If you’ve never heard of spine or joint mobilization/manipulation treatment, you’re not alone. The terms “mobilization” and “manipulation” in our clinic are often used interchangeably. Generally speaking, mobilization is a manual therapy technique performed by one of our physicians, chiropractors or physical therapists.

There are different “types” of mobilization, each having a specific use with a particular condition, need and clinical indication. Here at FORMA, we use a technique (or a combination of techniques) that will be the most effective for you — our patient.

Simply put, mobilization treatment incorporates the application of light force with rhythmic movements at the beginning of range, to sustained movement at the end of range. At times, a “thrust technique,” which may be accompanied by a popping sound, may be also used if clinically indicated.

The benefits of spine and joint mobilization are many, including:

• Pain reduction and control
• Re-establishes proper range of motion
• Increased body awareness of position and motion
• Synovial fluid (joint fluid) movement (which improves joint health)
• Increase flexibility and response of the connective tissue of the joints

In a typical physical rehabilitation program, mobilization is used to incorporate and enhance the effectiveness of therapeutic exercises. Here at FORMA, we have observed that restoring the joint range and quality of motion beforerecruiting and coordinating movement of the body provides faster and lasting results. We have also seen that patients who receive manipulation plus exercise show more and faster improvement than those who received stabilization exercises alone.

Here, we use therapeutic modalities — such as ultrasound, various electrical stimulation, moist heat and cold compress — for pain control and/or recovery after therapeutic exercises. Biomechanical taping or strapping is also used to ensure proper mechanics during functional training.

At FORMA, our Rehabilitation Exercise Treatment program focuses on exercise instruction and monitoring in non-painful positions. As you might expect, this approach allows your body to adjust to training, establish control, and accept more demanding exercises as time goes by. During this form of treatment, we also find and work on weak links that often keep people from feeling better and achieving peak performance.

After completing a personalized rehabilitation program, we prescribe a “self-care plan” to manage and keep any weak links from resurfacing, and to maintain and advance your overall physical health and wellbeing.

For the neck, mid-back and lower back (this is a very different procedure from the epidural anesthesia a woman receives during labor): the use of anesthetic (for diagnosis) and steroid medications (anti-inflammatory) injected into the epidural space to relieve pain or diagnose a specific part of the spine that is the cause of the pain.

Injections done to determine if a specific spinal joint is the primary source of pain.  Blocks also can be used to reduce inflammation and pain. For more information please click here.

A minimally invasive procedure that disables the medial branch nerves for six to nine months and prevents them from transmitting pain signals from the posterior column (facets). These are done after confirmatory diagnostic blocks to the target medial branch nerves are performed.

Electrodes placed near the nerves of the spinal cord that uses of electrical impulses to block pain from being perceived in the brain.

This injection block is used for diagnosis and treatment of piriformis muscle, which is possibly responsible for sciatic nerve irritation (sciatica pain).

The sacroiliac joint (a large joint in your buttocks region) can cause localized pain or it can refer pain into your groin, abdomen, hip, buttock or leg. A sacroiliac joint injection offers immediate pain relief, which will help confirm the joint as a source of pain. It can also allow for treatment of recalcitrant buttock and leg/hip pain.

A particular nerve may be the major sensory supply to a body area or specific joint, such as shoulder joint pain (suprascapular nerve), lateral hip crest pain (cluneal nerves) or headaches (occipital nerves). By injecting medications, including anesthetic and steroids on occasion, precise diagnostics can be derived and pain-reduction treatment can be performed.

Anesthetic injections targeting muscles, which have unresolved tenderness and are in painful spasms. These injections are normally performed with anesthetic solutions, allowing the interruption of spasms and pain.

Here, we use a “proliferative” solution (mostly dextrose or sugar water), which is injected into the ligament or tendon where it attaches to the bone. This causes a localized inflammatory reaction to increase the blood supply and flow of nutrients to stimulate the tissue to repair itself. Platelet Rich Plasma (PRP) is done by the injection of growth factors into injured areas, which are extracted from one’s own blood to stimulate healing.

Botox functions by temporarily blocking the neurotransmitters that tell muscles to contract. Thus, it decreases severe muscle spasm and pain for three to six months.

Botox is no longer just for celebrities — if you have chronic back and neck pain you may want to consider it as an option. The same injection that works to smooth out wrinkles just may work to relieve persistent, life-inhibiting pain caused by muscle tension.

The FDA originally approved Botox in the late 1980s to treat severe muscle contractions that caused strabismus (crossed eyes). It was then approved to treat painful spasmodic neck conditions such as cervical dystonia. In short, Botox was found to help relax the treated muscles because it functions by temporarily blocking the neurotransmitters that tell muscles to contract.

Interventional Pain Management Specialists use Botox as a very specific treatment for selected patients with chronic localized pain, such as specific types of headaches, facial pain, lower back, middle back and neck pain, which have associated chronic muscle spasms.

Since the drug is administered locally, there aren’t the systemic side effects such as fatigue and sedation that often accompany orally administered muscle-relaxant medications. Botox injections sometimes have to be repeated every three to six months to maintain a therapeutic effect if the problem is not significantly improved or resolved by a physical rehabilitation program.

Botulinum toxin A (Botox) has recently been studied as a treatment option for chronic low-back pain with promising results.  Unfortunately, due to the lack of FDA approval for the treatment of pain, the procedure is not covered by insurance.

At FORMA, Botox is used to decrease severe muscle spasm and pain in order to facilitate the re-education of important movement patterns through a physical rehabilitation treatment program, with the aim of achieving long-lasting results.

These are used to treat the inflammation of a bursa (bursitis), a tendon (tendonitis), or a joint (arthritis).  Systemic corticosteroid injections are also used for conditions such as allergic reactions, asthma and nerve inflammation.

Used to treat osteoarthritis of the knee with viscosupplementation medications injected directly into the joint.  These medications can help reduce pain in a joint affected by osteoarthritis, thus increasing mobility and allowing for maximization of your rehabilitation.