Back Pack Safety and Ergonomics

In honor of the American Occupational Therapy Association’s National Back Pack Safety Awareness Day, we are posting our tips on how to choose a back pack for your child as well as how to fit your child’s back pack.  If the back pack is not the right size, ill-fitted or too heavy, it can cause injury and aches and pains in the future.  To avoid all of that, follow these tips below.


Cold Vs. Heat, Which Do I Use?


By Adam Pharr, PTA, CFMS, NSCA C-Pt, Advanced Physical Therapy Center

An injury to the body can take many forms, e.g., lacerations, burn, breaks, sprains,
infections, etc. When injuries occur, two things happen. First, there is pain. Pain in an
injury is caused by damage to the tissues, blood vessels, and bones. Second, the body makes attempts to heal and repair the damage. One of the ways it does this is by dilating the blood vessels and increasing blood flow in and around the damaged area. This helps the healing process by bringing oxygen and nutrients to the injured tissues and removing toxic waste products.  However, the dilation of the blood vessels and all the increased blood flow actually are the root of pain.  The dilation of the blood vessels and the increased amount of blood in the area causes swelling and pressure causing pain.  Similar to when you have a sprained ankle, you won’t walk on it, because weight bearing causes pressure and the pressure causes pain.

How does this apply to the therapeutic use of heat and cold?

In physical therapy, we use heat when …

We use heat when we want to increase the blood flow to an area, because heat dilates the blood vessels. Heat is safe after all initial swelling has decreased, approximately two weeks after initial injury.

In physical therapy, we use cold when …

We use cold when we want to decrease the blood flow to an area, because cold constricts the blood vessels. Cold is used during the first two weeks of an injury, when swelling is at its greatest.

We use either heat or cold in other situations depending on the type of condition. Heat would be applied to tissues that are infected (without swelling) to bring oxygen, nutrients, and white blood cells that fight infection to the area. Cold would help an area that is painful because of swelling (e.g., a sprained ankle) by decreasing blood flow and pressure.

Heat and cold can also be used sequentially. Standard care for a sprained ankle is to first apply ice for a few days to decrease the pain caused by swelling and then apply heat to increase blood supply and promote healing.




Revolutionary Stretching Technique Now Available in Hartland, MI

The Active Isolated Stretching (AIS) method of muscle lengthening and fascial release is a type of Athletic Stretching Technique that provides effective, dynamic, facilitated stretching of major muscle groups, but more importantly, AIS provides functional and physiological restoration of superficial and deep fascial planes.

Over the past few decades many experts have advocated that stretching should last up to 60 seconds. For years, this prolonged static stretching technique was the gold standard. However, prolonged static stretching actually decreases the blood flow within the tissue creating localized ischemia and lactic acid buildup. This can potentially cause irritation or injury of local muscular, tendinous, lymphatic, as well as neural tissues, similar to the effects and consequences of trauma and overuse syndromes.

The AIS Technique Deep, Superficial Fascial Release

Performing an Active Isolated Stretch of no longer than two seconds allows the target muscles to optimally lengthen without triggering the protective stretch reflex and subsequent reciprocal antagonistic muscle contraction as the isolated muscle achieves a state of relaxation. These stretches provide maximum benefit and can be accomplished without opposing tension or resulting trauma.

Myofascial Release Achieve Optimal Flexibility

Aaron Mattes’ myofascial release technique, which also incorporates Active Isolated Stretching, uses active movement and reciprocal inhibition to achieve optimal flexibility. Using a 2.0 second stretch has proven to be the key in avoiding reflexive contraction of the antagonistic muscle. Without activating muscle group contraction, restoration of full range of motion and flexibility can be successfully achieved.  One of our very own practitioners, Jessica Souder, PTA has taken Aaron’s training class and has had great success with her patients using this method.    

Common Conditions Active Isolated Stretching Techniques Are Effective in Treating These Conditions

Hamstrings Lower – Strain/Tear

Lower hamstring problems may be caused by inadequate hamstring flexibility Read more »

Medial Epicondylitis (Golfer’s Elbow)

Medial epicondylitis is also called “little league” elbow. Read more »

Osgood-Schlatter’s Disease

This is a partial separation of the tibia tuberosity.Read more »

Shoulder Impingement

There is usually consistent irritation in the subacromial region. Read more »


Tenosynovitis is an inflammation of the synovial sheaths covering the tendons. Read more »

…and much, much more.

For more information about AIS and its benefits, watch the video below or contact us at our Hartland location at 810-632-8700.  




