Modalities & Procedures
At Atlas, we have modalities such as ultrasound, iontophoresis, phonophoresis, electrical stimulation, cryotherapy, paraffin, moist heat, and hydrotherapy to assist in the progression of the patients’ rehabilitation.
- Post-op Procedures including Total Joint Replacement
- Aquatic Therapy
- Soft Tissue Mobilization/Massage
- Joint Mobilization
- Mechanical Traction
- Therapeutic Exercise
- Passive Range of Motion
- Isokinetic Testing and Exercise
- Aerobic and Cardiovascular Exercise
- Gait Training
Aquatic therapy combines the physical properties of water and the ultimate modality of exercise. Increased buoyancy results in decreased weight bearing through the joints and spine and creates a more comfortable environment to exercise. The result: improved flexibility and strength, decreased pain, overall increased fitness and return to normal activities. Diagnoses that may respond well to aquatic therapy include:
- Joint Pain
- Low Back Pain
- Spinal Stenosis
- Sports Injuries
- Post-Surgical Conditions
- General Weakness & Poor Cardiovascular Conditions
Augmented Soft Tissue Mobilization Therapy
The Augmented Soft Tissue Mobilization system is a therapy approach that addresses problems such as scarring, fibrosis, and degeneration that occurs in soft tissue as the result of trauma, surgery, or overuse.
Our Skilled Augmented Soft Tissue Mobilization Providers use instruments along the skin’s surface to locate and stimulate problematic areas and begin the body’s healing process.
As the body heals, prescribed exercise and activity help to guide the healing allowing return to activities without pain and limitation.
Vestibular Rehabilitation Therapy (VRT)
Individuals with vestibular or inner ear disorders often experience problems with balance and position or movement-related dizziness. These primary symptoms are often accompanied by secondary symptoms associated with reduced activity levels. Secondary symptoms include decreased strength, loss of range of motion, and increased tension (particularly in the cervical and shoulder region), leading to muscle fatigue and headaches.
VRT is exercise-based therapy used to alleviate both the primary and secondary symptoms of vestibular disorders. Upon evaluation with a physical therapist, specific exercises are prescribed, and consist of eye/head movements, balance, and gait exercises with the goal of facilitating central nervous system compensation for vestibular loss.
The benefits of proper treatment provided by an experienced therapist are many, including quick recovery. Diagnoses that may respond well to VRT include:
- Vertigo/ BPPV
- Balance Disorders
- Labyrinthitis/ Neuronitis
- Cervical Vertigo
- Peripheral Neuropathy
- Meniere’s Disease
- Orthopedic Conditions
- Unsteady Gait
Licensed Athletic Trainers provide sports medicine coverage at local high schools, sport associations, and community events. We combine efforts with our local physicians and specialists to create a comprehensive team to facilitate the care of athletes from injury to return to play.
We are excited to offer Functional Capacity Exams (FCE) performed by our own clinicians. Our clinicians have been certified to perform FCEs through The Back School of Atlanta. We utilize an extremely thorough and comprehensive 4 hour exam process, which includes both subjective and objective data used to determine our client’s overall functional ability. Our testing process makes us confident in determining return to work capabilities of our clients.
Concussion Management Program
Atlas’ Concussion Management Program follows the FHSAA approved guidelines and is designed with the athlete’s health and safety in mind. Our program involves neuropsychological assessment including baseline and post-concussion testing using the imPACT program, physical therapy (when appropriate) for subsequent injuries, and monitored appointments for all graded exercise protocol (GEP) phases. We work closely with the patient’s physician to determine the best plan of care for the individual and to also determine appropriate return to play (RTP) decisions regarding athletes.
Concussion Management Package (valid for 12 months or one episode of concussion)
- One baseline test
- Unlimited number of post-concussion tests
- Monitored GEP visits
*Please note package applies to individuals who are not currently undergoing post-concussion care
What is a Concussion?
A concussion is a type of mild traumatic brain injury (mTBI) that results in temporary interruption of normal brain function. A concussion may cause neuropathologic changes; however, the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury. A concussion is typically caused by a blow to the head resulting in two principal mechanisms of injury:
- Focal brain damage due to contact injury
- Diffuse brain damage due to acceleration/deceleration injury forces
It is these acceleration & deceleration forces and especially rotational forces that can cause the brain to shake within the skull, which results in shearing forces that disrupt diffuse axonal connections running between the midbrain and the cortex. A forceful blow to the resting, movable head usually produces maximum brain injury beneath the point of impact on the skull (coup injury). A moving head hitting an immobile object usually produces maximum brain injury opposite the side of cranial impact (contrecoup injury) as the brain shifts within the skull.
