The Science Behind Being a Human Pin Cushion


Here at IP, dry needling is a frequently utilized treatment that contributes to a comprehensive, personalized treatment plan. There are some great benefits to dry needling that include, but are not limited to, quick pain relief, improving range of motion, achieving a quicker path to recovery and more! Dry needling is also called trigger point dry needling or myofascial trigger point dry needling. The word “myofascial” is made up of the roots “myo” (which refers to muscle) and “fascia” (which refers to the tissue that connects muscle). 

Injections into the myofascial trigger points were first proposed by medical doctors Janet Travell and David Simons in the early 1940’s. Travell discovered that certain nerves and neural hyperactivity were linked to pain in tender parts of the muscle and fascia. She and Dr. Simon carefully identified most of the trigger points located in the human body. They injected various substances including corticosteroids, painkillers, saline, etc. into the trigger points. That was the beginning of how modern dry needling was established. Dr. Travell was well respected and actually became President John F. Kennedy’s White House physician!

Seeing how the process originally used liquid to treat the trigger points, it’s a wonder why the procedure itself would be coined as “dry” needling. However, after Dr. Travell’s initial discovery, a study done by a Czech physician, Dr. Karel Lewit, found that the needling is what made the treatments effective, far more than the substances that were injected into the muscles. Further research proved that dry needling is more effective and not as invasive as “wet” needling, though it was only in 1976 when the procedure became a recognized practice in the healthcare industry. It was Dr. Chan Gunn who further developed the concept of dry needling. He researched the technique of Intramuscular Stimulation (IMS). IMS is a technique for the treatment of myofascial pain based on a comprehensive diagnostic that identifies the cause of the pain due to disease or dysfunction in the nervous system. It specifically identifies the nerve root as the generator of the anatomy, so it is referred to as a radiculo-neuropathic model. 

Muscles can develop knotted areas called trigger points. These trigger points are very sensitive and can be painful when touched. Our PTs will insert needles through the skin into trigger points. Those needles are used as a reset for the golgi tendon organ (GTO) to stimulate the tissue, not to inject medication. 

Pain affects how your body moves. Dry needling changes the way the brain and muscles talk to each other to help your system return to normal function.

You may experience different sensations when being needled. Muscle soreness, aching and an elicited muscle twitch when a needle is inserted are considered good signs of effective needling. The needles may be placed deeply, for various amounts of time, depending on what type of pain is being treated and pathology. Shorter periods of time would mean that the needle would stay in the muscle for seconds, while longer periods could mean 10 to 15 minutes.

Now you have a basis of where dry needling comes from and why we use it. Never hesitate to ask us more, we are all happy to explain why we love dry needling!

The Science Behind Being a Human Pin Cushion2022-10-11T17:07:14+00:00

Taking a break from movement…what about sleep?


Did you know that humans spend roughly a third of their lives sleeping?  Even though we sleep to “rest”, your body and brain really need that down time to keep your body functioning optimally.   In the U.S., 62% of our population experiences sleep problems several nights per week.  We know there’s mounds of evidence that poor sleep can lead to a myriad of health issues such as diabetes, dementia, increased fall risks, to name a few. So how does your team at I.P. address your sleep health when typically, your sessions at the clinic are far from restful?!? Because an added bonus from your PT sessions and a question we are always interested in throughout your rehab process – are you sleeping better?

Sleep quality and pain perception are inversely related. The worse sleep you get, the higher sensitivity to pain you have. The more pain you have, the harder it is to get to sleep, stay asleep, and sleep efficiently. Poor sleep over the lifespan is closely related to cardiovascular issues, depression, anxiety, cognitive function and impairs motor skill learning. All of these contributing factors can make the rehab process slower than it should, or could be. 

The therapists at I.P. care about how you’re sleeping – we ask questions about whether symptoms flare at night, how your symptoms vary before and after waking. The immune system works in synchrony with your body’s sleep-wake cycle. We have pro-inflammatory processes that enable our body’s immune response to be working overtime while we sleep. Additionally, our stress systems (like the sympathetic nervous system) downregulate during sleep, allowing us to fight off illness and promote tissue healing in the body.

