Author: Dr. Dan Witte

Neck Pain and Posture

September 6, 2022

Studies show that approximately 75% of the world’s population will suffer from neck pain at some stage in their life. Studies also show that up to 50% of those people with neck pain may never get full relief. This is a staggering number of citizens that are dealing with this type of discomfort on a daily basis. You may be reading this and thinking to yourself “I am one of them”.  With advances in technology over the past couple decades, a decline in postural awareness has prevailed. We don’t pay as much attention to how we are sitting as we scroll through our phones or the position of our spine while we slump on the couch playing video games.

Having been through a pandemic recently, many of us have transitioned to work-from-home positions with our companies. While this may sound great in theory, there are many factors with home offices that may be detrimental to our overall spine health as well. Whether it be improper desk height, poor seating, or decreased back support, posture when working for prolonged hours is a key player in how our neck functions on a daily basis.

Many of us choose to turn to doctors when neck pain occurs, which could lead to expensive imaging, medications, injections, or even surgery. All of these can be great options, but they are quite invasive and can cause your wallet to take a hit. Before jumping right into these pricey “cures”, let’s take a look at a few simple exercises and stretches you can complete on your own to help decrease pain or tension in your postural muscles.

• Upright Sitting with Towel Roll:

By tightly rolling a small hand towel and placing it at the small of your back, you are able to take hundreds of pounds of pressure off of your spine. You will automatically move from a slightly (or greatly) slumped position into a straight, neutral-spine position. Rather than being strained and elongated or shortened and tightened, muscles will be able to rest in their typical position, saving you from back pain occurring at any point on the spine.

• Towel SNAGS:

Towel snags are a common exercise we therapists give our patients to help stretch and gain range of motion within the neck. The first picture depicts a rotational stretch to help you turn and look over your shoulder. The second picture shows an extension stretch to help relieve pain we may have from looking down at documents, leaning forward towards the computer screen, or sleeping with our heads in a forward position.

• Scapular clocks:

Scapular clocks are utilized to encourage the activation of our postural muscles around our spine. When we have good control and strength in those muscles, it is easier to maintain an upright position for longer periods of time. They not only keep us upright, but also help stabilize the scapulohumeral complex, allowing for decreased pressure on the shoulders and neck muscles. With a greater balance in the muscles of the cervical and thoracic spine, there will be less stress and pain through the vertebrae.

• Chin Tucks:

Chin tucks are utilized to get our necks out of the forward-flexed posture we tend to spend our time in. We don’t always realize how far forward our head is sitting when we are on the computer, phone, or gaming system. As you can see by the first picture, we are encouraging our vertebrae to compress, causing increased pressure at the front of the neck as well as within all muscles attached to the area. By simply pushing our head back and tucking our chin, we resume proper alignment and strengthen our stabilizing muscles to help keep us there.

References:

https://mslongi.weebly.com/posture.html

https://www.hep2go.com/exercise_editor.php?exId=76060&userRef=0

https://www.youtube.com/watch?v=_LZE7BRvYjc

https://www.elitefitcenter.com/blog/alleviating-shoulder-pain/

https://cleanspine.com/2019/08/18/neck-pain-at-work-try-this/

How to Warm Up and Cool Down before and after Softball (especially you adult co-ed players!)

August 30, 2022

As fall approaches, we are quickly getting back into the routine of fall sports: practices, scrimmages, games, and tournaments. We are active and playing much more so than a couple months ago during those relaxing, summer months. Our bodies must gear-up for this drastic change in activity. But if we aren’t careful, the risk of injury can be high and the results detrimental to the season.

                One of the most common sports around this time of year is softball. Girls (and adults) are lacing up their cleats and hitting the dirt, sometimes as often as five times a week!  Think of the energy required of your body to handle such levels of activity! Studies show that females tend to be more prone to injury than males. This is due to the basic anatomy of a female. A wider-set hip structure puts females at higher-risk of leg injury than males. Smaller bones also place females in a higher-risk category for injury, more specifically in the ligaments and tendons. So how do we decrease our risk?

