August 2021 COVID Update – COR continues to follow COVID safety protocols

Category: Therapist Tips

Treating Uterine Prolapse without Surgery: The PFPT Approach

Treating Uterine Prolapse without Surgery

Pelvic floor physical therapy (PFPT) is the first step in treating uterine prolapse without surgery. Rigorous research shows a clear benefit of physical therapy as a first-line treatment for specific women’s health issues. In the PFPT approach, the physical therapist gives instruction on muscle strengthening, relaxation, and coordination exercises. Strategies also include manual therapy, biofeedback, and home exercises.

How do you fix a prolapsed uterus without surgery?

PFPT is the first-line treatment for uterine prolapse. A trained therapist can develop an effective treatment plan in most cases. However, surgery should be a last resort if less invasive treatments were unsuccessful or severe symptoms affect daily life.

What Causes Uterine Prolapse?

Uterine prolapse happens when weak pelvic floor muscles allow the uterus to descend into the vagina. This abnormal descent can cause a feeling of heaviness or fullness in the pelvic region. It can also cause back pain and problems using the restroom. Causes include:

  • Pregnancy and vaginal childbirth 
  • Weakening of pelvic muscles and tissue with advanced age and menopause
  • Conditions that put additional strain on the abdomen and pelvic area including obesity, chronic cough, and constipation.
  • Major surgery that causes decreased support in the pelvic region.

Is Treating Uterine Prolapse with PFPT Effective?

In 2014, the International Consultation on Incontinence report cited level 1, grade A evidence supporting the effectiveness of physical therapy in treating uterine prolapse. For example, a large study found PFPT improved prolapse symptoms after 12 months compared to those who received an educational leaflet or no treatment. Likewise, women who participated in a large Norwegian study showed improvement after pelvic floor muscle training under the supervision of a physical therapist. In addition, a meta-analysis published in the International Urogynecological Journal concluded that patients who received PFPT subjectively and objectively improved their pelvic organ prolapse symptoms and severity. 

Treating Uterine Prolapse without Surgery 

Uterine prolapse is not going away on its own. The best scenario is to treat it early and avoid surgery. Physical therapy can prevent pelvic organ prolapse from worsening and correct underlying causes. Pelvic floor muscle training such as Kegels strengthens the supporting structures around the uterus. An additional treatment option includes support pessaries—flexible devices inserted into the vagina. 

Physical Therapy for Uterine Prolapse

Physical therapy takes a multi-faceted approach to treatment. First, the therapist assesses the patients’ symptoms and lifestyle to develop an individual plan. The therapist begins with patient education, teaching them to avoid heavy lifting, reduce intra-abdominal pressure and engage core muscles when coughing, sneezing, and laughing. PT also includes core strengthening exercises and pelvic floor muscle training.

At COR, we have experts on staff to create and implement PFPT treatment plans. If your patients are interested in treating uterine prolapse without surgery, contact our referral office at 201-833-1333.

The Importance of High-Quality Postoperative Physical Therapy

High-Quality Postoperative Physical Therapy

What a patient does after surgery is almost as crucial as the operation itself. The procedure lasts a few hours, but the rehabilitation takes months. High-quality postoperative physical therapy is crucial for restoring mobility and strength. Therapy only works when done correctly. Improper healing could make the area worse and lead to complications. When referring to post-op PT, providers want to know that their patients are getting the best care possible. 

Why is physical therapy important after surgery?

Improper exercises put increased strain on the joint. The healing process slows, and range of motion can diminish over time. Those who don’t engage properly in post-op rehab may see atrophy of supporting muscles and soft tissue. 

The Importance of Personalized Support

Physical therapy improves overall health following an operation. Personalized support means proper healing and faster recovery times. Patients who actively participate in their rehabilitation process have better outcomes than those who don’t. A good PT teaches patients the best recovery methods and helps them maintain wellness over time. 

Consistency is key. When patients see the same PT every time, their progress is monitored and tracked by a single provider. The therapist and patient get to know each other and develop a therapeutic relationship. Each learns to trust that the other is working hard to contribute to the treatment’s success. Over time, patients will return to their daily lives better than before. 

Evidence-based Best Practices

High caliber PTs integrate the best available evidence, clinical expertise and patient values into post-op care. Clinicians who provide the best care for patients will take the time to find and apply the latest research. Moreover, knowledge and skill are a key aspect of evidence-based practice. 

Each PT has a unique body of knowledge. A clinician’s education, training, and competency all factor into their quality of care. Taking the patient’s needs and wants into account is an important part of care following surgery. A skilled PT will consider the person’s values, culture, and needs when developing a comprehensive treatment plan. 

