EDWIN SUAREZEDWIN SUAREZPHYSICAL THERAPYPHYSICAL THERAPY

“Setting Your Family in “Setting Your Family in Motion”Motion”

Provides Provides

Evidence-basedEvidence-based

RehabilitationRehabilitation

Our Physical Therapy PracticeOur Physical Therapy Practice When patients are referred to our office they are evaluated When patients are referred to our office they are evaluated

and treated on a one-to-one patient to clinician ratio.and treated on a one-to-one patient to clinician ratio. Receiving personal attention from our trained clinicians Receiving personal attention from our trained clinicians

involves designing an individualized treatment plan with involves designing an individualized treatment plan with many facets that fit his/her diagnoses.many facets that fit his/her diagnoses.

Treatment plans may include many of the stereotypical Treatment plans may include many of the stereotypical physical therapy protocols such as:physical therapy protocols such as:• Therapeutic ExerciseTherapeutic Exercise• High-Velocity Low Amplitude Thrusts / Joint Manipulations.High-Velocity Low Amplitude Thrusts / Joint Manipulations.• Modalities Modalities

UltrasoundUltrasound Neuromuscular Electrical StimulationNeuromuscular Electrical Stimulation EMG / BiofeedbackEMG / Biofeedback Hot Packs and CryotherapyHot Packs and Cryotherapy EtcEtc

• Massage TherapyMassage Therapy We at Edwin Suarez Physical Therapy also offer the We at Edwin Suarez Physical Therapy also offer the

following following evidence-basedevidence-based physical therapy treatments and physical therapy treatments and technologies that we feel set us apart from other practices:technologies that we feel set us apart from other practices:

Spinal Decompression TractionSpinal Decompression TractionTherapyTherapy

Lumbar & Cervical Lumbar & Cervical Traction Traction • Used in the treatment Used in the treatment

of lumbar / cervical:of lumbar / cervical: PainPain Herniated discs with Herniated discs with

associated upper / associated upper / lower extremity lower extremity radiculopathyradiculopathy

DDDDDD SciaticaSciatica Facet SyndromeFacet Syndrome HeadachesHeadaches

How Axial Disc Decompression How Axial Disc Decompression Traction WorksTraction Works

Centripetal Effect on DiscCentripetal Effect on Disc• Decompression refers to a reduction of Decompression refers to a reduction of

intradiscal pressure (IDP) and a centripetal intradiscal pressure (IDP) and a centripetal effect on the annulus polpusus.effect on the annulus polpusus.

• IDP and centripetal effect improves osmotic IDP and centripetal effect improves osmotic change, circulation, and healing of the disc.change, circulation, and healing of the disc.

• Studies suggest that prolapsed and severely Studies suggest that prolapsed and severely degenerated discs may have negative IDP due degenerated discs may have negative IDP due to a disturbed hydrostatic mechanism.to a disturbed hydrostatic mechanism.

• In cases with intact annular wall, the negative In cases with intact annular wall, the negative IDP created by decompression traction results IDP created by decompression traction results in centralization of pain.in centralization of pain.

Centralization of radicular pain is good clinical Centralization of radicular pain is good clinical outcome and is a viable indicator for reducing outcome and is a viable indicator for reducing likelihood of surgical intervention. likelihood of surgical intervention.

How Axial Disc Decompression How Axial Disc Decompression Traction WorksTraction Works

Centralization of radicular Centralization of radicular signs / symptoms (s/s).signs / symptoms (s/s).• i.e. Radicular lower i.e. Radicular lower

extremity pain that extremity pain that extended distally to the foot extended distally to the foot may only extend to mid may only extend to mid thigh after 2-3 weeks of thigh after 2-3 weeks of decompression traction.decompression traction.

• Most s/s resolve in 6 weeks Most s/s resolve in 6 weeks with a 3x / week frequency.with a 3x / week frequency.

All cases are unique.All cases are unique.• Negative IDP and Negative IDP and

centripetal effect on disc centripetal effect on disc created by decompression created by decompression traction reduce pressure on traction reduce pressure on nerves thus centralizing nerves thus centralizing radicular upper / lower radicular upper / lower extremity s/s.extremity s/s.