The work we do at I.P. promotes a healthy sleep-wake cycle during your sessions, and our therapists are able to make specialized sleep hygiene recommendations to help your sleep cycle improve. Exercises or postural adjustments to your sleep habits can also help to reduce disturbances that are causing sleep disruption.

 Check out this gentle exercise that’s simple to perform right before bed!

Taking a break from movement…what about sleep?2022-06-22T22:35:50+00:00

Physical Therapy & Your Immune System


Overwhelmingly, studies show that regular exercise boosts your immune system. The somewhat obvious caveat to this is that you must not overtrain or injure yourself in the process…this would lead to a major decrease in your immunity. In comes physical therapy to save the day!

Did you know physical therapists do way more than just address acute and chronic injuries? They prescribe series of movements and exercises that will protect and enhance your overall physical functionality (our therapists do this in a very specific way). These series of targeted exercises can help boost your immune system in ways regular exercise does not. One example of this, is that some exercises can be prescribed can help flush bacteria out of lungs and airways which reduce the likelihood of getting sick with a virus (Virvick & Zieve, 2020).

Another great example of how physical therapy can strengthen your immune system, is by improving the quality and amount of sleep you are getting. If you are one of the 60 million Americans that has sleep related problems, physical therapy can help reduce the underlying pain or discomfort that prevents you from great, uninterrupted sleep. Through expert evaluation and analysis, our team can work directly with you to resolve those underlying ailments and get your resting easy again!

Finally, physical therapy can reduce stress related hormones that suppress the immune system. Physical therapy can reduce these stress hormones in a number of ways. One way is the indirect benefit of being pain free. Pain is a leading cause of stress; physical therapy can help reduce pain which will directly reduce stress levels. Similarly, studies have shown that elevated levels of anxiety can negatively affect systemic systems in the body and ultimately lower your ability to fight disease (Otto et al., 2007). Physical Therapy can target and improve the performance of these systems to keep your body functioning and healthy.  Staying healthy is more important than ever, especially now!!  Contact your I.P. team with any questions or to see how we can help you start boosting your immune system today!


Otto, M. W., Church, T. S., Craft, L. L., Greer, T. L., Smits, J. A., & Trivedi, M. H. (2007). Exercise for mood and anxiety disorders. Primary care companion to the Journal of clinical psychiatry9(4), 287–294.

Vorvick, L., & Zieve, D. (2020, January 23). Exercise and immunity: Medlineplus medical encyclopedia. MedlinePlus.

Physical Therapy & Your Immune System2022-01-31T21:41:11+00:00

Prehab vs Rehab: How Physical Therapy Increases Outcomes


What is prehab? And why does it matter?  Prehab is just a fancy term for physical therapy before an event or occasion. This could be surgery [surgery is a top one] but PRP, marathon/military training or even activities of daily living are included. Prehab differs from rehab in that it is a proactive plan designed to prepare you for whatever life brings at you next. Here at IP, you know we love pumpin’ prevention to help patients optimize their potential!

Prehab has recently gained more traction in the research community. On the surgical side, prehab before surgery increased the likelihood of a successful recovery by 38% in one study (Gillis et al., 2014). Another study showed that patients who pre-habbed prior to surgery reduced the total health care costs to the patient by 45% (Gometz et al. 2018). Meaning that prehab can not only set you up for a better and easier recovery from surgery but can save you money in the process.

In non-surgical situations, prehab seriously decreases the chances of injury. Getting ready for hiking or ski season, but know it always bothers you knees for days afterwards? Preparing for a race but feel like your back has always held you back from really hitting your peak? Trying to pass physical testing for military testing? Prehab at IP would be of benefit to you! With our specialized biomechanical tips and tricks, we can help you prevent falls, sports injuries among other orthopedic ailments.

