Back Pain and Sciatica – Physical Therapy Treatments

This month I figured I’d post on a couple case studies related to back pain and sciatica, and how we evaluate and treat cases like this at Elite Physical Therapy.  We’ve had a lot of great success with these folks so thought I’d share a couple examples.

Back pain, and associated leg pain, can be difficult to treat but we like a challenge!  Playing detective can be fun if you know what to look for.  Check out the pictures below that show the paths the spinal nerves take throughout the body.  Leg pain (or what many people like to call ‘sciatica’) can follow a number of paths down the leg and sometimes that can be a dead give away to identify exactly where the pain is coming from.

dermatomes

***The letter and numbers above correspond to a particular spinal nerve, i.e. L4 means lumbar spinal nerve #4 ***

There are other ways to narrow down the location of the problem as well:

  • the muscles will be painful to palpation at a specific vertebral segment and may even refer pain down the leg when palpated with deeper pressure.
  • reflexes may be diminished.  A slow or non-existent patellar tendon reflex corresponds with lumbar spinal nerve #4.
  • Muscles may test weaker on the affected side which may indicate an injury to a particular spinal level or nerve.  An example of this would be weakness in the calf muscles (can’t lift up on to the toes) which are controlled by the first two sacral nerves (S1 and S2 on the chart).

So here’s a great example of a number of these factors all lining up and how quickly the pain and loss of function can be addressed.

Case Study #1

The patient in this case had left sided low back pain and pain running down through the back of her hip and leg to the mid-calf.  She felt a ‘pop’ in her back and immediate leg pain as a result of pushing and twisting trying to put a heavy object in the back of her truck.  She is an avid runner but even standing and walking significantly increase her pain after 10 minutes.

Exam

So here is what I found:

  • Symptoms following the S1 and 2 dermatomes down the back of the left leg
  • Increased muscle tone/spasm at the S1 and S2 levels of the spine, and these muscles are tender to palpation.
  • ‘Springing’  or pushing down on the S1/S2 vertebrae reproduced the symptoms into the back of her hip/upper thigh.
  • She could do only 12 calf raises on her left leg while doing 25 on the right side (this muscle corresponds with S1 and S2 nerves).
  • Achilles reflexes normal (S1 reflex)

It’s nice when everything points back to a specific level or two like that.  Doesn’t always work that way but when it does it makes me much more confident that we can knock this out quickly.

Treatment

In this case I chose to use dry needling to address the muscles at the S1 and S2 spinal levels on both sides of the spine.  Once the needles were placed I attached an electrical stimulation unit and she just relaxed for 10 minutes.  Dry needling in conjunction with e-stim are shown in the research to decrease tone within the muscles as well as alleviate pain through a number of local and global factors.

The patient was instructed in two exercises that had multiple purposes:

  • decrease pain through relaxation of the over worked muscles of the back and anterior hip
  • facilitate improved stability through the lumbar spine and pelvis

Pretty simple exercises that are beyond the scope of this article but lots of bang for your buck when they only take 5 minutes 2-3 x per day.

Results

The patient had near full resolution of symptoms for two days after the first session.  Her exercises relieved her pain at home and she could walk as much as she wanted.  She tried to run on the third day but was unable due to pain.

We repeated the same dry needling + e-stim treatment during the second visit and followed it up by progressing her exercise program.

The patient cancelled her appointment the next week as she reported being completely pain free and back to running.

Final Thoughts

Sometimes it just works that well but I certainly won’t make that guarantee in every case!  Back pain and ‘sciatica’ cases can be quite complex but knowing how to put together all the puzzle pieces definitely helps.

That’s probably enough to wrap your head around for this time.  Next month I’ll post another case study but with a different symptom presentation.  In the meantime if you have any questions just shoot me an email:  joe@elitepttc.com or call 231 421-5805.

