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We treat muscle, ligament and joint injuries throughout the body. Therapeutic procedures used at our clinics include joint mobilization and/or manipulation, muscle energy techniques, neuromuscular reeducation and electrotherapeutic agents to promote healing as indicated. Patients will also receive an individualized home exercise program. We treat a variety of orthopedic conditions including, but not limited to the following:

• Head, Neck, Low Back Pain and Sciatica due to herniated disc, following laminectomy or spinal fusion, whiplash, sprains and strains and arthritis. Additionally, we treat temporomandibular joint (TMJ) dysfunction.
• Hip pain and movement limitation due to bursitis, arthritis, degenerative joint disease, following hip replacement surgery, childbirth, fracture, groin strain, and Sacroiliac (SI) joint sprain/strain.
• Knee pain and movement limitation following a torn meniscus and repair, medical collateral ligament (MCL) and anterior cruciate ligament (ACL) sprain and repair or reconstruction, chondromalacia, tendonitis, bursitis, following knee replacement surgery, fracture and patellofemoral syndrome.
• Foot and Ankle pain and movement limitation due to plantar fasciitis, calcaneal spur, ankle sprain, following bunionectomy, ankle and foot fractures and swelling.
• Shoulder pain and movement limitation due to frozen shoulder, rotator cuff tear and repair, glenoid labrum tear and repair, shoulder impingement, bursitis, tendonitis, dislocation or subluxation, following shoulder replacement surgery, arthritis and other injuries including fracture.

Our hand therapists provide one-on-one, customized care to each of our patients. Therapeutic procedures used by our certified hand therapists include soft tissue mobilization, stretching and strengthening techniques, therapeutic exercises, home program instruction, wound and scar management, desensitization techniques, edema control, functional activities, modalities including ultrasound, electrical stimulation, paraffin wax, heat/ice, fluidotherapy and iontophoresis. Our therapists design custom splints and casts at our clinic and provide pre-fabricated splints for complete patient care.

We treat a variety of upper extremity conditions including, but not limited to the following:

• Wrist and Hand pain and movement limitation due to crush injuries and traumatic amputation of hand, fracture, tendon lacerations, nerve injuries, burns and wounds, carpal tunnel syndrome (nerve compression), Dupuytren's contracture, Dequervain's synovitis, Reflex Sympathetic Dystrophy / Complex Regional Pain Syndrome, rheumatoid arthritis and osteoarthritis
• Elbow pain and movement limitation due to tennis elbow, little league elbow, golfer's elbow, cubital tunnel syndrome (nerve compression)
• Shoulder pain and movement limitation due to frozen shoulder, rotator cuff tear and repair, glenoid labrum tear and repair, shoulder impingement, bursitis, tendonitis, dislocation or subluxation, following shoulder replacement surgery, arthritis and other injuries including fracture.

Vestibular and Balance Disorders therapy at Meadows Physical Therapy and Hand Clinic is provided by physical therapists with specialized training and certification in vestibular therapy and rehabilitation. The patient receives a thorough evaluation and assessment of their symptoms including balance and gait. Following the assessment, the patient begins a program of vestibular adaptation exercises. Later, these exercises are advanced and gait and balance skills are added. The outcome of this program is that patients accommodate to vestibular challenges and their symptoms of dizziness are resolved. Following resolution of the symptoms, our therapists provide a short home exercise program to maintain the patient's progress.

We rehabilitate our patients to achieve maximum pre-injury activity level and thereby facilitate return to work. Functional capacity evaluations are a series of tests to determine an injured worker's level of safe functional performance. FCE results are compared to the physical demands of work to decide readiness to return to work, level of safe work, or assist in case closure. Job specific or general testing is provided with recommendations for work modifications, if necessary

We provide specialized therapeutic programs to maximize function in patients following Stroke or CVA, Parkinson's Disease, Multiple Sclerosis and other neurological conditions.