If you or someone you know is interested in learning more about how prehab could benefit you, ask one of your IP team members and we are more than happy to help get you started!

Gillis, C., Li, C., Lee, L., Awasthi, R., Augustin, B., Gamsa, A., Liberman, A. S., Stein, B., Charlebois, P., Feldman, L. S., & Carli, F. (2014). Prehabilitation versus rehabilitation: a randomized control trial in patients undergoing colorectal resection for cancer. Anesthesiology121(5), 937–947.

Gometz, A., Maislen, D., Youtz, C., Kary, E., Gometz, E. L., Sobotka, S., & Choudhri, T. F. (2018). The Effectiveness of Prehabilitation (Prehab) in Both Functional and Economic Outcomes Following Spinal Surgery: A Systematic Review. Cureus, 10(5), e2675.

Prehab vs Rehab: How Physical Therapy Increases Outcomes2021-12-08T16:15:44+00:00

Ways to Stave off the Seasonal Slump


The days are getting shorter, the air is crisp and cool (and kind of gloomy)…We’ve been hearing consistently across our patient groups that the motivation to move is down and the craving for comfort foods are up. Did you know that physical activity levels decline significantly in the winter months?  This seasonal decline in activity is connected to higher blood pressure, increased body fat and many other health related problems (Shepard & Aoyagi, 2009). The color changes this fall sure have been exceptionally beautiful, but your I.P. team wants to help keep you moving as we transition into winter months!

We know as the weather cools down and days get shorter it gets increasingly difficult to exercise – especially before the opportunities for winter activities begin.  Keeping up with exercise and eating nutritious meals are ways to combat the season change in activity and boost your energy levels. Your I.P. Team wants to give you some tips to keep the body, mind and spirit hardy as we head into hibernation season!

Exercise of the Month – Bear Crawl [into hibernation]

Getting outside to exercise may not be as much of an option in the fall and winter for many people.  Dr. John and Dr. Lindsey recommend a simple exercise that you can do at home in any open space to stave off the seasonal slump. Try adding this Slider Bear Crawl for 8-10 reps for 2-3 sets to keep your low back stable and your core strong!  From this 4-point position, slide feet back to a plank position and return to starting. For more simple exercises you can do at home or modifications, don’t forget to ask Dr. John, Dr. Lindsey or Jen when you come in for your appointment.

Tag us on social media when trying these exercises out!

IG: @integrativePT

FB: @iptherapy

If comfort foods are your kryptonite, we recommend healthy and hearty soups! Dr. Lindsey recommends this easy Stuffed Acorn Squash recipe.

We can’t talk about staying healthy through seasonal changes outside of our control, without talking about mental health. Seasonal affective disorder (SAD) effects 5-10% of the U.S. population. If you’re feeling the winter blues, you’re not alone! Some ideas to help lift your spirits:

  • Get outside when you can for some Vitamin D
  • Stay hydrated
  • Stay in touch with friends and family
  • Join a group activity, take a class with a friend

Stay safe and stay warm!

Shephard, R. J., & Aoyagi, Y. (2009). Seasonal variations in physical activity and implications for human health. European Journal of Applied Physiology, 107(3), 251–271.

Ways to Stave off the Seasonal Slump2021-11-03T21:11:03+00:00

All About Arthritis


What is Osteoarthritis? 
Pain and stiffness associated with swelling, tenderness, and degeneration in one or more joints, typically a result of the repetitive overuse and worsens with aging. OA is most commonly seen in the thumb CMC (carpometacarpal joint), the knees, and hips.

One of the most common reasons we see patients in the clinic is due to the sequelae of symptoms from osteoarthritis. The disease first manifests as abnormal cellular activity and joint tissue metabolism which then will progress to anatomical/physiological derangements in the joint such as:

  1. Cartilage Degradation
  2. Bone Remodeling
  3. Osteophyte formation (bone spurs along joint lines)
  4. Joint Inflammation 

Now, that all might sound scary and like the worst thing that could happen to your body right?! The good news is, this doesn’t have to imply loss of function. 

