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Fix Your Lower Back Pain by Strengthening the Gluteus Medius Muscle

  • stand up desk can solve frequent back problems miami boca raton

If you get frequent lower back pain that is not an underlying disease, the issue is likely due to a weak Gluteus Medius Muscle.

The Gluteus Medius is one of the three gluteus (butt) muscles that play a role in stabilizing the hips. The other two areas being the Gluteus Maximus and the Gluteus Minimus. The Medius muscle begins on the outer surface of the Illium, the hip bone, and attaches to the greater trochanter of the femur (a bony landmark at the top/outer side of the thigh bone). Its fibers run in a superior/inferior direction anchoring the pelvis to the femur. 

This matters the most when we remember that the spine rests upon the sacrum, a portion of the pelvis, specifically at the L5-S1 junction. Providing a foundation for the vertebral column can help in reducing back pain that is felt from prolonged standing and/or walking. Instability of the vertebrae can result in disproportionate compression of an intervertebral disc, causing nerve irritation prevalent in low back pain. 

More often than not, a patient will walk through our doors with reports of low back pain, and after some investigative work, we’ll learn that their job requires daily long hours of sitting. Jeong et. al1 demonstrate that the Gluteus Medius provides that stability to the pelvis when our body needs it. However, after sitting in a chair for many hours every day, these muscles will atrophy and no longer perform their designated job for months. This can result in vertebral instability, as mentioned above or worse, to leave a person susceptible to graver spinal cord injury when dealing with bigger movements such as deadlifting or squatting. 

How to Strengthen the Gluteus Medius Muscle

This article aims not to scare you from performing these movements; it is more the opposite. One of our strongest recommendations to those experiencing low back pain is to purchase a standing desk, which now creates a need yet again for those Gluteus muscles to stabilize the hip. We also frequently recommend performing exercises that target the Gluteus Medius, such as clamshells, bridges, sidestepping, side planks, as safe movements that re-introduce the patient to healthy activity while developing the musculature around the hip. 

To conclude, when treating low back pain, often a Physical Therapist elects to focus on establishing “core” strength by concentrating on the Transverse Abdominis and Abdominal Oblique muscles. Choosing to develop the Gluteus Medius is an alternative approach that many patients have experienced more relief than core work. If you’re someone who has no pain but is apprehensive about lifting, or if you are currently experiencing low back pain, the Gluteus Medius is a solid place to start. [1]

  [1] Jeong UC, Sim JH, Kim CY, Hwang-Bo G, Nam CW. The effects of gluteus muscle strengthening exercise and lumbar stabilization exercise on lumbar muscle strength and balance in chronic low back pain patients. J Phys Ther Sci. 2015;27(12):3813-3816. doi:10.1589/jpts.27.3813


Thoracic Spine High-Velocity Low Amplitude Technique

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Learn How the Thoracic Spine High-Velocity, Low Amplitude Technique can help those suffering from neck pain, cervicogenic headaches, and shoulder pain

Thoracic spine high velocity, low amplitude technique (HVLAT) is proven to benefit those presenting with primary complaints of neck pain, cervicogenic headaches, and shoulder pain.

A study by Cleland 2020 demonstrated that those who received thoracic spine manipulation exhibited a reduction in pain at 1 week and improvements in disability at 1 week, 4 weeks, and 6 months; thus it was concluded by the author that those patients with neck pain and no contraindications to manipulation shoulder receive thoracic spine manipulation regardless of clinical presentation.

In another study, it was concluded that 6-8 sessions of upper cervical and upper thoracic manipulation were shown to be more effective than mobilization, and exercise in patients with cervicogenic headaches and effects were maintained at 3 months. Lastly, in a study conducted by Dunning et al 2015, patients with shoulder pain who received upper thoracic HVLA thrust manipulations showed significant reductions in pain and disability and improvement in perceived level of recovery.

For more information on the thoracic spine high velocity, low amplitude technique, and to schedule, a consultation contacts us today.

Fox Physical Therapy Teladoc Services

Fox Physical Therapy Teladoc Services

Fox Physical Therapy Now Serving Patients in Miami and Boca Raton Through Teladoc-Telerehabilitation

We are currently keeping our doors open, and have launched our teladoc-telerehabilitation program to allow patients to continue their care without coming into the office. We understand how important it is to receive treatment and we have created the ability for therapists and patients to interact.