                You’ve probably heard your coaches (trainers, therapists) preach on the importance of warming up and cooling down, so much so that it started to go in one ear and out the other. But there is a good reason for this repetitive reminder! Without proper preparation, your muscles and bone structures will struggle to tolerate the high demand of competition. Warmups usually consist of a series of exercises or stretches at a low load and slow pace. The idea is to drive blood flow to the muscle tissues, allowing them to relax enough to withstand a great force later. A proper warmup can also improve oxygen flow in the body. Oxygen is needed for your muscles to function during activity. With a greater oxygen flow, your muscles can readily access the supply and work more efficiently.

                So, what type of exercise is good for a warmup? There are many ways you can prepare those muscles and tissues, depending on your sport and intensity. For softball players, dynamic (movement-based) activity, as well as static (non-movement based) activity is recommended for a well-rounded preparation. Dynamic exercises can range anywhere from jogging around the field to agilities to throwing the ball with a partner. Static exercises would include those stretches you sit or stand and hold for 15-30 seconds. A prolonged hold is recommended to change the length of the muscle and improve its flexibility, which decreases the likelihood of strains and tears. As a softball player, you’ll want to make sure you get prolonged stretches completed at every joint! The ankles, knees, hips, shoulders, and neck are all vital when it comes to your softball game-there is never a time we aren’t using one of those joints!

                Now that you’ve properly warmed up and played your game, you can go slump on the couch to relax the rest of the evening, right? Wrong! One of the worst things you can do for your body is to halt all activity and sit still for the next couple hours. High-intensity physical activity causes microtears within the muscles. As the muscles repair themselves, they regenerate to a stronger, more stable state. A cool-down allows for muscles to regroup and repair without causing too much soreness. Exercises for a cool-down can mirror those of a warmup. Low load stretching to improve your range of motion and flexibility will help decrease symptoms over the next couple days. Walking is also a great way to cool down those muscles and allow time for your body to reset. A mild to moderate pace for about 10-15 minutes following a softball game will decrease your heart rate, decrease lactic acid build-up, and decrease your risk of DOMS (Delayed Onset Muscle Soreness) over the next 48 hours.

                While you may be ready to hit the field running, I’d encourage you to stop. Take the time to stretch out and warm up those tissues. Fully prepare your muscles for the undertaking they are about to experience. Set aside some time before and after your game to complete a regimen that includes all major muscle groups. This could save your body from injury and keep you in the game all season long!

Photo by Brandon Mowinkel on Unsplash

Proper Sitting Posture

August 23, 2022

School is right around the corner, and you know what that means—It is time to swap the couch for the desk. With the plastic chairs and wooden desktops, it can sometimes seem hard to find a comfortable position to sit in. When on the couch, we have the luxury of leaning back, kicking our feet up, and resting our head on a pillow to help hold our necks in a good position. When at a desk, however, our options for comfort seem limited. We all have a tendency to rest our elbows on the desktop, place our head in our hands, and position our backs in a hunched-over position. What we don’t realize is how detrimental this position can actually be for our overall health.

                Our bodies are made to rest in proper alignment-ears in line with the shoulders, shoulders back, equal weight bearing on both sides. Any time we leave this erect position, we add undue strain on all of our muscles and joints, which can cause pain. The number one complaint we get from those that sit at a desk most of the day is pain within the neck and back. Lucky for you, we have some key rules you can follow to avoid this unnecessary pain and discomfort.

1. Keep your feet supported: It is suggested that you keep your feet firmly planted on either the floor or a step stool. Any time we sit without our feet supported, our pelvis has to shift, forcing our core to work extra hard to keep our spine in a neutral position. These small compensations at the core can create muscle imbalances overtime and begin to create pain at the low back.
2. Keep your forearms rested on the desk: With your arms properly supported, you are able to prevent stress at the top end of the chain (the neck and shoulders). Typically, as our arms raise, our shoulders do as well, which could increase tension in the region between the neck and shoulders. With our arms rested on a solid surface near waist-height, we are able to keep our shoulders low and our muscles relaxed.
3. Follow the 90-90-90 Rule: Your elbows, hips, and knees should all be bent at 90 degrees. If you look down and see your elbows are nearly straight, that may mean you need to bring your keyboard and/or mouse closer to you. If your hands are near your belly, you may need to slide the keyboard/mouse back or scoot your chair back just a little. In order to adjust the degree of flexion in your hips, simply adjust the height of your chair. Keep in mind, we need your feet supported and your knees to remain at 90 degrees of flexion as well. By adjusting the chair/seat height and height of your foot support, you’ll be able to maintain good posture for a longer period of time.
4. Place the computer screen at or just below eye level: This is one of the harder adjustments to make when it comes to desk ergonomics. Many people will use a lift under their computer stand so they can easily adjust. Others will use a good old-fashioned phone book or catalog to get the proper height. You may have to get creative with your own desk in order to get the proper screen height. This is important to keep your neck in good alignment. If we are looking down for multiple hours throughout the day, we place extra stress on the vertebrae and muscles in our neck. After years in this position, we can actually develop what is called the Dowager’s Hump. Due to the weakness in our postural muscles along the backside of the neck and shoulders, our head starts to sit more forward and creates a more pronounced curvature within our vertebrae.
5. Use a towel roll: As mentioned above, many of us prefer to lean forward onto our desktop and “lounge”. A simple towel roll can fix this habit and transform your sitting posture. All you need is a small hand towel from the kitchen or bathroom. Fold that hand towel in half and roll it up as tight as you can. You want to place it at the small of your back (belly button height). This little towel acts as a lever and automatically places your spine in a more erect position. It has the ability to take up to 400 pounds of pressure off your spine while sitting at your desk.