Oakworks Inc. Mattes, A. (2010, October 7) Active Isolated Stretching with Aaron Mattes.  Retrieved from

Mattes, A. Active Isolated Stretching, Expanding the Potential of the Profession. Retrieved from


Acoustic Compression Therapy (ACT)™ – A sound approach to treating acute and chronic musculoskeletal pain

Acoustic Compression Therapy (ACT) is widely used in the treatment of acute and chronic painwellwave cart in muscles, tendons and joints.
ACT describes the use of acoustic
waves to target tissue at varying
depths to compress and manipulate
tissue resulting in a focused and
precise deep tissue massage. The
results of the mechanical stimulus
delivered by ACT can lead to
increased circulation and pain
relief – key components in
the healing process.

Focusing in on your pain

The acoustic waves generated by the WellWave painlessly pass through the body and converge at a point deep within the soft tissue to produce an intense, extremely short duration compression event. The focused acoustic compression is
translated to tissue to provide a massage with pin – point accuracy to the affected area.

Patient guided pain relief.  

The sources of pain are not always found in the area where
the pain seems to be radiating from. This is clinically called referred pain. The distancing of the pain sensation from its source can make treatment more difficult.  Diagnosis of referred pain and the recognition of the originating pain triggering points can be accomplished using the WellWave.  Abnormal musculoskeletal tissue can be “flared”
with focused ACT in order to define the areas that require
treatment. This process of defining the origins of pain is guided by the patient through verbal feedback to the healthcare professional providing the treatment.

How long does treatment take?

• A typical WellWave treatment takes between 10 and 20 minutes
• Normally, 1-2 treatments per week are performed
• A total of 3-5 treatments may be necessary before
lasting improvement is achieved
• With acute pain, a single session is often successful.

Are there known side-effects of
Acoustic Compression Therapy™?

• Treatment side-effects are limited to reddened skin and/or minor
soreness at the treatment site.

What to expect during your Acoustic
Compression Therapy treatment

1. Your clinician will identify the treatment site or sites. They may
mark these sites.
2. They will then apply a thin coat of coupling gel. This gel helps to translate
the acoustic sound waves generated by the therapy head to the body.
3. The clinician will start the treatment at a very low output setting and
increase the power to a level that you help define and is best suited for
your condition. The output level and acoustic wave frequency rate may
vary from location to location based on the depth and type of tissue
being treated.
4. As the clinician moves the therapy source around the treatment area,
you may feel a deep, dull ache that is familiar to you as being like the
feeling your condition produces. The clinician will ask you to report
when you feel the ache and will adjust the output of the device to the
appropriate level for your treatment. They may also ask you to confirm
that the therapy source is still creating the ache and may adjust the location
of the treatment based on your feedback. If at anytime the treatment
becomes uncomfortable, mention this to the clinician and they will adjust
the output level.
5. After the treatment is completed, the coupling gel will be removed and you
can return to your normal activities. You may experience some minor aches
or discomfort after treatment. It is not unusual for patients to notice
flushed or reddened skin around the treatment site.

WellWave is now available at our Grand Blanc location at 10809 S. Saginaw St.  Call us at 810-695-8700 for more information about how WellWave can help you!


Helping Patients Get Back On Their Feet

KOSHYAH_ANIL    DSC_11  6-6-16Did you know that physical therapy can help with dizziness and conditions such as vertigo? Well … yes it can! In fact, we have two therapists (AnilKumar Koshiya MPT, M.Ed. and Bret Peters PT, DPT) who that have treated many patients with conditions resulting from vestibular disorders (inner ear). Vertigo is a condition that develops in the vestibular system. The article below discusses the different types of vestibular disorders and how PT can help. If you or a loved one are suffering with vestibular issues, dizzines or balance problems, please give us a call at our Davison location. Anil or Bret would be happy to help you back onto your feet. (810) 412-5100.

Bret Peters

Meet Our Newest Member of the APTC Team

KOSHYAH_ANIL    DSC_11  6-6-16Meet our newest therapist, AnilKumar “Anil” Koshiya. Anil is from Surat, Gujarat, India. He has a master’s degree in physical therapy and a Master of Education Degree in Exercises Sports Science.

Previous to coming to APTC, Anil worked for a large physical therapy firm in Nova Scotia, Canada. He spent a number of years there treating a wide variety of orthopedic conditions and injuries. He also worked for one of the local hospitals in Nova Scotia.

It is important to Anil to read up on the latest research and newest treatments available in his profession. His special interests include vestibular rehabilitation, kinesiology taping, the Graston Technique, and functional trigger point dry needling.

There is a great need for healthcare in India, and seeing this need, Anil helped to organize a camp providing physical therapy for the disadvantaged. Anil is very proud of his heritage and enjoys sharing through teaching and hosting classes on Indian language, culture and health.

When Anil is not busy treating patients or volunteering, he enjoys listening to music and tries to stay active and healthy by hiking and biking in the summer and going to the gym several times a week. He is also an avid reader.