How to Schedule Physical Therapy Telreab

You have the option to speak on the phone or over a phone app called Simple Practice. Our program is HIPPA compliant and will be a video conference call with a therapist. We accept all major insurance carriers and now most insurance companies are now covering teladoc-telerehabilitation.  We can put you will be seen by a doctor one on one.

If you are interested in telehealth please call our main office 305-735-8901, and we can get you scheduled.

What is Fox Physical Therapy doing to prevent transmission of the Coronavirus?

As a health care company, we feel it is our duty to take part in helping to reduce the spread of the virus. We also understand that some patients really need treatment right now, especially if you had recent surgery, accident, or otherwise that is severely impacting your ability to function. As such, we will remain open to ensure patients get the care they need. We want to let you know that we are doing everything in our power to provide a clean and safe environment for our patients. This includes all staff washing hands in between patients, wearing gloves, masks if available, and constant cleaning of all surfaces with a disinfectant that kills coronaviruses. We will also be following the guidelines in regard to social distancing and ensuring that patients maintain a reasonable distance from others.

What can You do to help prevent the spread of Coronavirus?

If you are a patient of Fox Physical Therapy and you feel any symptoms, PLEASE do not come in for therapy. According to the World Health Organization, the three most common symptoms are fever, dry cough, and fatigue. Shortness of breath is an additional symptom that may indicate a more difficult situation. Take a look at the symptoms chart below for further detail. Current guidelines state that if you are feeling symptomatic, then please engage in a self-quarantine and contact your medical provider from your home.

How to Treat Frozen Shoulder

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Frozen shoulder: An interventional approach to improving functional mobility.

By Dr. Tyson Young, PT, DPT, CSCS

Frozen shoulder, also known as adhesive capsulitis, is a condition that affects the shoulder in which it becomes painful and stiff due to the shrinking of the surrounding capsule. This condition may occur following an injury to the shoulder, including the rotator cuff capsule, or labrum. However, it may also come about insidiously. Frozen shoulder is linked to conditions such as diabetes and thyroid disease. This condition typically occurs in three stages: freezing, frozen, and thawing, and can take up to 18 months to reach full recovery. Patients can have difficulty performing everyday tasks that require reaching with the affected upper extremity, including, but not limited to, reaching into overhead cabinets, washing their back, fastening a bra strap, washing their hair, etc. This condition affects roughly 2-5% of the population. However, I have had the opportunity to work with several of these patients recently and would like to describe my treatment approaches to restore functional mobility.

Step 1: Passive Mobility

 Any time the goal set forth is to increase mobility, it is essential to keep in mind that there are several variables to consider. Real tissue change takes extreme dedication, and I tell my patients it takes months of intense and frequent repetitions to achieve this change. Most immediate change occurs due to neurophysiological relaxation. For example, I am performing a hamstring stretch on a patient, and the first repetition is held for 30 seconds, and then returned to the starting position. When I attempt to perform this stretch for the second repetition, often, the leg can move into a further range of motion. The muscle has not increased its overall length within this time frame, but instead, the muscle has relaxed due to the nervous system response. This is strictly a short-term response. However, we can utilize this to our benefit if performed correctly. I begin my mobility work with passive interventions to decrease pain and to guard, as well as promote increased joint and soft tissue mobility via the aforementioned neurophysiological relaxations. Typical responses include joint mobilizations, soft tissue mobilization, active release technique, passive range of motion, stretching, and foam rolling. 

Step 2: Active Mobility

After any passive intervention has increased the patient’s ROM, it is crucial to follow this with active mobility exercises in which the patient moves actively into the end range. This allows us to re-educate the nervous system to fire into the newly acquired range of motion. I like to describe this process with the following example. Performing passive interventions in isolation are like typing the perfect essay and exiting off of your work without saving. However, active mobility is essentially saving the progress made. Interventions that I employ for active movement include a dynamic range of motion, controlled articular rotations (CARS), progressive angular isometric loading (PAILS), and regressive angular isometric loading (RAILS).

 Step 3: Load 

The final step in my mobility sequence includes loading the tissues. There are several ways this can be done, including resistance training. However, the approach that I utilize with the highest frequency includes eccentrics. This is the phase of a muscle contraction in which the muscle is lengthening. Eccentrics have been repeatedly shown in the literature to create true tissue-level changes in flexibility.