Occlusion Cuff

Blood Flow Restriction Training

Blood Flow Restriction training, aka BFR, has actually been around for awhile now but its finally starting to make its way into professional and collegiate sports as well as physical therapy.  Johnny Owens has been the driving force behind BFR in the U.S. after successfully using this technology with veterans recovering from devastating combat injuries.  Since that time he’s been training numerous professional sports teams in the use of blood flow restriction training including the Detroit Lions and Detroit Red Wings.

What the heck is it?

BFR training utilizes a tourniquet-like device which is placed proximally on a limb to limit arterial inflow to the limb while blocking venous outflow.

I should add a word of warning sooner rather than later.  There are commercial devices out there used by trained professionals for this type of training.  Do not make your own tourniquet and try this at home!

Benefits

I’m going to go a bit scientific on you here but just for a moment:

  • Training loads used are only 20-35% of 1 rep max, and often times are just body weight.  The same effects with weight lifting alone must be at least 70 – 85%.  Translation:  same results with less load = happier joints.
  • Higher release of growth hormone, insulin-like growth factor, and other substances known to speed tissue repair and create a positive environment for muscle hypertrophy.
  • Increased recruitment of Type II (fast-twitch) muscle fibers even with sub maximal loads
  • Increased muscle protein synthesis through the inhibition of catabolic substances.
  • Cell swelling : shift in fluid balance into the muscle cell creating a protective response to adapt and grow

Check out the chart below from Dr. Mario Novo at the LiftersClinic.com

LiftersClinic.com

Pretty cool stuff isn’t it?  Even with all the science thrown in.

How do you use it?

We work it into our rehab and training sessions closer to the end of the workout.  The build up of lactic acid will reproduce the ‘muscle burn’ sensation pretty quick causing a good amount of muscle fatigue with only body weight activities.  Body weight squats are usually a great place to start.  They are performed for 30 reps:15 reps:15reps:15 reps with 30 seconds between each set.  These will be the toughest body weight squats you’ve ever done!

The number of exercises performed and time training with blood flow restriction is gradually increased.  So far we’ve seen a rapid increase in tolerance to exercise among our athletes allowing them to do more and more work with BFR.  The results have been excellent too with quicker gains in muscle hypertrophy and strength.  If you notice the last column in the chart above – time to adaptation.  Within 2 weeks we are beginning to see positive changes compared to the traditional higher intensity training.

It might sound like I’m down playing the effects of higher intensity training regimens but I’m not at all.  There are tremendous benefits to lifting heavy and creating a great base level of strength.  BFR just offers a great way to increase training volume and intensity while decreasing load.  Over time the heavy weights will wear down your body – ask any collegiate or NFL football player – but this allows for a certain amount of unloading to happen and still reap all the benefits.

I know you want to try it!

Blood flow restriction training is safe when used with the right person at the right time and monitored appropriately.  It is also a pretty intense workout so definitely not for the faint of heart.

We are currently using BFR with athletes and patients post-knee injury, hamstring injuries, shoulder injuries, ankle sprains, and more.  Athletes that come in strictly to train have been having great success with it as well.  If you’ve struggled to make progress as a patient or hit a plateau in your training this would definitely be worth asking about.  We have a number of unique techniques to promote tissue healing and strength/power gains, and this is just one reason we have been setting ourselves apart from the competition!

Occlusion Cuff Shoulder

If you’re really into the science behind blood flow restriction training and would like to learn more, you can check out the two podcasts with Eoin Cremen (creator of the OcclusionCuff) on SportsRehabExpert.com

Questions?  Joe@eliteptt.com or give me a call at 231 421-5805

Dry Needling for Hip and Knee Pain

At Elite Physical Therapy and Sports Performance we strive to find new and innovative ways to treat pain and get you moving again.  Dry needling has been one on my go-to treatments for the past 3 years now, and the method I’m going to show you today works wonders for hip and knee pain.

