Physiatrists are the essential medical experts in value-based evaluation, diagnosis, and management of neuromusculoskeletal and disabling conditions. Our approach is to find the best conservative and alternative treatment options to maximize function and your quality of life. We aim to treat the whole person and not just the problem area. By taking the whole body into account, we are able to accurately pinpoint problems and enhance performance without surgery.
Platelet-Rich Plasma: Platelet Rich Plasma (PRP) Therapy utilizes a patient’s own blood to heal and repair an injury in a non-surgical manner. Platelets contain proteins that aid in tissue repair. With PRP Therapy, a patient’s own blood (or PRP) is drawn then spun using a specialized machine resulting in a concentrated form of plasma that is rich with growth factors and proteins. This concentrated plasma is then injected under ultrasound guidance to the area of treatment. By precisely injecting the PRP into an area, we can trigger the targeted area and accelerate tissue repair.
Biologic injections: preserved biologic amniotic tissue injections or amniotic “stem cell” injections are promising treatment options for those with orthopedic injuries. In its natural state, umbilical cord blood, placental tissue, and amniotic fluid contain numerous living stem cells that can be used to treat many diseases. Cryopreserved amniotic products contain growth factors similar to those found in PRP. The amniotic products also contain proteins and substances that can lead to tissue repair and healing. Amniotic tissue products can be used alone or in conjunction with other regenerative medicine treatments such as PRP to help improve outcomes. Amniotic products are good options for patients who are unable to have steroid injections, are not surgical candidates, or have failed other conservative therapies. Unlike with PRP, patients receiving amnion derived product injections do not need to stop taking their blood thinners or anti-inflammatory medications (NSAIDs). Because amniotic products do not contain the HLA antigen (a marker that allows your body to identify that a substance is foreign) allergic reactions are extremely rare.
Epidural Steroid Injections: An epidural corticosteroid (steroid) injection, ESI, is a way to deliver pain medicine that targets the nerves of the cervical, thoracic or lumbar spine. A solution of medicine, usually a combination of a steroid and anesthetic is injected into the epidural area under x-ray guidance or fluoroscopy. An epidural steroid injection treats pain of the arms or legs related to inflamed or pinched nerves. Epidurals are used to treat a variety of conditions:
- Herniated disks
- Sciatica or radiculopathy
- “Slipped” vertebrae or disks
- Spinal stenosis
- Degenerative disc disease
Facet Joint/Medial Branch Block: The facet joints (also known as the Zygapophyseal joints or Z-joints) are paired structures at the back of each vertebra that are involved with flexion and extension of the spine. Patients with facet pain complain of pain that is worse in the morning and worse with rotation as well as extension of the spine. A facet joint injection or lumbar intra-articular injection is an injection of an anti-inﬂammatory medication and an anesthetic into the joint capsule of the facet joint to alleviate spine pain. A lumbar medial branch block (MBB) is a diagnostic injection of anesthetic medication into the nerves (medial branch nerves) that transmit pain from the facet joints. A MBB is performed to determine if the facet joints are the source of a patient’s spine pain. A MBB also helps localize which facet joint is the source of a patient’s pain.
Radiofrequency Ablation: Radiofrequency ablation (RFA) is a procedure that uses radiofrequency waves to stop the pain signals from the spine and the knee. For the spine, RFA uses radio waves to target the medial branch nerve that transmits pain signals from the injured facet joint to the brain. The procedure involves ablating or burning the medial branch nerve. RFA is used in conjunction with the diagnostic medial branch block for treating pain that is caused by the facet joints. RFA can provide a patient with 8-18 months of relief or potentially longer. Radiofrequency ablation (RFA) may also be applied to treat chronic knee pain. As with the spine, RFA uses radio waves to target the genicular nerves that transmit pain signals from the knee to the brain.
Sacroiliac joint: The sacroiliac joints (SI) are paired structures, on the right and left of the lower aspect of the spine that connect the spine (sacrum) to the pelvis (ilium). Like other joints in the body, the SI joint is surrounded by a capsule that contains lubricating ﬂuid. This can be dysfunctional thus causing pain. A sacroiliac joint injection involves an injection of anti-inﬂammatory medication and an anesthetic into the SI joint capsule to treat the pain in your low back, buttock, or upper leg.
Dorsal Column Stimulator Trials
Dorsal Column Spinal Cord Stimulation (DCS) is a technique used in the management of certain chronic pain syndromes. DCS is used to treat pain associated with common disorders such as failed-back surgery syndrome, radiculopathy, and complex regional pain syndrome (CRPS). DCS involves the implantation of an electrode in the dorsal column of the spine to reduce the intensity, duration, and frequency of pain associated with the above conditions. The theory behind DCS is that electricity is delivered on the posterior part of the spinal cord through the stimulating electrodes, resulting in improvement of pain. The system is controlled solely by the patient.
