms. My specialty training provided me with a foundation in assessing the body from a neurological and musculoskeletal 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 structural 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 often initially directed at this most restricted area. The understanding is 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, tissues around internal organs, joints, skeleton, neurologic, craniosacral, circulatory, emotional and cognitive (thought patterns and beliefs).

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. Often, the presenting complaint may resolve quickly. Occasionally, the presenting complaint may linger, while the rest of the body heals, acting as a signal to maintain your awareness of the body's healing process.

My Practice Today: All patients who present to my practice undergo a complete medical evaluation, with an emphasis on the neuromusculoskeletal 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 neurmusculoskeletal and postural integrity.

Patients are often treated in conjunction with physical therapists who are skilled in manual therapy techniques, and can provide individualized treatment several times a week. Treatment is also supplemented with self care at home including stretching with myofascial techniques, strengthening and movement based programs such as Feldenkrais/Awareness/Through Movement.


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. Please note that I will not provide medical information via the email on 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.

Fascia consists of elastic and collagen fibers with a more fluid ground substance layer, containing mucopolysaccharides including hyaluronic acid and proteoglycans. It plays an important role in determining our structural shape, and also acts as a communication network that carries bioelectrcic signals throughout the body. The ground substance acts as a lubricant allowing the fibers to slide over each other, and acts as a gel to absorb shock and to maintain tissue structure. The gel quality of the ground substance can change from a jelly-like consistency to a more liquid consistency. The ground substance also allows for the transport and exchange of ions, nutrients and waste products to and from the cells.

Traumatic injuries and inflammatory processes can cause shortening of the elastic fibers and hardening of the polysaccharide layer, with associated dehydration of the fascial tissues. Since fascia is continuous throughout the body, the whole "fabric" of the fascial system will become distorted, and have areas of restricted mobility with areas of increased pressure and tension, often on pain sensitive structures. Pressure generated by fascia can compress the tissues of our body, includig muscles, nerves, blood and lymphatic vessels, and organs, causing secondary pain, inhibiting the flow of vital communication through the fascial system, and impairing normal bodily functions which may interfere with cell's abilities to communicate, release waste products and receive nutrients via the fascial systems. Myofascial restrictiond may be associated with pain, dizziness, tinnitus, imbalance and postural deviations.

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. In addition, memories related to traumatic injuries can perpetuate pain on an unconscious level by creating unconscious holding patterns that cause the fascia to tighten into habitual positions of strain.

Treatments: Myofascial release techniques are designed to achieve elongation of the fascial tissues. Sustained myofascial release techniques involve using sustained pressure of 3-5 minutes or longer. It is postulated that this causes stretching of the elastic component, shearing of crosslinks in fascia, changes the viscosity of the ground substance from a solid to a more gelatinous state, and rehydrates the fascia, which normalizes bodywide communiation, relieves pressure and allows for a more complete release of the collagenous layer down to the cellular layer. Other myofacial release techniques use heavier pressure which may inhibit physiological activity; and often stop prematurely after releasing the elastic and muscular layers, without waiting for the full collagenous release.

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.
Sleep disturbance may be a factor in myofascial pain, thus the restoration of normal sleep may decrease 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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