Physical Therapy

Twin Cities Pain Clinic is a Postural Restoration Certified (PRC) Center

Our highly skilled Minneapolis physical therapy staff specializes in treatment of acute and chronic pain. Combined, our PT department has more than 50 years of experience treating patients with pain.

We have a comprehensive on-site physical therapy department. It allows for regular collaboration between physical therapists and medical staff to coordinate the plan of care which may include a combination of both physical therapy and medical intervention.

Our Minneapolis physical therapy treatment times run longer than the industry standard, lasting from 45 minutes to an hour. Longer treatment time allows for individualized patient care. With chronic pain patients, the additional time is used to identify factors in a patient’s lifestyle that may be the source of pain. Once a patient leaves TCPC Physical Therapy, he or she will have gained the knowledge and tools to ward off future flare-ups. 

PAIN MANAGEMENT PROCEDURES 

Following are a list of conventional and nonconventional approaches used by our physical therapists.

Exercises

Nearly all our patients are given a personalized exercise plan suited to his or her area(s) of pain and subsequent rehabilitation program. Our physical therapy staff uses a wide variety of exercise programs suited to the individual patient including:

Neuromuscular – This is also referred to as muscle reeducation. It’s any type of exercise directed at facilitating inhibited (hypertonic) muscles with incorrect neural instruction.

It also encompasses proprioceptive retraining or joint position sense awareness.

Therapeutic Exercises – A class of exercises which stretches and strengthens your muscles and increasing range of motion.

Manual Therapy

Passive exercises the physical therapist will do to the patient to increase range of motion.

Myofascial Release – An application of gentle static pressure into the facial (connective tissue) system to release restrictions.

Muscle Energy Technique – Using the patient’s own muscle contraction to reposition a joint to normal.

Active Release Techniques – Apply external pressure with dynamic movement of the muscle to achieve release of restriction.

Strain Counterstrain – A method of positioning muscles to change inappropriate neural activity.

Joint Mobilization – Moving the joint through a plane of motion to release restriction and improve range of motion.

Soft Tissue Mobilization – A hands-on technique to reduce muscle spasms.

Craniosacral Therapy – This form of treatment is also referred to as cranial osteopathy, or CranioSacral bodywork. It is a method of alternative medicine that addresses the whole body, mind and spirit. A craniosacral therapy session involves the physical therapist placing her hands on the patient in order to tune in to the craniosacral system. By gently working with the spine, skull and its cranial sutures, diaphragms, and fascia, the restrictions of nerve passages are said to be eased, the movement of the CSF through the spinal cord can be optimized, and misaligned bones are said to be restored to their proper position.

Craniosacral therapy can be used to treat mental stress, neck and back pain, migraines, TMJ syndrome, and chronic pain conditions.

Postural Restoration

Postural Restoration is a physical therapy technique in Minneapolis that aims to restore a more neutral posture for patients. The goal of postural restoration training is to allow injured areas of the body to heal faster and more efficiently. Postural restoration uses manual treatments by a therapist and specific exercises to help patients use their body in a more balanced state.

Here are the common symptoms that Postural Restoration therapy would be used to help treat: 

  • Difficulty breathing, shortness of breath.
  • The feeling of being “out of alignment”.
  • Hip, pelvic, low back pain.
  • Abdominal, chest wall, and rib cage strains.
  • Cervical pain or headaches.
  • Knee and foot injuries.
  • Stress related muscle tension.
  • Shoulder impingement or tendonitis.

Postural Restoration therapy is often used in conjunction with other treatments for pain and muscle spasms, including use of heat and massage. Pain and inflammation can also be treated with ultrasound and electrical stimulation. A home exercise program may also be given to a patient undergoing Postural Restoration therapy.

McKenzie Method

Also known as Mechanical Diagnosis and Therapy (MDT), the McKenzie Method is a philosophy of active patient involvement and education that is trusted and used by practitioners and patients all over the world for back, neck and extremity problems. An evidence based approach, the key distinction of MDT is its initial assessment component – a safe and reliable means to accurately reach a diagnosis and only then make an appropriate treatment plan. Certified McKenzie clinicians have valid indicators to know right away whether – and uniquely how – the method will work for each patient.

