William Paranto is the director of physical therapy services at Progressive Spine and Sports Medicine. He runs the rehabilitation component of this practice, which provide its patients the latest nonsurgical treatment options for pain and sports injuries.
Tell us about your practice. What sets you apart from other practitioners in your area?
We are a multi-disciplinary practice where physical therapists, massage therapists and doctors work side-by-side to provide the highest quality care we can deliver. What sets our team apart from other practices is our commitment to holistic treatment of our patients and ample one-on-one time with our therapists. We start by performing a full-body movement assessment on all our clients, no matter what their symptoms are, in order identify both their current limitations and other undiagnosed or unrecognized movement dysfunctions that may have caused or contributed to their current symptoms. These unrecognized limitations tend to be the root cause of many of the symptoms I see. We then perform a detailed soft-tissue examination to identify which muscles and other tissues are contributing to their current symptoms. This is important because some muscle dysfunction can mimic commonly misdiagnosed problems such as sciatica, carpal tunnel or headaches. By the time we have completed this thorough examination, we will have identified the root cause of their pain and problems.
Our treatment philosophy is centered on three aspects: First, we start with a variety of hands-on techniques in order to improve your soft-tissue health, reduced your pain levels and get your body ready to move. We use a variety of manual therapy techniques to achieve this including: massage/myofascial release, manual trigger point therapy, instrument-assisted soft tissue manipulation, kinesiotaping and dry needling.
Dry needling has been an incredible and invaluable addition to my clinical toolbox; there is no other technique I have that is so powerful in resetting muscle tone. By using a small filament needle, we are able to stimulate both a mechanical release of tight tissue bands and also create a neuromuscular “reset” to help an overly tight muscle return to its normal resting tone. I found that using dry needling on problematic muscles which don’t respond initially to my other techniques, followed by gentle massage, works really well to help the muscle relax.
Second, in terms of our therapeutic exercise and training, we take a movement-based approach to treatment. This means focusing on fundamental movement patterns that, biomechanically speaking, every person should be able to perform in order to do all the things you love to do correctly and pain-free. By focusing on these key movements, your body’s muscle groups work together to get stronger as whole.
Third, and perhaps most important, is our commitment to one-on-one time with our patients. By spending an hour directly with one of our therapists, we can ensure we are providing specific, high quality care to address the problems of our patients. This allows us to make sure we are making improvement on every single session you come in, not just going through repetitive exercise programs.
We’d like to talk about a patient success story you’re especially proud of. Tell us about the patient. How did they learn about your practice?
The first person that comes to my mind is a young man I worked with last year who was referred to us by his friend, whom we had previously treated.
Why did this patient come to your practice? What problems was he experiencing?
He came to us in really bad shape. He had been in a severe car accident about a year prior to starting with us and had suffered really severe back and neck problems as well as extensive soft tissue strains throughout his body. He also stopped his previous therapy treatment because he felt it wasn’t helping and over the past few months had gotten worse and worse. By the time he came in to us, he was having daily headaches and migraines, was unable to turn his head in any direction without pain, couldn’t lift his left arm higher then his shoulder nor could he reach behind his back. He had numbness and shooting pain down both his shoulders/arms. He described herself as being in constant pain, couldn’t get comfortable when sleeping, could not drive, and couldn’t do any of his daily tasks (food shopping, taking care of his dog) nor could he return to his work.
How did you go about diagnosing him?
As we discussed above, we took him through a comprehensive movement-exam first where we found his neck, back and shoulder movement was significantly restricted and painful in all his movements. We also reproduced his pain through our soft tissue exam; some his neck muscles sent pain right down his arm while another reproduced his headaches. This taught us which specific muscles we had to work on first, in order to reduce his muscle spasms and pain levels.
What treatment course did you decide on?
Because of the extensive soft tissue trauma he experienced from the accident, his whole thorax and neck were basically in spasm. So we took a gentle, manual therapy-focused approach first with the goal of reducing his muscle spasms and pain levels in order to allow us the freedom to begin moving.
We spent the first two weeks focused strictly on soft tissue techniques starting with gentle massage and heat and slowly progressing to our more effective but stronger techniques such as our manual trigger point therapy.
Slowly but surely his pain levels started going down and his headaches reduced in severity. We then used our dry needling techniques on the muscle bands and trigger points around his neck and shoulders that had not responded to our other manual techniques. We noticed the biggest difference in his pain after two sessions of needling. His ROM increased almost immediately and headaches subsided even more.
Once his extensive soft tissue limitations had been release by our manual therapy, we progressed to our movement-based exercise. I used my taping techniques as part of his home program to help reinforce to progress we had made in the clinic.
What was the impact your treatment had on the patient? How did you help him?
His pain severity reduced incrementally on each session and he would report that his pain and headaches were not as strong or frequent. The biggest change happened after our first dry needling treatment. He initially felt sore from the treatment, however, when he came back for his next session he was so excited to tell us that she had not had a headache since the dry needling and that he even had some feeling return to her shoulder area (around his upper trapezius muscle). By the time he finished with us, he was able to return to driving, playing with his dog and was able to return to his job, which was quite labor intensive.
What advice would you give PT students today? For instance, looking back at your own career is there anything you would do differently?
I think the most important advice I can give any student, regardless of profession, is the same advice my last clinical instructor gave to me – choose your first job wisely. You will learn more in your first 2-3 years on the job than in all your years of schooling and the stronger your learning experience is in this time period, the stronger your career growth can be.
I chose a lower paying job at a renowned teaching hospital in New York over a higher-paying job in a private clinic. Being part of a teaching institution with weekly organized in-services, lectures and great mentorship from the senior therapists provided me with an incredible learning experience. I attribute all my clinical and professional growth to them.
So as tempting as a high paying first job can be, my recommendation is choose the job that will provide you with the best learning experience; it will pay off in the long run.
Please talk about any ways you are trying to impact the community you’re a part of:
One key area of health where I think physical therapists are uniquely qualified to help is injury prevention and wellness. Many of the injuries I see in my clinic are from overuse problems or injuries from poor movement that could have been prevented. So one service we provide to our local community are free-injury screens. By taking community members through a few basic movements, I can identify any basic movement dysfunctions they may have and then give advice on how they can keep their bodies healthy and reduce their risk of injury. This has been especially appreciated in our local youth sports population as well as our older adults as it helps them understand how their body is meant to work as whole.
What is the funniest thing, if any, that has happened to you in practice?
I once had a patient bring in her cat for me to examine! I am not a veterinarian nor do I have any training in animal therapy (although now I am interested!). But my client had so much faith in our practice that she wanted me to use my massage techniques on her cat to help it walk again. Although I couldn’t treat the animal in our clinic, I gave her some general advice and the cat was able to walk just fine!
Anything (that you care to admit) that you would never do again?
As therapists, we are lifelong learners and there will be times where you may not know an answer to a question or may not be sure what is going on with a patient. So another piece of advice I would give is just be humble and honest. If you don’t know an answer to a patient’s question or are unsure how to help them, be honest with them and refer them to someone who may. They will appreciate your honesty in caring for them and the trust that this builds will help you and your practice in the long run.
