A Guide for Parents and Students

Practical Advice to Prevent Injury

BACKPACK “WORST CASE SCENARIO”improperly worn backpack

According to doctors and physical therapists, backpacks that are overloaded or worn improperly can, over time, cause painful misalignment and harmful compression of the spine. Excessive weight (defined as more than 10-15% of body weight) and unevenly distributed loads can prevent disks from working properly as ‘shock absorbers’ for vertebrae, and can result in shoulder, neck, and back pain. Studies have also confirmed that heavy backpacks can actually alter the shape of a young person’s spine.

Research published in the journals Spine and Science Daily confirm that repeated use of heavy backpacks may result in disc compression, lower back asymmetry or curvature, and injury to the soft tissues of the shoulder that can lead to nerve damage. The harm caused to nerves may range from simple irritation to impeding movement of hands and dexterity of fingers.

SIGNS OF TROUBLEchildren boarding school bus with backpacks

  • struggling to get the backpack on or off
  • increased forward head posture, rounded shoulders
  • strained muscles and pain in the shoulder, neck, and lower back
  • numbness or tingling caused by straps
  • headaches


Large, overloaded backpacks create safety hazards in tight spaces (like school buses), where children’s movement and balance are impeded, and they can cause tripping hazards both on and off students. Smaller, lighter backpacks are better all-around choices for school kids.Properly worn backpacks with both shoulder straps


A backpack should be worn with both shoulder straps to distribute weight evenly, and it should fit close to the body, resting in the middle of the back (not sagging toward buttocks). It’s best to place heavy items closer to the body or at the bottom of the bag, rather than in outside pockets.

Rule of Thumb for Maximum Loads

Student Weight (lbs.) 40 60 80 100 120 140
Max Load (lbs.) 4-6 6-9 8-12 10-15 12-18 14-21



  • Encourage kids to use their cubby, desk, or locker for items that don’t need to go home—including textbooks that are not needed for homework.
  • Create a weekly routine for sorting through backpacks and eliminating excess cargo.


Boy wearing backpack correctly

Choose a backpack that meets these criteria:

  • lightweight
  • two wide, padded shoulder straps
  • a padded back, and hip/chest belt (for larger packs)
  • multiple compartments to distribute weight.
  • reflective material for added visibility

Keep in mind that a smaller pack will be less likely to collect extra “stuff” that adds to the burden, and that while wheeled bags are great for airports, they are generally heavier, and can often be difficult to use on stairs and in buses.

Rucking? Not for kids!

heavy military backpackSoldiers must often march (or even run) while carrying packs weighing from 40 to 90 pounds or more, which can mean loads of as much as 25-50% of their body weight. That’s extreme, and soldiers commonly suffer injuries to shoulders, neck, and back as a result.


ABCs of Smart Backpack Use (APTA)
Backpack Safety (National Safety Council)

Other Cioffredi Resources

Pediatric Physical Therapy
Pediatric PT Success Story: Sofia Tomek

JOIN US: Carrying Sports Through Life

Community Speaker Series Event – Wednesday, November 1, 2017


112 Etna Road, Lebanon, NH

Cioffredi & Associates


Join us for our FREE Fall Speaker Series event, co-presented by Dr. Daniel J. O’Rourke, MD, MS, M.Ed (Chief of Cardiology at the VA Medical Center, and Hanover HS Girls Varsity Basketball Coach) and Billy Cioffredi, PT (Founder of Cioffredi & Associates). The entire community—parents, coaches, sports fans, and youth athletes alike—is invited to join the conversation about Coaching for Life Lessons and Ethics and Safety in Sports. Light refreshments will be served.

Carrying Sports Through Life

Mind Over Matter

Placebo, Confidence, and Certainty: Are They Related?

William J. Cioffredi, PT - FounderMike Pauletich believed he had undergone surgery to alleviate Parkinson’s symptoms during a trial at Stanford University in 2011. Parkinson’s disease is a difficult degenerative disease that has no cure, where current treatments simply try to retard the progression of the disease. The Stanford study involved both an actual and a “placebo” surgery in which a drug was or was not administered, and Mr. Pauletich not only had a good result from the study procedure, his outcomes far surpassed expectations. Many of the chronic effects he had experienced were actually reversed, such that you could hardly tell he had the disease at all. When the results came in at the conclusion of the research trial, those who received the actual treatment, on a whole, didn’t improve any better than the control group who had received a sham surgery. A researcher looking at the data afterwards noticed something remarkable: Mike had received the sham surgery!

