A really friendly, energetic middle aged lady recently was at Peak Performance PT for her Low Back Pain and Radiating Leg Pain.  We’ll call her Suzanna for the sake of our story.  This is kind of like the old Mission Impossible where the recording would self destruct seconds after playing.  Our HIPPA laws require confidentiality so rather than inventing a space age Memory Zapper that would pop out of this email to erase her actual name from your memory, it’s easier to just go the fictitious route. 

I wanted to share Suzanna’s story with you because it’s a really common mindset out there that I think I can help you better understand.   Suzanna had been going to the Health Club for years, doing classes along with weight machines and cardio machines.  She felt pretty fit and really didn’t have any complaints. 

But then her bubble burst and about two months ago she developed not only Low Back Pain but she was also getting radiating symptoms into both hips and thighs.  That really stinks.  The back pain is something many of us are familiar with.  In fact, studies suggest that humans are 80% likely to have at least one episode of significant Low Back Pain in their life – to such an extent that it limits function.

Suzanna’s pains into the hips and thighs were a different thing though.  That was a bit of a wake up call to know this wasn’t just some tiny little back pain episode that could be ignored.  It’s especially hard for someone like her who enjoyed going to the club and being active so much.  It was really cramping her style.

Recently during a treatment when I was sharing with her some of the shortcomings I’d found on testing, she said something to the effect of “But I was just healthy a month ago….I was fine.  I was working out three days a week.  How could I have all these issues when I exercised so much?”

BINGO!  That was the Million Dollar Question. 

She was flabbergasted.  Maybe she was thinking  that she put in all that time yet was being told her body wasn’t quite the Picture of Health ….that it wasn’t that idealistic example of what dedication and consistent hard work could result in.   Maybe even in the back of her mind imagining her Health Club grown fitness served as a shining example to her peers of how good middle aged bodies could look and feel with a little work.  Nope!  Reality had set in and she was not a happy camper.  She was frustrated, disappointed and then throw in a little confusion!

I can shed a little light on this for you and that day I explained the same thing to Suzanna.  You see, when you do rhythmic activities like running or the elliptical machine, complex activities such as actual sports that require timing and reaction and especially contain significant components out of your control, or when you’re using both limbs (ie. both hands or both legs) simultaneously your body will do whatever it can to accomplish the end goal. 

Whatever you “bring to the table” you will use.  If you’ve got a little left sided hamstring tightness you’ll still run on that treadmill.  Your body just adapts and cheats – or a nicer word to use is “compensates” around that tight hamstring.  It doesn’t usually stop you from actually running, but it also isn’t the case that the exercise – the running in this case – will actually stretch out that tight left hamstring. 

The same is true for an Aerobics or Boot Camp class, playing soccer or baseball or golf, being active in the yard at home, or having a physically demanding job.  All those things are great activities to challenge your body and contribute to overall fitness.  Your body will do whatever it takes to do what you tell it to do. 

So Suzanna, all the while she was enjoying and relatively succeeding in all of her fitness endeavors, nevertheless, had a number of important limitations that little by little were adding up to eventually overstress her tissues….and, in the end, result in pain and inflammation that led her to seek out help.

I’m glad she came in for Physical Therapy.  The Evaluation picked up some areas she needed to work on and she’s improving now that she’s doing exercises CUSTOMIZED for her own unique needs.  I reminded her that it was critical that she specifically addressed the areas I found deficient because the generic exercises she’d been performing at the Health Club, things that were total body in nature and often rhythmic or alternating in nature, were just never going to help undo the asymmetries and imbalances she had. 

Suzanna asked “Well how is anyone ever supposed to know these things are wrong with them?  Who is going to find and fix these issues?”  That’s where we step in as Physical Therapists.  PT’s are uniquely trained in musculoskeletal evaluation and the non-operative management of those things that ail you.  The Functional Biomechanics training that Mike Golisano, Karen Napierala, and myself have gone through helps us even more to be prepared to evaluate your Function and figure out the best ways to quickly get your body working the way you hope it can. 

So remember – you can’t fix asymmetric physical deficiencies with bilateral or generic exercises!

Peak Performance Physical Therapy first opened its doors on January 17, 2005 and since that time we have helped over 3200 local patients with their Physical Therapy needs! 

We would like to thank each and every one of you for placing your trust in us with not only your own rehabilitation but for having the faith and confidence in our work to refer your friends and family to Peak Performance as well.