Utilizing this sequential progression, I have had great success with my patients, and have seen much quicker functional gains than the previously mentioned 18 months. A frequent question that I am asked is, “how often should I perform my mobility exercises?” and my response is as often as possible but at a minimum one time/daily. However, with any intervention given to the pathological population, it is essential to monitor response and consistently re-assess. One rule of thumb that I give my patients is to expect some discomfort when performing mobility exercises. However, there should not be immense amounts of pain. It is crucial to have an understanding of pain vs. strain; when pushed too far, we can initiate an inflammatory response. Following any mobility work, it is vital that symptoms return to baseline values at a relatively quick rate, and should return within 24 hours. Should the symptoms last longer than this, an immediate re-assessment should occur from a medical provider.

References:

J Orthop Sports Phys Ther 2013;43(5):351. doi:10.2519/jospt.2013.0503

Debunking Myths behind the Deadlift

how to dead lift properly miami boca raton florida

Research shows that doing proper deadlifts DO NOT lead to lower back injuries.

We have all heard the saying that performing deadlifts is the worst thing you can do for your lower back, or you may know people who have horror stories about deadlifting and how it causes your discs to herniate immediately. This statement is not only an extremely outdated way of thinking but more dangerously, it feeds into the rhetoric that the human body is some weak and fragile thing that can break down at any second. Most exercise (whether performed in the gym or a physical therapy clinic) when performed incorrectly or when inappropriately loaded can lead to a potentially devastating injury. Taking that into consideration, the physical therapy community needs to stop shunning the deadlift as the culprit causing lower back pain and transition to using this movement (hip hinging) as a way to relieve pain and restore function.

What does the research say about deadlifting?

You should never blindly believe something just because it is on the internet, so let us provide you with facts supported by research. (Welch et al 2015.) Published a research study looking at the effects of a four-month free weight resistance training routine on patients with chronic low back pain incorporating deadlifts, squats, and step-ups. Their findings showed statistically significant improvements in fatty infiltrate of the lumbar muscles, a 72% decrease in pain scoring, 76% improves in disability measurements, and increases in quality of life assessments. Another study, Asa 2015, took patients with chronic low back pain. It had one group do deadlift training while the other group did low load exercises to target specific impairments, and both groups saw significant decreases in pain intensity as well as increases in strength and muscle endurance measurements.

The Nachemson Chart, which is a measure of intradiscal pressure (pressure on spinal discs) in response to compressive load, shows that prolonged sitting in a slouched position places almost as much compressive load as a deadlift. However, directly sitting leads us to stop activating our glutes due to constant compression on the soft tissue and reciprocal inhibition of the hip flexors. A proper deadlift builds posterior chain strength, core stability, and allows us to train our glutes to reduce strain on our spine with daily activities.

Overall, the main reason I am an advocate for deadlift training is that it can teach the patients a fundamental movement pattern; a proper hip-hinge (getting our hips to move without our low back flexing or rounding). One of the most important things to address when teaching a proper hip-hinge is the ability of your abdominal musculature to maintain a neutral spine (aka core stability). Educating our patients on how to deadlift incorporates lumbopelvic dissociation, core stability, and glute strengthening, and all 3 of these factors are all essential to any proper treatment of the low back.

Who can perform deadlifts?

I am not advising that a 65-year-old osteoporotic person should be performing deadlifts on day one of physical therapy evaluation. However, with proper treatment, education, and guidance, even this patient should eventually be able to complete an appropriate hip hinge. There are parameters for when a person is ready to begin deadlifting under load, such as patients with lower intensity of the pain (<60mm on the pain VAS) and with better lumbar spine endurance (>60 seconds on the Biering-Sorensen Test). A properly trained physical therapist can help a patient with low back pain progress towards doing deadlifts. The physical therapist should be a biomechanics and movement analysis expert and be able to discern which lower back patients would benefit from deadlift training (a vast majority in my opinion).

