Treatments – Four Pines Physical Therapy

Specialty Treatments

Annual Teton Tune-Up

As Benjamin Franklin once said: “An Ounce of Prevention is Worth a Pound of Cure.”

Some preventative health habits are instilled in us at a young age. For as long as you can remember, for example, you made annual treks first to the pediatrician and dentist. As you get older, your annual treks may include your doctor, OBGYN, optometrist and dentist.

You know the drill: During your annual visit, your primary care physician will order a cholesterol test, check your blood pressure and possible draw blood for labs. Your dentist will clean your teeth to prevent gum disease.

Anytime you have moved or switched insurance carriers, one of your first priorities has been to track down new providers for your preventative care.

You probably figure that between the three to four healthcare professionals (doctor, dentist, optometrist, OBGYN), all of your health needs are covered, right?

There is One Annual Checkup That’s Missing From Your Calendar!

Why not begin, or continue, your preventative health care journey with your Personal Physical Therapist? No Physician Prescription is Required!

Most healthcare professionals aren’t specifically trained to assess your musculoskeletal system, which is comprised of your muscles, bones, cartilage, tendons, ligaments, joints and other connective tissues.

A Physical Therapist is a Specialty Trained Health Professional for your Musculoskeletal System

What if there was a way to know that you’ll develop chronic neck pain ten years from now? What if there was also a way to know that there’s something you could be doing naturally and drug-free NOW to prevent it?

Whether you are young or old—how you move is a great predictor of injuries and other dysfunctions to come, and no one is better trained to identify your risks than a PT. From a full assessment of your fundamental movements, PTs can get a clear picture of what the future will bring you.

Better yet- If you do get injured or experience pain or develop physical limitations, you can come straight back to YOUR PT for immediate care and they will have a base-line for you to compare. This will make your immediate care more effective and efficient since you have established a relationship with YOUR PT.

What Does The Teton Tune-Up Entail ?

A Specialized Physical Therapist will:

  • Talk about past medical history, injuries, surgeries, current medications and supplements.
  • Talk about your concerns
  • Talk about any pain that you may have or worried that you might have
  • Perform a full body muscle assessment (flexibility, strength and coordination)
  • Perform a Full Body Joint Assessment (range of motion)
  • Assess your functional limitations (stairs, lifting, moving)
  • Teach you how to take care of yourself naturally, without dangerous medications.
  • Teach you how to prevent or avoid risky surgery
  • Provide you with important information and a program that is designed for you so that you can take care of yourself, naturally

How To Prepare for your Teton Tune-Up (No Prescription Needed)

To maximize your Teton Tune-Up with one of our Physical Therapists, it’s important to be prepared before your appointment. To ensure that you cover everything and address any issues you may be having, make a list and bring it with you that includes:

  • Health issues like diabetes, high blood pressure, sleep issues, etc
  • Current medications and supplements
  • List of what may be bothering you (back, neck, knees, pelvic floor, etc)
  • List of what you have difficulties doing due to pain or weakness—if any
  • List of any concerns that you may have
  • List of what you would like to prevent or take care of!
  • What physical fitness / sports activities that you participate in
  • New activities you are considering
  • Fitness goals

By understanding what you need, your PT will be better prepared to make recommendations and tailor a home program designed to help you achieve your goals. The information exchanged between you and your PT is critical to forming an ongoing relationship, and to ensure that you are functioning and moving at top form.

Trigger Point Dry Needling (Intramuscular Therapy)

Dry Needling

When muscles develop trigger points, they often become shortened and can create compression on the structures around them, which can cause immense pain and impair your ability to lengthen and/or contract a muscle. Dry needling deactivates these trigger points, which draws white blood cells and plasma cells into the area and create a healing response.

Trigger Point Dry Needling is defined as the insertion of filiform (solid yet flexible) needles into trigger points/knots within the muscle belly to stimulate release of the firmly contracted tissue. It can also be used to facilitate muscles. It has long been proven to be an effective and efficient treatment to reduce pain, spasm, soft tissue restriction, and alleviate referred symptoms.