It has been a blessing to help so many people in the Rochester area recover from simple overuse injuries to post-operative care and everything in between.

We look forward to many more years of helping you, your friends, your family and our community members get back to their Peak Performance!

I asked her lots of probing questions, trying to piece together the details of how she’d gotten herself into trouble.  Pam ended up being really insightful as she reflected on her answers. 

I figured Pam’s introspective discovery would ring true and be helpful to many of you out there, or to family or friends you pass this on to.

In Physical Therapy we so often have to deal with fluctuating symptoms that a patient offers.  These changes from session to session – from day to day or week to week, can be a real source of confusion and oftentimes can lead you as a patient to poor decision making. 

Pam had been seeing some really encouraging progress since coming to Peak Performance PT for her hip.  It had actually been a problem for years and she’d had PT before but it mostly entailed typical standardized “hip PT exercises” that one might expect. 

Her Physical Therapy Evaluation I performed ended up revealing some important specific issues that I felt would benefit from manual therapy techniques (hands on methods of promoting motion in the joints and/or connective tissues) along with some customized functional exercises (a weight bearing joint like the hip really appreciates exercises that look and smell like the “function” they do each and every day  -  vs. a generic “give the same exercises to everyone” list of lying down or sitting exercises with the foot off the ground).

Pam was feeling so good that one day over this past weekend she decided to spend a few more consecutive hours working than she had the prior weeks/months.  It didn’t seem to her an impressive amount of work compared to “what she used to do” when she was healthy.  (Does that sound familiar to any of you out there……”But I used to …” or “That’s nothing compared to ….”?)

Pam made a common fatal mistake – some of you have done, or maybe even right now are doing the same:  a good few hours or days = “I’m better” or the opposite a few bad hours or days = “I’m worse.”  But are you really sure you’re actual condition is “better” or “worse” – or are you just having a few good or bad hours/days?

Your answer to that question is critical!

Pam’s joy over feeling better lead her to recall years ago when hours of continuous work at her computer was no problem at all, and then  mistakenly think her body was right back there too – in a healthier and prepared state, ready for hours of uninterrupted stresses. 

Well, unfortunately Pam’s hip quickly reminded her a few hours later that her leap from the sense of “feeling better a few days” to literally being considerably better was a mistake.  She needed more time of extended “better” days to add up to actually being able to increase her work by 200-300%. 

Pam offered a great insight as to how that happened to her.  Think about this a bit – it may resonate with you some.

She shared that “When you’re having bad days you feel like they’ll go on forever” and that it causes so much worry and concern and hopelessness.  You get tired of always having to modify your activity, your work, your recreation. 

What she said next was really interesting – I guess I never thought of it this way….she said “When you have good days you tend to not think they’re going to stay for long” and feeling that way makes you want to do what you can while you have the chance.

Are you feeling the hopelessness of pain or limitations that are holding you back from your normal activities?  Have you had to cut back on your work activities?  On your fitness activities?  On your recreation, your fun? 

You can really dig a big hole for yourself when you experience a few good hours or days and make the leap to thinking you’re all better and ready to roll.  The opposite mistake is thinking that a few bad hours or days mean you’ve slipped backwards and the injury is literally worse.  Keeping perspective can be really tough can’t it?

At Peak Performance PT we are dedicated to providing our patients with a thorough evaluation and designing a custom treatment program to help you get back on track.  Every single day I find myself helping to remind patients to keep perspective on the fluctuations they might have in symptoms.  You have to balance the attention to detail of those changes with a “big picture” sort of view – so you don’t make poor decisions that get you in more trouble down the road. 

Pam hit the nail on the head for many of you…the frustrations and hopelessness over symptoms that are so slow to change can lead to a sort of time-sensitive pressure to “enjoy it while you can” when you do have a lack of pain. 

Give us a call if we can help you or your friends and family with their injury or surgery. 

And thanks “Pam” for that little bit of wisdom!

We thank Robert for his years of service and for contributing to our successes, and really also for helping you be successful.

He has helped tremendously by sharing with each of you what is going on at Peak Performance, developing and working our Annual Coat Drive to donate to our area youth and adults for their winter needs, and providing valuable tips and reminders through the excellent website and newsletters he is responsible for.