As a physical therapist myself, I can personally vouch for deadlifts in terms of treating LBP. I suffered a weight lifting injury in 2018 and was experiencing horrible low back pain and shooting pain down my left leg whenever I tried to get into/ out of my car, put on my shoes/ socks, and sit down for prolonged periods. After reducing my pain levels, my home exercises incorporated a lot of hip hinge training, core stabilization, and glute activation for me to properly learn how to deadlift. With time, patience, and progressively loading my spine via deadlifts and squats, I am now completely pain-free and without question much stronger than I was before my injury.

In conclusion, I think it is time to put to bed the stigma behind that deadlifting (especially heavy weight) is dangerous and should never be done in therapy. On the contrary, I think with proper coaching and progression, this exercise is one that will help strengthen your lower back and reduce the risk of future injury.

Contact us today to schedule a free consultation.

My (insert body part) cracks every time I… Is that bad?

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Does your body often make craking, popping, clicking, grinding noises when you move?

By: Dr. Ashley O’Rourke

This is one of the most frequently asked questions I get on a day-to-day basis. A patient will be on the table and say to me “my shoulder cracks every time I raise my arm…is that bad?” or “I feel a click in my knee every time I extend it…how do I get it to stop?”. The reality is that there are many explanations for these sounds- most of which are often entirely harmless if not accompanied by pain. There are, however, some cases in which the sounds should be addressed with the general rule of thumb being: any of these sounds occurring in a joint that is not accompanied by pain are typically nothing to worry about.

Let’s Differentiate the Noises:

Popping: all joints are surrounded by synovial fluid. Think of this as your body’s natural oil. It lubricates the joints to decrease friction between the surfaces. Changes are pressure- which can occur with movement- can cause gas bubbles to form within the fluid. When these bubbles implode or “pop” the sound associated with “cracking your knuckles” is produced. To physical therapists and chiropractors, this sound is known as a “cavitation”. They are painless, do not cause damage, and often even relieve symptoms (at least temporarily). It takes time for this gas to build back up, which is why you cannot repeatedly crack the same joint over and over and over again. While one should not be worried about cracking their knuckles from time to time, repeated attempts over a short period of time should be avoided as this can eventually cause changes in the joint capsule or train the brain into thinking they “need” to perform this activity over and over again (forming a habit) when in fact it is not necessary.

That being said, a “popping” sound coming from the lower leg that occurs after landing from a jump shot while playing basketball or in the knee after cutting/pivoting on the soccer field could indicate serious injury such as an Achilles rupture or ACL tear- both of which would most often be heard/felt in conjunction with pain.

Snapping: There are other sounds that are not serious, but over time could lead to chronic injury. An example of this could be snapping in the outside of the knee. In the beginning, this snapping sensation may be quite annoying, but not cause any pain. It is by no means an emergency, however, with repetitive motion and frequent activity this friction that occurs as the connective tissue (iliotibial band) rubs against and snaps over the thigh bone can cause inflammation and irritation of the tissue leading eventually to pain. Similarly, people can experience a like feeling in the hip known as the “snapping hip phenomenon.” This can be due to tightness in the muscles/tendons rubbing over the bone.

Clicking: this sound can sometimes be problematic if it is a result of connective tissue abnormalities such as a torn meniscus in the knee or torn labrum in the shoulder/hip. These would both be typically associated with pain. Additionally, sometimes a clicking sensation can be felt in the knee cap which can indicative of a tracking issue where the knee cap does not stay perfectly in the groove that it is meant to stay in. While this may not cause additional symptoms in the short term, it too could cause pain in the long term like patellofemoral pain syndrome (PFPS) or generalized knee pain caused by muscular imbalances that lead to abnormal stresses to be placed upon the knee.

Shift/Clunk: This sound/sensation can be a little more concerning and indicative of instability or laxity in the joint leading to subluxation or full dislocation. People with joints that are “too loose” may experience clunking when the two joint surfaces rub together. Seeking treatment would be indicated to work on the stability of the joint through strengthening the tissue around it in order to prevent dislocations that could result in tissue damage such as torn ligaments/joint capsule damage etc.

Grinding: This type of sound is most often associated with general degeneration of cartilage within a joint, such as osteoarthritis, and occurs when there is bone on bone contact. This sound may increase over time as it is normal for joint surfaces to change with age.

Other Noises: sometimes a painful or non-painful “pop” can be heard during manual therapy- perhaps while a PT is moving a knee after surgery. This sound can be indicative of the breaking up of scar tissue and may be beneficial if it leads to improved mobility.