“Mind over Matter,” a recent National Geographic article, caught my eye… (Healing Power of Faith, December 2016) You can read it at Cioffredi.com/NatGeoPlacebo

Numerous studies have revealed and supported this “placebo effect.” A significant portion of people improve when they receive an intervention (some form of care) that should have no physiological effect on them—a placebo. On a fairly consistent basis, if we think we’re going to improve, we do. Healing happens through an idea, a thought.

Bill treats a PT client for headaches.The power of “positive thinking” is a generally accepted concept as an influence on one’s performance. Our ability or competence in something is, to a large degree, based on an idea, a thought. We call it confidence. Conversely, anxious thoughts, or the idea that we don’t know what will happen to us (or whether we’ll have the ability to handle what might happen to us) stresses our system and causes physical responses that can harm our health. Prolonged stress (anxiety) results in elevated levels of cortisol and causes the body to break down. Think high blood pressure, ulcers, cancer.

So, if our thoughts can cause our bodies to be ill, can our thoughts cause our bodies to be well? Thinking positive thoughts doesn’t seem to be enough, but where do we start? Perhaps we start with confidence. I’m not talking about cockiness, arrogance, or false pride. Confidence is not a “yes I have it” or “no I don’t.” Rather it’s a spectrum: “I hope I can…, I believe I can…, I know I can…, I will…” (Maybe Mike Pauletich “knew” something that others didn’t?)

Intention is a direction of force. It’s just a thought, an idea—but it may have tremendous power. What if we each had a continuous strategy to develop our own self-confidence? What if we interacted with our friends, family, colleagues, clients, community in a way that enhanced their confidence? And what if we avoided interacting in ways that would cause them self doubt, like invalidating their beliefs or viewpoint? Hey, it’s just a thought.

If you want to learn more about building one’s confidence, consider coming to listen to Dan O’Rourke, M.D. at our Speaker Series on November 1.

Billy Cioffredi, PT


Pain and Resilience: What I’ve Learned
Getting Out of Our Own Way
Happy, Healthy New Year
Humanities and Health


Join Us for Our Fall 2017 Institute Speaker Series


Coaching For Life Lessons

Ethics and Safety in Sports

Athletes Clip Art

Wednesday, November 1, 2017

5:15-7:00 p.m.

at Cioffredi & Associates | The Institute for Health & Human Performance

112 Etna Road – Lebanon, NH


Daniel J. O’Rourke, MD, MD, MEd

Chief of Cardiology, VA Medical Center

M.Ed in Coaching & Athlete Development, Xavier University

Head Varsity Coach, Hanover High School Girls Basketball Program


William J. Cioffredi, PT, Founder

Cioffredi & Associates | The Institute for Health & Human Performance

Dr. Daniel O'Rourke and Billy Cioffredi

This event is free and open to the Upper Valley Community. Light refreshments will be served.

Seating is limited. Pre-registration is requested by phone at 603-643-7788, by email to scheduling@cioffredi.com, or using our online RSVP form.


Daniel J. O’Rourke, MD, MS, MEd

Hanover Marauders Basketball Coach Dan O'Rourke Dan earned his MD degree from SUNY at Syracuse, completed internal medicine training at the University of Pittsburgh, completed his cardiology fellowship at DHMC, earned a master’s degree from The Dartmouth Institute at Dartmouth College in 1997, and a master’s degree in education from Xavier University in Coaching and Athlete Development in December 2016. He is Chief of Cardiology at the White River Junction Veterans Affairs hospital and a staff cardiologist at Dartmouth-Hitchcock Medical Center.

Dan began coaching basketball in 1995 and is entering his 23rd year of coaching with the Hanover High School girls’ program and the 17th year as varsity head coach. During his tenure, Hanover has been a perennial contender reaching 11 final fours, 8 championship games and won 5 state championship titles. In addition, he has coached boys and girls youth basketball, ranging from third to eighth grade, for over 10 years.


WILLIAM J. CIOFFREDI, PTBilly Cioffredi, PT, administering dry needling to a PT client.

Billy graduated from the University of Pennsylvania in 1979 with a degree in Physical Therapy. He has extensive experience in orthopedic and sports rehabilitation, with areas of special interest including the spine, ankle & foot disorders, headaches, TMJ dysfunction, and injuries related to the fine arts.