He has helped some of you with insurance or billing questions and explaining the ever-changing process known as health insurance coverage when confusions arose.

We believe that each of our staff plays an important part in your recovery, not just your actual Physical Therapist.  

We couldn’t provide you the quality care we work towards without the diligent and caring efforts of each of our staff. 

So please join us in thanking Robert for his work and wishing Robert the best in his new endeavors.

The Peak Performance PT staff remain excited about our future.

We continue to see an increasing base of referring physicians and surgeons but especially have seen a growing number of  word of mouth referrals from prior patients like yourself.

So many of you have also offered your heartfelt and sincere words of thanks and success stories as well.

Thank you – I know that your words of encouragement and successes have been uplifting to prospective patients searching our website for information about Peak Performance.

We look forward to serving you and your family and friends in 2012!

Mike Napierala

Owner, Peak Performance PT

You can leave a message for Robert at the bottom of this post if you would like to do so.

Image: Rawich / FreeDigitalPhotos.net

If you have fallen previously, you may be feeling nervous, anxious, or even helpless about moving around in your home, or in new environments. 

We at Peak Performance PT want to make sure that you are able to do the activities you desire. 

Here is something you can do TODAY to “fall- proof” your home! (See prior posts on medical checks, and assessing your risk for falling.) 

Remember, this is only one starting point.  You still have your physicians check, and exercise which will be the next and final Fall Prevention Program.  

Let’s go through your home room by room…..

FLOORS:  Be sure to look in each room.

-  Ask someone to move the furniture so that you have a clear path from room to room.

-  You can either remove throw rugs, use double sided tape to hold them down or make sure they have a non-slip backing so they don’t slide around or bunch up.

-  Always keep objects like magazines, shoes, or towels off of the floor.  If it is difficult to do so, there are a wide variety of “reachers” available at local stores (i.e. Debbie’s Supply in East Rochester), or on-line, that will allow you to reach high or low places to pick up light weight objects without getting into a position that puts you off balance.

-  Coil up or tape cords and wires next to the wall so that you do not walk over or trip on them.

STEPS AND STAIRS:

-  Always keep stairs free from ANY objects.

-  Fix loose or uneven steps.

-  Have an electrician, or family member put in a light at the top AND bottom of the stairs!  Both top AND bottom should have light switches.  If they can get light switches that glow, that is even better.

-  If you have a light that is burned out, ask a friend or family member to change it.

-  You should make sure your carpet is firmly attached to EVERY step, or remove the carpet and apply non-slip rubber treads instead.

-  Place a bright colored strip of tape at the top and bottom of the last stair, especially in stairwells to the basement, or garage, where it may be difficult to see.

-  Fix or attach handrails to both sides of the stairwell.  They should run the entire length of the stairs, and be able to hold your body weight if you were to slip and grab a hold of them for support.

KITCHEN:

-  Rearrange your cupboards to have the things you use most on the middle shelves.  Waist to shoulder level shelves will be the easiest to reach.

-  If you must use a step stool, get one with a bar to hold onto. It is MUCH steadier than a chair!

BATHROOMS:

-  Put a non-slip rubber mat, or self stick strips on the tub or shower floor.

-  Have a carpenter or handyman (or woman), attach grab bars inside the tub/shower stall, and next to the toilet if necessary.

-  Consider a night light in the bathroom, and/or a non-skid shower chair.

-  Avoid pulling yourself up by the sink.  They are often not secured to the wall well enough to support your weight.

-  Consider a hand held shower head if you need to sit in your shower.

BEDROOMS:

-  Place a lamp close enough to reach while you are in bed. 

-  Keep a flashlight nearby your bed also.

-  Clear a path from the bed to the bathroom.  It should be lit by at least a night-light, preferably one that goes on automatically when it gets dark.

-  Keep emergency contact numbers in large print near each phone.

LIVING ROOMS:

 -  Avoid sitting in low furniture or chairs with no arms, as these are difficult to get out of. Remember, you should always be able to touch your feet on the floor when seated.  If not, try a pillow behind you. Use chairs that are firmer, and have arm rests.

GENERAL:

-  Wipe up ALL spills immediately.

-  Change the batteries in your smoke detectors when changing your clocks for daylight savings time.  If it is too high, ask for assistance.

We just concluded our second annual coat drive for kids in honor of National Physical Therapy Month.