Dry Needling (without any medication) is used to relieve pain and tightness in muscle and scar tissue. Dr. Kapasi is certified in performing dry needling therapy. Along with other forms of physical therapy, dry needling can be an important part of your care.

What is dry needling? - Dry needling is an invasive procedure in which a solid filament needle is inserted into the skin and muscle directly at a myofascial trigger point. A myofascial trigger point consists of multiple contraction knots, which are related to the production and maintenance of the pain cycle.

Is dry needling similar to acupuncture? - There are many similarities and differences between dry needling and acupuncture. Licensed physical therapists in a growing number of states can use dry needling under the scope of their practice. Dry needling also falls within the scope of acupuncture practice. Physical therapists at Meadows Physical Therapy and Hand Clinic are not licensed acupuncturists and do not practice acupuncture. In contrast to most schools of acupuncture, dry needling is strictly based on Western medicine principles and research.

How does dry needling work? - There are mechanical and biochemical effects that occur from dry needling. Based on the pioneering studies by Dr. Jay Shah and colleagues at the National Institutes of Health, we know that inserting a needle into trigger points can cause favorable biochemical changes, which assist in reducing pain. It is essential to elicit so-called local twitch responses, which are spinal cord reflexes. Getting local twitch responses with dry needling is the first step in breaking the pain cycle.

What type of problems can be treated with dry needling? - Dry needling can be used for a variety of musculoskeletal problems. Muscles are thought to be a primary contributing factor to the symptoms. Such conditions include, but are not limited to neck, back and shoulder pain, arm pain (tennis elbow, carpal tunnel, golfer's elbow), headache to include migraines and tension-type headaches, jaw pain, buttock pain and leg pain (sciatica, hamstrings strains, calf tightness/spasms). The treatment of muscles has the greatest effect on reducing pain mechanisms in the nervous system.

Is the procedure painful? - Most patients do not feel the insertion of the needle. The local twitch response elicits a very brief (less than a second) painful sensation. Some patients describe this as a little electrical shock; others feel it more like a cramping sensation. Again, the therapeutic response occurs with the elicitation of local twitch responses and that is a good and desirable reaction.

Are the needles sterile? - Yes, we only use sterile disposable needles.

What side effects can I expect after the treatment? - Most patients report being sore after the procedure. The soreness is described as muscle soreness over the area treated and into the areas of referred symptoms. Typically, the soreness lasts between a few hours and two days.

What should I do after having the procedure done? - Our recommendations vary depending on the amount of soreness you have and on the individual response to the treatment. Recommendations may include applying heat or ice over the area, gentle stretches and modifications of activities.

How long does it take for the procedure to work? - Typically, it takes several visits for a positive reaction to take place. Again, we are trying to cause mechanical and biochemical changes without any pharmacological means. Therefore, we are looking for a cumulative response to achieve a certain threshold after which the pain cycle is disturbed.

Why is my doctor not familiar with dry needling? - In the US, dry needling is a relatively new method for treating myofascial pain and not everyone is already aware of this effective modality. Feel free to inform your doctor about this treatment option. It is upon all of us to educate others about new and innovative ways to treat pain.

Where does dry needling fit in the entire rehabilitation program? - Frequently, dry needling is needed in the beginning in order to break the pain cycle. Once that is achieved, other treatment options are introduced.

Once I am feeling better, how often do I need to come back to maintain my progress? - The musculoskeletal system is under constant pressure from gravity, stress, work etc. A regular exercise program combined with good posture can prevent many problems. If the pain comes back, "tune-ups" are recommended to treat and prevent serious injuries.

What if I am afraid of needles? - Manual pressure can be used in place of dry needles. However, it may take more sessions and relief may not be as quick when manual pressure is used in place of dry needles.

In response to a new study published in the Journal of the American Medical Association showing that pelvic floor disorders, such as urinary incontinence, affect up to one-quarter of American women, the American Physical Therapy Association (APTA) is urging women who suffer from this widespread disorder to consider examination and treatment from a physical therapist.

