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Your Spine Does Not Go Out Of Place

It is a common report in the physical therapy clinic that a patient’s spine or hips go out place. This belief is followed by a need for the patient to seek healthcare practitioners that can simply “put their bones and joints back in place” using manual force through joint manipulation or adjustment. This results in lifelong visits and dependency for continuous adjustments as the spine continues to go “in and out of place”. What if I told you that this concept of the spine going out of place is not true and has been scientifically disproven through multiple studies?

In actuality, your joints and bones do not easily move in and out place unless there is a large traumatic force causing a
dislocation, which is a medical emergency. This belief can be quite detrimental to patient recovery and facilitates a dependence on a healthcare professional, requiring monthly and sometimes weekly “adjustment” to put bones and joints back in place. In addition, having this belief creates a fear of movement which then causes avoidance of particular motions that ultimately hinder recovery. Both of these factors result in a worse prognosis for the patient and can actually do more harm than good. Our bodies are much stronger and more resilient than we think. Studies have shown that it takes over 1000 pounds of force to deform fascia (a connective tissue covering) by only 1%! Performing a joint manipulation/adjustment cannot come close to the amount of force to put a joint “back in place”.
Tullberg et al. performed a study on joint position in patients with one sided low back pain involving the sacro-iliac joint (better known as the SI joint). He performed joint manipulations/adjustments to the SI joint and measured the position of the joint pre- and post- manipulation to assess if the joint was moving in and out of place. The findings of the study were that there were positive changes in terms of pain, but no change in joint position in any of the participants of the study!
What patients are actually feeling when they perceive a bone or joint to be out of place is a combination of unilateral low back pain, a lack of muscle stability in the low back area and a reluctance of the body to fully bear weight on the affected side, secondary to pain. Joint manipulations can be a useful technique to decrease pain and improve movement, however, the effects are only temporary in nature leading to the need to be continuously “adjusted.” Patients who are experiencing low back pain actually require a combination of manual therapy techniques, such as manipulation, followed by specific exercise and strengthening techniques to address pain and weight bearing/muscle instability to facilitate long term changes in pain. There is a large growing body of evidence through research on the positive and sustainable impact that physical therapy has on patients with low back pain.
In conclusion, it is a scientific fact that your joints are unable to go in and out of place so easily and that the adjustments or manipulations received are a temporary change in pain. Our bodies are much stronger than we think and are capable of the long term changes. Patients with low back pain require appropriate strengthening and stability in combination with manual therapy techniques. Schedule an appointment with BREAKTHRU Physical Therapy and Fitness for a free consultation for assessment of the low back and the development of a treatment program aimed to reduce or eliminate your low back pain, teach independent management of your low back pain and to facilitate a return to normal activities that may be currently hindered by your pain!


-Dr. Brandon Fredhoff PT, DPT

Spring Off the Treadmill

The transition from winter to spring can be a difficult time of year to get out of the house for a run. Rainy, cold days can lead us to opt for a run on the treadmill rather than braving the elements for a long run outside. The question becomes how different is running on a treadmill versus running over ground? Today we are going to be discussing a recent research article looking at different forces through the knee and ankle when running on treadmill versus running over ground.
Knee pain, specifically patellofemoral pain, and achilles tendon injuries are two of the most common injuries sustained by runners. Patellofemoral pain occurs due to an increased load between your kneecap and your femur. This can cause pain with prolonged sitting, climbing stairs, or standing up from a seated position. Achilles tendon injuries are often associated with overuse, and can be painful with push off while running/walking or going up a hill. These injuries can be lingering issues for runners, and if left untreated, can be very painful, often resulting in an inability to run. This study evaluated the different stresses placed on these two areas between running on a treadmill and overground.
Previous studies have shown that when running on a treadmill, runners tend to adopt a 1 to 5 percent shorter step rate compared to their selected step rate on ground. An increase in step rate has also been shown to decrease patellofemoral stress while running. This helps to limit stride length, decreasing the tendency to overstride. The research showed no difference between patellofemoral stress on the treadmill versus overground running. This was not the case for the achilles tendon loads. Running on a treadmill produced a higher loads sustained through the tendon, meaning that the calf muscles are working much harder when running on a treadmill. Further studies are needed to determine how this may impact injury rates for those who prefer to run on treadmills, and how this information can be utilized for returning from injury.
As April showers turn into May flowers, it is good to get out on the road and leave the treadmill behind. For those runners who have been experiencing pain in their achilles, or even knee pain, please contact your local Breakthru Physical Therapist to help you get back to running pain free.
-Dr. Dan Pinto PT, DPT
Williy R. et al. Patellofemoral Joint and Achilles Tendon Loads During Overground and Treadmill Running. JOSPT 2016. 46:8.

