Blood Flow Restriction Therapy

We are the 1st in the area to incorporate blood flow restriction training into our lower body rehab programs.

What is it?
Blood flow restriction (aka occlusion) training involves placing a pressure cuff around the thigh to decrease blood flow away from the leg; blood flow into the region continues.

1. Exercise at 20-30% of max effort yields similar results as training at 60-70% of max.
2. Prevents or slows muscle atrophy (getting smaller).
3. Increase local growth hormone by 200-300% –> increased muscle size and strength.

What this means for you…
You get back in action more quickly! After injury or surgery, you may not be able to exercise at high enough intensity to promote strength gains due to pain or risk for re-injury.  But with the addition blood flow restriction training, strength gains can be made earlier while training at a safe, lower intensity.  The sooner your strength returns, the quicker you can get off crutches, start running, and return to the activities you love.

Contact us to learn more or schedule an appointment to experience the difference.

By |January 4th, 2017|Uncategorized|0 Comments|

Nerve Glide for Carpal Tunnel Syndrome

Carpal tunnel syndrome is a common condition caused by irritation of the median nerve as it travels through a tight tunnel in the wrist.  There are many causative factors, but overuse is one of the most common issues, such as computer work and construction work.  Symptoms will occur in the thumb, index finger, and middle finger.

Carpal tunnel








*image from

Symptoms include:

hand numbness 

sensation of pins and needles

hand clumsiness

hand pain at night

hand weakness

wrist weakness

Clinically, we assess neck motion as there is often an issue in the cervical spine that will need to be addressed.  We will check the mobility of the median nerve and often recommend nerve glides of the median nerve in addition to other manual techniques and education on activity modification.  Here is a short video demonstrating one way to glide the median nerve through its tunnel.


By |July 19th, 2016|Uncategorized|0 Comments|

Frozen Shoulder

Adhesive capsulitis, commonly referred to as Frozen Shoulder, is a debilitating condition of the shoulder, marked by pain and progressive loss of motion. The shoulder joint is surrounded by a fibrous joint capsule, which in this condition, becomes inflamed and thickened, forming adhesions. In this sequence below, the image on the left shows a normal, healthy shoulder joint capsule, whereas the image on the right is typical of adhesive capsulitis. I’m no radiologist, but that does not look good!

frozen shoulder


This condition is most prevalent in women from 40-60 years old, typically with no known cause, just a gradual loss of motion and increasing pain. A thorough history may reveal a rather insignificant act that precipitated this condition, something as simple as feeling a slight discomfort when taking down a box of Christmas ornaments. Periods of immobilization, such as using a sling after surgery, can also trigger a frozen shoulder. Xray and MRI imaging will usually be unremarkable, but arthroscopic evaluation will show a thickened, inflamed joint capsule. Studies have shown risk factors to include Diabetes and thyroid issues; prevalence in diabetics is 10-20% and thyroid (hyper- or hypo-) is 10-17.4%(

Adhesive capsulitis is a process that can last for 12-24 months. It typically goes through 3 phases: freezing, frozen, and thawing.
(1) Freezing stage: characterized by pain and progressive loss of motion; sleep is often disturbed in this stage.
(2) Frozen stage: pain will usually lessen considerably and there is no significant change in motion.
(3) Thawing stage: motion will begin to return and the ability to use the affected arm will improve.

So, what can be done? After seeing your physician and possibly receiving a cortisone injection, physical therapy […]

By |November 12th, 2015|Uncategorized|0 Comments|

Early vs Delayed rehab after rotator cuff repair

Over the past 10 years, I have seen a large number of clients following rotator cuff repair.  The protocols from various surgeons are all over the place, and rightfully so, depend a great deal on what the surgeon saw during the procedure – size and location of tear, soft bone, tissue quality, tendon retraction, etc.  All of these things have an impact on post-op rehab.

Some surgeons want the client seen the day after surgery, while others wait 3-6 weeks.  Some recommend a sling for 1 week, while others recommend using a sling for 4-6 weeks.  As we can see there is no consensus on these matters, but the good news –  PEOPLE GET BETTER.

I recently came across this article in the American Journal of Sports Medicine  –

Early Versus Delayed Passive Range of Motion Exercise for Arthroscopic Rotator Cuff Repair: A Meta-analysis of Randomized Controlled Trial

In a nutshell…

The authors of this study reviewed 6 randomized controlled trials consisting of 482 patients. They compared outcomes of those receiving early versus delayed range of motion (ROM) after rotator cuff repair. Those receiving early ROM had 3.5 degrees greater forward flexion (reaching overhead) ROM at 12 months post-op. However, the early group also had a higher incidence of re-tear, especially if they had a large tear.

In my experience, I haven’t seen much difference in outcomes of those with small to medium tears who start PT the day after surgery or 4 weeks after surgery; those starting the day after surgery are just less excited to see me:)   I do agree that large tears need a little more time to heal before beginning the rehab process.

Shoulder – Hip Connection

Scher S et al.  Associations among hip and shoulder range of motion and shoulder injury in professional baseball players.  J Athl Train. 2010;45(2):19-197.

The Down Low:  According to this study, pitchers with a history of shoulder injury had decreased hip extension on the throwing side coupled with increased shoulder external rotation of the throwing shoulder.  In other words, if the dominant (throwing side) leg is lacking hip extension flexibility, the body will compensate by increasing the shoulder external rotation to create the “whiplike” effect.  This places more stress on the front of the shoulder (and elbow), potentially causing SLAP tears, rotator cuff tears, and ulnar collateral ligament tears in the elbow (Tommy John).

