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Physical Therapy

Although our practice is located in a retirement community, and geriatric care IS one of our areas of expertise, our Physical Therapists have specialized skills to treat adults of all ages.

Our Physical Therapists are licensed and fully trained to care for the individual needs of all our patients.  The clinic provides treatment for both neurological and orthopedic problems and is fully equipped with specialized equipment to assist with your recovery.

Physical Therapy services include:

Parkinson’s Disease is a neurodegenerative condition related to the body’s ability to maintain and use dopamine, an important neurotransmitter in the brain.  The disease course is highly variable but multiple scientific studies, with more coming out every year, strongly support targeted exercise as the one means of affecting the course of the disease process.  Intervention by Physical Therapists trained in neurorehabilitative techniques has been shown to be effective at all stages of the disease process – from diagnosis throughout the life span – in improving movement and quality of life.

This wealth of research is hinged on the power of neuroplasticity – the ability of the brain to reorganize itself by forming new neural connections.  Key to this approach is the Physical Therapist performing a comprehensive evaluation to target deficits, and then treating with the correct dose of exercise to make these gains possible.

The Virginian has developed a Parkinson’s Rehab Team, led by staff members in all disciplines who attended the National Parkinson’s Foundation “Allied Team Training”.  We truly employ a team approach.  When you call our practice, after the Office Manager takes the usual insurance information, one of our team members will talk with you to determine your specific needs and any problems you may be having.  This helps us to pinpoint what services may be the most effective in helping you reach your specific goals.  We also work with you to develop specific programs tailored to you to maintain gains made in therapy, after the course of treatment is completed.  We host many Parkinson-specific group exercise classes here at our facility, partnering with the Parkinson Foundation of the National Capital Area.  Also recommended is scheduled follow ups for determining if any changes are needed to your program, to keep you engaged and working on any problems that need addressed.  We are your partner in fighting PD!

Three Physical Therapists and three Physical Therapy Assistants on our staff have advanced specialty training in treating Parkinson’s Disease.  The approach of our team of specialists is something you will not find in a typical outpatient practice!  For more information on our Parkinson’s Rehab Team, visit our PD team website at  Please also see other helpful links for information under resources on this site.

Causes of Spine and Joint Dysfunction

There are many potential causes of spine and joint dysfunction ranging from osteoarthritis, rheumatoid arthritis, spinal stenosis, myofascial tightness, prior surgical interventions, prior injuries, and/or neurological insults.  Physical therapists are specially trained to assess and treat spine and joint dysfunction and its relationship to the client’s functional mobility.

Types of manual therapy

There are several treatments within the realm of manual therapy that physical/occupational therapists seek specialized training and certifications to perform.  Specialized approaches available at Virginian Outpatient Therapy include Maitland joint mobilizations, McKenzie joint mobilizations, myofascial release techniques, contract-relax techniques, and deep tendon friction techniques.

Manual Therapy versus Chiropractic versus Massage Treatment

Manual therapy techniques are within the scope of practice for physical/occupational therapists which include special training and certifications that address both joint and surrounding structures and can be applied to orthopedic, chronic, acute and neurological diagnosis. 

Chiropractic techniques mainly focus on spinal adjustments, such as high-force thrusts on the spine itself.  Most chiropractors work in conjunction with skilled physical/occupational therapists when the main deficit is postural impairment which requires spinal manipulations.

Massage treatment can be used as an adjunct to manual therapy techniques administered by a licensed therapist. Massage addresses soft tissue structure restrictions such as stiffness in muscle bodies, tendons, ligaments, and fascia.  Massage treatment is used primarily for chronic tightness and in conjunction with active physical/occupational therapy treatment and exercise prescription to decrease acute onset episodes.

What is Lymphedema?

Lymphedema is a condition in which the lymphatic system of the body is unable to properly move the fluid from the tissue spaces back to the blood stream for the body to eliminate. This leads to swelling, and can occur in the extremities, trunk, genitalia, head or neck. Lymphedema is unlike normal edema or swelling, in that it is made up of protein rich fluid (lymph) that can only be drained by the lymphatic vessels. If the lymph system is not functioning properly, then the fluid and proteins will remain in the tissue spaces despite elevation, and may turn into a chronic condition. Treating lymphedema early helps ensure faster, more successful outcomes. However, those with lymphedema can also benefit significantly from intervention in later, more chronic stages of the disease. Because lymphedema is often caused by structural damage to the lymph system, lymphedema is a life-long condition. There is no cure, but the condition can be successfully managed.

What causes Lymphedema?

Lymphedema has a variety of causes including, but not limited to: Hereditary condition, trauma, surgical intervention (most well known is lymph node dissection during surgery for cancers), infection, or radiation treatment.