We set our goal this year at 70 Coats, Hats, Gloves and Scarves…here is what you helped donate:

• 57 Coats
• 14 Scarves
• 12 Hats
• 11 Pairs of Gloves

That’s a total of 94 items to be donated to local area children this winter!

The Peak Performance Team would like to extend our thanks to everyone who helped spread the word and dropped off donations to make this year’s coat drive a great success and allowed us to help children in our community that are in need of winter items.

We would like to also give a special thank you to our neighbors at Peerplace for their staff’s efforts in collecting coats and monetary donations to assist in our coat drive.

The items will be distributed to both the Salvation Army Genesis House Youth Shelter and The East Rochester Community Resource Center to help out with their ever-growing need for warm winter coats, hats, gloves and scarves for local children from toddlers to teens.

If you still have coats or other gently used winter gear that you would like to donate it’s not too late!

We are going to keep our collection bin in our lobby throughout the entire winter and distribute your donations to those in need as we receive them.

Once again thank you for your help!

The Peak Performance Team

As an infant, we are like “Gumby” and we seem to bounce back with no apparent issues.  But as we age and usually pass the 6th decade of our life, our bodies just don’t have that elasticity. 

The next two articles will describe your possible medical and home intervention.  As in the first article, if you even know who Gumby is …you may read this with renewed interest!

Check with your doctor on the following conditions: 

Vision:  your eyes are closely tied to your balance. Your eyes give your brain feedback on your body’s position. If your vision has been getting blurry, the information to your nervous system will be inaccurate, or incomplete.  Have your eyes retested.  Wear your glasses when you need them.

-be careful with bi or tri focal lenses on stairs or uneven surfaces.  You will have to look down to see through the proper portion of your glasses. Your lenses may make objects appear closer than they really are, so moving slowly is a good strategy.

Hearing: If you are missing out on the sounds around you that may protect you, you may not even know it. Usually, you can tell that you are starting to have difficulty in a room full of people, or on the phone.  You will start straining to hear clearly, maybe set your TV volume very high, or start avoiding the phone, or crowded gatherings.  Rely on someone close, and if they say you should have your hearing checked, believe them.  Hearing loss will also affect your balance.  There are so many new advances in hearing loss and correction now, you will be surprised! Ask your doctor.

Orthostatic Blood Pressure: This is when you change positions or levels (laying down to sitting up, sit to stand) and your body doesn’t react appropriately so you get dizzy, or temporarily light headed. Taking multiple medications daily can also cause this, but I am referring here specifically to an inability of your nervous system to control pressure changes in your arteries and veins.  It may help to squeeze your hand and leg muscles a few times before getting up, and then get up slowly.  If you are still getting light headed, consult your doctor.

Drug interaction:  More than four medications daily is the standard issue.  Check with your doctor yearly on the medications you are taking and any interactions that may be causing you difficulty.

Urinary tract infection: alert your doctor immediately if you suspect a UTI.  Symptoms can include fever, pain in the lower abdomen just above the pubic bone, or below the navel, burning when urinating, blood in the urine, sleep disturbances or fatigue as a result of increased bathroom trips at night, or sudden overnight changes in your ability to think or remember.  The changes mentioned here can increase risk of falling. These are treatable by your doctor.

Remind your Doctor:

-  about any fall you have had

-  if you have weakness in one or both legs, or other leg problems

-  if you use an assistive device such as a cane or walker

-  about any other medical problem you have ie: heart, blood pressure, diabetes, stroke, or neurological.

-  about any sickness that has left you laying down for more than a week

After your doctor’s assessment, they may recommend:

-  Modifying your medication dosages

-  A medical check on your symptoms

-  Vision or hearing referral

-  Physical Therapy for balance and strengthening

HERE IS THE GOOD NEWS!

Once your medical issues have been addressed, Peak Performance PT can help address those issues like strength and balance! Working your strength and balance has been shown to prevent falls!!!   We can assist you with how to fall proof your house, and work with you on different strategies if you do end up on the ground.

We want you to be able to do those things that you love like hiking, walking, dancing, biking,or playing with your grandchildren. 

We want you to be able to do the things necessary things to keep your house in order like raking, laundry, negotiating stairs, gardening, or washing your kitchen floor.

Feel free to contact us about a relative, spouse, or yourself if you feel that your balance and/or strength are limiting you from living the life you want!  

I would love to help you to help yourself.    