See X-ray.See X-ray.

Research on Lumbar / Cervical Research on Lumbar / Cervical TractionTraction

1.1. Constatoyannis C, et. al: Intermittent Cervical Traction for Constatoyannis C, et. al: Intermittent Cervical Traction for Radiculopathy Due to Large-Volume Herniations. JMPT, 25 Radiculopathy Due to Large-Volume Herniations. JMPT, 25 (3) 2002.(3) 2002.

2.2. Komari H., et al.: The Natural History of Herniated Komari H., et al.: The Natural History of Herniated Nucleus with Radiculopathy. Spine 21: 225-229, 1996.Nucleus with Radiculopathy. Spine 21: 225-229, 1996.

3.3. Saal, JA Saal, JS: Nonoperative Treatment of Herniated Saal, JA Saal, JS: Nonoperative Treatment of Herniated Lumbar Disc w/ Radiculopathy. Spine 14 (4): 431-437, Lumbar Disc w/ Radiculopathy. Spine 14 (4): 431-437, 1989.1989.

4.4. Lidstom, A Zachrisson M: PT of the low back pain and Lidstom, A Zachrisson M: PT of the low back pain and sciatica. Scan Joul of Rehab Med, 2: 37-42, 1970.sciatica. Scan Joul of Rehab Med, 2: 37-42, 1970.

5.5. Gose E. Naguszewski W & R: Vertebral Axial Gose E. Naguszewski W & R: Vertebral Axial Decompression for Pain Associated with Herniated and Decompression for Pain Associated with Herniated and Degenerated Discs of Facet Syndrome: An Outcome Degenerated Discs of Facet Syndrome: An Outcome Study. Neuro Research, (20) 3, 186-190, 1997.Study. Neuro Research, (20) 3, 186-190, 1997.

6.6. Shealy N, Leroy P: New Concepts in Back Pain Shealy N, Leroy P: New Concepts in Back Pain Management, AJPM (1) 20: 239-241 1998.Management, AJPM (1) 20: 239-241 1998.

Carpal Tunnel TractionCarpal Tunnel Traction Non-surgical approach Non-surgical approach

to treatment of Carpal to treatment of Carpal Tunnel Syndrome Tunnel Syndrome (CTS).(CTS).

Effective with patients Effective with patients that have failed other that have failed other conservative conservative treatments (NSAIDS, treatments (NSAIDS, acupuncture, acupuncture, massage, hand massage, hand therapy, therapy, manipulations, resting manipulations, resting hand splints, and/or hand splints, and/or steroid injections).steroid injections).

Research on Carpal Tunnel Research on Carpal Tunnel TractionTraction

1.1. Porrata H, Porrata A, Sosner J: New Porrata H, Porrata A, Sosner J: New Carpal Ligament Traction Device for Carpal Ligament Traction Device for the Treatment of Carpal Tunnel the Treatment of Carpal Tunnel Syndrome Unresponsive to Syndrome Unresponsive to Conservative Therapy. J Hand Ther. Conservative Therapy. J Hand Ther. 2007 Jan-Mar: 20 (1): 20-7; quiz 282007 Jan-Mar: 20 (1): 20-7; quiz 28

Acoustic Shockwave TherapyAcoustic Shockwave Therapy Non-invasive alternative to Non-invasive alternative to

surgery.surgery. Clinical studies report Clinical studies report

success rate above 75% (see success rate above 75% (see research section).research section).

Extremely strong sound Extremely strong sound pulse expands as a wave pulse expands as a wave within the body. This within the body. This method was originally used method was originally used to disintegrate kidney to disintegrate kidney stones. In physical therapy, stones. In physical therapy, a lower energy is used to a lower energy is used to avoid disintegration of the avoid disintegration of the tissues; instead it causes tissues; instead it causes microscopic interstitial and microscopic interstitial and extra- cellular biological extra- cellular biological effects that lead to:effects that lead to:• RevascularizationRevascularization• Pain reliefPain relief• Tissue repairTissue repair

Acoustic Shockwave TherapyAcoustic Shockwave Therapy Diagnoses treated:Diagnoses treated:

• TendinopathiesTendinopathies Calcified Rotator Cuff Calcified Rotator Cuff

Tendons (see X-ray to the Tendons (see X-ray to the left) / Painful shoulder.left) / Painful shoulder.