Anil practices out of our Davison clinic and feels that his specialty lies in treating patients with cervical and shoulder pain, sciatica and pelvic asymmetry. He also has achieved great outcomes for patients suffering from shoulder impingement syndrome. He utilizes various manual therapy techniques to ensure that each patient receives the best possible outcome. Patients have described Anil as kind, compassionate, and gentle. He has been told by many of his patients that he has a healing touch.

If you would like to ask Anil a question relating to therapy or for a free consult, please contact him at our Davison clinic at (810) 412-5100, or you can email him at

10 Exercises To Do In the Pool

Pool (aquatic) exercise provides many benefits, including an ideal environment to exercise throughout the year. The buoyancy of the water supports a portion of your body weight making it easier to move in the water and improve your flexibility. The water also provides resistance to movements, which helps to strengthen muscles. Pool exercises can also improve agility, balance, and cardiovascular fitness. Many types of conditions greatly benefit from pool exercise, including arthritis, fibromyalgia, back pain, joint replacements, neurological, and balance conditions. The pool environment also reduces the risk of falls when compared to exercise on land.

Preparing for the Pool

Before starting any pool exercise program, always check with your physical therapist or physician to make sure pool exercises are right for you. Here are some tips to get you started:

  • Water shoes will help to provide traction on the pool floor.
  • Water level can be waist or chest high.
  • Use a Styrofoam noodle or floatation belt/vest to keep you afloat in deeper water.
  • Slower movements in the water will provide less resistance than faster movements.
  • You can use webbed water gloves, Styrofoam weights, inflated balls, or kickboards for increased resistance.
  • Never push your body through pain during any exercise.
  • Although you will not sweat with pool exercises, it is still important to drink plenty of water.

10 Excellent Exercises for the Pool

1. Water walking or jogging: Start with forward and backward walking in chest or waist high water. Walk about 10-20 steps forward, and then walk backward. Increase speed to make it more difficult. Also, increase intensity by jogging gently in place. Alternate jogging for 30 seconds with walking in place for 30 seconds. Continue for 5 minutes.

2. Forward and side lunges: Standing near a pool wall for support, if necessary, take an oversized lunge step in a forward direction. Do not let the forward knee advance past the toes. Return to the starting position and repeat with the other leg. For a side lunge, face the pool wall and take an oversized step to the side. Keep toes facing forward. Repeat on the other side. Try 3 sets of 10 lunge steps. For variation, lunge walk in a forward or sideways direction instead of staying in place.

3. One leg balance: Stand on 1 leg while raising the other knee to hip level. Place a pool noodle under the raised leg, so the noodle forms a “U” with your foot in the center of the U. Hold as long as you can up to 30 seconds and switch legs. Try 1-2 sets of 5 on each leg.

4. Sidestepping Face the pool wall. Take sideways steps with your body and toes facing the wall. Take 10-20 steps in 1 direction and then return. Repeat twice in each direction.

5. Hip kickers at pool wall: Stand with the pool wall to one side of your body for support. Move 1 leg in a forward direction with the knee straight, like you are kicking. Return to start. Then move the same leg to the side, and return to the start position. Lastly, move that same leg behind you. Repeat 3 sets of 10 and switch the kicking leg.

6. Pool planks: Hold the noodle in front of you. Lean forward into a plank position. The noodle will be submerged under the water, and your elbows should be straight downward toward the pool floor. Your feet should still be on the pool floor. Hold as long as comfortable, 15-60 seconds depending on your core strength. Repeat 3-5 times.

7. Deep water bicycle: In deeper water, loop 1-2 noodles around the back of your body and rest your arms on top of the noodle for support in the water. Move your legs as if you are riding a bicycle. Continue for 3-5 minutes.

8. Arm raises: Using arm paddles or webbed gloves for added resistance, hold arms at your sides. Bend your elbows to 90 degrees. Raise and lower elbows and arms toward the water surface, while the elbows remain bent to 90 degrees. Repeat for 3 sets of 10.

9. Push ups: While standing in the pool by the pool side, place arms shoulder width apart on pool edge. Press weight through your hands and raise your body up and half way out of the water, keeping elbows slightly bent. Hold 3 seconds and slowly lower back into pool. (Easier variation: Wall push up on side of pool: place hands on edge of pool shoulder width apart, bend elbows, and lean chest toward the pool wall.)

10. Standing knee lift: Stand against the pool wall with both feet on the floor. Lift 1 knee up like you are marching in place. While the knee is lifted even with your hip, straighten your knee. Continue to bend and straighten your knee 10 times, and then repeat on the other leg. Complete 3 sets of 10 on each leg. For more of a challenge, try this exercise without standing against the pool wall.

Learn more about aquatic physical therapy.

Authored by Julie A. Mulcahy, PT, MPT (Summer 2016) Top 10 Exercises to Do in the Pool Retrieved from