How can Physical Therapy help?

Physical therapists with special training can help control and manage lymphedema through Complete Decongestive Therapy (CDT). CDT consists of four parts including Manual Lymphatic Drainage (MLD) which is a gentle hands-on technique, meticulous skin care, compression bandaging, and decongestive exercises. Initial management of lymphedema is often quite intense, and patients work closely with their therapist in developing a treatment plan that will best address the swelling and fit the patients’ needs. Maintenance management will consist of wearing compression garments.

Through the evaluation the therapist will determine which portion of the inner ear is affected and the proper treatment method to address the cause of your problem. Following the evaluation the therapist will provide detailed instructions and exercises to perform in your home to begin to manage your symptoms.

What is Vestibular Rehabilitation? 

Vestibular Rehabilitation therapy is an exercise based program which is designed to facilitate central nervous system compensation for inner ear dysfunction.  

What is the difference between vertigo and dizziness?

Vertigo is a feeling of spinning when you are not actually moving.  Dizziness can result from a variety of causes including: a feeling of unsteadiness called disequilibrium, cardiac problems such as low blood pressure, or from anxiety leading to hyperventilation.

Who is appropriate for Vestibular Rehabilitation?

Individuals who need treatment for benign paroxysmal positional vertigo (BPPV) often associated with Meniere’s disease, labryinthitis and patients with vestibular neuritis can improve their symptoms. People with symptoms of dizziness or those with poor balance may also benefit from treatment.

Treatment for Benign Paroxysmal Positional Vertigo (BPPV):

The most common form of treatment for BPPV involves moving your head and trunk in a sequence of proper positions to facilitate movement of small crystals in the inner ear called otoconia out of the semicircular canals and back into their proper position.  There is a specific 48 hour protocol for you to follow after this procedure. This type of treatment can result in a quick correction of your BPPV. 

Vestibular habituation exercises:

A method of treatment which includes specific movements and/or positions that provoke your dizziness or vertigo.  The theory behind this form of exercise is that repeated exposure to the specific stimulus causing the vertigo will allow the brain to habituate and ultimately decreased the response to vertigo.

Balance retraining exercises:

This form of exercise will help improve your balance through the use of compensatory strategies and involves training on unlevel and compliant surfaces. Individualized exercises are designed to improve the coordination of muscle responses, as well as, the organization of sensory information from eyes, ears and tactile receptors for balance control.

What is the Pelvic floor?

The pelvic floor is made up of several layers of muscles, tissues, and ligaments joined to help support the bladder, urethra, uterus, vagina, and rectum. Primary roles of pelvic floor musculature include:

  1. Supporting of the pelvic organs, bladder, and colon
  2. Stop and start the flow of urine and passage of stool
  3. Serve for sexual function
  4. Stabilize the hips, lumbar spine, sacrum, and pelvis during movement to minimize back, hip, and lower extremity pain

What is pelvic floor dysfunction?

Pelvic floor dysfunction refers to a wide range of problems that occur when the muscles of the pelvic floor are weak, tight, or if there is an impairment of the sacroiliac joint, low back, coccyx, and/or hip joint. The tissues surrounding the pelvic organs may have increased or decreased sensitivity and/or irritation resulting in pelvic pain. This dysfunction affects both men and women equally. Symptoms of pelvic floor dysfunction to include:

  1. Bowel disorders:
    • Constipation
    • Incontinence
    • Diarrhea
    • Incomplete emptying
  2. Unexplained pain in low back, pelvis, genitals, or rectum
  3. Pelvic muscle spasms
  4. Bladder dysfunction:
  • Urinary frequency-greater than one bathroom trip every two hours
  • Incomplete emptying of bladder
  • Weak urine stream
  • Pain or difficulty with initiating urination
  1. For women, painful intercourse

How is pelvic floor dysfunction diagnosed?

Physicians and physical therapists, which are specially trained in treating pelvic floor dysfunction, diagnose the condition during a physical examination. Using external or internal “hands on” approaches or manual techniques to assess the function of the pelvic floor muscles, these specialists can assess your ability to contract and relax these pelvic floor muscles.

Walking requires many systems to work in synchrony, such as your muscular system, joints, coordination, and balance systems.  Many of these bodily systems can be affected by injury, medical events, and disease. A Physical Therapist will evaluate each of these systems to determine how they are affecting your ability to walk as you would like, and then develop a treatment plan to improve deficits seen.

At the Virginian Outpatient therapy, we thoroughly assess each client for his/her range of motion, strength, coordination, and balance, in addition to their current ability to stand and walk. Our Physical Therapists have expertise in selecting and training in the appropriate assistive devices for optimal safety with walking, and to reduce fall risk. For clients who require extensive assist to stand or walk, we have a Lite –Gait system to provide supported standing and ambulation utilizing a harnessed system. Our staff has extensive training in use of the Lite-Gait, and this expertise has led to many success stories for getting clients to walk again, when that did not seem possible.