The prevalence of concussions continues to rise with 1.6-3.8 million sports and recreational TBI’s occurring in the US each year. Concussions do not often present with obvious physical signs of trauma making them more difficult to detect. There is no “one true” treatment for a concussion; however, it is agreed that the key to a healthy recovery requires appropriate management of symptoms by a qualified healthcare professional.
Concussions can present with a wide array of symptoms including but not limited to:
Headache, dizziness, loss of consciousness, amnesia (retro/anterograde), neck pain, “pressure in head”, tingling/numbness, confusion, memory difficulties, balance deficits, difficulty concentrating, lightheadedness, tinnitus (ringing in ears), cognitive deficits, changes in personality, vertigo, sleep disturbances, fatigue, nausea or vomiting, photophobia, sensitivity to noise, irritability, blurred vision, slurred speech, drowsiness/fatigue, confusion/lack of concentration, “in a fog”, glassy-eyed (vacant stare), personality change, and motor or sensory symptoms
Concussion Assessment Tools
Sports medicine clinicians are increasingly using standardized methods of concussion assessment tools on and off the field to obtain a more objective measure of post concussion s/s, cognitive dysfunction, and postural instability. Concussions are generally assessed using a multitude of tests that look at self reported symptoms, neuropsychological assessment (including cognitive tests), and medical imaging. Data from these objective measures helps in making a determination about the severity of the injury and post injury recovery, especially when baseline data for the individual is available. Baseline testing provides an indicator of what is “normal” for a particular individual and allows the clinician to establish an accurate and reliable benchmark against which post-injury test results can be compared. Without a baseline measurement, the individual’s post-injury results must be interpreted by comparison with normative values of the population.
Assessment tools commonly used:
- Signs & Symptoms Checklist– a list of symptoms that are rated for severity and that are self-reported by the individual to the clinician.
- SCAT (Sports concussion assessment tool)– Pencil and paper test that includes assessments of strength, sensation, and coordination, as well as measures of orientation, immediate memory, concentration and delayed recall.
- BESS (Balance Error Scoring System)– assessment of postural stability that uses 3 stance positions, each is tested on both an even and uneven surface with the individuals eyes closed. This test is used as a clinical measure in identifying balance impairment that could indicate a neurologic deficit.
- imPACT (Immediate post-concussion Assessment and Cognitive Testing)– a computerized concussion evaluation system that is a sophisticated test of cognitive abilities and is an important tool in the overall concussion evaluation and management process. ImPACT provides a neuropsychological assessment of verbal and visual memory as well and information processing speed, reaction time and impulse control.
- MRS (Magnetic Resonance Spectroscopy)– a form of MRI that is used to measure biochemical changes in the brain. This text is expensive and laborious and more commonly used for research rather than diagnostics.
- CT/MRI– these tests are not typically used as a diagnostic tool for concussion but may be used in an emergent situation when an epidural or subdural hematoma (brain bleed) is suspected.
Managing a Concussion
It is imperative to seek immediate medical attention/activate 911 if any of the following symptoms occur:
*Decreasing level of consciousness, decrease or irregularity in respirations, decrease or irregularity in pulse, seizure activity, any symptoms of associated injuries such as spine or skull fracture or bleeding, mental status changes: difficulty maintaining arousal, confusion, or agitation, unequal dilated, or un-reactive pupils, worsening of any symptoms recognized at time when concussion occurred*
Not all concussions happen in an athletic setting, many concussions happen at home, in backyards & pools, and on playgrounds. Motor vehicle accidents & slip and fall incidents are all common mechanisms of injury for concussion and it is highly recommended that you seek medical attention if you have suffered or suspect a concussion.
It is important to note that no matter the mechanism of injury, the effects of concussion are still the same. Cognitive function (attention and concentration, processing speed, learning and memory etc.) is typically affected in most individuals suffering from a concussion but most research suggests that cognitive impairments resolve within the first 5-7 days (it is important to note that in some cases, symptoms may be prolonged). Children suffering from a concussion may need extra time with school assignments and tests, it is important that you speak with your child’s school about his/her condition so accommodations can be made accordingly. Just the same employees suffering from a concussion may require additional time for work tasks and daily job functions; the individual may want to request a note from his/her physician and should inform his/her employer of their condition. A physician may recommend additional treatment, including physical therapy for subsequent strains/sprains, balance, or vestibular/ocular symptoms that are commonly associated with concussion.