Billy played football growing up and through college where he played at the Division 1 level. It was his interest in biomechanics and physiology that led him into the PT profession. “Through my involvement in sports I had an interest in the physiology and biomechanics of how the body worked. As part of my participation in the Shrine game we went and visited the kids at the children’s hospital in Springfield, Mass. It was a very positive experience that left a lasting impression on me and was an influence in my decision.

Billy started his career at Dartmouth Hitchcock Medical Center where he met his wife Ruth. Together they opened Cioffredi & Associates in 1985. In 2012 Billy received his certification in Trigger Point Dry Needling (TDN), which uses solid filament needles, like those used in acupuncture, to target trigger points deep within the muscle. TDN is an additional tool that Billy uses in his care, when appropriate, to help lengthen and loosen tight muscles. Outside of the office he enjoys running, hiking and skiing. Billy resides in Lebanon, New Hampshire with his wife, Ruth.


Iliotibial Band (ITB) SyndromeIliotibial Band (ITB) Diagram

Pain and Tightness Along the Thigh

Having pain and tightness along the side of the thigh is quite common, especially for athletes. When the pain encompasses the lower half of the thigh towards the outside area of the knee, it often carries the diagnosis of Iliotibial Band (ITB) Syndrome. For many people it can be persistent or unresponsive to typical treatment. The IT band is a stiff layer of tissue that blends from a broad attachment of muscles from the side and back of the hip. The band becomes narrower as it descends toward the knee where its attachment broadly blends with tissues about the knee cap and into the tibia bone.

Stretch for Tensor Fascia Lata Muscle

Standing stretch for TFL and ITB.

The condition is frequently described as the ITB being ‘tight,’ and typical treatment often includes attempts at ‘stretching’ the ITB.  But when you look at the tissue of the band and how it attaches, it becomes difficult to understand how the band itself could get ‘tight’ in the first place. The tissue is relatively rigid and doesn’t have the quality to length or shorten. Then what could possibly have an effect to cause the band to functionally shorten or cause the pain?

Three Overlooked Components

In these cases, I see three major components that sometimes get overlooked. First, what does have the tendency to tighten up are the muscles that the band directly attaches to; a relatively small muscle coming off of the front and side of the hip called the tensor fascia lata (TFL), and the large gluteus maximus (the outer part of the major muscle of the buttock). These muscles can be stretched effectively with the following technique, among others. First, standing with the right leg crossed behind the left, then side-bending the trunk to the left (this stretches the TFL of the right leg and ITB). Also, lying on your back and pulling your right knee towards your chest would stretch the Gluteus Maximus. In my experience, however, these stretches are often not successful by themselves.

Stretch for Gluteal Muscles

Stretch for gluteus maximus.

A second influencing factor for ITB Syndrome are muscles that attach to the pelvis, spine, and thigh that have shortened. The iliopsoas, gluteus minimus, and deep hip rotators such as the piriformis, once shortened, cause the thigh bone to be rotated on the pelvis. Some signs that this condition may exist may be seen in the following: When standing erect, does one foot’s arch appear noticeably flat compared to the other? When lying flat on your back with legs relaxed, does one leg appear turned out noticeably more than the other? While these situations are not the only reason that may cause an arch to be flat or a leg to be turned out, it is a hallmark of a muscle imbalance that I see regularly in clients who have ITB pain. This condition is quite amenable to targeted stretching. It could include stretching the hip flexors (iliopsoas) as seen in a forward lunge stretch or similar modification, and a deep hip rotator stretch or the “pigeon pose” stretch. (See photos.)

Forward Lunge and Pigeon Pose

Forward Lunge and Pigeon Pose

Finally, there is a large and significant muscle that runs immediately underneath the IT band, the vastus lateralis. It is the outside muscle of the four quadricep muscles in the front of the thigh. This muscle can get irritated and develop trigger points. A trigger point (TP), is a small band of hypersensitive muscle fibers that, when pressed, can give rise to pain in characteristic patterns, in this case along the ITB, and can involve the outside of the knee. This component can be treated effectively with deep tissue mobilization.

Iliopsoas Muscle Group Diagram

Deep Tissue Rolling

Some people perform their own deep tissue mobilization by rolling the side of their thigh with a foam roller or ‘stick.’ (See photos.) For some, this can be quite effective, but I don’t believe it is ‘rolling out the ITB’ that is being effective; it is the muscle underneath. And sometimes deep tissue rolling and massage are not fully effective and the TP requires deactivation with dry needling.