This form of intramuscular needling is commonly confused with acupuncture. The eastern medicine approach to acupuncture is based off of specifically mapped acupuncture points within the meridian system, a series of channels along which specific points are stimulated utilizing needles for both local and systemic benefits. Unlike acupuncture, dry needling is specifically geared towards utilization of needles to stimulate a twitch response, an instantaneous and brief contraction of the muscle which has been held in sustained contraction, to subsequently allow the muscle to release its chronic tightness and restriction.

Pro athletes, weekend warriors, high school athletes, and desk jockeys with poor posture behind a computer can all benefit from the uses of dry needling.  Releasing trigger points reduces tightness, restriction, and inflammation, allowing your muscles to create greater power and endurance while decreasing overall symptoms.

Therapeutic Low Level Laser Therapy

Laser Therapy

Laser therapy is the non-invasive use of laser energy to generate a photochemical response in damaged or dysfunctional tissue. Laser therapy can alleviate pain, reduce inflammation and accelerate recovery from a wide range of acute and chronic clinical conditions as well as accelerate wound healing. As rehabilitation specialists know, the main goal of treatment for many when treating painful, debilitating conditions is to facilitate improved function and mobility. Laser therapy is a safe drug-free, surgery-free technique to help make that goal a reality.

Clinical Benefits

  • Effective for difficult conditions
  • Alternative to surgery
  • Fast treatment times
  • Easy non-invasive treatment
  • Scientifically proven treatment


BPPV (benign paroxysmal positional vertigo) is the most common disorder of the inner ear’s vestibular system. The vestibular system is vital for maintaining a person’s balance and coordination of the eyes with the head and body movements. When the system is out of balance a sensation of spinning, nausea, visual disturbances, and loss of balance can occur. The issue occurs with a change of head position and symptoms can be delayed by up to about 30 seconds. Most commonly symptoms occur with rolling over in bed or with lying down or sitting up from a lying position. Symptoms can be mild to very severe in nature and can be debilitating enough to cause diminished quality of life, reduced employability and complicate all aspects of life.

The cause of the issue is the otoconia in the inner ear, which are tiny crystals that are part of the normal anatomy. The otoconia can detach from the otolithic membrane and cause issues with the signals that tell the brain how to have the eyes track with the head, causing involuntary eye motions (nystagmus). This is different from lightheadedness and dizziness that occur ‘in’ the head, where vertigo occurs in the visual field.

Physical Therapy is highly successful in treatment of BBPV and often can resolve symptoms in 1-3 sessions. There are many exercises that can then be used to sharpen the Vestibular Ocular Reflex to help with balance and eye tracking issues to allow someone to get back to their normal activities.

TMJ / TMD / Jaw Pain

Treating temporomandibular disorder (TMD) with physical therapy is an effective method to relieve pain and discomfort. Temporomandibular Disorder (TMD) involves the temporomandibular joints (TMJ) and or masticatory muscles. TMD is a common source of jaw pain, headaches and orofacial pain and contributes to functional limitations with chewing, yawning, and talking. When you come to Four Pines Physical Therapy for your physical therapy evaluation and treatment, you can expect your therapist to analyze your jaw mobility and release muscle tension in the head and neck region. Our physical therapy team will perform a comprehensive evaluation of your TMD, neck, thoracic spine and shoulder girdle to determine the structures causing TMJ symptoms. Our patients are receiving immediate relief with physical therapy.

The National Institute of Dental and Craniofacial Research, part of the National Institutes of Health (NIH), classifies the categories of TMD by the following criteria:

  • Myofascial pain, the most common form of TMD, which is discomfort or pain in the muscles that control jaw function and the neck and shoulder muscles.
  • Internal derangement of the joint. This means a dislocated jaw or displaced disc, or injury to the chondyle (the rounded edges of the jaw).
  • Degenerative joint disease, such as osteoporosis or rheumatoid arthritis in the jaw joint.

What are the Symptoms of TMD?