The Vastus Lateralis (VL) is one of the four muscles that make up your quadricep and is the most lateral.  Trigger points in this muscle will often refer pain to the lateral knee.  Check out the photo below of the VL and corresponding trigger point referral patterns.

Vastus Lateralis Trigger Points

Even without active trigger points, the VL is often in a state of high tone which can significantly limit hip mobility in certain directions.  With it’s attachment all along the IT band, it can also create greater stress on the knee joint through that IT band.

In the video you’ll see the limitations in our patients hip adduction (her knee should hit the table when I try to lower the leg across midline).  Her right hip does this easily.  This is a fairly standard PT test, known as the Ober test in most circles.  In the video you’ll see how dramatically dry needling the Vastus Lateralis with a few minutes of muscle stimulation can change her hip mobility.

Just a quick note on the video.  This was originally created for my SportsRehabExpert.com website which is read by other PT’s, Athletic Trainers, Chiropractors, etc.  Sorry for all the medical talk but you’ll get the idea with the huge change in range of motion following the dry needling treatment.

Here are some of the common diagnoses you’ll hear from your doctor that will respond well to dry needling:

  • IT Band Syndrome
  • Runner’s Knee (distal IT band syndrome)
  • Patello-Femoral Pain Syndrome/Patellar Mal-Tracking
  • Hip Bursitis

There are many other ‘diagnoses’ that can benefit from improved hip mobility but those above are what we would see most frequently.  For those that are needle-phobic, we can get similar results using Graston Technique and other manual therapy techniques, it’s just often not quite as dramatic.

There are also a number of specialized motor control and strengthening exercises that need to be used following this treatment to maintain this new mobility.  Just because she can move her hip now on the table doesn’t necessarily mean its going to move that well when she is standing, walking, or running.  Strength must also be established in that new range.

Hope that was helpful to see plus you get a bit of a glimpse at what we do here at Elite Physical Therapy and Sports Performance.

Big thanks to our Athletic Trainer, Lydia Case, for being our ‘patient’!

Advanced Kettlebell Carries

We love kettlebell carries here at Elite Physical Therapy and Sports Performance as they have numerous benefits to our patients and athletes including:

  • improved shoulder girdle and trunk stability
  • increased grip strength
  • improved core control and strength

My current PT student, Mitch Babcock, has brought some new ideas to the table to make our carries even more challenging as far as the stability demands go so thought I’d share those with you.

Check out the videos here:  http://www.sportsrehabexpert.com/public/1181.cfm?sd=2

Bio

Mitch Babcock Kettlebell CarriesMitch Babcock SPT is a final year Doctor of Physical Therapy candidate from the University of Michigan — Flint. Mitch received his Bachelor’s Degree from Saginaw Valley State University in Mitch BabcockExercise Science and pursued his passion for movement and exercise to the graduate level. Mitch is certified in the Selective Functional Movement Assessment (SFMA) and the Functional Movement Screen (FMS), as well as a RockTape FMT Level II professional. He has also spent time with clinical rotations in a manual-based orthopedic clinic in mid-Michigan, a sports clinic in Charlotte, NC, and an outpatient neurological rehabilitation clinic in mid-Michigan. With a passion for full human optimization, Mitch is ready to help you get moving, get out of pain, and get back in the game.

Multi-Planar Single Leg Deadlift

The single leg deadlift is a staple exercise here at Elite Physical Therapy and can improve hip mobility, core and hip motor control, and also challenge balance.  Adding movement into other planes can also add value to an already excellent exercise.

Originally published on SportsRehabExpert.com by Greg Schaible
This is a great way to start exploring movement and introducing variability of motion once your typical single leg deadlift has been mastered. Start including these variations to develop better body awareness. It also can effectively be used as part of an athletes warmup.

  • Keep a soft knee and stay long through the torso
  • Torso should be in parallel with the ground

This doesn’t take the place of a progressive loading program with your standard single leg deadlift. Don’t forget the benefits that a progressive resistance program can have on tissue remodeling.