Common Types of Surgery Requiring Postoperative Physical Therapy

Any type of surgery can be traumatic for the mind and body. So, patients  need excellent post-op care especially following joint replacements. Common types of surgery that require physical therapy include:

  • Total Knee Arthroplasty
  • Total Hip Arthroplasty
  • Shoulder Labral repair
  • Spinal Laminectomy and/or Fusion
  • Rotator Cuff Repair
  • Meniscus Repair
  • Knee Arthroscopy for various problems

        Total Shoulder 


Benefits of High-Quality Postoperative Physical Therapy 

A carefully supervised rehabilitation plan is crucial. Therapy helps patients reduce pain quickly and avoid relying on opioids. It also improves emotional and psychological states. Exercise releases endorphins that improve mood. Plus, having the support and encouragement of a PT means patients don’t feel like they are recovering alone. Other significant benefits include:

  • Improved circulation and reduction in swelling
  • Reduced risk of postoperative pulmonary complication
  • Faster recovery time and return to prior level of function
  • Balance and coordination training
  • Gait analysis and instruction in proper mechanics
  • Manual therapy
  • Self-care education
  • Home exercise instruction

The COR Difference 

At Churchill Orthopedic Rehabilitation, we create treatment plans specific to each patient. Our trained PTs have in-depth knowledge of the different types of orthopedic surgery. In addition, we understand the importance of continuity of care. At COR, patients see the same PT every time they come in. If your patients need high-quality postoperative physical therapy, call our office at 201-833-1333.

Cold Laser Therapy to Treat Pain: Can Exposure to Red Light Promote Healing?

Cold Laser Therapy to treat pain

Cold laser therapy to treat pain is a rapidly growing technology used to reduce inflammation and pain. The red light activates the body’s response to increasing tissue repair, healing, and relief. The low-levels of light are not enough to heat body tissue or cause skin damage. When used correctly, this non-invasive, natural treatment is free from damaging side effects. Other names for this process include low-level laser therapy (LLLT), low-power laser therapy (LPLT), and soft laser biostimulation.

What’s the Science Behind Cold Laser Therapy?

Cold or low-level laser therapy treats pain and inflammation through skin exposure to red and near-infrared light. The long wavelengths stimulate pigment molecules in the mitochondria of skin cells to produce chemicals the body needs for healing and repair.

Uses for Cold Laser Therapy to Treat Pain

LLLT is approved by the FDA for several conditions, from acne to autoimmune disorders. In physical therapy and rehabilitation, it helps alleviate the chronic pain of carpal tunnel syndrome and arthritis. It also reduces pain and swelling for minor injuries such as:

  • Sprains
  • Strains
  • Tendinitis
  • Tennis elbow
  • Neck and back pain
  • Knee and joint pain

Pros and Cons of Cold Laser Therapy

Soft lasers are safe and effective when used by a qualified practitioner. The process is quick and non-invasive. The procedure takes a few minutes, and all the patient feels is the device on their skin—there is no heat or pain.

On the downside, most patients require multiple sessions per week, and it may take several weeks before you feel the full effects. Some insurers may not cover laser treatments. Fortunately, the staff at Churchill Orthopedic Rehabilitation will provide the best care possible regardless of insurance.

When to Avoid Cold Laser Therapy

While there are no known side-effects in healthy patients, there are times when LLLT is not advisable. For example, avoid using it directly over malignant tumors except for pain relief in terminal cases. You also don’t want to use cold laser therapy over tattoos or thyroids. The effects have not been tested on unborn children, so women should avoid this treatment while pregnant.

When to Refer for Cold Laser Therapy

When patients experience pain, start with the least-invasive options. Consider referring patients for cold laser therapy to treat pain before moving to shots or surgery.  Laser therapy is also good for weaning patients off pain medications. If you are interested in learning more about our low-level laser treatment options, give us a call at 201-833-1333.

What Out-of-Network Physical Therapy Means at Churchill Orthopedic

Out-of-Network Physical Therapy

Out-of-Network Physical Therapy can sound scary.  When the PT is not a member of the insurance plan, patients often are required to pay the full amount of a treatment upfront, then are given a ’superbill’ to submit to their insurance. This can mean a couple of things for the patient. One is that they have to wait a period of time to receive reimbursements for their PT care, and secondly, they may have to argue with their insurance carrier about what may be covered. This can pose a real headache for many patients. Of course, primary care and specialist providers want to refer in-network providers of PT to save patients any hassles and make sure cost isn’t a barrier to recovery. Referring physicians must balance this goal with referring to practitioners who may provide a higher level of care, by virtue of providing one-to-one care, as in most out-of-network settings. We do things differently at Churchill Orthopedic Rehabilitation by facilitating the process for your out-of-network care, and we guarantee that your experience with us will be far superior to any in-network experience. The choice, ultimately, is yours.