Karen Napierala PT, AT, MS 

Call 218-0240  

Peak Performance PT

Rochester's 2nd Annual Physical Therapy Coatdrive For Kids

In honor of National Physical Therapy Month, this October we will be holding our Second Annual Coat Drive for Kids.

Last year you helped us collect and donate 65 coats in addition to numerous hats and gloves to the Salvation Army Genesis House Youth Shelter and the East Rochester Community Resource Center.

This year we are hoping you will help us reach our goal of 70 Coats!

As the Fall weather approaches and temperatures begin to drop in the Rochester area we are reminded that there are many children in our own local area that are in desperate need of warm winter coats, hats and gloves.

You can bring your gently used and new winter clothing into Peak Performance throughout the month of October. We will have donation bins set up in our entranceway during our normal business hours.

Take a look through your home for coats, hats and gloves of all sizes that you could donate to a local child in need this winter in Rochester.

The Salvation Army Genesis House Youth Shelter is in need of winter coats for teenagers through young adults with larger sizes being the most needed this year.

The East Rochester Community Resource Center can use winter clothing for children of all ages and sizes from toddlers to teens!

Please stop in and say a quick hello to your favorite Physical Therapist or Office Team Member when you come by to make your donations, we always love to hear from our current and former patients!

We look forward to your help and the local children do too!

Now, although I do it, when I think about getting down, I am much more tentative.

I don’t know about you, but over the past few years I have even noticed my parents using their hands on their thighs or the chair hand rests as a necessity to get up! 

They also seem to look down more frequently as they walk, especially outside on uneven ground.

            Have you noticed any of the following in YOURSELF or A LOVED ONE? 

-                  Difficulty negotiating your way to the bathroom at night, and/or in the dark?

-                  Using both hands to push yourself up out of a chair?

-                  Reaching to grab something to pull yourself up out of a chair, or off of the toilet?

-                  Keeping your eyes focused on the ground more and more as you walk, especially in new places?      

-                  Depending on the hand-rail to navigate up and down stairs?

-                  Tentative to go DOWN a step, or curb without support?       

-                  Painful knees, hips, or ankles with a “hitch in your get-along”?

-                  Losing your balance more frequently?

-                  Feeling dizzy when you stand up?

-                  Not being able to see as well as you used to?

            Note:  If you actually know what a “hitch in you get-along” is then I am speaking to you directly!!

Well, you are not alone…

Every 8 seconds in the US someone turns 60 years old! 

While I believe that age is a state of mind, and 50 is the new 20….(humor me), the fact is that as we pass the 60 year mark, we often fight the effect of decreased physical activity  and the natural aging process.

 These are the years that you begin to experience the effects of decreased muscle mass, risk of osteoporosis, decreased vision or use of bi/trifocals, an increase in the number of medications taken, changes in bladder control and just plain gravity.

 You may notice difficulty standing on one leg to get pants on. You may get that stiff feeling in your ankle, knee, hip, shoulder, or spine.  (You may recall  even the last time you tried to turn around to back out of your driveway that it used to be easier!)

Studies show that these are just some of the factors that predispose us to falls.

A “Fall” is defined as an unintentional loss of balance which the person comes to rest on the ground, floor, OR a lower level.  

As a matter of fact, 33 % of people over 65 years old WILL fall and that rises to 50% of us after we reach 85 years old!
In 2005, 433,000 people were hospitalized with injuries after a fall and a staggering 15,800 deaths occurred as a consequence of the fall itself or a complication from it.

Falls account for over 81% of fractures over the age of 66!  The estimated cost of individual expenses as a result of these falls cost $19 billion in 2000 with the projected expectation of $55 billion in 2020!

I would say that this issue is a huge burden to our health care system as well as to each of us affected with the repercussions of a fall individually wouldn’t you!?  

So what does this mean for you? 

Is there anything that you can do to prevent, or slow these aging processes?

First, you need to find out if you are in the risk category.

Take this quick little quiz:

Y   N      1.  Can you get out of a chair without use of your hands, or chair rests?

Y   N      2.  Do you take more that 4 medications per day?

Y   N      3.  Can you stand on your right leg alone for 10 seconds?

Y   N      4.  Can you stand on your left leg alone for 10 seconds?

Y   N      5.  Do you get up to go to the bathroom in the middle of the night in the dark? ( including a night light?)