Check out our VIDEO: Foam Rolling Techniques for Runners

Trigger Point Dry Needling

Dry needling is a technique used by certified clinicians that uses a very thin, solid filament needle that is placed directly into the TP within the muscle. They are the same needles used in acupuncture, though this is only for the purpose of deactivating the TP. (See photo.) Again, the IT band itself does not have the ability to contract or lengthen to any substantial degree. When these deep tissue techniques or dry needling are effective, I believe it is predominantly due to the effect on the vastus lateralis muscle.

In the case where the pain is only in a small, local spot where the ITB attaches just to the side of the knee, ice can help reduce the pain temporarily. But the source of the problem is usually elsewhere, like the some of the faulty biomechanics described above, and it can include how and where a person might train. For example, the curved elements of a track will increase the strain on the left leg if you are running clockwise. Indoor tracks have tighter turns, and increase loading further if the turns are not banked. Even if you routinely jog on the road, always facing traffic results in an asymmetrical strain on the left and right legs due to the crown design for roads to shed water.

Deep Tissue Rolling

Deep Tissue Rolling

Customized Orthotics and Kinesiology Taping

Orthotics, or inserts for shoes that customize the arch for the individual, as well as specialty elastic tape (Kinesiotape or Rock Tape®) can be helpful components for selective individuals. I recommend you consult a professional trained in orthotics or taping application.

Note that while I have described the IT band condition as it presents on only one leg, it is possible that some folks have the pain on both legs, though the same principles apply.

Finally, the challenging part of ‘persistent’ IT Band Syndrome is in knowing how many of these components are contributing to the individual’s condition, and which ones are the predominating factors. The good news is that clinicians well trained in these conditions can help you if needed.

I hope you have found the information helpful.

Billy Cioffredi, PT/founder

Cioffredi & Associates

Trigger Point Dry Needling

Trigger Point Dry Needling


Overview of the Knee

Runner’s Knee (Patellofemoral Pain Syndrome)

Common Running Injuries

Trigger Point Dry Needling: Applications & Evidence

Piriformis Syndrome: That Pain in the Butt




Nancy 1Our next FREE Fall Prevention Screenings are taking place on

Thursday, September 28, 2017

10:30 a.m. – 12:30 p.m.

There is still time to register for this event! Call us at 603-643-7788 to register today.

This free one-on-one screening with one of our physical therapists will evaluate your balance and mobility, provide valuable insight into fall prevention, and offer solutions to decrease your risk.

Participants will need to complete a medical history and balance scale prior to their screening. The therapist will review your history, and put you through a series of test to evaluate your balance and determine your risk of fall. You will leave the screening with some tools that you can use to improve your balance.

The screening will take approximately 30 minutes, and openings are by appointment only. Space is limited, and pre-registration is required. Call us at 603-643-7788 to register. 

standing quad stretch

Pull one ankle back toward your buttock, bending your knee to stretch the front of your thigh.

First of all, effective stretching is not a total secret, though in my experience it is not a commonly understood concept. When we think about stretching, it’s often done with the idea that it’s like taking a piece of leather and, using force, mechanically lengthening it out. One of the problems with this idea is that ligaments and tendons are not designed to lengthen. Muscle tissue is designed to actively shorten and lengthen, however it will not lengthen effectively if it is held in an activated or tense state. Activation or tension causes muscle tissue to be more rigid—more leather-like—and it can be irritated if forced. That may be one reason some people don’t ‘enjoy’ the process of stretching. The other problem is that rigid tissue, like Turkish taffy, gets thinner and weaker as we forcibly stretch it out. That doesn’t sound good, especially to athletes who simultaneously want to optimize their strength.

Now, instead of thinking of leather that you are stretching and thinning out, think of a spring that has shortened, and your goal in stretching is to relax the tension of the spring.

Muscles will shorten when we activate them, just like tightening a spring. When we release the tension on a spring it lengthens and becomes longer. This is not an ‘all or none’ concept. If, for example, you tense your muscles to make a tight fist, you can ‘let go’ of the fist a little, a lot, or somewhere in between. Our effectiveness is the

standing forward fold

Flex forward from the hips (touching toes) without rounding your back, to stretch the backs of the thighs.

degree to which we can intentionally ‘relax’, ‘release,’ or ‘let go’ of our muscle tension. For some, it’s helpful to picture the tissue doing this. It seems tensing our muscles is easier than selectively releasing muscle tension. But it is a skill and, like any skill, we can improve with practice.