The following are the most common symptoms of TMD. However, each individual may experience symptoms differently. Symptoms may include:

  • Jaw discomfort or soreness (often most prevalent in the morning or late afternoon)
  • Headaches
  • Pain radiating behind the eyes, in the face, shoulder, neck, and/or back
  • Earaches or ringing in the ears (not caused by an infection of the inner ear canal)
  • Clicking or popping of the jaw
  • Locking of the jaw
  • Mouth motions are limited
  • Clenching or grinding of the teeth
  • Dizziness
  • Sensitivity of the teeth without the presence of an oral health disease
  • Numbness or tingling sensation in the fingers
  • A change in the way the upper and lower teeth fit together

The symptoms of TMD may resemble other conditions or medical problems. Consult a dentist or your physician for a diagnosis.

Treatments Include:

  • Physical Therapy
  • Resting the temporomandibular joint (TMJ)
  • Medication and/or pain relievers
  • Relaxation techniques and stress management
  • Behavior modification (to reduce or eliminate the clenching of the teeth)
  • An orthopedic appliance or mouth guard worn in the mouth (to reduce bruxism)
  • Posture training
  • Diet modification (to rest the jaw muscles)
  • Ice and hot packs
  • Surgery

Fall Risk Prevention Program

Research shows that having a cluster of factors will increase your risk of falling:

  • Muscle weakness
  • History of falls
  • Difficult with balance or walking
  • Use of an assistive walking device
  • Vision problems
  • Neurological deficits
  • Arthritis, Parkinson’s
  • Difficulty with daily activities
  • Depression
  • Conditions that cause confusion
  • Age >80 years old
  • Medications >4 at a time
  • Cardiovascular deficits
  • Environmental hazards (pets, throw rugs, etc)
  • Lower blood pressure or blood sugar
  • Urinary frequency

Fear of falling can be extremely self-limiting and lead to overall deconditioning: less strength, decreased balance and poor reflexive response when an accident occurs.

Four Pines Physical Therapy has specialized trained Doctors of Physical Therapy who will assess your current physical condition, including cardiovascular, strength, balance, proprioception and vestibular systems to determine your risk of falling. From this information, we will design a personalized program of exercises and functional activities for you to achieve functional safety in your home and community

Arm Care for Performance Improvement

Four Pines Physical Therapy offers an Arm Care program for local athletes to prevent shoulder and arm injuries during the season by enhancing athletic performance and keeping them on the field longer. This research-based approach is designed to target the specific soft tissue, joint, and movement adaptations seen as a result of the repetitive microtrauma that occurs from the high eccentric muscle demands of sports participation. Our arm care program is intended to both restore the necessary ranges of motion required for peak performance and re-establish muscle activation of the shoulder stabilizers that get weak with repeated use. Protecting our over head athlete from over-use injures that prevent them from performing to their highest potential is important to us at Four Pines Physical Therapy.

Injury Prevention Screening

Four Pines Physical Therapy offers athlete screening to help identify strengths, weakness, and altered movement patterns that may contribute to injury. This unique program takes the athletes through over 40 different clinical measure of strength, flexibility, range of motion, and functional movement base on the demands of their specific sport. The information gathered allows our trained clinical professionals to develop an individualized program for each athlete to address any substandard findings before they become a bigger issue. Injury prevention screening is designed to identify any movement, strength, or flexibility limitation that has been proven in the research to potentially contribute to decreased performance and injury. Each sport has different physical demands and our clinicians are trained to know the sport specific adaptations and acceptable norms based on that specific patient population. If screening is done by an entire team, coaches will be provided with a team profile of the strengths and weakness to assist in their training plans.

Running Assessments


Whether you are new to the running world or a professional marathoner with years of experience, Four Pines Physical Therapy’s running assessment is designed to help runners feel better, train harder, and go faster. Using slow-motion video analysis of your running form, we will develop an individualized program to help you achieve your running goals.

We offer 2 Running Assessment Levels of Service

BASIC: This evaluation will focus solely on footwear assessment and the clinician can make recommendations as to what type of shoe and/or orthotic would be best for your foot type and running style.

COMPREHENSIVE: Includes footwear assessment of the BASIC package, however, also allows time for the provider to look at your strength, mobility and assess your running form. From this information, the clinician will make recommendations for running technique to improve performance and prevent injury.