BIO

Dr. Greg Schaible is a physical therapist and strength coach specializing in athletic performance. He attended The University of Findlay as a Student Athlete. As an athlete he competed in both Indoor anGreg Schaibled Outdoor Track & Field where he earned honors as a 5x Division II All-American and a 6x Division II Academic All-American. In 2013 he completed Graduate School earning his Doctorate of Physical Therapy (DPT). Greg is the owner of On Track Physical Therapy in Ann Arbor, Mi. In addition to his rehabilitation services, Greg has a passion for youth sports specific training. Follow On Track PT Performance on Facebook.

Exercise of the Week – Wall Slides for Shoulder Pain

At Elite Physical Therapy we know that shoulder pain and rotator cuff dysfunction is often the result of multiple factors such as poor scapular stability, loss of cervical and/or thoracic mobility, and poor trunk stability just to name a few.  Wall slides are one of those exercises that will address each of these areas of concern in one shot.

I’ve featured wall slides here in the past with the back up against the wall, but in this version there isn’t the input for the wall to correct posture and there is more of a focus on scapular upward rotation.

  • Posture – get tall and press away from the wall. You’ll notice in the video how this even assists with a bit of cervical retraction.
  • keep the forearms vertical to keep the posterior rotator cuff and scapular stabilizers engaged – this will be much more difficult with the band.
  • only go as far as the forearms can stay on the wall – this forces you to work through the lats and stiff upper back muscles.

You should feel a lot of muscle activation in the back of the shoulders and between the shoulder blades.  At no time should you have shoulder pain.  If so, this exercise may not be appropriate and probably a good time to have your physical therapist or physician take a look.

Any questions feel free to email me:  joe@elitepttc.com or call 231 421-5805.

Originally posted on SportsRehabExpert.com

Trigger Points and Shoulder Pain – Part II

originally posted on SportsRehabExpert.com

Joe Heiler PT

Shoulder pain is such a common diagnosis that we’ll see here at Elite Physical Therapy, and there are a number of structures that can be pain generators to the shoulder and arm. Last month I talked about trigger points in the posterior rotator cuff (Infraspinatous and Teres Minor) along with their common referral patterns. Another common shoulder muscle to find active trigger points is the supraspinatous. Active trigger points in this muscles can refer pain to the deltoid and down the lateral aspect of the arm.

Check out the typical trigger points and referral patterns below:

Supraspinatous Trigger Point Referral

Check out the video below for a demonstration of dry needling to the supraspinatous:

Case study:

Feel free to check out this case study but it was originally written for physical therapists and chiropractors. Ultimately the point is that a combination of dry needling and soft tissue mobilization, in addition to corrective exercises, can significantly decrease pain while improving range of motion and movement.

Current patient of mine presents with lateral arm pain of 3 months duration. No known cause of injury but diagnosed with tricep injury/tear.

Pre-Treatment

SFMA dysfunctional non-painful patterns:

  • all cervical patterns (mobility)
  • R shoulder medial rotation extension (mobility) – FN to the L
  • MS rotation R (motor control deficit) – FN to the L.

    SFMA dysfunctional painful patterns:

  • R shoulder lateral rotation flexion
  • MS extension (R UE pain)

    Special tests:

  • Hawkins + on the R
  • Passive shoulder IR 20 deg.

    Palpation:

  • Tenderness with palpation of both trigger point in the supraspinatous with referral of pain down the lateral upper extremity to the wrist (indicates that is the pain he gets into the upper arm)

    Treatment on Day 1 consisted of Functional Dry Needling to the supraspinatous (x2) with electrical stimulation followed by more superficial Graston technique to the R upper trap, supraspinatous, infraspinatous, and teres minor along with light strumming at the supraspinatous insertion. Corrective exercise included 3pt. thoracic rotation (UE positioned in internal rotation – hand behind the back) with manual assist to hold/relax work until pt. was able to control the full available range.