Will insurance cover out-of-network?

Every insurance plan is different. HMO plans do not cover out-of-network costs, except in cases of emergency. PPOs offer more flexibility and cover partial payments for out-of-network providers.

In-Network vs. Out-of-Network Physical Therapy  

Health care payments are complicated—at times, it can be like speaking another language. Insurance companies use terms like in-network and out-of-network physical therapy. It can be challenging for patients to know how much each service costs and if they are getting the best deal.

Here’s how it works. Insurance companies negotiate lower costs with in-network healthcare providers. The term “in-network” means the PT is included in your plan because the insurance company contracted a discount with them. “Out-of-network” means the PT doesn’t have a special deal with the company, but it does not mean your insurance won’t cover some of the cost. Providers are not bound by the insurer’s rules. We can work with insurance companies and provide the best care possible at the lowest price to patients.

The Churchill Difference

At Churchill, we care more about providing exceptional physical therapy than we do about who pays the bill. We treat all patients the same, regardless of their insurance network. Once a patient has met their deductible, we accept their insurance payment. Referring physicians can rest easy that their patients will receive the highest quality care without breaking the bank. 

Our billing staff is here to help answer any questions you may have. Call the office to talk with Stephanie to discuss how the plan will work for your circumstances. We will work with your insurance company to determine the cost based on your remaining deductible if any. Patients recovering from surgery or injury should talk to their doctor about using Churchill for physical therapy. Give us a call at 201-833-1333.

COR’s Essential Personnel Program

Hello Everyone!
Our office re-opened after being closed for approximately two months and during that time we have been developing a performance program to give back to all our essential workers.  Through this program, our team wants to help people who have been dealing with nagging pains that have not been resolved and be relieved with appropriate physical therapy services.  If you have any questions about this promotion, please feel free to reach out to us.
Kind regards,
The Churchill Rehab Team

Churchill’s New Standard of Care

Hello Churchill Family!

We want to be sure you feel safe for your physical therapy visits as our community starts moving again. Some of the steps we are taking include”

  • frequent washing of tables/equipment/handles
  • utilization of masks by everyone in the building
  • adhering to social distancing guidelines
  • having our room sanitized daily
  • Tempature Checks For Patients and Staff 

If you have any questions or concerns please feel free to reach out to us.  We have returned to the office and seeing limited in-office visits at this time. We are here to help with all your orthopedic concerns!

Here is a round-up of recent content, enjoy!

Office Virtual Tour…We have implemented new changes in our clinic to keep our team and patients safe…

Office Setup and Safety Protocol…Check out our new office design and use of personal protective equipment (PPE)…

Quarantine Upper Body Edition…Here is a short demonstration of several exercises that you can do at home to stay active and strong!…

Kind Regards,

The Churchill Orthopedic Rehab Team

Ways to Reduce Swelling

Ways to Reduce Swelling

In our last blog, Dr. Breitinger defined what makes up the components of inflammation. In our next segment, we will briefly discuss ways to control and reduce joint inflammation whether acute (new injury) or chronic (lasting more than one month).

First, and most importantly, you need to identify the reason for a swollen joint.

  • Did you sustain an injury?
  • Was a new activity performed?
  • Did you perform TOO MUCH of that new activity?

Sometimes it can be the cumulative stress of a regular activity that pushes your joint behind its normal capacity. Often times, the new or repetitive stress lowers a joints normal tolerance, and then your daily activity keeps the joint irritated.

Classically, we have been conditioned to use the mantra, RICE, for inflammation control:

  • Rest
  • Ice
  • Compression
  • Elevation

Complete REST, which some may take literally, is not the best method. First you need to stop or reduce the activity that is causing the overstressing. Mobility WOD founder and Physical Therapist Kelly Starrett uses the phrase to “Decongest the joint”.  He emphasizes light, or non-stressful activity as a way for your muscles to pump the fluid out of the joint. If you are just lying on your couch, the fluid in that joint has the potential to remain.

For decades, ICE has been the preferred method for reducing inflammation. I completely agree with this statement, especially if you sustain a new injury, which causes immediate swelling and/or bruising. However, after 48 hours of that cycle starting, the arguments can me made to use either ice or heat.  There continues to be a discrepancy on which method is better, with the research still lacking on which is superior, despite the aforementioned conventional wisdom that ice is better.  Because ice and heat can both work as pain control methods, I always defer to my patients which method they prefer.  In my eyes, it’s better to use what typically works for them, instead of getting resistance for something they dislike.