Breakthru is excited to announce…

Dr. Mark Kitz PT, DPT is the NEW Facility Manager at our Medford Fitness office!

Dr. Mark Kitz is a lifelong resident of Southern New Jersey. He graduated cum laude from Thomas Jefferson University in 2009 with a Doctorate in Physical Therapy. As a Graduate Research Assistant at Thomas Jefferson, he conducted scientific literature reviews for faculty and assisted with human motion analysis and electromyographic studies. He completed his undergraduate studies at Rutgers University where he earned a BS in Exercise Science & Sport Studies.
Mark’s extensive background and full time experience in fitness as a Personal Trainer and Fitness Specialist allows him to facilitate patients along the continuum to achieve health and fitness, no matter what their injury or problem is. BREAKTHRU’s continuum model empowers patients and clients to achieve meaningful and lasting change in their lives with the consistent monitoring and support created by the entire team from the front office to the Doctors of Physical Therapy, personal trainers, sports performance coaches, and massage therapists.

Mark specializes in treating patients with a variety of orthopedic, neurological, and cardiopulmonary diagnoses. He utilizes an innovative, patient-centered approach to providing physical therapy emphasizing hands-on care and close guidance with individualized exercise programs. He also focuses his efforts on proper patient education to help individuals alleviate their symptoms, restore function and prevent recurrent injury. Mark has a strong interest in evaluating and treating patients with balance and vestibular issues.




Balance Program: We use standardized measurement tools to assess your current balance level, and then apply best practice
treatments which incorporate Tai Chi, balance exercises, unstable surface training, dynamic movement, and motor learning.


Vestibular Rehabilitation Program: Our physical therapists are trained to differential diagnose vestibular problems in order to provide the correct treatment.  The program will address one’s individualized impairments with balance, vertigo, and dizziness and aim to decrease associated symptoms and any risk of falling.  Some conditions such as Benign Paroxysmal Positional Vertigo (BPPV) can be treated effectively in a few treatments.





Scoliosis and The Schroth Method

A Conservative Treatment Approach to Combat the Progressive Nature of the Condition

For far too long, individuals and their family members have expressed the feelings of helplessness, like “there is nothing that can be done” and are forced to adapt a “wait and see” approach as the only model of care after a loved one is diagnosed with scoliosis. This condition can present at any point in development, but onset typically occurs during the adolescent years, when growth and skeletal maturity are really starting to progress. Physical therapy over the years has not been considered as a “primary treatment option” for patients diagnosed with scoliosis, however evidence is being developed and global techniques which have been around for decades are being studied and introduced more frequently now more than ever. This is resulting in at least “options” for patients and their families as a means to combat this condition. Instead of “wait and see”, the mantra is shifting to “try and see”. The Schroth Method is one of these options that could be beneficial for you or a loved one who has been diagnosed with scoliosis.

The Schroth method is a cognitive & sensory-motor 3-dimensional approach to treating the scoliotic spine through trunk elongation and rotational breathing strategies to improve trunk and spinal imbalances. The goal is to strengthen and develop the inner muscles of the rib cage and torso in order to influence the shape of the unique spinal curve pattern of each individual patient, while also maximizing the patient’s postural awareness. This technique has been used in Europe for decades; however, only recently began growing in popularity in the United States.

There is growing evidence to support the need of incorporating scoliosis specific exercise techniques, or this “try and see approach”, to provide alternative options for patients and families who are not exactly sure what the future looks like or what to expect in regards to the “severity and progression of the curve”. The Scoliosis Research Society advocates that the goal of conservative treatment should be to “reduce the risk of a curve progressing to a point where surgery is indicated”1. It also acknowledges that recent evidence studying patients with mild scoliosis of 10-20 degrees revealed that scoliosis specific exercises may prevent curve progressions to further levels of deformity resulting in additional medical management, such as surgery.1,2

What are the Goals of Treatment?
• Correction of the scoliotic posture
• Stabilize the spine and arrest the curve progression
• Improve self-image
• Improve function
• Improve pain
• Improve respiration and lung function
• Improve confidence and empowerment over scoliosis

Who would benefit from the Schroth Method?
Although onset typically occurs in adolescence, patients of ALL AGES can benefit from this method of treatment. The exact strategy and approach is dictated by the unique curve patterns as well as levels of skeletal maturity; however The Schroth Method can be beneficial for patients in all stages of scoliosis. This includes patients who have not yet begun bracing, patient who are currently being braced, as well as pre-operative or post-operative treatment when surgery is indicated.

