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Gardena Physical Therapy specializes in these and other specific areas.

Bursitis

Auto Injuries

Work Injuries




Nerve Impingement


Impingement occurs when pressure is applied to a nerve either by a bone, cartilage, a tight muscle or an outside force. It can cause damage to the myelin sheath which insulates the nerve and to the nerve itself in significant cases. Nerves typically do not begin to function normally immediately after the compressive force is removed. Damaged nerves take weeks or months to return to normal. In some cases normal function may not return at all.

Pinched nerves can occur at the spine due to herniated discs, bulging discs or degenerative disc disease. The initial symptoms of a pinched nerve may be tingling, numbness, burning sensation or shooting pains down the buttocks and legs or in the neck, shoulders, arms and fingers.

Impingement can also occur elsewhere in the body, referred to most commonly as a peripheral nerve impingement. Peripheral nerve impingement occurs when soft tissue structures are irritated following a trauma, repetitive injury or sustained faulty posturing. Adhesions or scar tissue is formed with resulting pain, numbness and tingling of the affected area.

Carpal Tunnel Syndrome (CTS) is a complex condition caused by swelling and pressure on nerves of the palm side of the wrist.

Symptoms of Carpal Tunnel Syndrome:

Numbness and tingling in the thumb, forefinger and middle finger and sometimes in the hand generally

Weakness in some of the muscles associated with the thumb and sometimes in the hand generally

Clumsiness with the hand and difficulty with functional tasks, i.e. grasping, lifting

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Tarsal Tunnel Syndrome is a compression on the Posterior Tibial Nerve that produces symptoms anywhere along the path of the nerve. The Posterior Tibial Nerve runs along the inside of the ankle into the foot.

Symptoms of Tarsal Tunnel Syndrome:

Tingling, numbness, burning or shooting pain into the inside of the ankle or into the bottom of the foot

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Thoracic Outlet Syndrome (TOS) results from compression of nerves or blood vessels in the area between the neck and the armpit. The nerves in this area are collectively referred to as The Brachial Plexus. The Brachial Plexus is a network of peripheral nerves that transmits motor (movement) and sensory signals to and from the spinal cord to the arm. Impingement of these nerves can occur at various sites; a thorough evaluation is needed to determine the structures that are involved.

Symptoms of Thoracic Outlet Syndrome:

Pain can be variable depending on the structures involved. Most commonly, pain occurs in the shoulder and arm; however, pain patterns can also occur in the neck and chest.

Muscle atrophy, weakness and numbness can occur over time due to prolonged compression of the nerves.

Poor circulation resulting in a “cold arm” can occur due to restricted blood flow to the arm.


Contributing factors in the development of thoracic outlet syndrome include the presence of a cervical rib, an abnormal first rib, postural deviations or changes, body composition, degenerative disorders and hypertrophy, spasms or length tension issues of the anterior neck and/or shoulder muscles.

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Musculo-Skeletal Dysfunction


Musculo-skeletal dysfunction refers to any dysfunction involving the muscles and bones of the body as they relate to each other. Dysfunctions associated with the musculo-skeletal system often involve unresolved postural or biomechanical issues that have caused compression, sheering or mal-alignment at the associated joints as well as soft tissue abnormalities such as muscle spasms and trigger points.

Neck and Back Pain can be caused by many factors. Whether your neck or back pain is caused by an injury or an unknown cause, a complete evaluation addressing the musculo-skeletal and nervous systems should be done.

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Osteoarthritis is the most common form of arthritis. It involves the breakdown of cartilage within the joint. Cartilage normally protects the joint, allowing for smooth movement. Cartilage also absorbs shock when pressure is placed on the joint, like when you walk. Without the usual amount of cartilage, the bones rub together, causing pain, swelling (inflammation), and stiffness.


Symptoms of Osteoarthritis:

Joint pain and joint stiffness can occur at rest or more commonly, with weight-bearing for extended periods of time

Tenderness in and around the joint

Limited range of motion in one or more joints

Redness and warmth around the affected joint

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Temporomandibular joint disorder (TMD, TMJD or TMJ) are terms used to describe dysfunction involving the temporomandibular joint.


Symptoms of TMD, TMJD or TMJ:

Inflammation that may be acute or chronic

Joint noise

Locking and/or pain at rest or with range of motion


Dysfunction at the Temporomandibular joint (TMJ) can occur for many reasons. Physical therapy treatment is focused on improving the muscle balance in the muscles associated with the head, neck and jaw to improve alignment and congruency at the joint. Postural issues must also be addressed as a forward head and/or anterior shoulder positioning with their subsequent muscle imbalances can also effect alignment at the TMJ.