Take Home Message:   Train the entire body… throwing is not just about the shoulder.  Work on dominant side hip extension flexibility (ie. 1/2 kneeling stretch) and lead leg strength and hip stability.  Incorporating trunk control / core stabilization is equally important.

                hip flexor 3 Roy-Oswalt27

                        Roy O image courtesy of
By |January 21st, 2015|Uncategorized|0 Comments|

The Next Level

Early last month I got a text from the father of one of my former clients, a local high school football player.  He mentioned his son had some news he wanted to share with me and would stop by.  Well, football season carried on….all the way to the State Championship Game!!  A few weeks after the big game, Zack stopped by to share his big news – he had accepted a scholarship offer to play football for the Fresno State Bulldogs!  This young man is so humble about his accomplishments and I know he will do great things.

At his visit, Zack also brought in an article where he was honored by the Houston Touchdown Club.  As I read the article, I saw my name…what? my name?  I am so honored and blessed to have worked with this young man.  He is a testament to hard work, dedication, and focus.  We wish Zach success at the next level and beyond!!

Zach Kinninger article copy

By |January 12th, 2015|Uncategorized|0 Comments|

Improve your ankle motion

In some cases after an ankle or foot injury, especially if it required a cast or walking boot, the ankle will become stiff and maybe even painful…going down stairs can be difficult.  You usually begin stretching and foam rolling the calf, but after several weeks or months, the ability to pull the top of the foot towards the shin (dorsiflexion) does not improve, and often you feel a “pinch” at the front of the ankle. One possible cause is tightness in the ankle joint, not the muscles around it.

Clinically, I assess the ankle joint capsule by gently moving the bones of the ankle, specifically moving the talus towards the back of the ankle; also performing a squat to see if the heel of the affected foot/ankle lifts off the grounds before the other one.

At Propel Physical Therapy, we use specific joint mobilizations to improve this ankle joint motion and then use the following exercise at home.

By |December 8th, 2014|Uncategorized|0 Comments|

Heal your Heel

“I have had tendonitis for 6 months. Why does it still hurt?”

Let’s first quickly discuss tendons. By definition, a tendon connects muscle to bone and transmits the force the muscle produces. So, anywhere there is a muscle, there is a tendon. Common sites of tendon injuries occur at the ankle (Achilles), knee (patellar tendon), shoulder (rotator cuff), and elbow (golfer’s, tennis). Most often, tendinitis results from overuse/inadequate recovery, a drastic change in intensity or type of activity, or biomechanical issues.

By definition, the ending “–itis” refers to inflammation. Inflammation is the 1st stage of healing, but often gets a bad rap. Inflammation is good and necessary; without it, the body cannot heal itself. The problem arises when the body gets stuck in the inflammatory phase and there is improper healing.

So, tendinitis describes a recent injury that is less than a week old and is often the result of overuse or a change in the type or intensity of activity. Simply refraining from the painful activity can typically resolve the symptoms. However, many will “push through” the pain and the condition worsens to the point they can no longer perform the activity they love. Unfortunately, this is when most seek medical attention and physical therapy.

Left untreated, the structure of the tendon changes, becoming less effective at transmitting forces, which creates pain. Under microscope, the once shiny, white healthy tendon will now look brown and “gunky”, a sign of degeneration. This “chronic inflammation” of the tendon is termed tendinosis.

What does this mean? If it is true tendinitis and just started hurting this week, return to activity is much quicker if you stop doing what hurts. If this has been an issue for […]

By |October 8th, 2014|Uncategorized|0 Comments|

The Missing Link

Do you have neck pain?  Low back pain?  Shoulder pain?  While it is important to address issues at the local site of pain, it is equally important to look at the link that connects each of these areas – the thoracic spine (t-spine for short).

The spine is made up 3 regions: cervical (neck), t-spine (mid-back), and lumbar (low back).  If the t-spine is stiff, the adjacent regions will have to move more to achieve full motion…it’s the old adage, you are only as strong as the weakest link.  For example, when reaching overhead to grab a coffee cup or lift a weight overhead, if the t-spine is stiff, the shoulder will be unable to reach all the way overhead (just slouch and see how high you can raise your arms) so the low back will arch more to gain extra overhead motion.  In this example, you can see how the t-spine links the shoulder and low back.  Additionally, the neck will have to move through a greater range of motion if the t-spine is not moving well.  Again, slouch and see how much farther you have to lift your head to see an object.  In these 2 examples, the neck and low back have to move to the limits of their respective motion, which places them at greater risk of injury.

There are numerous ways to improve t-spine motion.  Most of us, myself included, sit too much and let gravity win by slouching, especially when working on the computer (I just sat up straight).  This places the t-spine in a rounded position – flexion.  Typically, we need to move the t-spine the opposite direction – extension.   There are many ways […]

By |September 16th, 2014|Uncategorized|0 Comments|

Online Scheduling Available!

Schedule your next Physical Therapy appointment with our safe and secure online appointment scheduler, GenBook. Real-time appointment scheduling, on your time.

View open time slots and select a time that works best for you. Just click the Book Now Button below.


By |September 3rd, 2014|Uncategorized|0 Comments|