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Graston Technique Helps Our PT’s Do Even Better!

More gratitude for the amazing work our Physical Therapists do to get you back to doing what you love! Great job applying the Graston Technique to make this one happy patient, Hana Liebowitz!

Hana Liebowitz 2013

“I began PT at Excel after experiencing shoulder and bicep pain in both arms from my daily workout routine. I had experienced the pain for several months, trying various treatments with little to no success. I was referred to Excel by an acupuncturist I used because his treatments had hit a wall.

Almost instantly I noticed a tremendous result in my bicep from the use of state-of-the-art technology, such as Graston tools, and the treatment plan my therapist, Hana Liebowitz, put me on. She designed a program for my visits and also for use on non-appointment days that allowed me to not only progress, but also supported the workouts and athletic activities I participate in. My range of motion instantly improved and within weeks the pain and discomfort I had felt during every day activities had dissipated. By the end of my 6 weeks I was fully healed and able to do things with my shoulders that I previously could not even consider.

Hana took the time to not only show me what to do, but more importantly explained to me the science behind each movement and how it would repair the damage done. She was a pleasure to work with and I feel I learned a great deal that will help me avoid future injuries. Beyond the therapeutic aspect, Excel was a very comfortable place to do my therapy and the staff and therapists were friendly, engaging and enjoyable to work with.

Hopefully I do not need to return to therapy, but if I do I will absolutely return to Excel. Thank you so much for your time and commitment to my health



Graston and Eccentric Exercises help Achilles Tendon Pain

The Achilles tendon is a thick and springy band of tissue connecting the calf muscle to the heel bone. The calf muscle points the toes, pushes off when you walk or run and gets you up on your tippy toes to reach that high object overhead.  Since it is involved in almost everything we do when standing, it is highly susceptible to injury, especially in athletes who run and jump.

Achilles Tendon Problems

The extent of damage to the tendon will determine the grade level of the injury. Muscle and tendon injuries are referred to as strains.

• Grade I is a minor strain, with damage to just a few fibers. Pain, swelling and stiffness are generally mild to moderate. Functionally, people will report heel or Achilles pain toward the end of an activity that generally subsides quickly after stopping.
• Grade II will be a disruption of more fibers with pain and other symptom levels increasing to more moderate and possibly severe level. Functionally, people will have more pain during the entire activity as well as having difficulty walking.
• Grade III is a complete rupture of the tendon with instant pain and incapacity to bear weight or walk. When it ruptures, a “pop” is felt and often people turn around and ask who hit them from behind.

Repetitive strain or trauma to the Achilles tendon can cause a slow breakdown of the tissue and result in chronic Achilles tendinopathy. This type of injury can usually be treated with physical therapy successfully; however a Grade III injury, or complete tear of the tendon, will usually require surgery followed by physical therapy.
The following factors contribute to the development of Achilles tendon problems:

• Overuse – not allowing the body to recover
• Calf and hamstring muscle tightness
• Absence of proper stretching
• Improper footwear, such as high heels (sorry, ladies!)
• Foot problems, such as fallen arches which can cause over stretching of the muscles and tendons due to the arch of the foot collapsing
• Training errors like stepping up your physical activity level too quickly

If you experience tightness in the calf, heel or Achilles tendon tenderness, swelling around the Achilles tendon, pain and stiffness while walking or going up on your toes, the culprit may be Achilles tendinopathy.

A physical therapist (PT) can help assess the injury through an evaluation and series of tests to establish the severity of the injury as well as determine if there are any strength, flexibility or balance deficits. After a thorough review of your medical history, exercise habits, daily activities and footwear choices the PT will be able to identify additional factors that may be contributing to the condition.

As always, your PT will devise a personal program specifically designed for your needs, ability and degree of your injury. They will work with you on pain management through the use of ice or a brace, help to increase the range of motion through the ankles and knees, address any lower extremity weakness or imbalances found in the evaluation. Manual therapy, which is a hands-on treatment, is specifically directed at the Achilles tendon and calf muscle. Commonly used techniques are Graston and ART. These techniques help to improve range of motion and promote healing in the tendon. Once you attain a satisfactory level of improvement you will also receive functional exercises that are designed to help you get back to the activity you want to do, included in this are eccentric exercises. Finally, a comprehensive home exercise program is developed to maintain mobility, muscle strength and balance of the lower extremities to help to prevent Achilles re-injury. At the appropriate time, a gradual return to activities is undertaken to prevent a re-occurrence of the pain and disability.

If you think you may have injured your Achilles tendon, don’t let it get worse by putting it off. Contact one of our clinics to get your treatment started today.

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A Quick Note of Thanks

It doesn’t take much to show how appreciative our patients can be! A quick note to Jason and Brian at our Cherry Hill Excel clinic. Fantastic job, guys!

“You guys were all so amazing! I am very appreciative of all the staff for your constant encouragement. A special thanks to Jason and Brian – thanks for
the bruises that ultimately allowed me to get back into running! You guys are the best!!
Thank you!



      Jason Bink                                                        Brian Hrynczyn

Jason Bink Jan 2014Brian Hrynczyn Jan 2014

ACL Injuries

ACL Tears

What is the Anterior Cruciate Ligament (ACL)? It’s one the four major ligaments of the knee; connecting the thigh bone (femur) to the shin bone (tibia) and plays a major role in keeping  the knee stable and controlling back and forth motion, especially when cutting and pivoting.