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Headaches can be caused by many things including muscle tension, eye strain, sinusitis, low blood sugar and dehydration. Cervicogenic headaches originate from disorders of the neck, including the anatomical structures innervated by the cervical roots C1–C3. Cervical headache is often precipitated by neck movement and/or sustained awkward head positioning. It is often accompanied by restricted neck mobility as well as neck, shoulder or arm pain. Associated pain in the shoulder or arm can present as a vague ache/pain or a more severe radiating type pain.

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Joint Pain can be caused by many types of injuries or conditions. Two common causes of joint pain are Rheumatoid arthritis (an autoimmune disorder that causes stiffness and pain in the joints) and Osteoarthritis (growth of bone spurs and degeneration of cartilage at a joint.)

Joint pain can also be caused by compression or sheering forces in or around a joint. These forces are often caused by muscles imbalances in the muscles associated with the joint.

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Bursitis is inflammation of the fluid-filled sac (bursa) that lies between a tendon and skin, or between a tendon and bone. Bursitis can be caused by chronic overuse, trauma, rheumatoid arthritis, gout or infection. Sometimes the cause cannot be determined. Bursitis commonly occurs in the shoulder, knee (washmaid's knee), elbow, and hip. Other areas that may be affected include the Achilles tendon and the foot.

A tendon is a fibrous connective tissue which attaches muscle to bone. A tendon serves to move the bone or structure. Tendonitis is inflammation, irritation, and swelling of a tendon. Tendinitis can occur as a result of injury, overuse, or with aging as the tendon loses elasticity. It can also be seen in systemic diseases such as rheumatoid arthritis or diabetes. Tendinitis can occur in any tendon, but some commonly affected sites are the shoulder (biceps tendonitis or rotator cuff tendonitis), the wrist, the heel (Achilles tendonitis) and the elbow (tennis elbow, golfers elbow.) Tendinosis (tendon degeneration) may also be present.

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Spinal Dysfunction

Degenerative Joint Disease (DJD) is more commonly known as osteoarthritis (OA), most of the time; the cause of OA is unknown. It is mainly related to aging, but metabolic, genetic, chemical, and mechanical factors can also lead to OA.

The symptoms of osteoarthritis usually appear in middle age and almost everyone will have it by age 70. Before age 55, the condition occurs equally in both sexes. However, after 55 it is more common in women.

The disease causes the cushioning (cartilage) between the bone joints to wear away, leading to pain and stiffness. As the disease gets worse, the cartilage disappears and the bone rubs on bone. Bony spurs usually form around the joint.

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Degenerative Disc Disease is not really a disease but a term used to describe the normal changes in your spinal discs as you age. Spinal discs are soft, compressible discs that separate the interlocking bones (vertebrae) that make up the spine. The discs act as shock absorbers for the spine, allowing it to flex, bend, and twist. Degenerative disc disease can take place throughout the spine, but it most often occurs in the discs in the lower back (lumbar region) and the neck (cervical region). As we age, our spinal discs break down, or degenerate, which may result in degenerative disc disease in some people. A loss of fluid in the discs reduces the ability of the discs to act as shock absorbers and makes them less flexible. Loss of fluid also makes the disc thinner and narrows the distance between the vertebrae. Tiny tears or cracks in the outer layer (annulus or capsule) of the disc can also occur. The jellylike material inside the disc (nucleus) may be forced out through the tears or cracks in the capsule, which causes the disc to bulge, break open (rupture), or break into fragments.

As the space between the vertebrae gets smaller, there is less padding between them, and the spine becomes less stable. The body reacts to this by constructing bony growths called bone spurs (osteophytes). Bone spurs can put pressure on the spinal nerve roots or spinal cord, resulting in pain and affecting nerve function. This condition is most commonly referred to as Spinal Stenosis.

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Scoliosis is not a disease – it is a descriptive term. All spines have curves. Some curvature in the neck, upper trunk and lower trunk is normal. Humans need these spinal curves to help the upper body maintain proper balance and alignment over the pelvis. Scoliosis is an abnormal side-to-side (lateral) curve in the spinal column. There are many causes of scoliosis, including congenital spine deformities, genetic conditions, neuromuscular problems and limb length inequality.

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Clinical Spinal Instability is considered to be one of the most common causes of neck and low back pain. Spinal instability is an abnormal movement at the spinal level caused by degeneration, injury or muscle dysfunction. Improving neuromuscular control in the muscles associated with stability and segmental movement of the spine is the key to improving instability and decreasing pain.

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Myofascial Dysfunction

Fascial restrictions can occur from many things including trauma, faulty posturing and faulty, repetitive movement patterns. Fascia is a tough connective tissue that encompasses the entire body in a three dimensional web from head to toe without interruption. Trauma, posture, inflammation and even lack of normal motion can create a tightening of fascia. Certain areas of the body have fascia that serve a special function such as the plantar fascia in the bottom of the foot, the iliotibial band on the outside of the upper leg and the “aponeurosis” of the head and neck and middle and lower back. These types of fascia can also be considered to be “postural fascia” and are often the first areas to display changes associated with postural dysfunction and their associated pain patterns.