By keeping all of these rules in mind, you’ll be sure to find relief in your muscles and joints as you sit through your classes this upcoming school year. If you are already suffering from back pain or feel your posture is suffering due to your job or classes, give us, here at Witte Physical Therapy, a call so we can help get you straightened out!

Proper Lifting Mechanics

August 16, 2022

We all do it; most of us multiple times a day.  As it turns out, it is a common cause of back pain and something we can reduce or prevent problems with a little care and attention. Of course we are talking about lifting techniques.

Improper lifting technique can lead to back, leg, and arm pain. Poor technique can cause both acute injury, or aggravate existing back pain. Learning the right way to lift can assist a person in avoiding these problems. Most people know this, but actually taking the time to perform lifting activities properly is often forgotten.

https://stock.adobe.com/search?k=ergonomics+lifting&asset_id=515612279

Steps to Ensure Proper Lifting Position and Technique

1. Plan ahead before lifting. Knowing what you’re doing and where you’re going will prevent you from making awkward movements while holding something heavy. Clear a path. If you are lifting with another person, make sure both of you understand the plan.
2. Lift close to your body. You will be a stronger and more stable lifter if the object is held close to your body rather than at the end of your reach.  This also reduces the physical load on the back muscles by reducing distance that increases the torque load on the body.
3. Feet should be shoulder-width apart. Having a solid base of support is important while lifting. Placing your feet too close together will be unstable, while if they are too far apart it will hinder movement.
4. Bend your knees and keep your back straight. Practice the lifting motion before you lift the object.  Focus on keeping your spine straight. Raise and lower to the ground by bending your knees rather than bending at the waist or hips.
5. Tighten your stomach muscles. Tightening your abdominal muscles will hold your back in a good lifting position and will help prevent excessive force on the spine.
6. Lift with your legs. Your legs are many times stronger than your back muscles. Again, lower yourself to the ground by bending your knees, not your back.
7. Don’t twist or bend. Face in the direction you are walking. If you need to turn, stop, turn in small steps, and then continue walking.
8. And remember, if you’re straining, get help. If an object is too heavy, or awkward in shape, make sure you have someone around who can help you lift.

Its Fair Time!!!!

August 9, 2022

One of my favorite times every year is the when the county fairs get going in early August. I have fond memories of my time in 4H and spending time at the county fair. I really enjoyed getting to see my 4H friends, getting to show off my animals, and having the opportunity to spend so much time and do some many things at the fairgrounds. As I am now an adult I get the relive some of those experiences. Last week I spent an afternoon at the Dodge County Fair and this week I plan to spend some time at the Cass County Fair (where our Louisville and Plattsmouth clinics are located). While I will not be showing any animals, the fair still provides an opportunity to see a lot of people and to reconnect with them and some found memories. 

Being in 4H provides so many wonderful opportunities and experiences for our youth. Perhaps one of the best things that it does is to teach them about responsibility, project and time management. These are all things I still use as a physical therapist and that our patients can use to get better. It is important to have and take responsibility and ownership in what we are doing. Our therapists take responsibility in making sure that they are doing their due diligence and absolute best to get our patients what they need. This ensures that we are providing the best, most efficient and individualized care as possible. 