Free Consultation

If you are uncertain whether you are experiencing a normal joint sound or something problematic, let the qualified doctors at Fox Physical Therapy assess the tissue to determine whether intervention is warranted. Give us a call today for a free consultation.

Kinesiotape Helping Athletes in Miami Recover Faster

Learn How Kinesiotape Helps Athletes to Recover Faster

By: Tim Alemi

Kinesiotape is a type of elastic taping technique that has increasingly become more popular since the widespread use by Olympic athletes during the 2008 Summer Olympics. Now, it is common to see professional athletes, cross-fit enthusiasts, weekend warriors, and general population patients wearing brightly colored kinesiotape for both function and fashion. The application of kinesiotape technique is designed to help enhance the body’s healing process, improve stability, and decrease stress load on tissues. It is similar to a brace in that it may provide support to the surrounding structures to decrease the load of impact activities, also, the tape does not restrict the range of motion like a brace typically would. According to RockTape which is a different brand of tape, pathologies commonly treated with tape include achilles tendonitis, plantar fasciitis, jumpers knee (PFS), ACL/MCL issues, rotator cuff injuries, groin and hamstring pulls, lower back issues, shin splints, tennis and golf elbow, pain associated with pregnancy, postural corrections, and skin abrasion protection.

Taping can be used for various reasons, and depending on the application it may have several different proposed benefits. According to RockTape, it is able to decrease the sensation of pain by raising the threshold required for nerve fibers to send an impulse to the brain4. Also, it can decompress an area of swelling, bruising, or inflammation by lifting the skin away from underlying tissues resulting in vasodilation. It is widely proposed that tape can normalize tone by activating or inhibiting appropriate corresponding musculature; as well as support tissues by absorbing and properly distributing stress forces. Patients often prefer this method of treatment because of ease of application, comfort, convenience, and longer wear times (2-7 days) with decreased pain and no loss of range of motion2.

Further research needs to be assessed to make an appropriate determination on the effectiveness of kinesiotape versus alternative taping techniques. However, experts suggest that the application of kinesiotape may provide the immediate short-term reduction in pain2. There is limited moderate level evidence that suggests kinesiotape is no more effective than sham tape or other modalities, but it is difficult to make any definitive conclusions due to a limited number of RCTs included in reviews2, 3. This does not mean that kinesiotape is ineffective, but it does suggest that it may not be more effective than other alternatives. However, kinesiotape is beneficial compared to other modalities because it may provide a safe and immediate reduction in pain for short periods of time2.

Testimonial:
“ I had shoulder instability that would not allow me to workout. The taping helped support my arm while I did my stability exercises until I was able to gain enough strength from the physical therapy”
— Sandra S.

For More Info

Contact us today and schedule a complimentary consultation for Kinesiotape taping at 305-735-8901 or click here.

Why You Want Instrument-Assisted Soft Tissue Mobilization Therapy

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Heal Faster With Instrument-Assisted Soft Tissue Mobilization Therapy

By: Tim Alemi – Fox Physical Therapy

Patients experiencing soft-tissue dysfunction such as the formation of scar tissue, trigger points, or sprains/strains are often treated with manual therapy techniques such as Instrument-Assisted Soft Tissue Mobilization (IASTM), manual soft-tissue mobilization, or many other types of massage techniques. These techniques are used to help stimulate the healing response, promote correct realignment of collagen fibers, and decrease pain. Instrument-Assisted Soft Tissue Mobilization is a manual therapy technique that utilizes specifically designed concave/convex tools to identify and breakdown myofascial restrictions, soft tissue fibrosis, scar tissue adhesions, and chronic inflammation, which should result in improved outcomes for both the patient and the physical therapist when compared to other manual therapy techniques. The shape of the tools allow for ease of use, swift and comfortable adjustment to contours of the body, minimal stress on the PT’s hands, and maximal penetration into soft tissue.

Patients that are typically treated with IASTM include those diagnosed with soft-tissue dysfunctions such as tendinopathies, ligament sprains, muscular strains, and scar tissue adhesions. Further examples of common injuries treated with this technique include Achilles tendinitis, plantar fasciitis, IT band syndrome, medial and lateral epicondylitis, cervical/lumbar sprains/strains, patellofemoral disorders, rotator cuff tendinosis, shin splints, and carpal tunnel syndrome. Further research needs to be completed to appropriately determine which pathologies are most effectively treated with IASTM.