What Comprises Balance?

Three distinct systems work together to comprise our balance.  They are the Visual system, Vestibular system and our Proprioceptive system. The Visual system provides visual cues identifying how a person is oriented relative to other objects. The Vestibular system in located in our inner ear and it provides sensory information about motion, equilibrium, and spatial orientation to our brain. Finally the proprioceptive system collects information from skin, muscles and joints regarding their position in space.

The three of these systems work in conjunction to provide information to the brain where it is sorted and integrated.  As this information is being integrated the brain stem transmits signals back to the periphery (eyes, head, trunk, and legs) allowing the person to have a correct response and maintain their balance.

What Can PT Do? 

Our balance system involves a unique set of sensory motor control systems which work together.  However, damage to one or multiple of these systems through injury, disease or aging can have a significant effect on a person’s ability to maintain balance.

Our skilled therapists can assist you in improving your balance through customized exercises which address your particular deficits maximizing your outcome and independence. 

Whether it is a hip, knee, ankle or other joint replacement the staff at the Virginian will work closely with you and your surgeon along your road to recovery.  We have the orthopedic knowledge and expertise to manage your care in order to maximize the outcome.  Our staff includes therapists who are extensively trained in manual orthopedic therapy techniques, as well as, a licensed medical massage therapist can assist with pain reduction which is common post joint replacement.

We also highly recommend a pre-surgical consolation in order to provide patients with specific exercises which can be performed prior to surgery to facilitate a quicker recovery as research shows that a stronger joint going into surgery will allow for a faster following surgery. 

Neurological rehabilitation is a multi-disciplinary program offering physical, occupational and speech therapy services to address diseases and disorders of the nervous system. Our team of physical therapists at Virginian Outpatient therapy will provide a comprehensive evaluation and treatment plan to develop and implement strategies for balance retraining, strengthening, gait/walking training, visual and perceptual functioning. We have extensive expertise working with individuals after a stroke, and persons with Parkinson ’s disease, Multiple Systems Atrophy (MSA), Progressive Supra-nuclear Palsy (PSP), Dementia with Lewy Bodies, Alzheimer’s Disease, and multiple sclerosis (MS).

Skilled Physical therapy interventions post-surgery, no matter what type, can be crucial to assisting you along your road to recovering your strength and independence. Weakness after a hospitalization, if not addressed with a safe, appropriate rehabilitation program, can lead to significant functional difficulties down the road.  Our therapists are trained to manage the recovery process of all types of surgical interventions ranging from orthopedic to neurological, medical and cardiac procedures.  We will work closely with you and your surgeon to create an individualized plan of care to address your concerns and maximize your outcome.   

Chronic vs Acute Back and Neck Alignments

Licensed physical/occupational therapists can assess and treat both chronic and acute onset back and neck ailments whether from long-standing arthritis to acute injuries.

Possible treatment approaches

Upon evaluation by a licensed physical/occupational therapist, the following are some possible treatment techniques utilized to improve quality of movement and mobility, and to decrease pain:

  • Joint mobilizations
  • Soft tissue manual therapy techniques
  • Active exercises to strengthen weakened structures and/or stretch tightened structures
  • Postural re-training
  • Balance and endurance activities
  • Home exercise program (HEP) and/or wellness plan prescription

LSVT BIG is an intensive, amplitude based focused Physical and Occupational Therapy approach developed from principles of the effective Parkinson’s specific speech treatment LSVT LOUD.  These programs have been developed and scientifically researched over the past 25 years with funding from the National Institutes of Health (NIH).

Research on LSVT BIG has documented improved ratings on tests of motor functioning in people with Parkinson’s Disease following treatment including:

  • Faster walking with bigger steps
  • Improved balance
  • Increased trunk rotation/less trunk stiffness
  • Improvements in activities of daily living (ADLs) such as rolling over and getting out of bed, and getting dressed more efficiently

LSVT BIG is a standardized treatment protocol which is customized to the unique goals of each client.  The program is adapted and progressed to meet each client’s individual needs across the range of disease severity and specific mobility problems.

The standardized program consists of:

  1. 16 total sessions: 4 consecutive days a week for 4 weeks
  2. Individual 1 hour sessions with the therapist
  3. Daily home exercises/ “homework practice”
  4. Daily specific functional task to perform “carryover exercises”

The Virginian has 3 PTs, 3 PTAs, and 3 OTs who are certified in this method of treatment.  Only certified therapists can render the program.

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