Viscosupplementation is a procedure in which a thick fluid called hyaluronate is injected into an arthritic joint. The material in the various viscosupplements is thought to improve the lubricating properties of the synovial fluid. By injecting the viscosupplement, the pain related to arthritis can be reduced thus improving mobility and providing a higher and more comfortable level of activity and quality of life. Viscosupplementation is performed under ultrasound guidance to assure the precise application of the solution.
Ultrasound Guided Injections
Ultrasound Guided injections: Ultrasound is used to assist in the guidance of a needle and hence medication to a specific area of the body. With ultrasound, a provider can localize the targeted area during an injection and be more specific of the placement of medication. Ultrasound guided injections allow providers to be more precise when treating patients.
Electrodiagnostic Testing: Electromyography (EMG) and nerve conduction study (NCS) is a combined test (EMG/NCS) used to detect the presence, location, and extent of diseases that damage the nerves and muscles. An EMG specifically measures muscle response or electrical activity in response to a nerve’s stimulation of the muscle. EMG/NCS is used to identify disease such as carpal tunnel syndrome (median neuropathy), cervical or lumbar radiculopathy and peripheral neuropathy. An EMG is used to detect neuromuscular abnormalities. During the test, one or more small needles are inserted through the skin into the muscle to measure electrical activity of the muscle. NCS involves the use of electrical stimulation to measure the amount and speed of conduction of an electrical impulse through a nerve. Together the EMG/NCS helps to localize if and where a specific nerve may be entrapped or damaged.
Diagnostic Testing: Synergy Rehabilitation and Wellness Center offers a variety of services to diagnose and identify the source of a patient’s pain. Diagnostic ultrasound is a non-invasive, efficient and cost-effective imaging technique used to identify muscle, tendon and ligament disorders. Electrodiagnostic testing is used as a complement to the physical exam to identify and localize nerve disorders. Diagnostic injections such as selective peripheral nerve injections, selective nerve root blocks, or medial branch blocks are used to identify which nerve is the source of a patient’s complaint.
Acupuncture & Massage
Acupuncture is a component of traditional Chinese medicine. The premise behind acupuncture is that the body contains energy, chi or qi, that flows along different pathways or meridians. Disruptions or imbalance in the energy flow is what is thought to be the cause of different disease or pain patterns. Acupuncture, through the insertion of thin needles in different parts of the body, attempts to correct imbalances in the energy flow of the body thus restoring the body’s natural balance within. Acupuncture may also work by stimulating blood flow, nerves, muscles and connective tissue thus boosting the body’s natural pain fighting response. Acupuncture has been used as an effective treatment for several conditions. At Synergy Rehabilitation and Wellness Center, we feel that acupuncture can be used as a complement in treating pain.
Cupping Massage: While we offer traditional massage, cupping massage therapy is an ancient form of alternative medicine in which the therapist puts special cups on your skin for a few minutes. The cupping creates a suction of the skin, while the therapists moves the cups across the skin to help loosen muscle tension and enhancing circulation and blood flow, while relaxing the body. It is used to relieve pain and reduce inflammation while pulling toxins from the body for overall wellness. Massage Therapy cupping is different from sports cupping and leaves little to no bruising or markings on the skin. Research has shown that traditional massage is effective in alleviating acute and chronic pain. Massage therapy promotes relaxation and assists in the one’s perception of pain.
Nutrition and Food testing
Individualized Experience (Unique to you, your body, your goals). Learn how to fuel your body well, and gain control of your health. Learn appropriate amounts of protein, fat and carbs based on your lifestyle and goals. Learn which foods and/or supplements are best for you based on your test results. Gain freedom to still enjoy your favorite foods. Receive tools, guidance, support, structure and accountability every step of the way. Frequent check-in communication every 7 to 10 days.
Nutritional balance plays a key role in optimal wellness, chronic disease prevention and managing the aging process. Micronutrient testing measures the function of 35 nutritional components including vitamins, antioxidants, minerals and amino acids within our white blood cells. Eating a well-balanced diet, exercising and taking a multivitamin is simply not enough. Tests allow your nutritional assessment for a broad variety of clinical conditions: General Wellness
Prevention of chronic disease (arthritis, cancer, cardiovascular risk, diabetes, various immunological disorders and metabolic disorders)