The final piece to understand is that we activate groups of muscles. And we often tend to activate groups of muscles in patterns. Developing skill to release groups and patterns of muscle tension can result in tremendous success. Whether for athletic performance or just basic daily living, this can result in increased freedom of movement, comfort and ability.

Start with stretches that focus on only a few or selected muscles. For example, stand and pull one ankle back toward your buttock, bending your knee to stretch the front of your thigh. Another simple stretch, from the standing position, is to flex forward from the hips without rounding your back, to stretch the hamstrings on the back of your thigh. Then, gradually move into more complex stretches.

Warrior II Pose

The “Warrior II” pose lengthens on diagonals.

Lengthening on diagonals, and when different parts of our bodies are positioned to go in different directions simultaneously, can be especially effective. It requires us to release holding ‘patterns’ of muscle groups that can be a fundamental limiting factor on greater dynamic movement. For those reasons, some yoga poses can be of particular value. Warrior Pose is one example.

So the next time you do some stretching, think of “releasing” your body into that position. See how far it takes you. It’s safer, and quite possibly more enjoyable.

I hope you found this helpful.

Billy Cioffredi, PT/founder
Cioffredi & Associates

P.S. Our eldest daughter, Anna, was kind enough to model these stretches for me. She is now a school teacher (English as a Second Language) in the Greater Boston area, and was home for a summer visit.


Getting Out of Our Own Way
Off Season Training Gains
Piriformis Syndrome
Plantar Fasciitis: The Pain That Won’t Go Away
Can Stretching Really Be Bad?
Play it Safe: Prevent Injury


Bill Cioffredi, PT - Founder

In the bodywork and exercises that we use in our work, I often feel we are simply undoing what people have done to themselves. Most of our clients didn’t have an accident. Rather, they developed a painful condition gradually, often times without a known reason. Postural pain, as well as joint and muscle pain, are often the result of unknowingly tensing or activating muscles that don’t need to be working or are working too much for the demand. Herniated discs, sciatica, arthritis pain, and rotator cuff problems are all just examples that are influenced by this issue. To a large degree, our work in helping people to restore pain-free movement involves freeing up stiff tissues in joints. But then we need to teach people how to “relax” their muscles. “Release” may be a better term, as we want our clients to release the excessive tension and muscle activation—not have muscles go totally soft.

“Good posture” is not a held position; it is free of excessive tension. You can see this kind of freedom in action in a master glassblower. They move smoothly and effortlessly, free of excessive tension as they work with the glass. We are often involved in teaching people to “release” their excessive muscle tension and “get out of their own way.” It can be learned. To that end, we have added a Qigong movement class on the weekends taught by Peter Payne, who is a master at teaching people how to “get out of their own way.” Check out the videos at Cioffredi.com/Qigong.

Best Wishes,
Billy Cioffredi, PT

Related Articles

Pain and Resilience: What I’ve Learned
Treating the Cause of Tension Headaches
Why Qigong?


Pediatric Physical Therapy Benefits Child with Cerebral Palsy

Sofia Tomek has received pediatric physical therapy care at Cioffredi & Associates since the age of four, after being diagnosed with spastic diplegia cerebral palsy at age two. As a result of her condition, Sofia has stiffness in both legs and issues with balance. Her mother, Sheri Hancock of Hanover, shared these words recently about Sofia’s experience here with the Cioffredi team.Ten-year-old Sofia Tomek works with PT Becca Swope

“Rebecca and the other wonderful staff at Cioffredi’s have worked with [Sofia], often twice a week, for a number of years and have seen her progress from using a walker to canes to now independent walking and even running. Currently they are working to prepare her muscles for an upcoming surgery and will be a vital part of her rehabilitation. They make exercising fun but challenging, knowing her personality so well as to offer the perfect distractions and encouragement. Thank you Cioffredi for always being there for her!!”

UPDATE: Sofia is now rehabilitating from surgery, under Becca’s care, and she continues to inspire us with her strength and resilience.


Read an earlier newsletter article about Sofia from January 2015.

Learn more about Pediatric Physical Therapy.