    Post-Treatment

    Functional Non-Painful patterns:

  • R shoulder medial rotation extension
  • MS rotation B

    SFMA dysfunctional non-painful patterns:

  • all cervical patterns (mobility)

    SFMA dysfunctional painful patterns :

  • R shoulder lateral rotation flexion
  • MS extension (R UE pain)

    ***both are still painful although intensity has decreased while motion has increased***

    Special tests:

  • Hawkins + on the R but much less intense
  • Passive shoulder IR 50 deg.
  • Graston Technique – Treating the Painful Shoulder

    Here is the video I promised using Graston Technique to treat soft tissue dysfunction in the posterior shoulder girdle using and in particular the trigger points that can refer pain to the front of the shoulder and down the arm.

    If you haven’t read the previous article discussing why we would want to treat this area, you can check that out here:  http://www.elitepttc.com/blog/trigger-points-and-shoulder-pain/

    If you have any questions concerning Graston Technique, Dry Needling, or shoulder pain please contact us at 231 421-5805 or Joe@elitepttc.com

    Trigger Points and Shoulder Pain

    There are a number of manual therapy techniques we use here at Elite Physical Therapy and Sports Performance, including Graston Technique and Trigger Point Dry Needling, to address muscular pain.  What many people don’t realize is that taut bands of hyperirritable muscle (a.k.a. trigger points) can cause local and referred pain.

    This article is one I wrote for SportsRehabExpert.com awhile back showing how trigger points in the back of the shoulder, specifically the muscles of the posterior rotator cuff, can refer pain to the front of the shoulder and down the arm.

    If you have shoulder pain that has not responded to other types of treatment, then check out this article and please contact us with any questions you may have!

    Manual Therapy Technique of the Week – Treating the Infraspinatous and Teres Minor 

    Joe Heiler PT

    I’ve become much more familiar with trigger point referral patterns and treating these out the past couple years since taking the Kinetacore Functional Dry Needling course.  A couple of the more common trigger points I end up dry needling and/or using Graston Technique to treat in the shoulder are the infraspinatous and teres minor.  Active trigger points in these muscles can refer pain to the anterior and middle shoulder, and on occasion will also refer pain down the arm.

    Check out the typical trigger points and referral patterns below:

    Infraspinatous Trigger Points and Pain Referral Pattern

    Infraspinatous Trigger Points and Pain Referral Pattern

    Teres Minor Trigger Point and Pain Referral Pattern

    Teres Minor Trigger Point and Pain Referral Pattern

     

    Case Study

    Current patient of mine presented with R shoulder and scapular pain of 2 year duration.  MS rotation limited to 50% bilaterally (DP) and R shoulder medial rotation extension (MRE) reach only to L4 (DP).  Palpation of the infraspinatous trigger point (most superior and lateral) referred significant pain to the anterior shoulder and slightly down the lateral arm reproducing her typical pain.  The teres minor trigger point referred pain to the middle deltoid area.

    Post trigger point dry needling of these trigger points the patient’s MS rotation improved to 90% (dysfunctional still but non-painful) and R shoulder MRE to T9 (still DP but much less pain).

    It’s not always this dramatic but this is also not the first time I’ve seen the great results like this.

    I’ll get a video up soon showing how we use Graston Technique to treat the posterior shoulder to reduce this type of pain and improve shoulder function.

    In the meantime feel free to contact us with any questions:  231 421-5805 or Joe@elitepttc.com

    Vastus Medialis Obliquus Muscle (VMO) “Isolation” Exercises Fact or Myth?

    At Elite Physical Therapy and Sports Performance we take pride in the fact the we are well ahead of the curve with out treatment techniques compared to the rest of the traditional PT world, but we also acknowledge that it is important to use evidence based treatment techniques.