How is OA treated?
Most of the current research supports the use of a combination of manual therapy techniques paired with therapeutic exercise to treat osteoarthritis. Having an understanding of load management through the affected joints and how to mitigate unwanted forces while still maintaining strength is key! If joint replacements are necessary, the evidence states that the better range of motion and strength pre-op, the more favorable the outcomes post-op. Moral of the story: even if you need surgery, call us for a few months of “prehab.” 

Outside of PT, or as an adjunct to PT, there are various options for medical management of OA. NSAIDs such as Celebrex may help in the short term to decrease pain and improve function. Viscosupplementation with hyaluronic acid is a non-invasive series of injections into the knee joint that will help improve the water content of the synovial joints to help decrease stiffness. Finally, regenerative medicine with stem cell therapy can help regenerate bone and soft tissue to delay the need for surgical intervention. 

I don’t have much pain, but my x-ray looks really bad, do I need a joint replacement?
Radiographs ≠ Pain!!!   Many people may have moderate to severe arthritis on imaging that do not experience much pain and are still able to participate in their daily activities of daily living as well as recreational activities. In fact, staying active and participating in functional strength training can help prolong and in some cases eliminate the need for a possible joint replacement. Think of your muscles as your “shock absorbers” throughout your body decreasing the amount of bone on bone contact during weight bearing activities. If you are weak, you lose this shock absorption and are more likely to experience pain, stiffness, and decreased function. To summarize: ARTHRITIC JOINTS NEED TO MOVE!

What is the difference between Osteoarthritis and Rheumatoid Arthritis?
Osteoarthritis is the result of repetitive loading manifesting in a somewhat predictable pattern of asymmetrical degeneration of the subchondral bone and cartilage in weight bearing joints that progresses as one ages. Rheumatoid Arthritis (RA) is an autoimmune disease that is more often seen in women during child-bearing years (20-40 years old). This systemic origin results in synovial membrane inflammation throughout the body. It is most often seen as a symmetrical pattern starting in the small joints of the fingers and wrist, eventually affecting the upper cervical spine, and then into the weight bearing joints. Instead of seeing bone spurs and degeneration on x-ray, you may see osteopenia/osteoporosis, joint subluxation, or erosion of joints in an x-ray of someone suffering from RA. RA and OA will respond well to strength training programs that are targeted toward one’s individual impairments.

Are there any other types of arthritis? 
There are other systemic inflammatory arthritis disorders including: 

  1. Psoriatic Arthritis: This often follows after a diagnosis of skin involvement from psoriasis. This will often affect one sacroiliac joint, the small joints of the fingers and toes, followed by splitting/pitting of the nail beds, and eye inflammation. Typically, this is managed medically (no cure) and supervised activity is encouraged.
  2. Ankylosing Spondylitis: This typically affects young males up to 40 years old and results in stiffness of the midback to low back and decreased rib expansion caused by fusing of the spine (often caused “bamboo spine” when seen on x-rays). Pain is often managed with exercise and anti-inflammatories and feels worse with rest.
  3. Reactive Arthritis or Reiter’s Syndrome: This is a multi-joint inflammatory arthritis that is the result of an infection originating from the gastrointestinal or genitourinary system. May begin as severe joint pain that will often dissipate/resolve within weeks to months. Along with joint pain, a patient may experience difficulty/pain with urination and eye inflammation and pain.
  4. Gout: This causes joint inflammation due to high levels of uric acid in the bloodstream resulting in painful urate crystal deposition in joints of the big toe, elbows, knees, wrists, etc. High uric acid is caused by a diet rich in purines which includes: high sugar content foods, beer, sardines, liver, live game, shellfish, and soda. Typically, this will be managed with lifestyle/diet changes and medical management.