Disclaimer: Superficial heat or ice treatments can irritate the skin if too hot or cold, and left on for prolonged periods of time. Please check skin integrity regularly and avoid over treating (For ice, greater than 20 min).

COMPRESSION, in the form of wraps, neoprene bracing, or ACE bandages are excellent ways to control swelling from worsening, especially after an initial injury. They act as subtle barriers to restrict increasing joint volume. They also keep the area warm and stimulate skin receptors, which can be soothing for some.

Disclaimer: Compression should not be tight enough to cut off circulation or leave marks on the skin.

ELEVATION, can also aid in swelling reduction by limiting blood from pooling in the joint, especially in the lower leg (if indicted). Keeping the involved limb above the heart has shown beneficial results, especially with acute swelling.

Medication: While it is not within a physical therapist scope of practice to recommend specific types of medications, over the counter NSAIDS (Non-steroidal anti-inflammatories) can have a big impact on swelling and pain complaints associated with a joint injury, should it not cause significant side effects.

 Disclaimer: NSAIDS should not be used more than 4-5x/week or over two-week period. If so, they should see a physician for further consultation, if they haven’t already done so.

Lastly, swelling can persist for other non-injurious reason including;

  • Decreased sleep
  • Increased life stress
  • Poor nutrition

A physical therapy consultation can further meet your individual needs and help get to the root cause of your issue.

Schedule an appointment today!

Gabriel Scher, DPT, SCS

But what is inflammation?

You may hear your Physical Therapist, Medical Doctor, or the general public talking about inflammation in the body…but what is inflammation?

Straight from Merriam-Webster, “inflammation is a local response to cellular injury that is marked by capillary dilatation, leukocytic infiltration, redness, heat, and pain that serves as a mechanism initiating the elimination of noxious agents and of damaged tissue”.

More simply put, inflammation is your body’s way of trying to protect and then start healing itself. Inflammation needs to occur in order for infections to clear and for wounds to heal, however, if inflammation lasts too long then it can actually cause harm to the body.

It is important to distinguish between acute and chronic inflammation.

Acute inflammation increases in severity quickly and normally only last for a few days. Examples could be immediately after twisting an ankle or cutting your finger, appendicitis or a sore throat. Medical News Today describes the symptoms of acute inflammation of the skin following the acronym “PRISH”:

Pain = the inflamed area is likely to be painful to the touch because chemicals that stimulate nerve endings are released and this increases the sensitivity in that area

Redness = the inflamed area is likely to be red because the capillaries in the area are filled with more blood than normal; capillaries need to enlarge so that fluids/proteins can move between the blood and cells more easily

Immobility = the inflamed area may become less functional/mobile

Swelling = the inflamed area may become built up with fluid

Heat = the inflamed area may become warm to the touch because more blood flows to the area

Chronic or long-term inflammation can persist for months to years. Different cells are involved…instead of healing the body, these cells release toxins that cause additional harm to the surrounding tissues and other structures.

Chronic inflammation can present as fatigue, mouth sores, chest pain, abdominal pain, fever, rash, and joint pain. Some examples would be Rheumatoid Arthritis, Crohn’s disease, and asthma. Medical News Today states that chronic inflammation can result from the following:

  • Failure to eliminate the cause of acute inflammation
  • Autoimmune disorders attack normal healthy tissue, mistaking it for a pathogen (bacteria, virus, or other microorganisms)
  • Exposure to a particular irritant over a long period of time (ex: industrial chemical)

A very important thing to note is that if inflammation is not treated appropriately, it can potentially cause additional problems such as atherosclerosis (plaque build-up inside arteries), some cancers, hay fever, and more.

In many circumstances, Physical Therapy can help to control acute inflammation and to work towards eliminating chronic inflammation. A physical therapist can aid in managing pain caused by inflammation while also taking a look at the bigger picture – what is causing this inflammation and what else has been affected because of this inflammation? Treatment plans can vary greatly and must be customized to each individual, however, potential treatment could include therapeutic exercises, manual therapies and/or use of modalities, such as laser therapy. Overall, the major goals of these interventions are to reduce swelling/pain, increase strength/range of motion, and encourage proper function. If you are suffering from inflammation, Physical Therapy can play an important role in getting you back to being you.

Call to schedule an appointment today in order to determine the best course of treatment based on your specific needs.


Nordqvist, C. (2017, November 24). “Everything you need to know about inflammation.” Medical News Today. Retrieved from