    Evidence based practice is the buzz word in PT circles but despite this strengthening/isolating the VMO continues to be utilized as a way to decrease knee pain and improve function.   PT’s and physicians alike continue to prescribe strengthening for the VMO muscle of the quadriceps group even though the research has proven this concept to be faulty and ineffective.

    This short article was written by a couple PT friends of mine in New York (one of which is in the PT and Strength and Conditioning Halls of Fame!) showing once and for all that you can not isolate the VMO, nor should you bother trying when it comes to solving knee pain.

    Enjoy!

    Originally posted on SportsRehabExpert.com

    Robert A. Panariello MS, PT, ATC, CSCS
    Timothy J. Stump MS, PT, CSCS, USAW

    Professional Physical Therapy
    Professional Athletic Performance Center
    New York, New York

    Patellofemoral pathology is a fairly common condition observed in clinical setting. The treatment philosophy of some rehabilitation professionals to resolve this painful condition may include the prescription of exercises in the attempt to isolate the Vastus Medialis Obliquus muscle (VMO). Although this VMO exercise isolation “myth” has been negated at least 20 years ago (1, 2) it continues to presently endure.  During this attempt to isolate VMO activity, some designated exercises executed include but are not limited to the following:

    • Quad sets
    • Terminal open chain knee extension exercises
    • Straight leg raises (SLR) with external rotation of the lower extremity

    These exercises may or may not be performed with the adjunct application of electric stimulation.

    Although these exercises will enhance the strength of the quadriceps muscles, likely assisting in resolving the patient’s knee pathology, this is not due to isolation of the VMO. The case some clinicians formulate for the performance of SLR with external rotation is based on the false premise that by externally rotating the femur will result in further activation of the VMO.

    The knee is a hinge joint and during the execution of a SLR, the force of gravity will act in a perpendicular manner between the knee and ground surface. The quadriceps mechanism will now be required to resist the resultant force attempting to flex the knee as this is the only contractile soft tissue structure that is capable of resisting that force.  The quadriceps mechanism like any other dynamic structure can only resist this external force via the neural activation of the muscle group.  The external rotation of the femur gives rise to the placement of stress on medial collateral ligament (MCL), a static stabilizer of the knee.  This treatment philosophy actually removes stress from the very muscle(s) the clinician is attempting to enhance.  As an example a patient with a diagnosis of polio, a condition affecting the anterior horn of the femoral nerve or a patient with a quadriceps tendon rupture can still perform a SLR when externally rotating their femur based on the static stabilizing properties of the MCL.  Therefore one may inquire why would a clinician who is attempting to activate and enhance the quadriceps muscle group perform the SLR exercise in external rotation.

    The anatomy and neuroanatomy of the quadriceps muscle group

    The quadriceps muscle group is comprised of the rectus femoris, vastus lateralis, vastus intermedius, and vastus medialis. The vastus medialis (VM) is located at the medial aspect of this muscle group and has been reported to consist of two separate components, the proximal vastus medialis longus (VML) and the distal vastus medialis obliquus (VMO) (4). The neuroanatomy of the quadriceps muscle complex reveals an innervation from the femoral nerve.  The femoral nerve is comprised of large motor units that innervate all four heads of the quadriceps without individual fine motor unit innervation of the separate muscle heads.  Therefore, since the VMO does not have a distinct and separate nerve innervation, it is not possible to “isolate” this muscle from the other quadriceps muscles via a specific exercise performance. The most beneficial way to enhance the VMO is to incorporate the same exercise philosophy used to improve any other muscle or muscle group, the application of unaccustomed stress. The application of unaccustomed yet safe levels of stress is simply known as the “overload principle”. This may be accomplished in two ways; expose the patient to higher levels of unaccustomed resistance or overload them by increasing the velocity of the movement. Both methods will result in a positive adaption of the entire quadriceps muscle group.