Project and time management are also important attributes for our therapists and patients. It is important for our patients to understand that “project management” occurs in two forms. One, as a member of their healthcare team in the clinic, and two as their own project manager outside the clinic. When our patients work to doing their home exercise program, improve their movement quality, and make routine adjustments to their daily life they are often improving much more efficiently. This efficiency leads to better time management in the clinic and at home. 

4H and the county fair has provided me with many attributes and memories that are still present with me today. These things have had tremendous carry over into other aspects of my adult life. I hope everyone can get out to their county fairs this summer, see the exhibits, meet the vendors, enjoy the food and fellowship, and reflect on what these fairs mean and how their values can be applicable to all aspects of our lives. 

https://www.cassfair.com/

School Backpacks: How to choose and wear them properly

August 2, 2022

As summer begins to wind down, we all must start thinking about what we need to buy and gather for the new school year. Pencils, pens, folders, and notebooks are all items that seem to make the supply list every year. We tend to look for the ones that draw our eye and suit our personal taste. Maybe we need something bright with a fun design. Maybe we look for something simple and solid. Either way, we want it to match our personality so we can feel excited to use it!

This “personalized” approach to supply shopping may work just fine for the small, essential items we need, but what about when it comes to backpacks? While a backpack may look like it suits us based on the color or pattern, it may not be the best for us. It is important to find a bag that is comfortable, durable, and has all the features to offload the bundle of books we will be dragging around. There are a few tips we need to keep in mind when finding and using the proper backpack.

1. Choose a bag with two straps: While a duffel bag provides more room to carry your items, they are made with one long strap. This is going to place the full weight of your school items on only one shoulder. As we continue to overload one half of the body and not the other, we cause a lot of strain on our muscles. This can disrupt the balance in our muscles and joints and potentially create pain within the neck, shoulders, and upper back. By splitting the weight of the bag between both shoulders, we keep the muscles working evenly and in sync with each other. It also places the center of the bag at the center of your back, allowing for your large back and core muscles to support the weight as opposed to the smaller neck and shoulder muscles.
2. Make sure the straps are wide: Wide straps on a bag will ensure the weight is distributed throughout the entire muscle it is resting on. A skinny strap places a lot of undue stress on a very small portion of the muscle belly. When pressure occurs in a small area such as this for a longer period of time, it has the potential to cause swelling or bruising in the area, both of which are indicative of tissue irritation and damage.
3. Do not overload the backpack: While it may seem efficient to carry a full days’ worth of books around with you, it can become very taxing on your body. Excess weight sitting atop your shoulders will strain not only the muscles your straps are on, but also the muscles in the mid and low back. This downward pressure from the backpack combined with typical pressure from gravity could cause spinal issues. The weight tends to pull your spine, or posture, downward and forward, rounding out your trunk. This position allows for shortening and tightening of your front side and increased tension or stretch on the backside. Joints will then shift and create misalignment, which ultimately leads to pain that could require therapeutic or surgical intervention.

So now, when you head to the store to pick out that perfect backpack for your new year at school, don’t automatically choose the fanciest or brightest or biggest one you can find. Take a good look at it and ask yourself a few questions. Can I fit a couple books at a time in this bag? Does it have two straps that can be adjusted to fit around both of my shoulders? Are the straps wide enough to sit comfortably on my shoulders without causing pain? The answer to these will surely lead you to a smart choice that works best for you!

Fibromyalgia – What to Do When the Fibro Ignites

July 26, 2022

As we head into the dog days of summer, the weather is heating up. For the nearly 5 million people in the United States with Fibromyalgia, they might experience a different kind of heat – the burning pain that typically comes along with this diagnosis.

What is Fibromyalgia?

Fibromyalgia is a chronic condition that can cause a wide range of symptoms throughout the body. It’s usually diagnosed between the ages of 30 and 50, and 80% to 90% of the people affected are women.

The most common symptoms are:

• chronic pain all over the body
• fatigue
• memory problems
• sleep disturbances
• depression or anxiety.

How Does Physical Therapy Help?