For successful treatment, one must first be effectively evaluated. Through a series of repeated movements and positions, certified MDT practitioners assess two things as a result of these movements – symptomatic and mechanical response. Patterns of response can be determined for what makes symptoms better or worse. Patients are classified accordingly and an effective set of exercises is established based on a "directional preference". The treatment consists of education and self-directed exercise supplemented with manual therapy to make the exercises more effective. Once the appropriate treatment is determined, fewer visits can be expected. The McKenzie Method uses a self-management approach. Patients gain control of their pain by learning how to treat themselves and prevent recurrence.

McKenzie MDT is a proven methodology:

  • Difficulty breathing, shortness of breath.
  • Low cost, fast and effective, even for chronic pain
  • Non-invasive
  • Self-directed – we work with you and teach you
  • Be in control of your own symptom management
  • Gain life-long pain management and preventive skills

The goals of McKenzie MDT are to promote the body's potential to heal itself.

MedX

Many back and neck problems can be helped through aggressive therapy using MedX equipment. This state-of-the-art, computerized exercise equipment isolates the muscles of the back and neck and increases your strength and flexibility, which assists in a reduction of pain. MedX isolates the back and neck extensors so that the treatment can be focused on the musculature that has been injured. MedX allows you to exercise safely at higher intensity levels.
MedX exercise programs follow medically documented protocols for people with persistent back pain.

Modalities

Modalities are treatments the Minneapolis physical therapy administers with the help of a machine to achieve a specific goal. The following treatments are sometimes preparations to help patients tolerate other therapies.

Electrical Stimulation (E-Stim) – A TENS Unit (transcutaneous electrical nerve stimulation), would be one form of E-Stim therapy. A TENS Unit is a small, battery operated device that delivers low-voltage electrical current through the skin via electrodes placed near the source of pain. The electricity from the electrodes stimulates nerves in the affected area and sends signals to the brain that scramble normal pain perception. TENS is not painful and has proven to be an effective therapy to mask pain.

Cervical and Lumbar Traction – Traction gently extends the neck or low back, opening the spaces between the vertebrae and temporarily alleviating pressure on the affected discs. Cervical or lumbar traction can either be done continuously or intermittently, alternating between short periods of pulling and resting.

Pain Management Procedures

TCPC provides a full range of therapeutic pain management injections in all areas of the spine (lumbar, thoracic and cervical) as well as joints (shoulders, hips, knees, etc.). Some of these procedures are performed in the office, such as joint, tendon and muscle injections.

Dr. Will and Dr. Kokayeff perform other precision spinal procedures under guided X-ray imagery, at the Twin Cities Pain Clinic Edina location. The doctors both have advanced training in the image-guided approach to ensure that your therapeutic injection is accurate and safe.

Dr. Will is a member of the International Spine

Intervention Society (ISIS), American Society of Interventional Pain Physicians (ASIPP),and Physiatric Association of Spine, Sports and Occupational Rehabilitation (PASSOR).

The procedures described in the following list may cure your pain or may reduce your pain in order to enable you to participate in other treatments such as physical therapy.

Epidural Steroid Injections

Epidural steroid injections provide pain relief by delivering local anesthetic (numbing medication) and steroid medications (anti-inflammatory medication) into the spinal area on the surface of the spinal column.

An epidural steroid injection may reduce inflammation, resulting in long-term pain relief. It can also provide valuable information on the source of your pain. While the effects of an epidural steroid injection may be temporary (lasting anywhere from a week up to a year), it can deliver substantial benefits for many patients experiencing back pain, including improved mental health, minimizing the daily need for pain medications and potentially delaying or avoiding surgery.

An injection delivers steroids directly to the painful area to help decrease the inflammation that may be causing the pain. Dr. Will performs the procedure in the hospital under guided fluoroscopy to ensure accurate placement of the steroid. The injection may also remove or “flush out” inflammatory proteins from around the structures that may cause pain. In addition to relieving pain, the process of natural healing can occur more quickly once the inflammation is reduced.