In addition, research on the Schroth Method and similar treatment strategies is also developing to evaluate the benefits and effectiveness on postural related spinal deformities for people of all ages.

What are the exercises like?
During each session, you will be guided through specific exercises designed for you based on the curve pattern, curve severity, age, overall health, and other factors. Your certified Schroth Therapist will provide extensive verbal and tactile cuing throughout each exercise to facilitate curve correction through appropriate muscle activation, spinal positioning and breathing patterns.

Team Approach is Essential:
Proper management of the scoliotic spine requires a successful multi-disciplinary team approach between the treating Physician, Schroth Therapist, Orthotist (when bracing is required), and family members. Our certified Schroth Therapists understand these relationships are essential and work closely with these health care providers in order to provide seamless care for the patients to achieve optimal outcomes.

Ask for the “Schroth Method” to schedule an evaluation with our certified Schroth Experts!

1. https://www.srs.org/about-srs/quality-and-safety/position-statements/screening-for-the-early-detection-for-idiopathic-scoliosis-in-adolescents2. Monticone M, Ambrosini E, Cazzaniga D, Rocca B, Ferrante S: Active self-correction and task-oriented exercises reduce spinal deformity and improve quality of life in subjects with mild adolescent idiopathic scoliosis. Results of a randomised controlled trial. Eur Spine J (2014) 23:1204–1214

Acute Management of Lateral Ankle Sprains

Ouch! You rolled your ankle running pick-up basketball this weekend with your friends. Frustrating….we know.

Lateral ankle sprains are injuries that pose a major inconvenience. They limit your ability to walk, move, sleep, and perform your typical self-selected physical activities… plus your friends will be short a player next weekend. Don’t lose hope, we are here to help teach you how to properly manage these injuries and provide advice and strategies for the most effective and efficient rehabilitation.
Lateral Ankle Sprains account for nearly 25% of all musculoskeletal injuries and nearly 10% of all admissions to emergency rooms. However this rush to the emergency room is often unnecessary. The gold standard in the diagnosis of acute lateral ligament injury is the delayed physical examination. Research has shown that, barring the complete inability to bear any weight through the injured ankle, you should be waiting 4-5 days before seeking medical attention. Rushing to the doctor during this acute phase of injury has been shown to result in unreliable diagnosis of the injury. Because of the diffuse location of the pain and swelling, the examiner cannot differentiate the pain or instability you are feeling, leaving you without a true answer or diagnosis.

So what should you do? Remember what your parents always said… ice it! Well how about RICE it.

Well how about RICE it. The combination of Rest, Ice, Compression, and Elevation during that first 4-5 day period has been shown to very effectively reduce pain and swelling. Following this initial period, researchers can tend to disagree. However a majority feel that a brief period of immobilization (5-7 days via air-cast/walking boot) should follow. But don’t baby it! Prolonged use of immobilization (>10 days) can have a detrimental impact on muscles, ligaments and other joint surfaces, resulting in inferior outcomes post-injury. Instead, switch over to a less-rigid support, i.e. compression wraps, lace-up braces, tape.
Finally, at the 7-10 day period, it is now time for a structured, individualized rehabilitation program. Structured physical therapy, from a Certified Doctor of Physical Therapy, focusing on pain relief, swelling reduction, dynamic stability, mechanical analysis/correction of movement, and progressive strengthening of surrounding musculature, has been shown to significantly accelerate the healing process. Not only can therapy help rehabilitate an old injury, it can help prevent a new one. Did you know that the #1 risk factor for a lateral ankle sprain is a previous lateral ankle sprain? With a skilled, trained professional guiding your care, not only will your current injury improve, you will be preparing your body for a safer and more efficient return to activity with an eye towards preventing another injury in the future.
Ankle injuries can be a nuisance. They are painful and difficult to manage. However, utilizing the strategies and guidelines laid out above, you are now equipped with a well rounded approach on how you can help address your injury. By taking the proper steps and seeking the proper care at the appropriate times, you have the tools to turn this potentially chronic issue into an afterthought and before you know it, you will be that mighty weekend warrior once again!