    Since stress transpires throughout the kinetic chain of the lower extremity during the performance of ADL’s as well as athletic endeavors, the activities prescribed for patellofemoral pathology should also include exercises for both the hip and ankle. “Critical thinking” is a requirement for the approach to the patient’s optimal exercise selection and treatment design. The health care professional’s obligation to provide optimal treatment does not include the application of myths during the patient’s plan of care.

    References

    1. Cerny K “Vastus medialis oblique/vastus lateralis muscle activity ratios for selected exercises in persons with and without patellofemoral pain syndrome”, Phys Ther (8):672-83, 1995
    2. Malone T, Davies G, Walsh WM, “Muscular control of the patella” Clin Sports Med 21(3); 349-362, 2002.
    3. Hubbard JK, Sampson HW, Elledge JR, “The Vastus Medialis Oblique Muscle and Its Relationship to Patellofemoral Joint Deterioration in Human Cadavers”, J Ortho Sports Phys Ther 28(6):384-391, 1998.
    4. Weinstabl R, Scharf W, and Firbas W, “The extensor apparatus of the knee joint and its peripheral vasti: anatomic investigation and clinical relevance”, Surg and Radiological Anat  11(2): 17-22, 1989

    Robert A. Panariello MS, PT, ATC, CSCS
    Rob Panariello PicRob is a Founding Partner and Chief Clinical Officer with Professional Physical Therapy presently with 44 facilities in the New York and New Jersey Metro areas and the Professional Athletic Performance Center located in Garden City, New York. He has Bachelor Degrees in Physical Therapy and Physical Education/Athletic Training from Ithaca College in Ithaca, NY. He also holds his Master’s Degree in Exercise Physiology from Queens College in Queens, NY.

    Rob has more than 30 years of experience in the related fields of Sports Physical Therapy, Athletic Training, and the Performance Training of Athletes. His experience includes the study of the Science of Strength and Conditioning of weightlifters and various sport athletes in Bulgaria, the former Soviet Union, and former East Germany. He previously held the positions as the Head Strength and Conditioning Coach at St. John’s University of New York (1986-1995), the World League of American Football NY/NJ Knights (1991), and the WUSA NY POWER Women’s Professional Soccer League (2001-2002). He continues to rehabilitate, athletic performance train, as well as serve as a consultant to many NFL, NBA, MLB, NHL, Collegiate and University teams, coaches, and players.

    Rob has more than 60 peer reviewed Orthopedic and Sports Medicine Research, Sports Physical Therapy Research, and Strength and Conditioning Journal Articles and Book Chapter publications. He has also presented his research at the International World Confederation of Physical Therapy in Washington, D.C. He is nationally renowned and lectures throughout the country with regard to the related fields of Sports Physical Therapy and the Performance Training of Athletes.

    Rob received the 2015 APTA Sports Physical Therapy Section Lynn Wallace Award for Excellence in Clinical Education, the prestigious National Strength and Conditioning Association’s Presidents Award in 1998 and was elected to the USA Strength and Conditioning Coaches Hall of Fame in 2003.

    Tim StumpTimothy J. Stump is a partner with Professional Physical Therapy, and is also a founding partner with the Professional Athletic Performance Center. He  has more than 20 years of experience in the related fields of Orthopedic and Sports Physical Therapy, Strength & Conditioning, and Performance Training of Athletes of all levels of competition. Tim’s experience includes the successful participation as a nationally ranked competitive strength athlete in the sports of Powerlifting and Weightlifting from 1990-2010. He continues to actively participate in these sports as a coach and mentor to many athletes.

    Tim has published several peer-reviewed original research articles and has presented his research at the APTA National Conference and at CSM. Tim was also awarded the Jacob & Valeria Langeloth Foundation research grant for studies on ACL functional outcomes while employed at the Hospital for Special Surgery. Tim was the 2012 recipient of Columbia University’s Award for “Leadership in Clinical Education” and co-chairs Professional’s Clinical Affiliation Program with over 64 school contracts providing PT, PTA, ATC and Exercise Physiology students with quality clinical affiliation experiences.