Our Services

Electromyography Test (EMG)
Functional Capacity Evaluation (FCE)
Independent Medical Examination (IME)
Physiotherapy/Physical Therapy
Trigger Point Injection
Paraspinal Injections
Epidural Injections

Electromyography Test (EMG)
An EMG test is preformed by a physician, usually a neurologist or physiatrist. It measures to see if there are any injuries or problems with nerves or muscles. Conditions that can be detected by an EMG: Carpal tunnel, cervical and lumbar radiculopathy and peripheral nerve paths.

Functional Capacity Evaluation (FCE)
An FCE test is performed by physician or physical therapist, that objectively measures how much a patient can lift, push and pull safely. Also a FCE test can objectively measure how long a patient is capable of sitting or standing for any length of time. The evaluation can take several hours to perform. This test is good for evaluating a patients parameters safely as to what a patient can and can not do if and when a patient returns to work.

Independent Medical Examination (IME)
An IME is an impartial medial evaluation conducted by a healthcare provider to clarify a number of issues that need to be determined for the patient and/or the requesting party for the IME, which is usually an insurance company. However, it can also be an independent person, a court, or any third party.; As part of an IME examination, a physician conducts a comprehensive history, physical examination, review of pertinent medical records. He then arrives at a complete diagnosis or diagnoses, the patient’s disability status, future medical care and needs and its frequency, and/or any other diagnostic studies. It also may include any need for transportation services or household services. If any further information is required for an IME, the requesting party will request in advance so that the conducting IME specialist will address those issues.

Physiotherapy/Physical Therapy
Physical therapy or physiotherapy is a treatment that is conducted given either by a physiatrist or a licensed physical therapist for the treatment of muscles, nerves, joints, trying to restore function to an injured person. Many different modalities and electronic machines are used to facilitate this type of rehabilitation. Such electrical machines used are direct current, galvanic current, biphasic current, tetanizing current, interferrential current (high/low) microcurrent. Also, specific exercises are delivered along with manual massage to diminish pain and spasm and improve muscular function and muscle reeducation, and restore function and health as soon as possible. Many conditions are treated with physical therapy and our medical director makes the determination as to what type of physical therapy should be given to a particular patient by writing updated monthly prescriptions.

Trigger Point Injection
A trigger point is an area of muscle fibrosis, muscle scarring, muscle ischemia, which is typically caused by trauma or high tension muscle state (such as severe stress, spasm, and repetitive motion). Trigger points are usually detected clinically by way of small circumscribed hyperirritable foci in muscle fibers. When a physician looks for them, he feels painful knotted muscle fibers in specific areas. The most common specific areas are the upper back muscles (the trapezius, supraspinatus, infraspinatus, teres major, and the rhomboid muscles) and the lower paraspinals and the gluteal muscles. Also, trigger points can be found almost anywhere in the body including the forearm, the biceps, the quadriceps, the hamstrings, and the calf muscles. There is no specific laboratory or imaging test to establish the diagnosis of trigger points. It is merely based on clinical condition. Although, infrared thermography can help confirm this, but this test is very expensive and is being used less and less in many areas. The best way to treat trigger point injections after they have failed conservative treatments is by injecting them with a local anesthetic such as lidocaine or a long-lasting anesthetic such as Marcaine. Cortisone is specifically avoided (unless in some rare instances) because cortisone can aggravate muscle fibrosis and muscle degeneration. If the patient is allergic to the specific medication, dry needling can be used and accomplish the same. It is just a little bit more uncomfortable and/or painful when used. After the trigger point injections, the physical therapy is given to the patient the next two days to minimize the soreness from the needling. Trigger point injections are given on a weekly basis, followed up by physical therapy the next two to three days until the patient reaches maximum medical improvement. If a patient does not have any significant response and/or improvement after four weeks of trigger point injections, then a different regimen is to be pursued.

Paraspinal Injections
Paraspinal injections are typically given for the treatment of lumbar disc bulge, protrusions, herniations, and/or lumbar radiculopathy. The paraspinal injections are conducted on a weekly basis followed by physical therapy for the next two to three days and are given for maximum of four weekly injections. This is done to avoid any possible side effects.; The usual cocktail of medication used is a local anesthetic, a short-acting cortisone derivative, and a long acting cortisone derivative, giving the patient continuous sustained release of different medications to optimize the healing and the inflammatory damages caused by this specific problem that is causing the patient’s pathology/pain.

Each week, the patient is reevaluated. If the paraspinal injections did work, they are to be continued. If they did not work and there is no sound rationale for why they did not work, the physician may pursue with a different treatment regimen. But, typically a physician gives the patient at least 2 to 3 attempts of paraspinal injections before he pursues a different route. If the patient is cured after the first injection, then when the physician conducts his next weekly examination and the pain is all gone, then, there is no need to give a second, third, or a fourth injection. However, if a patient receives partial progress from the first injection, then the injections are given on weekly intervals until maximum medical improvement is obtained. Some of the most common side effects from the paraspinal injections are: Upset stomach, slight beating of the heart faster than usual, trouble falling asleep the first night, a temporary change in menstrual cycle, water retention, and in rare cases a gastrointestinal bleed and/or skin lesions which goes away once the medication has stopped.

In most cases, the paraspinal injections are a very effective method of treatment.

Epidural Injections
Epidural injections are similar to the paraspinal injections with the exception that they are given directly into the spine. They have much more side effects, risks, and complications, but they are considered to be more effective than paraspinal injections.