What do I Need to Bring?

  • All current running shoes (trail, race etc)
  • Athletic clothes to run in
  • Any current orthotic devices

Barbell Assessment


  • Back Squat
  • Front Squat
  • Overhead Squat
  • Bench Press
  • Deadlift
  • Snatch
  • Clean and Jerk
  • Push Press
  • Lunges
  • Pull-ups
  • And so many more…

Do you have a nagging injury that flares when you lift? Do you love to lift but worry that you will get injured? Have you plateaued in your lifting and are wondering how to take it to the next level? Four Pines Physical Therapy Barbell Lifting Assessment is designed to help improve technique both to optimize performance and avoid injury. A Certified Physical Therapist will take you through and physical examination to look at your strength, mobility, and flexibility. Then, they will watch you perform several lifts – catered to your interest. The therapist can make personalized recommendations for form and technique tweaks to optimize your lifts. The Physical Therapist will also provide stretching or accessory work that you can use to treat nagging aches and pains or even avoid injury in the first place. Whether you are experienced in weightlifting, powerlifting or CrossFit or brand new to an exercise program Four Pines customized Barbell Assessment is right for you!

Rehabilitative Pilates

Core Strength. Core Stability. Mind-Body Connection

Pilates is a core-based exercise system, founded by Joseph Pilates in the early 20th century, which has now become hugely popular across the world! Pilates training requires body awareness of your core alignment and musculature. Once this is accomplished, exercises for the spine and extremities are performed to not only challenge the core stabilization, but to make increases in flexibility, strength and endurance all over your body!

Aside from practicing Pilates on the mat for your exercises, Pilates can also be performed on equipment, such as a Pilates Reformer, which is part of the Four Pines rehabilitation equipment. The Reformer is a spring resistance-based platform machine which is extremely versatile, so it can comfortably be used for all body conditions and types. Depending on your site of injury or limitation, you may find yourself exercising while standing, lying on your back, sitting on a box or in high kneeling.

Plus, unlike other exercises that stop working for you when you stop exercising - the practice of learning to engage and hold your core doesn’t need to stop after your Physical Therapy session at Four Pines Physical Therapy– it’s a practice to be used throughout your day, at work and in PLAY!

Pilates Movement Principles

  • Breathing
  • Core Activation
  • Neutral Spine
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    Abdominal Strengthening
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    Lumbopelvic Stability
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    Spinal Strength and Mobility
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    Scapular Stability and Mobility
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    Correcting Alignment
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    Release Work
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A short list of diagnosis that Rehabilitative Pilates is effective for (although not limited to):

  • Plantar Fasciitis
  • Patella Tendonitis
  • Post-Op Dysfunction
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    Chronic Hamstring Strain
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    Chronic Ankle Sprain
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    Balance Dysfunction
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    Postural Imbalances
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    Shoulder Impingement
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    Shoulder Tendonitis
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    Back Pain
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    Pregnancy Pain
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    Sports Specific Training

Custom Orthotics and Knee Braces

Four Pines Physical Therapy offers custom molded inserts for your shoe that biomechanically aids in keeping your foot and entire lower extremity functioning properly. They can be used in athletic shoes, winter boots, dress shoes and heels.

They are used not only to treat foot problems, but also ankle, knee, hip, and low back symptoms.  Our physical therapists have been trained and certified in the newest technologies regarding orthotics.   In addition, we have therapists who have been working with orthotics for more than 30 years. Let us help you when your feet touch the ground! 

Four Pines Physical Therapy also provides custom fit Don Joy knee braces for ligament injuries and for osteoarthritis.  If you would like a custom knee brace to support your ACL, PCL or because of severe osteoarthritis in your knee, let the professionals of Four Pines Physical Therapy measure and order a custom knee brace for you. 

“Look Who Else Came For Specialist Physical Therapy At Four Pines PT And Left Feeling More ACTIVE, HEALTHY And HAPPY…In Just A Few Short Weeks”!

Chose which option works best for you

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