Treatment can include:

• Education about the bladder, pelvic floor muscles and normal emptying techniques.
• Bladder retraining and timed schedules for urinating.
• Exercises to strengthen the pelvic floor muscles.
• Biofeedback for targeted feedback on pelvic muscle contractions.

Recent research has demonstrated physical therapy's effectiveness in treating the symptoms of urinary incontinence. A study published in the Annals of Internal Medicine (March 18, 2008) reports that pelvic floor muscle training, in conjunction with bladder training, resolved the symptoms of urinary incontinence in women. According to APTA, proper preventive measures and examination and treatment by a physical therapist can help patients manage, if not alleviate, this often debilitating condition.

In a case study published in the New England Journal of Medicine (March 6, 2008) regarding urinary incontinence in women, it is noted that "first-line treatment for stress incontinence includes pelvic floor muscle training." Affirming the Annals of Internal Medicine results, this second study points out that women unable to identify their pelvic floor muscles "may benefit from seeing a physical therapist trained in pelvic floor therapy."

Patients are encouraged and seem to do well with home management of their condition after discharge from our program. Jamie Miner, PT is an experienced UI therapist and is available at both our Lawrenceville and Johns Creek offices to evaluate your patients with this disorder.

Please contact us with any questions or to schedule an evaluation.

There are now more than 20 million drivers in the U.S. who are 70 years old or above. And according to the American Automobile Association, the older these drivers are, the higher the risk of an accident. For every mile driven, collision rates for seniors 70 years-old and up is second only to teens. Thus, we are now offering driving evaluations and occupational therapy services by certified driver rehabilitation specialists.

Driving evaluations are appropriate for new drivers and experienced drivers who may require adaptive equipment to compensate for physical disabilities, older adults who are experiencing memory loss, persons who have cognitive or perceptual disabilities, people who have to transport a mobility device and even for people who suffer from post traumatic stress disorder symptoms related to a motor vehicle collision.

A driving evaluation allows an impartial professional to assist the patient, family and physician in determining if it is safe for that person to continue to drive, if they can drive with restrictions or if modifications such as adaptive equipment would allow them to continue to drive safely.

The most frequent question we receive is whether this is covered by insurance. With a few exceptions, Medicare and private health insurance companies do not pay for occupational therapy driver evaluation services at this time, although this is expected to change in the future. However, if therapy is indicated to address a specific deficit, that is covered by insurance.

Please contact us with any questions or to schedule an evaluation.

Lymphedema is the swelling of a body part, most often an arm or leg, resulting from the accumulation of fluid when lymph nodes and vessels are blocked, removed or damaged. Lymphedema causes tissues to become swollen, thick and painful, and increases the risk for infection leading to more complicated medical conditions. With proper evaluation and intervention, lymphedema therapy can allow a person to lead a positive and productive life.

Meadows Physical Therapy provides a Lymphedema Program for the upper and lower extremities resulting from post cancer surgery or other surgical procedures. Lymphedema treatment provides an alternative for those patients who are very motivated and willing to purchase their own supplies. The program involves manual mobilization of swelling followed by bandaging and an extensive home program that begins immediately.

Lymphacare Lymphedema Kits can be purchased from Sammons Preston or at our facility and is a one -time cost. Bandages typically last for 2 months but this may vary depending upon usage. Please refer to the website www.sammonspreston.com and search for the codes below for up to date pricing:

A733-461 Lower Extremity: 1 Kit $ 179.95 + S & H

A733-460 Upper Extremity: 1 Kit $ 139.95 + S & H

Treatment sessions are available up to 3 times per week. This will allow you to extend your therapy visits over a longer period of time, which is helpful if you have limited numbers of visits available from your insurance carrier.

We offer neuromuscular, sports, orthopedics, Swedish and deep tissue massage for pain relief and relaxation. Additionally, we practice reflexology, positional and myofascial release. Also, we offer Infant Massage Instruction which teaches parents and caregivers how to massage their baby.

Coming soon.