Read more about pediatric PT success and featuring Graham Portnoy and Marsha Wykes, PT, OCS, Cert. MDT

Back on the Job: Hanover Firefighter Jack Emerson

Jack Emerson, Hanover Firefighter and Cioffredi Client

“When I hurt my back at work I was unsure if I would ever be able to return to work at the firehouse. The staff here was so encouraging and motivating. I had to put the hard work in, but Zac kept me focused and on track. The entire staff knows your name, it feels like they are all in your corner. I had heard I might be out for 4-6 months, at best, but 2 ½ months later I’m back on shift working full duty.” –Lieutenant Jack Emerson, Hanover FD



Did You Know?

Low Back Pain is Responsible for 33% of Workers’ Comp Claim Costs

Low back pain is one of the most frequent and disabling conditions affecting workers in their productive years. Quality of life and job selection are limited, and recurrence is a major reason for early retirement and disability claims. Low back pain is responsible for 16% of workers’ compensation claims, and a disproportionate 33% of total claim costs.
-Garg et al. BMC Musculoskeletal Disorders 2013, 14:84

How Can We Help?

Learn more about the benefits of physical therapy for low back pain.


Get a Grip on Your Texting Thumb

Texting Thumb is Painful

While many people will admit to spending a little too much time with their mobile device, few people may be considering the risk of repetitive strain injuries that result from all that use. Fewer still have ever heard of texting thumb, a painful condition that can affect the tendons of the thumb and wrist.
U.S. mobile service subscribers send and receive an average of 764 text messages per month, according to the most recent nationwide data (Neilson, 2013), and it’s a safe bet that teen texting totals are much higher. Even the average of 25 texts per day can put a person at risk for the pain of texting thumb, a real and growing pain problem in our smartphone-saturated society.

Ruth Cioffredi, OTR/L Occupational Therapist“Repetitive tasks should never be done for more than 20 minutes continuously without a break. Switching the muscle group allows for tissues to be more flexible and avoids strain in chronically overused areas.”


Are you experiencing sharp or shooting pain, a constantly aching thumb joint, or a thumb that seems to pop out of place when it’s extended during typing? You might be suffering from Texting Thumb. The strain of constantly holding a cellphone and curling the wrist and thumb to type text messages restricts and thickens the tendons responsible for flexing the thumb and wrist, causing inflammation, searing joint pain, and eventual weakness.

Two Different Sources of Texting Thumb Pain


Trigger Thumb Diagram Cioffredi

Pain centered at the base of the thumb on the palm side, which can radiate up the thumb and is often accompanied by snapping or locking of the thumb, is likely caused by an aggravated and inflamed tendon—a condition called trigger thumb that is the most commonly associated with texting.


Pain that originates on the thumb side of the wrist. A person with DeQuervain Syndrome may feel localized tenderness, pain, and, swelling at the wrist near where the thumb is attached to the forearm. They also may have difficulty pinching or grasping with the thumb or hand, and feel pain when moving the wrist from side to side or when twisting it. DeQuervain Syndrome causes difficulty when flexing the thumb, and may result in limited motion and feeling of weakness in the thumb.

DeQuervain Syndrome Diagram


If you are experiencing the symptoms of either trigger thumb or DeQuervain Syndrome, for best results you should seek treatment early. A physical or occupational therapist will work with you to assess your condition and review how you use your thumb, and start working with you to relieve pain and inflammation. Your therapist can give suggestions on how to make adjustments to alleviate stress to that area, and can also help you with exercises for your hand, wrist, and arm that strengthen your muscles and reduce painful tendon irritation. In some cases, an immobilizing splint may be prescribed to support recovery.

Ruth Cioffredi OT Hand Specialist

WE CAN HELP Call us today to schedule an evaluation with one of our physical therapy clinicians: 603-643-7788 


Is it Necessary to Have a Referral?

While a written referral is not required to seek care, it may be a requirement of your insurance company.

A benefit of getting a written referral from your doctor or dentist is that it will ensure that they get a copy of your evaluation, re-evaluation, and discharge notes, so that they can keep up with your treatment progress. We are happy to provide referral forms upon request.


Is it really carpal tunnel syndrome?
Surgery Avoided with a Little Teamwork
Preventing “Computer Neck”

Further Reading

The American Society of Hand Therapists  (https://www.asht.org/patients/education-resources)

Ashurst JV, Turco DA, Lieb BE. Tenosynovitis Caused by Texting: An Emerging Disease. J Am Osteopath Assoc 2010;110(5):294-296. (Accessed from: http://jaoa.org/article.aspx?articleid=2094077&resultClick=1)

American Physical Therapy Association (Accessed from: http://www.moveforwardpt.com/SymptomsConditions.aspx)