The steroid medication can reduce the swelling and inflammation caused by spinal conditions including spinal stenosis, radiculopathy, sciatica, and herniated discs. In some cases, it may be necessary to repeat the procedure as many as three times to get the full benefit of the medication.

However, many patients get significant relief from only one or two injections.

Epidural steroid injections are done from one of three approaches: Interlaminar, Transforaminal and Caudal. A Selective Nerve Root Injection can also be done.

Interlaminar Epidural Steroid Injection

In an Interlaminar Epidural Steroid Injection, the needle tip is inserted into the back side of the spine between two vertebrae. This placement allows delivery of the medication to a broader area.

Watch Educational Video

Transforaminal Epidural Steroid Injection

In a Transforaminal Epidural Steroid Injection, the needle tip is placed up next to a particular foramen. A foramen is an opening on the side of the spine where a nerve root would come out. Placing the needle here focuses the medication closer to the problem area.

Watch Cervical Transforaminal Epidural Steroid Injection Video
Watch Lumbar Transforaminal Epidural Steroid Injection Video

Caudal Epidural Steroid Injection

A Caudal Epidural Steroid Injection is placed through the sacral hiatus (an opening at the base of the tailbone). This type of injection usually affects the spinal nerves at the end of the spinal canal near the sacrum or tailbone. This collection of nerves is called the cauda equina.

Selective Nerve Root Injection

Selective Nerve Root Injections are done for diagnostic purposes only. In these cases, only a small amount of anesthetic (ie. Lidocaine) is injected next to a specific spinal nerve root. If this relieves the patient’s pain temporarily, then it helps confirm that the patient’s pain is coming from that specific spinal nerve.

Watch Educational Video

Facet Joint Injections

A facet joint injection is a procedure that treats the source of irritation in the small joints at each segment of the spine. These joints provide stability and help guide motion. A cervical (neck), thoracic (upper back) or lumbar (lower back) facet joint injection involves injecting a steroid and local anesthetic into the small facet joint.

If multiple levels of pain exist, several facet joints may need to be injected to treat the pain. By placing numbing medicine into the joint, the amount of immediate pain relief you experience may help confirm or deny the joint as a source of your pain. This pain relief will enable you to undergo necessary conventional treatment, such as physical therapy, to rehabilitate your back.

Watch Facet Radiofrequency Neurotomy Video
Watch Facet Joint Injections Video

Facet Nerve Blocks (Medial Branch Blocks)

In this procedure, a small amount of local anesthetic (ie. Lidocaine) is injected next to the nerves that supply a particular facet joint. The injection temporarily blocks the pain coming from this joint. The procedure is usually done as a trial to see if the patient is a candidate for a radiofrequency neurotomy procedure.

Sympathetic Nerve Blocks

A sympathetic nerve block is an injection to anesthetize the sympathetic nerves along the front of the spine to decrease your pain temporarily and to define it more precisely. Often a series of sympathetic nerve blocks are done on a weekly basis until the pain is under control. If the pain relief is only short term with each injection, a neurostimulator may be considered.

Radiofrequency Neurotomy

Radiofrequency Neurotomy treatment in MN by Dr. Will Radiofrequency neurotomy is intended to identify and interrupt the nerves that contribute to chronic pain. The procedure has proven to be a valuable asset in the treatment of spinal pain that originates from the facet joints. The process of radiofrequency neurotomy begins by identifying which facet joint or joints are causing the pain. A series of two test injections are performed on separate days. Individual facet nerves are numbed to see if the pain can be temporarily stopped. If the two test injections are both successful at alleviating the pain temporarily, then the painful joint has likely been identified. Statistics show that a patient who has passed both test injections has about an 80% chance of getting pain relief with the final step, which is called radiofrequency neurotomy.

October 2011 – Read Dr. Will's article in MD News for more information on how Radiofrequency neurotomy is a new advanced alternative solution to chronic pain.