Fascia prevents muscles from tearing and breaking, and also prevents muscle hernias. If muscles were not surrounded by fascia, their action would not be even and coordinated, and they would rupture and tear. They would not reach the strength or power that they are capable of achieving.

The elastic property of fascia helps to push on and maintain venous openings after they have been squeezed by contraction. Lesions of the fascia and the adjacent muscle inhibit venous return and lead to congestion and eventual pathology. The movement of venous blood and lymph depends to a large degree on muscular activity that works against and along the fascial planes. Thickening and/or shortening of the fascia combined with insufficient muscular activity slow the influx of blood and lymph.

Fascial thickening develops as a response to forces of tension and mechanical demands. Excessive thickening is frequently accompanied by shortening, which results in excessive restriction so that movement in the area becomes restricted.

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Plantar Fasciitis is a common diagnosis for heel pain. This condition occurs when the long fibrous plantar fascia ligament along the bottom of the foot develops tears in the tissue resulting in pain and inflammation. The condition is often misspelled as plantar fascitis. Correctly pronounced it is "plantar fash-eee-eye-tiss".

There are a number of plantar fasciitis causes. The plantar fascia ligament is like a rubber band and loosens and contracts with movement. It also absorbs significant weight and pressure. Because of this function, plantar fasciitis can easily occur from a number of reasons. Among the most common is an overload of physical activity or exercise. Certain types of arthritis and diabetes can also make the body more susceptible to plantar fasciitis.

A thorough clinical evaluation should be performed when the plantar fascia has become inflamed. Irritation and subsequent inflammation commonly has an underlying cause such as poor motor control in the associated muscles or muscle imbalances in the body that have allowed for altered foot mechanics and undue stress at the plantar foot.

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Other

Sports Injuries and Strength and Conditioning
Patients requiring treatment for injuries associated with sports or recreational activities will receive a complete functional evaluation consisting of a full bio-mechanical evaluation, range of motion and strength testing, stability testing for the spine, shoulder girdle and pelvic girdle, postural evaluation and screening for commonly found faulty movement patterns.

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Balance Deficits
We provide a comprehensive balance re-training program for patient’s experiencing balance deficits. Our balance program is designed to accommodate all levels of dysfunction from age-related deficits to sport specific balance deficits.

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Chronic Pain was originally defined as pain that has lasted 6 months or longer. More recently it has been defined as pain that persists longer than the temporal course of natural healing, associated with a particular type of injury or disease process.

Why pain can become worse: There is a "wind-up phenomenon" that causes untreated pain to get worse. Nerve fibers transmitting the painful impulses to the brain become "trained" to deliver pain signals better. Just like muscles get better at sports with training, the nerves become more effective at sending pain signals to the brain. The intensity of the signals increases over and above what is needed to get your attention. To make matters even worse, the brain becomes more sensitive to the pain. So your pain feels much worse even though your injury or illness is not getting any worse. At this point, pain may be termed chronic pain.

Treatment for chronic pain usually requires a detailed and well-planned treatment protocol. Care must be taken to make the necessary changes in the associated structures without irritation of the already irritated nervous system. Patient’s treatment plans are completely individualized and re-evaluated and progressed routinely to accommodate the special needs of each patient.

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Pregnancy Related Pain
Literature states that low back pain during pregnancy usually evolves from three mechanisms: biomechanical/musculoskeletal, hormonal, and vascular.

Biomechainical/musculoskeletal causes can be safely and effectively treated in physical therapy. Typically, pain during pregnancy is a result of spinal dysfunction or posterior pelvic dysfunction. Spinal dysfunction is a common cause of low back pain and is also common among the non-pregnant patient. Posterior pelvic pain tends to be an acute, ill-defined pain that is pregnancy induced and rare among the non-pregnant population.

A thorough evaluation of range of motion, strength, muscle balance and biomechanics is provided to each patient. Treatment for pain during or after pregnancy requires individualized treatment protocols as each patient will have special needs and considerations.

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Post-Surgical Related Pain
Patients that have a post-surgical diagnosis will receive a comprehensive evaluation consisting of a full bio-mechanical evaluation, range of motion and strength testing, stability testing for the spine, shoulder girdle and pelvic girdle, postural evaluation and screening for commonly found faulty movement patterns. We consult with your referring physician to ensure that proper protocols are in place.

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Auto Injuries
Patients requiring therapy following an auto accident will receive a full bio-mechanical evaluation, range of motion and strength testing, stability testing for the spine, shoulder girdle and pelvic girdle, postural evaluation and screening for commonly found faulty movement patterns.

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Work Injuries
All patient’s requiring physical therapy for a work-related injury will receive a full bio-mechanical evaluation, range of motion and strength testing, stability testing for the spine, shoulder girdle and pelvic girdle, postural evaluation and screening for commonly found faulty movement patterns.

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