-Dr. Dave Pasi, PT, DPT

Van den Bekerom, M., Kerkhoffs, G., McCollum, G., Calder, J., Niek, C. (2012). Management of acute lateral ankle ligament injury in the athlete. Knee Surgery Sports Traumatology Arthroscopy, 21, 1390-1395

Complimentary Seminar 4/6/17 on: The Female Runner: Maximizing Health to Improve Performance

Join Breakthru Physical Therapy +Fitness at our Medford Taunton Forge Location  for an evening discussion featuring Coach Jason Kilderry and our very own, Dr. Kevin Schnitzer!  Coach Jason will be discussing training, nutritional, and recovery considerations for female endurance athletes that aid in improved performance, less injuries, and most importantly, improved health, based on the latest scientific literature.  Coach Jason has an extensive background in exercise physiology and kinesiology and is able to break down popular claims about these topics and deliver real answers in a fun, applicable, interactive and easy to understand manner.

When:  Thursday, April 6, 2017
Registration: 6:30pm-7:00pm
Presenters: Coach Jason Kilderry
                          Dr. Kevin Schnitzer, DPT, PT 
-Differences in the female athlete with focus on anatomical, biomechanical, and neuromuscular differences
-Clinical significance of differences and relationship to injury and rehab
-Injury rate trends in female runners: as in patellofemoral, ITB, shin splints plantar fasciitis etc
-Rehab/neuromuscular correction
-Research: findings and faults
Q&A: 7:50pm-8:00pm

Food and beverages will be served!


Falls Risk Post-Surgery

After highly invasive surgeries, there are many different life adjustments necessary for optimal recovery. Your body will be adjusting to loss of blood which reduces the rate of oxygen to your entire body. Pain and weakness will also play a huge factor in mobility. Mobility will be especially difficult because of the traumatic stress your body is undergoing.
People going through orthopedic surgeries have higher likelihood of falls due to increased medication, pain, weakness, fatigue, and other complications from surgery. If you had a fall prior to surgery, the risk is increased. There are many things that you can do to create the safest environment possible for recovery. You can talk to your doctor regarding medication if you have any dizziness or nausea. Because of decreased blood volume in your body, you may also have dizziness when transitioning from laying on the bed to sitting upright. This is called orthostatic hypotension. If this occurs, be sure to stay seated until dizziness subsides before standing up. Weakness occurs secondary to the muscle being cut through during surgery, and also because of the swelling that results from the trauma.
In post orthopedic surgeries such as hip or knee replacement, walking may be difficult or impossible without assistive devices. If you or a loved one are going through a recovery process from a surgery, it is vital to maintain safety while continuing to move around your house. This means removing any throw rugs or objects on the ground that may be a safety hazard. Excessive flights of stairs should be avoided if possible. You may also need to consider moving your bed down to the first floor if stairs are too painful.
With difficulties in mobility, a home physical therapist may be excellent choice for you or your loved one. The home therapist can come to your house directly and make sure you are safe with mobility as well as help strengthen your muscles. After you are discharged from home therapy, outpatient clinics can help you return to your normal lifestyle and hobbies. Your physical therapist will prescribe a personalized treatment plan based on your needs and goals.
-Dr. Lihn Nguyen, PT, DPT


Breakthru’s physical therapists are trained to perform a thorough evaluation and treatment for patients recovering from a concussion. We will perform tests of the visual and balance systems as well as identify any musculoskeletal impairments. Treatment will be carried out with a specific, personalized program based on the evaluation’s findings. We will be able to perform a treatment program starting at the initial phase of concussion and ending with a return to a patient’s prior functional level and/or return to sport. Our concussion team leaders are certified by Impact.

Sports Medicine

With athletic injuries, we alleviate our patient’s pain, maximize their performance, and address imbalances and weak links to prevent recurrences and future sports related injuries. We make sure to get you back on the field (safely) as soon as possible!


Developed specifically to address the unique movement impairments for individuals with Parkinson’s Disease. This program is evidence based, and uses multiple repetitions of core movements that are used in daily living to optimize learning and carryover improved movement into everyday life.