The proposed mechanism of IASTM utilizes controlled microtrauma resulting in increased fibroblast production to the treatment area, stimulating an inflammatory response triggering the healing process of affected tissues. Also, this technique is believed to increase blood flow to the area, as well as facilitate the breakdown of cross-link adhesions found in collagen fibers of myofascial soft tissues and scar tissue. However, perhaps the greatest proposed advantages of IASTM is that the tool helps to protect the PT’s hands from injury, and provide the clinician with greater palpation skill to specifically identify an area that needs to be treated.

Although further research needs to be completed to determine if IASTM is truly any more beneficial than other manual therapy techniques, much of the evidence supports IASTM as an effective treatment to determine. Burke et al proposed that the primary benefit of IASTM over other manual therapy techniques may only be the decreased stress on the hands of the physical therapist2. However, according to Loghmani et al, injured ligaments treated with instrument-assisted soft tissue mobilization were “43% stronger, 40% stiffer, and 57% more able to absorb energy” than the untreated contralateral injured side3.

The jury is still out if this is a more effective treatment than traditional manual therapy, IASTM continues to make a strong case to be greatly beneficial for both the patient and the clinician. In our clinic, we have seen great results with patients that have soft tissue restrictions. Within one treatment session patients are able to move better after use of IASTM. Some common areas we see great results with are low back, knee, neck, and ankle.

For more information on IASTM Therapy and to schedule your free consultation contact us at 305-735-8901 or click here.

AlterG® Anti-Gravity Treadmill®

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Get Faster and Safer Results with the AlterG Anti-Gravity Treadmill

Fox Physical Therapy in Miami, Florida is proud to announced the arrival of our newest rehabilitation technology, the AlterG Anti-Gravity Treadmill, the world’s first and only treadmill using NASA based anti-gravity technology, has been installed to help patients in their short-term rehabilitation programs.

The AlterG treadmill will be a huge asset to our facility and our patients will benefit the most. Patient’s recovering from all lower extremity injuries, surgeries, and back pain will get relief with the Alter-G treadmill.

AlterG Anti-Gravity Treadmills enable faster rehabilitation, safer conditioning for the geriatric population, and weight loss, which can help remove major obstacles associated with these activities. Impact on the body and the pain of recovery are reduced, which helps people achieve better results. Patients at Fox Physical Therapy can now rehab better, train smarter, and exercise safer with the AlterG.

With the AlterG, patients can run and walk without bearing their entire weight, reducing the impact on the body to optimize rehabilitation and physical therapy outcomes. Its Differential Air Pressure (DAP) technology applies a lifting force to the body that reduces weight on the lower extremities and allows precise unweighting – up to 80% of a person’s body weight, so people can find exactly where the pain stops and natural movement feels good again.

There are a multitude of benefits when training and rehabilitating on the AlterG. Patients can use the AlterG Anti-Gravity Treadmill to recover from injury and surgery and it allows them to immediately do partial weight bearing exercises. Patients with neurological disorders maintain, and in some cases even regain functionality and mobility working with the AlterG. It is also used as a motivational tool for obese patients, as users can immediately experience what it would feel like to weigh less, exercise with less joint impact and stress, and improve their cardiovascular health.

“With AlterG you get all the gain, without the pain,” says Steve Basta, CEO of AlterG. Adopted initially by nationally renowned hospitals and rehabilitation facilities, most recently nursing facilities are seeing the benefits the AlterG can provide for their patients. “We are pleased that Fox Physical Therapy is one of those pioneers,” he said. “Our unique approach to unweighted physical therapy preserves natural body movement, helps with fall prevention and benefits a broad range of medical conditions.”

AlterG Anti-Gravity Treadmills are designed to be used for lower body injury and surgery rehabilitation, aerobic conditioning, weight control and reduction, sport specific conditioning programs, neurologic retraining, and geriatric strength and conditioning.

Contact us today to schedule a consultation with Dr. Fox and learn if the AlterG Anti-Gravity Treadmill is right for your rehab. Call 305-735-8901 or click here.