Medial / lateral Medial / lateral epicondylitis (Pitcher / epicondylitis (Pitcher / tennis elbows).tennis elbows).

IT-band friction syndrome.IT-band friction syndrome. Achilles Tendinitis.Achilles Tendinitis.

• Back PainBack Pain Myofascial Trigger PointsMyofascial Trigger Points

• Plantar FascitisPlantar Fascitis• Heel SpursHeel Spurs• Sports Injuries.Sports Injuries.

* X-ray on left taken from * X-ray on left taken from Research Article #3 on Research Article #3 on next slide.next slide.

Research on Acoustic Shockwave Research on Acoustic Shockwave TherapyTherapy

1.1. Wang C-J, MD, Chen H-S, MD: Shockwave Therapy for Patients with Lateral Wang C-J, MD, Chen H-S, MD: Shockwave Therapy for Patients with Lateral Epicondylitis of the Elbow. A One to Two-Year Follow-up Study. The American Epicondylitis of the Elbow. A One to Two-Year Follow-up Study. The American Journal of Sports Medicine. Vol. 30, No. 3, 2002, pgs 422-425.Journal of Sports Medicine. Vol. 30, No. 3, 2002, pgs 422-425.

2.2. Norris D.M., Elckmeir K.M., and Werber B.R.: Effectiveness of Extracorpeal Norris D.M., Elckmeir K.M., and Werber B.R.: Effectiveness of Extracorpeal Shockwave Treatment in 353 Patients with Chronic Plantar Fascitis. Journal of Shockwave Treatment in 353 Patients with Chronic Plantar Fascitis. Journal of Podiatric Medical Association. Vol. 95, No. 6, Nov/Dec 2005, pgs. 517-524.Podiatric Medical Association. Vol. 95, No. 6, Nov/Dec 2005, pgs. 517-524.

3.3. Cacchio A., Paoloni M., Barile A., Romildo D., Fosco de Paulis, Calvisi V., Ranavolo Cacchio A., Paoloni M., Barile A., Romildo D., Fosco de Paulis, Calvisi V., Ranavolo A., Frascarelli M., Santilli V., and Spacca G.: Effectiveness of Radial Shockwave A., Frascarelli M., Santilli V., and Spacca G.: Effectiveness of Radial Shockwave Therapy for Calcific Tendonitis of the Shoulder: Single-Blind, Randomized Clinical Therapy for Calcific Tendonitis of the Shoulder: Single-Blind, Randomized Clinical Study. Physical Therapy. Vo. 86, Number 5, May 2006, pgs 672-682.Study. Physical Therapy. Vo. 86, Number 5, May 2006, pgs 672-682.

4.4. Aschraff M.S., MD, Dorotka R., MD, Goll A., MS, and Trieb K., MD: Extracorpeal Aschraff M.S., MD, Dorotka R., MD, Goll A., MS, and Trieb K., MD: Extracorpeal Shockwave Therapy in the Treatment of Calcific Tendonitis of the Rotator Cuff. Shockwave Therapy in the Treatment of Calcific Tendonitis of the Rotator Cuff. Physical Therapy. Vo. 86, Number 5, May 2006, pgs 1365-1368.Physical Therapy. Vo. 86, Number 5, May 2006, pgs 1365-1368.

5.5. Fridman R., DPM, Cain JD, DPM, Weil L, DPM, and Well L., DPM: Extracorpeal Fridman R., DPM, Cain JD, DPM, Weil L, DPM, and Well L., DPM: Extracorpeal Shockwave Tehrapy for the Treatment of Achilles Tendinopathies. Journal of Shockwave Tehrapy for the Treatment of Achilles Tendinopathies. Journal of American Podiatric Medical Association. Vo. 98, Number 6, Nov/Dec 2008, pgs American Podiatric Medical Association. Vo. 98, Number 6, Nov/Dec 2008, pgs 466-468.466-468.

