Did you know you can see a physical therapist without a doctor's referral?

That’s right! You do NOT need a referral to see a physical therapist. Don’t wait…. get started NOW, so you can get back to doing the things you love.

Most insurances (in California) require a doctor’s referral after 45 days OR 12 PT visits, whichever come first. We can let you know if and when a referral is required.

The point of “direct access” is to get you started, so you don’t have to wait to see your doctor THEN make an appoinemnt with us! As physical therapists, we are trained to know if youre injury is appropriate for physical therapy treatments, or if you additionally need to see a doctor for imaging.

What can physical therapy help with?

What Can Physical Therapy Help With?

Physical therapists can provide supplementary treatment to a wide variety of medical conditions, depending on their specialty.

Physical therapists treat musculoskeletal conditions and work to optimize recovery or educate a person on how to optimize their movement patterns.

Some conditions that our physical therapists specializein include:

• Post- op Rehab, including total knee replacements, labrum repairs, menisectomy, spinal fusion.

• Conditions that affect the hand, such as carpal tunnel syndrome, and trigger finger.

• Musculoskeletal dysfunction, including back pain, rotator cuss tears, and knee pain.

• Sports-related injuries, such as tennis elbow, achilles tendonitis, ACL tears.

• Chronic pain.

• Hypermobility, leading to joint instability and pain.

How Long Should We Stretch?

How Long Should We Stretch?

When stretching our muscles, the general consensus is that we should stretch up to 60 seconds per muscle. Whether it is 20 seconds 3 times or 30 seconds 2 times as long as the muscle is stretched for 60 seconds.

There are others however who advocate a different stretch duration and repetition. Thirty years ago a man by the name of Aaron Mattes developed the 2 seconds, 10 times stretch. The premise of this technique is holding a stretch for only 2 seconds inhibits the protective stretch reflex (myotatic reflex).

The stretch reflex inhibits the muscle from lengthening for the stretch after 2 seconds. If the target muscles is indeed being inhibited then true lengthening without soreness will not occur.

The stretch is performed using Active Isolated Stretching. Using the muscle opposite in action to the target muscle to be stretched and only holding for 2 seconds, performing up to 10 repetitions with progressive increase in range of motion will allow progressive lengthening and eliminate overloading the stretched muscle which could cause potential microtears. An example would be contracting your quadriceps muscle to stretch the hamstring. By activating the quadriceps the brain then tells the hamstring to relax thus allowing the stretch.

So does it work? I put AIS to the test with myself and several patients. The muscle to be stretched was the left Middle Scalene which bends the neck to the side and is often a source of neck pain and tightness. I did not experience any rebound tightness later in the day or the following day. The increased ROM persisted for several days. One of my patients did not feel any difference between the 2 second x 10 reps stretch and the traditional 30 seconds x 2 reps stretch. The remaining 3 patients felt less soreness and improved ROM with AIS.

I then tried stretching my painful L Iliopsoas muscle. I had been doing 30 seconds x 2 reps with temporary relief (a few hours). The next day I tried the 2 seconds x 10 reps. I noticed a slight ache post stretch which resolved quickly. The pain and tightness remained improved for at least 2 days. Next, I tried stretching my non painful Hamstrings. I did not notice much of a difference between traditional stretching and AIS for reduction in tightness and duration.

My study is small and limited but it is possible the 2 second stretch works well for a painful muscle which is not responding to traditional stretching and other patient populations which have to be careful with stretching.

So which stretch to use? Check with your physical therapist if you are in rehab or other wellness provider who may be aware of both techniques. Most importantly, stretching should not make you feel worse than when you started and NEVER stretch a cold muscle.

To your health and wellness!

Joann Tippett, PT, MSPT, CKTP, CCI

30 minute stretching routine (advanced)

Level 3: Advanced Stretches

Before you begin any level of stretching, follow these tips for best results:

• Warm up for a few minutes first so your muscles stretch more easily (walk briskly, march in place, or do another physical activity).

• Stretch at least two to three times on each side, taking turns.

• Keep good form and posture.

• Breathe throughout each stretch — never hold your breath.

• You should feel slight discomfort and a pulling sensation, but not pain, with each stretch.

• Never bounce while stretching — hold steady till you feel the stretch and try to relax while holding.
  
  

Advanced Hamstring Stretch

1. Stand facing a chair or counter and put your heel on top of it. Choose a chair if you are less flexible or a counter if you are more flexible.

2. Keep your hips directly facing the chair and place both hands on the outside of your thigh.

3. Lean forward, leading with your chest. Keep your head up as you slide your hands down the outside of your thigh. Do not allow your back to round or bring your chin down.

4. You should feel a stretch behind your thigh and knee.

5. Hold this position for 15 seconds. Repeat two to three times or more, as you feel matches your fitness level.
   
   
   

Advanced Groin Stretch

1. Sit on the floor with your back against the wall. Keeping your knees straight, spread your legs apart as far as you can.

2. Leading with your chest, place your hands together out in front of you, and lean forward. Do not allow your back to curl or bend.

3. You should feel a stretch in your groin.

4. Hold this position for 15 seconds. Repeat two to three times or more, as you feel matches your fitness level.
   
   
   
   

Advanced Quad/Hip Flexor Stretch

1. Kneel on a pillow or folded towel and place one leg out in front of you (Photo A).

2. Leading with your waistline and keeping your chest upright, lunge forward (Photo B).

3. You should feel a stretch in the front of your hip. For further challenge, increase the stretch by grasping your back foot and try to bring your heel to your buttocks (Photo C).

4. Hold this position for 15 seconds. Repeat two to three times or more, as you feel matches your fitness level.
   
   

Advanced Calf Stretch

1. Stand on a stair with your heel over the edge.

2. Slowly lower your heel so it falls below the stair and you feel a stretch in the back of your calf (Photo A).

3. First, do this exercise with the back knee straight. Then try it with a slight bend of your knee for added stretch.

4. Hold this position for 15 seconds. Repeat two to three times or more, as you feel matches your fitness level.
   
   

Advanced Overhead Reach

1. Stand tall with your toes at the front edge of a doorway. Place the outside of both hands (little finger side) on the doorframe as high as possible (Photo A).

2. Do NOT lean through the door. SLOWLY step through the doorway, keeping an upright posture (Photo B).

3. Slowly step back to your starting position.

4. You can do this stretch with your arms in various positions of elevation.

5. Hold this position for 15 seconds. Repeat two to three times or more, as you feel matches your fitness level.
   
   

Advanced Spine Flexion and Extension

Flexion

1. Sit on the front edge of a chair with your feet flat on the floor and your knees spread out as wide as possible (Photo A).

2. Tuck your chin to your chest (Photo B) and slowly "roll down" from your head (curling down like a wave), allowing your arms and shoulders to go between your legs (Photo C).

3. You should feel a stretch in your spine and low back.

4. Hold this position for five to 10 seconds.

5. To come back up, "unroll" from your waist back up to an upright sitting position. Repeat two to three times or more, as you feel matches your fitness level.
   

Extension

Caution: If this position is too uncomfortable for you based on age or history of spine pain, do not do this exercise.

1. Lie on your stomach with your upper arms straight out at shoulder height, elbows bent to 90 degrees, and palms down.

2. "Press up" and straighten out your arms keeping your waist on the floor, then slowly return to the starting position.

3. Repeat this five to six times, slowly.

4. Repeat another one to two times, locking your elbows and allowing your back to sag and "relax" in this position for five to 10 seconds, keeping your waist on the floor, then return to your starting position.

5. Repeat two to three times or more, as you feel matches your fitness level.