Return to Play (RTP) Procedures for High School Athletes
- Per FHSAA guidelines:
“Once a removed from play with a suspected concussion, an athlete may not return to play until evaluated by an appropriate healthcare practitioner; in Florida, an appropriate healthcare practitioner, as defined by the FHSAA Sports Medicine Advisory Committee, is a licensed physician (MD) or licensed osteopathic physician (DO).”
RTP Criteria (FHSAA guidelines):
- No athlete should return to play (RTP) or practice on the same day of a suspected concussion. “When in doubt, sit them out!”
- Any athlete suspected of having a concussion must be evaluated by an appropriate health-care professional (A as soon as possible and practical.
- Any athlete who has sustained a concussion must be medically cleared by an appropriate health-care professional (as defined above) prior to resuming participation in any practice or competition.
- After evaluation and examination by an AHCP, return to play must follow a step-wise protocol as defined by the FHSAA Sports Medicine Advisory Committee (SMAC) and under the supervision of an AHCP, athletic trainer, coach or other health care professional.
- A written medical clearance from an AHCP is required for return to competition
Athletes suffering from a concussion that are waiting to return to play (RTP) must first become asymptomatic before exertional testing can be performed. Once asymptomatic and cleared by an MD/DO, the athlete may begin the graded exercise protocol (GEP) required by the FHSAA to resume competition. The athlete must complete each phase of the test with no symptoms present during or within a 24-hour period following each test. Once the athlete has completed all five phases symptom free and has returned to individual “normal” baseline values (if baseline is available) they are seen once again by the MD/DO for final clearance for RTP.
Comprehensive Women’s Therapy
Effective non-surgical treatment for fecal and/or urinary stress and urge incontinence. Proven behavioral interventions include progressive pelvic floor muscle exercises, biofeedback and electrical stimulation. Patients are taught methods to reduce bladder irritability including the effects of diet on bladder control.
This treatment is effective for post-surgical recovery or for patients trying to avoid surgery. Currently, this treatment is available for both men and women.
Obstetric and Postpartum Musculoskeletal Pain Program/ Pregnancy Back School
Pain is often easily eliminated with flexibility, strengthening and postural exercise, including aquatic exercise, as well as body mechanics training. In the post-partum phase, as new mothers care for their infant, musculoskeletal problems may persist or worsen. These problems, specifically lower back pain, respond well to the conservative holistic approach of physical therapy.
Pre- and Post-Natal Exercise Consult
Many women are unsure of how to exercise safely during and after pregnancy. A physical therapy consult includes a musculoskeletal evaluation and history of exercise, prescription of appropriate exercises and progression of exercises specific for each individual patient.
Menstrual cramps and discomfort can be relieved or eliminated with electrical stimulation, the use of ice or heat, and appropriate relaxation techniques and exercises.
Fibromyalgia Syndrome/Chronic Fatigue Immune Deficiency Syndrome are difficult syndromes to manage without the proper knowledge of effective self care techniques, non-irritating stretches and exercises, including aquatic exercise, proper nutrition, and pain management strategies. Patients undergo a complete musculoskeletal evaluation prior to treatment and exercise program. Progressive training in body mechanics, flexibility exercises and spine stabilization exercises help the patient to prevent/manage pain. The goal of treatment is independent management of symptoms by the patient.
Abdominal and Pelvic Pain Treatment
Pelvic and abdominal pain can be effectively treated with conservative physical therapy techniques, once a physician determines that a patient is not a candidate for medical/surgical intervention. Pain is often caused by scar tissue, muscle spasms, flexibility and strength deficits, and muscle imbalances. A full musculoskeletal and pelvic floor evaluation by a physical therapist will determine the plan and course of treatment. Pelvic floor muscles and soft tissues are treated with ultrasound, electric stimulation, ice, scar mobilization, relaxation, strengthening, and biofeedback. Treatment also includes postural and body mechanics training, flexibility and strengthening exercises, and manual physical therapy.
Osteoporosis Treatment and Prevention Program
As an adjunct to medical management, patients undergo complete musculoskeletal evaluation. They are prescribed an individualized program of postural and corrective exercises, education, pain management treatment and techniques, and self care strategies. Fall prevention and weight bearing exercises are an integral part of the program. Patients are taught safe body mechanics to avoid forward bending and twisting which may cause vertebral fractures.
High Risk Pregnancy Program
Any woman placed on restricted activity levels during pregnancy will benefit from a physical therapy consult. Patients are instructed in energy saving body mechanics, comfortable positioning and how to avoid Valsalva Maneuver during movement. Women benefit from maintaining good general physical condition, monitoring of heart rate, and the safe use of ice, heat and massage for pain management.