6.6. Wess, OJ: A Neural Model for Chronic Pain and Pain Relief by Extracorpeal Wess, OJ: A Neural Model for Chronic Pain and Pain Relief by Extracorpeal Shockwave Treatment. Urol Res. Vo. 36. 2008, pgs. 327-334.Shockwave Treatment. Urol Res. Vo. 36. 2008, pgs. 327-334.

Low Level Laser Therapy (LLLT)Low Level Laser Therapy (LLLT)

LLLTLLLT• Light speeds up many Light speeds up many

stages of healingstages of healing Accelerates inflammatory Accelerates inflammatory

responseresponse Promotes fibroblast Promotes fibroblast

proliferationproliferation Enhances ChondroplasiaEnhances Chondroplasia Upregulates synthesis of Upregulates synthesis of

type I and II procollagen type I and II procollagen mRNAmRNA

Quickens bone repair and Quickens bone repair and remodelingremodeling

Fosters revascularization Fosters revascularization of wounds (granulation of wounds (granulation tissue formation)tissue formation)

Low Level Laser Therapy (LLLT)Low Level Laser Therapy (LLLT)

LLLT used to treat:LLLT used to treat:• Pain and Edema Pain and Edema

associated with:associated with: Plantar FascitisPlantar Fascitis Achilles tendinitisAchilles tendinitis Back painBack pain Muscle StrainsMuscle Strains Shoulder Shoulder

Impingements Impingements (Tendinopathies)(Tendinopathies)

Carpal TunnelCarpal Tunnel Rheumatoid ArthritisRheumatoid Arthritis

Research on LLLTResearch on LLLT

1.1. Stergioulas A.: Low-Power Laser Treatment in Patients Stergioulas A.: Low-Power Laser Treatment in Patients with Frozen Shoulder: Preliminary Results. Photomed with Frozen Shoulder: Preliminary Results. Photomed Laser Surg. 2008 April; 26 (2); pgs 99-105.Laser Surg. 2008 April; 26 (2); pgs 99-105.

2.2. Asada K., Yutani Y., Shimazu A.: Diode Laser Therapy Asada K., Yutani Y., Shimazu A.: Diode Laser Therapy for Rheumatoid Arthritis: A Clinical Evaluation of 102 for Rheumatoid Arthritis: A Clinical Evaluation of 102 Joints Treated with Low Reactive Laser Therapy (LLLT). Joints Treated with Low Reactive Laser Therapy (LLLT). Laser Therapy. 1989, Vo. 1,, pgs. 147-151. Laser Therapy. 1989, Vo. 1,, pgs. 147-151.

3.3. Stergioulas A.: Low-Level Laser Treatment can Reduce Stergioulas A.: Low-Level Laser Treatment can Reduce Edema in Second Degree Ankle Sprains. Journal on Edema in Second Degree Ankle Sprains. Journal on Clinical Laser Med Surg. 2004 April; 22(2): pgs 125-Clinical Laser Med Surg. 2004 April; 22(2): pgs 125-128.128.

4.4. Terashima H., Okahima K., Motegi M.: Low Level Laser Terashima H., Okahima K., Motegi M.: Low Level Laser Irradiation for Lateral Humeral Epicondylitis and De Irradiation for Lateral Humeral Epicondylitis and De Quervain’s Disease. Laser Therapy. 1990, Vo. 2: pg 27.Quervain’s Disease. Laser Therapy. 1990, Vo. 2: pg 27.

Contact UsContact UsDear MD’s,Dear MD’s,

If you feel that any of your patients would If you feel that any of your patients would benefit from any of these previously benefit from any of these previously mentioned non-surgical and evidence-mentioned non-surgical and evidence-based physical therapy treatments as part based physical therapy treatments as part of their rehabilitation with us, please feel of their rehabilitation with us, please feel free to have your office staff contact us at: free to have your office staff contact us at: Phone: (702) 368-6778 Phone: (702) 368-6778

Fax: (702) 368-6775Fax: (702) 368-6775

e-mail: edwinsuarezpt.come-mail: edwinsuarezpt.com

Thank You.Thank You.