An ACL tear is a very common knee injury, especially in sports. The majority of tears are due to non-contact injuries and women are 4-6 times more likely than men to get an ACL tear*.  When ligaments are injured, it referred to as a “sprain” and is broken down into three grades:

Grade 1: The ACL is marginally stretched, but still is able to help support knee joint.

Grade 2: Also referred to as a “partial tear”, the ligament is stretched to the point it becomes loose.

Grade 3: When the ligament is split in two and the knee becomes unstable it is a “complete tear”.


                                         Healthy ACL                                                                           Torn ACL

                     ACL                                  ACL Tear                            


There are several movements that may result in damage to the ACL, such as:

    • Twisting your knee while keeping your foot planted on the ground
    • Stopping suddenly while running
    • Suddenly shifting your weight from one leg to the other
    • Jumping and landing on an extended (straightened) knee
    • Stretching the knee farther than you should
    • Experiencing a direct hit to the knee*

When the ACL is torn, the most common report by those who are injured is that they felt or heard a “pop.”  There is usually immediate pain and swelling in the knee and further participation in the activity is not possible. If this happens to you, seek medical attention. A physical therapist (PT) has several tests they are able to complete to determine if you have a tear, but it may still be necessary for you to see a sports physician for additional tests.

Unfortunately, very few ACL sprains will heal without surgery. The stresses are too great that a compromised ACL, even a grade one sprain, will notice “giving way” when they attempt to cut or pivot.  Even if surgery is required, having physical therapy beforehand can help improve your outcome. Prior to surgery, your PT can work with you to help reduce swelling, strengthen your thigh and hip muscles and increase the range of motion. For an optimal and smooth recovery, the knee should fully extend before surgery.

 Post-surgical physical therapy will play a very important role in getting you back to your top performance level. Your PT will set up a program specific for you and will be created to rebuild mobility and strength in the knee and the surrounding area; followed by a more functional rehabilitation tailored for your activity or sport. It will take a good six – twelve months to get back to full capacity and you should always check with your PT and doctor for the OK. Indicators that you may be ready to go back to playing include:

    • You no longer have pain and swelling
    • You have no feelings of instability during sport-specific activities, such as cutting, jumping, and landing
    • Your quadriceps strength is 90% of that on your uninjured side
    • Your performance of the 1-legged hop test is at 90% of that on the uninjured side*

Although it may be difficult to completely prevent an ACL tear; proper strength, balance, core and sport-specific training can certainly help to reduce the chance for injury. If you feel you may have a damaged ACL, contact a PT at any one of our 19 locations for a consultation.

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*Move Forward PT – Physical Therapist’s Guide to Anterior Cruciate Ligament (ACL) Tear

Dynamic Stretching

As athletes and active people, we all know the importance of a good warm-up and stretch before engaging in physical activity. But what is the best kind of stretching routine? We’re mostly familiar with static stretching; holding a position for 20-30 seconds while applying light force (without bouncing) to lengthen muscle and connective tissue. However, this type of stretch can actually hinder performance and hasn’t been shown to do much as far as injury prevention. Static stretches are best done at the completion of activity to help lengthen muscles and increase flexibility.

Dynamic stretching proves to be more beneficial when done before your game or workout in combination with a warm-up. These are basically slow-controlled movements; such as arm circles, side lunge stretch or straight-leg kicks, and will help preserve power, improve range of motion and reduce the chance for injury. Dynamic stretches also help raise the muscle’s core temperature and prepare them in a sport-specific way. A program can be tailored to include movements similar to what you will do during your sport or workout. When done on a regular basis proper dynamic stretching can also improve overall flexibility, speed, endurance, power and strength. Please click the photo below for a video showing some dynamic stretches to get you started.

Dynamic Stretching1

Some Love for our Chalfont Clinic

Timothy Brown2Another great success story from a happy patient! Nice job Tim! Gooo Apex!

“On September 9, 2013 I was in a car accident, where I was broadsided by another car, who had run a red light. As time progressed I started to have a great deal of pain from my cervical spine, radiating down my left arm, as well as lower back pain with pain radiating down my left leg.

MRI studies revealed some spinal cord compression and I was referred to physical therapy. Being in the medical field I asked a coworker if they could recommend a physical therapy company that was good and close to home. Apex was referred to me by one of our attending physicians. I am very grateful for his recommendation.

These past few months I have had the fortune to be treated in your Chalfont clinic by Tim Brown, PT, DPT.

Tim is very professional (but not overdone!), and knowledgeable. From one medical professional to another, I have to say, Tim never ceased to impress me. He always knew how far to push me without overdoing it, in spite of my incessant whining and reminding him of my advanced age. I can honestly sat I saw measurable progress with each challenge.

When I first came to Apex I was very uncomfortable and in a great deal of pain. Tim worked his magic and my pain levels improved dramatically. I am aware that I will probably always have some discomfort, but I have plans to go resume my activity level to my optimum if Spring ever arrives, as planned.

The entire team at Apex, Chalfont were friendly and warm. I would not hesitate to ever make a recommendation to use Apex for their physical therapy needs.