Y   N      6.  Are you comfortable standing on your tip toes and reaching over your head for  something?

Y   N     7.  Can you comfortably bend over to pick up something off the floor without something to hold on to?

Y   N     8.  Have you fallen, OR lost your balance in the last 3 months?

Y   N     9.  Have you had a Urinary tract infection in the last 3 months?

Y   N     10.  Do you get dizzy when you turn your head quickly?

If you answered YES to more than 2 of these you are at risk for a fall!! 

The more questions you answer YES to, the higher the risk. 

Anything above 5 and you are at very high risk of a fall!

Over the next two weeks we will be offering a series of hints to help you stay safer, and avoid falling.

They include:  

1.  Fall Proof your Home: These are things you can do right away to insure that your home is as safe as possible for you.

2. Fall Proof your Life: Start looking at your present health and make sure the proper medical personnel are working with you.

3.  How to “Get up and Go” independently:  For those at lower risk (1-4) of the above predisposing factors, Peak Performance will provide you with a program to improve your balance and strength. 

For those of you at high risk, a supervised exercise/balance program and gait screening may be necessary. 

Feel free to contact your physician to clear you of any medical issues, and then contact Karen at Peak Performance Physical Therapy for an initial evaluation and custom tailored fall prevention program.

This very nice teacher who was in for knee problems, we’ll call her Sylvia, wanted to resume her fitness workouts.  She missed the feeling of being active, feeling stronger and more fit, having more energy, and not to mention the calorie burning benefits of her cycling escapades.

Sylvia was accustomed to 3 hour rides on the weekends.  That’s awesome to be able to go out and enjoy the outdoors for that long on a bike.  Not everyone can do that.  Sylvia was feeling better and really eager to get back on the saddle.

BUT, here’s the problem.  She still did have knee symptoms and we weren’t sure how long she could tolerate biking for, especially outdoors where elevation changes would come into play.  

Here’s Sylvia’s take on it…..”So should I just go out and ride for 40 minutes or so and see how it goes?”

Wow!   Forty minutes.  Is she serious?  Are you wondering the same thing I was? 

I asked her “When’s the last time you successfully rode for 40 minutes?”  She looked at me puzzled a bit.  I could almost see her musing in her head….”Mike knows I’ve been in PT for over a month or so – how could he be asking a dumb question like that?” and prior to that her symptoms were even worse before she started PT. 

In actuality it had been a long time since she’d proven she could ride for 3 hours, let alone just even 40 minutes.  But that prior success was her best memory.  It was her only reference point.

Or at least the one she was choosing to recall.

Don’t we all do that when we’re hurt or recovering from a set back? 

You kind of think back to when you were at your very best and define that as who you physically are. 

That right there is a set up for disaster. 

Because you and I both know what happens next. 

When you say “But I used to ride for 3 hours”…then your next thought is “Then I’ll just go out for an hour or two and see how I feel”. 

Sylvia needed a Shorter Memory! 

With a short memory….maybe back to only a week or two, she’d realize that she had only been on the stationary bike for 5-10 minutes and proven she could do that without symptoms. 

So, if she were going to try to resume outdoor cycling then maybe choosing what – maybe let’s say 15-20 minutes max might make more sense. 

My piece of advice for you today is this.

• BE WIMPY! 
• Yes, that’s right…I said be wimpy. 

Think of it this way…

 If you’ve been away from some particular activity for some time then you’ve got to Have a Shorter Memory. 

Don’t think way back to 3 months ago or a year ago “When I used to do…..” but rather think back to just days or a week or two ago.  If you don’t have recent evidence of SUCCESS doing some specific amount of that activity then you MUST start with tiny, WIMPY, amounts of whatever it is that you like. 

You shouldn’t go out and play singles tennis for “only” a best of two sets but rather just hit some balls around for 15 minutes. 

It’d be better to go swim a two laps then rest and repeat it a few times rather than go swim non-stop for 30-45 minutes with your training partner. 

It makes more sense to see if you can cut just a part of the back lawn and take a break than to start in the front where you won’t let it remain unfinished (even if you start hurting). 

If you or your loved ones have some musculoskeletal ailments that are holding you back from what you enjoy, now is the perfect time to call us to see if we can help you address them before you miss more of this beautiful end of summer and fall weather in pain.  We’d love to help you get back to Peak Performance!