Watch Educational Video

Neurostimulation Therapy

A neurostimulator is a small system that would be placed in your body like a pacemaker. They are sometimes referred to as “pacemakers for pain.” A neurostimulator generates mild electrical pulses and sends them to your spinal cord. These electrical pulses replace the feeling of pain with a tingling or massaging sensation. A variety of neurostimulators are available to relieve a patient’s specific region of pain, such as the spinal cord or the peripheral nerves.

Three major medical manufacturing companies make neurostimulators: Medtronic, ANS: A St. Jude Medical Company, and Boston Scientific.

Watch Educational Video

Intrathecal Pain Pump

The Intrathecal Pain Pump drug delivery system is made up of two implantable components: an infusion pump and an intraspinal catheter. The pump is placed in a subcutaneous pocket while the catheter is inserted into the intrathecal space of the spine, tunneled under the skin and connected to the pump. Medication can be delivered at constant or variable flow rates.

Because there are no external parts, the system usually does not interfere with daily activities. A programmable pump allows clinicians to adjust doses non-invasively, minimizing patient discomfort. In addition, the pump can be programmed to deliver different doses at various times of the day depending on the patient's needs. Medtronic is the only medical manufacture of a programmable intrathecal pain pump.

Watch Educational Video

Vertebroplasty

A proven treatment for vertebral compression fractures with a 20-year clinical history.

Watch Short Patient Education Video

Fragility fractures are a serious and growing problem for older adults and the healthcare system. In fact, 50% of women and 25% of men will have an osteoporotic fracture in their lifetime. Vertebral compression fractures (VCFs) are the most common type of osteoporotic fracture, with an estimated 700,000 reported nationally each year.

Vertebroplasty offers a proven and safe treatment that assures the best quality results.

This minimally invasive, image-guided treatment, in which bone cement is injected into the vertebral body, significantly decreases pain and increases mobility in more than 90% of patients.

Here are the steps involved in a vertebroplasty:

Performed in our Edina clinic; 90% success rate

The procedure is performed on an outpatient basis at our Edina clinic under local anesthesia and mild sedation. The patient is generally ready to go home one hour post-procedure.

The overall success rate for vertebroplasty in treating osteoporotic fractures is approximately 90%. Patients experience a dramatic reduction in pain, increased mobility, and improved overall quality of life.

Medication Management

Prescription medications are sometimes required to help manage acute or chronic pain conditions. If this is necessary, patients can be safely treated under our careful supervision with the most effective pain medications available today.

Dr. Will is a Diplomate of the American Board of Pain Medicine. This is the certification restricted to pain management specialists whose focus is on pain management and who have demonstrated their skills through comprehensive testing.

Nonsteroidal Anti-Inflammatory Drugs

Some of these are available over the counter such as Advil and Aleve. Others are available by prescription, such as Celebrex. All of these relieve pain by reducing inflammation.

Steroids

Steroids are available in oral form and injections (see Epidural Steroid Injections). They have a more powerful anti-inflammatory effect than the NSAIDS, but are used only on a short-term basis to eliminate inflammation that is causing pain.

Muscle Relaxants – These are prescription medications that reduce muscle spasms and thereby can reduce pain.

Anticonvulsants

These prescription medications reduce pain by lessening the sensitivity of the nervous system.

Sleep medications – Pain can often disrupt sleep and make it more difficult for a person to cope with their pain. Sleep medications are prescribed to improve restorative sleep.

Antidepressants – Chronic pain patients often have depression. Antidepressants can improve mood and make it easier to tolerate pain.

They can also have a direct effect on reducing pain.

NSAIDS

Opioids – These are the most powerful prescription pain medications available. They can be used to treat acute or chronic pain successfully. However, opioids medications can have negative consequences including: addiction, tolerance to the medication, constipation, drowsiness, and other side effects. Therefore, these medications are closely regulated and are not suitable for everyone.

Only a thorough medical consultation can determine whether opioid therapy is appropriate for a particular individual.