Because of the wide range of symptoms, fibromyalgia can be a debilitating condition. It is not uncommon for people to begin avoiding activities altogether because of pain and fatigue. This begins a cycle of deconditioning that not only impacts the person’s overall health, but also makes the symptoms of fibromyalgia worse. The cause of fibromyalgia is currently unknown and there is no cure, so physical therapy treatments are designed to reduce and manage the symptoms. This requires a multi-pronged approach. Common treatments include:

Education

The first step in treating fibromyalgia is often helping people understand what’s going on, and what they can do about it. Research has shown that people who are knowledgeable about their condition have better outcomes, more confidence, and cope better.

Decrease Pain and Improve Range of Motion

Physical therapists are movement experts with a lot of tools and techniques to help with the pain and stiffness caused by fibromyalgia. A PT might use gentle manual therapy or massage, prescribe specific stretches, or a simple yoga routine. They might also use modalities like electrical stimulation, biofeedback or in states where it is allowed, dry needling.

Exercise

Once patients understand the condition and are able to move a little better with less pain, exercise often enters the treatment picture. Research has shown that low to moderate intensity aerobic exercise like walking, biking, or swimming is important in managing fibromyalgia symptoms. It can help with pain, fatigue, sleep disturbances, depression, and more. Physical therapists and patients work together to find the right type of exercise and the right intensity to best manage fibromyalgia. They often have to start slow, and make adjustments along the way.

Each physical therapy session is tailored to the needs of the patient and will vary depending on the severity of their symptoms. Despite there still being no cure for fibromyalgia, physical therapists can help with pain management, strength, mobility, fatigue and function to help patients find relief from their symptoms.

How to Start A Walking Program

July 19, 2022

Now that the summer months are here, many of us try to spend ample amounts of time outdoors. We slowly return to life after being cooped up during the cold, winter months. This is the time to get out and moving again! Typically, when it is cold and dreary outside, we are less likely to exercise. It tends to slip on the priority list, and we make every excuse we can to avoid the workout regimen. As the weather warms, it is much easier to feel motivated, and maybe even excited, to get back at it! Whether you are 10 or 75, generally active or a couch potato, athletically inclined or clumsy and uncoordinated, everyone could benefit from a walking program.

                Walking doesn’t only increase your heart rate and improve your endurance. There are many other benefits as well. As you walk, your muscles must activate and work, improving strength within them. And we all know the greater the strength in the muscles, the less stress on the bones and joints. As your blood begins to pump through the body, your organs learn to run at this accelerated rate. They need the exercise just as much as your muscles and joints do! Walking is one of the greatest exercises to help lower blood pressure, decrease your risk of heart disease, and can even decrease your risk of stroke. Another big benefit is weight loss. Many of us may think we need to run in order to drop those extra holiday pounds, but that is not true! With a proper walking regimen, you can promote weight loss and feel better overall. But what is a proper regimen? How do we know how long or fast we should be walking for?

                Getting set up on a proper regimen may require a few steps. Generally, if you have any medical conditions or a history of medical conditions, you always want to check with your primary doctor first. They will be able to assess your past and current status, the medications you are on and how cardiovascular exercise may affect those, as well as recommend the best pace or distance to begin your walking regimen. There are also a couple questions you need to ask yourself. “Am I walking to lose weight?” “Am I walking to improve my endurance and overall health?” “Do I want to decrease my pain?” Depending on your answer to these questions, your walking regimen may appear different than someone else’s.

It is recommended to reach at least 10,000 steps a day if you are aiming to lose weight. This equals roughly 5 miles. Now, it may seem overwhelming to go out and walk 5 miles straight—don’t stress! Break it down into quarter or half mile increments if that sounds a bit more manageable for your fitness level and timeframe. Pace will vary depending on your weight, fitness level, and medical conditions. There are ways, however, to be sure you keep within a tolerated level of activity. By calculating your target heart rate, you can get an idea of how hard your body should be working in order to receive max benefit without overstressing the system. To figure your target heart rate, you want to take 220-your age. You will then multiple this number, first by .5, then by .85. This will give you your range in which you want your heart rate to stay within as you exercise.

Walking to simply decrease pain, improve your mental health, or feel better overall does not have to be quite so regimented. 3-5 times a week at this 10,000 step goal is still recommended; however, you don’t need to be quite as vigorous with it. Take your time, moving at a steady pace that will keep the heart rate on the lower side of the spectrum, but still higher than your resting rate. Think of this more as a daily stroll through your neighborhood or local park. Enjoy the walk, but make it productive at the same!