In the end, any diagnosis of arthritis does not have to be a life sentence. Make an appointment to discuss your options with your PT and other medical providers to keep you mobile and functional! Remember: movement is medicine, motion is lotion, ______ (insert cheesy motivation here!)

All About Arthritis2021-09-01T23:27:21+00:00

Get Assessed This August


As you might have seen in recent social media posts, we’re offering a FREE SFMA to anyone who refers a patient to IP this month!

What is the SFMA? Read below to find out! 

The SFMA is a set of seven full-body movement tests evaluated and scored in patients. This assessment examines what movement pattern is dysfunctional and non-painful first, and then is broken down in detail to determine the root of this dysfunction. The two main root problems typically stem from a lack of MOBILITY or STABILITY (motor control deficit). This dysfunction can then be treated by the clinician using targeted therapeutic exercise, manual therapy, and neuromuscular reeducation. 

Do you have pain performing normal day to day activities or carrying on your active lifestyle? For most of us, pain free functional movement with any activity is the goal. Many components comprise pain-free functional movement including adequate posture, ROM, muscle performance, motor control, and balance reactions. Impairments of each component could potentially alter functional movement resulting in or as a consequence of pain. Utilizing the SFMA, the clinician is able to identify key functional movement patterns and describe the critical points of assessment needed to efficiently restore functional movement.

During your SFMA, we will examine and assess:

  1. Cervical Flexion (looking down)
  2. Cervical Extension (looking up)
  3. Cervical Rotation (looking side to side)
  4. Upper Extremity Pattern 1 (reach behind back)
  5. Upper Extremity Pattern 2 (reach overhead)
  6. Multi-Segmental Flexion (touch toes)
  7. Multi-Segmental Extension (lean back)
  8. Multi-Segmental Rotation (twist and look behind back)
  9. Single-Leg Stance
  10. Arms Down Deep Squat

Let us know if you’ve referred a friend for the IP experience in the past month so we can schedule your SFMA today!

Get Assessed This August2021-09-01T23:27:22+00:00

November 2018: Fallin’ Into Fall Prevention


Fall Into the Root of the Problem:
Falls are one of the leading causes of injuries across the ages in the U.S. However, as you likely expect…the prevalence of fall-related injuries is higher in older adults and is more common in women compared to men. Factors such as balance (vestibular), vision, and deficits in gait patterns all contribute to fall risk.

In people ages 65+ falls are a major cause of injury related to hospitalization. In this age group specifically, fall-related injuries are frequently associated with disability, loss of independence, fear-avoidance behavior, restriction in daily activities, and functional decline.

Preventing Falls (And Picking Yourself Back Up)
Maintaining an active lifestyle is one of the most effective ways to avoid fall-related injuries and to help you pick yourself back up so you don’t find yourself saying “I’ve fallen and I can’t get up!”. Consuming enough calcium (milk, yogurt, fish, broccoli…) to prevent osteoporosis and weight training for strong bones will help reduce any damage if you take a tumble. Use good gait patterns (avoid shuffling, pidgeon-toe patterns…) and don’t forget to swing your arms! The counterbalance between arms and legs when moving is imperative to promote positive gait patterns.

Fall Facts:
As we’re heading into snow season, falls become more prevalent in ALL age groups. Whether you’re snowboarding, navigating icy parking lots, winter hiking, or hanging decorations outside in slick conditions, some key approaches will help keep you strong and stable!
 Strengthen your knees
 Stabilize and strengthen low back
 Keep posterior chain active
 Maintain glute activation in ambulation (“Strong Foundations” as Dr. John likes to say!)

IP Exercise: Plow
For this exercise you need a friend, partner or friendly neighbor! (As well as slippery socks, sliders, or paper plates). Stand on the sliders and wrap the band around your friend, hold the ends of the band and bend the knees have your partner pull you – side to side and make it fun. Have more questions? Schedule today to learn more about how to move to your best self!

November 2018: Fallin’ Into Fall Prevention2021-09-01T23:27:23+00:00
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