                If you’re like me, the thought of walking the same path every day may seem boring and decrease your motivation to go. Don’t be afraid to get creative with your walking regimen. Hills will encourage your cardiovascular system to work a bit harder and, in turn, will help the body burn more calories. Find a hiking trail or a riverwalk along some new terrain. This will keep you engaged with your regimen and excited to move again tomorrow! It will also challenge your muscles and joints in a new way, improving your overall strength and stability.

                Are you still unsure of exactly how to start? Reach out to your local therapist or primary care physician. We have the knowledge and background needed to help you get started on the right path today. We can assess your current status, help you set personal goals, and create a regimen tailored specifically to your needs. Call us today at 402.234.3333 if you’d like a physical assessment and help beginning your new fitness journey!

Its Summer, Let’s Hit The Pool!!!

July 12, 2022

                Now that summer is upon us, the heat can seem unrivaled most days. This will drive all of us to the nearest watering hole for some relaxation and cool-down. While the pool is a great way to cool off and have some fun with family and friends, it can also be a chance for us to get in some exercise! There are many benefits to aquatic therapy and various reasons why doctors may prescribe it.

Aquatic therapy refers to exercise performed in a pool for the purpose of rehabilitation for troubled muscles or joints. Due to the buoyant nature of water, pressure no longer rests on the joints when they are submerged, opposite of what we find to be true on land. This provides relief, allowing for a greater tolerance to strengthening and stability exercises. Exercise within a therapeutic pool is also known to decrease edema, or swelling, which will allow for improved joint mobility. Water provides a good resistance against the joints and muscles, improving strength without having to use weights or bands. This could save you money you may feel pressure to spend on equipment. If you have access to a therapeutic pool, the water sits at a higher-than-normal temperature, soothing sore muscles and decreasing pain. Water exercise is also known to decrease spasticity in muscles, helping to improve function and motor control with daily activities. There is a wide range of patient populations that may benefit from aquatic therapy. These include but are not limited to those diagnosed with arthritis, fibromyalgia, spinal cord injuries, vestibular deficiencies, and total joint replacements.

Here at Witte Physical Therapy Louisville, we have a state-of-the-art aquatic therapy pool in our clinic. The temperature rests at 93 degrees and has an underwater treadmill to assist in functional movement and gait training in a gravity-assisted environment. We have skilled therapists on-site and ready to guide you through a personalized plan of care set forth by the evaluating therapist. We provide the tools and exercise regimen needed to help you succeed. We will also help you set goals, create a plan to reach those goals, and help you progress back to your prior level of function. If you are looking for a different treatment option or are interested to learn more about our therapeutic pool, give us a call today at 1-402-234-3333.

Common Hand Injuries

July 5, 2022

It is (was) fireworks season. Unfortunately the hand surgeons and therapists never look forward to this time of year because inevitably accidents will happen that will cause injuries to hands, bodies and face due to fireworks. While these injuries are not overly common, it does give us a great platform to discuss the most common hand injuries.

OVERUSE INJURIES

These injuries in the hand tend to be directed more towards nerves and tendons. Carpal tunnel syndrome, cubital tunnel syndrome, medial or lateral epicondylitis, and De’Quervein’s syndrome. These can all be treated with activity modification, physical therapy interventions, and medications. Physical therapy will help you adjust your activities, regain your ROM and strength, and decrease you pain so that you can return to your normal life without issues. 

DEFORMITIES

These injuries tend to occur due to tendon or ligament dysfunction or rupture. Swan Neck, Boutonniere, Mallet, Trigger, and Depuytren’s are all issues that can cause a finger deformity. These issues often need splinting or surgery to be corrected. Physical therapy tends to be indicated after surgery to help regain normal function and strength. Physical therapy can also help with bracing, activity modification, and pain/swelling management.

MISC INJURIES

These can be caused by nerve dysfunction (such as peripheral neuropathy, hypo/hypertonicity) or traumatic injuries (fractures, burns, sprains, amputations). The physical therapy treatment for these items can vary depending on what is going on and its severity. However an individualized treatment plan can be developed to meet your wants and needs and contain a variety of interventions to help you reach your goals.

No matter the hand  injury, physical therapy can and  should be an integral part of your rehab. An evaluation by a physical therapist can get your started on the right path to decrease your pain and improve your function to get you back to work, back on the course, or just back to taking care of yourself. The quicker you start this path the quicker you will be back to being you!