(949) 999 - 0777 | 230 E 17th St., Ste 202, Costa Mesa, CA 92627
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Treatments 2017-10-07T01:08:47+00:00

Diagnostic Studies

Diagnostic studies or tests are not “routinely” necessary for most of our patient’s episodes of acute musculoskeletal injuries. Obtaining a comprehensive medical history and a thorough physical examination often provide the primary indicators of the real problem. Therefore, here at FORMA, the main purpose of our diagnostic tests is to confirm suspicions of the cause of the problem or to rule out serious underlying structural, pathologic conditions.

As you can imagine, we apply careful and selective criteria to determine the usefulness of our diagnostic examinations. At FORMA, in-office diagnostic studies are performed when clinically indicated after a determination by a physician, and can include fluoroscopy (x-rays), electrodiagnostic studies (EMG/NCS) and musculoskeletal ultrasound, each of which is described in detail below.

Electrodiagnostic studies are important diagnostic evaluations of several conditions where nerves and muscles are involved. These studies — including nerve conduction studies (NCS) and electromyography (EMG) — are used to measure nerve-conduction velocity (NCV) and muscle-action potential. If that sounds confusing or complicated, just know this: These tests determine if symptoms (e.g., weakness, unresolved numbness or nerve pain in the legs or arms) are caused by a disorder of the nerve supply or the muscle fiber.

At FORMA, these types of tests can establish what nerve is pinched, and where the impingement is, confirming the image (MRI or CT Scan) findings. In addition, electrodiagnostic testing will give a measurable value to how severely it is affected and if the injury (denervation) is healed (chronic) or ongoing (active).

Measuring the electrical activity in muscles and nerves can also help us identify diseases that could damage muscle tissue or nerves. They are also helpful in excluding other causes of sensory and motor disturbances, such as peripheral neuropathy and motor neuron disease, and are sometimes used to diagnosis neck and shoulder pain, arm pain, numbness and tingling.

EMG and nerve-conduction studies are often performed together to provide more complete information. This information can then be used to help the FORMA medical and treatment team formulate further treatment plans.

An electromyogram (EMG) measures the electrical activity of muscles at rest and during contraction. During the EMG portion of the test, your FORMA doctor places small (acupuncture-like) needles into select muscles in the arm or leg to record specific electrical signals from each muscle. A muscle doesn’t broadcast normal electrical responses if it doesn’t receive adequate signals from a sick nerve, or if the muscle itself is sick.

nerve-conduction study (NCS) is a test commonly used to evaluate the function — especially the ability of electrical conduction — of the motor and sensory nerves of the human body. Nerve-conduction velocity (NCV), which is a common measurement made during this test, is used mainly for evaluation of damage to the peripheral nervous system, (i.e., numbness, tingling, burning and/or weakness of the arms and leg), which includes all the nerves that lead away from the brain and spinal cord and the smaller nerves that branch out from those nerves.

Some of the common disorders that can be diagnosed with the help of nerve conduction studies are:

  • Peripheral neuropathy
  • Carpal tunnel syndrome
  • Tarsal tunnel syndrome
  • Thoracic outlet syndrome
  • Ulnar neuropathy
  • Guillain-Barré syndrome
  • Facioscapulohumeral muscular dystrophy
  • Plexopathies
  • Other entrapment injuries and neuropathies.

To prepare for these types of tests, if possible, prior to your test, shower with a neutral soap and do not apply skin lotion. Certain medicines that act on the nervous system (such as muscle relaxants and anti-cholinergics) can change the results of your EMG/NCS.  You may need to stop taking these medicines three to six days before the test. If you take blood thinners, talk with your doctor and find out if you need to stop taking them before the test. Also, be sure to tell your doctor if you have a pacemaker. Do not smoke for three hours before the test. Do not eat or drink foods that contain caffeine (such as coffee, tea, cola, and chocolate) for two to three hours before the test. Wear loose-fitting clothing so your muscles and nerves can be tested.  You may be given a hospital gown to wear.

Ultrasound imaging is a non-invasive medical test that helps FORMA’s medical staff diagnose and treat medical conditions right in the office, delivering immediate information to you and to the rehabilitation team. Unlike x-rays, ultrasound exams do not use radiation.

Also called ultrasound scanning or sonography — involves scanning part of your body using sound waves to produce pictures of the inside of the body. Because ultrasound images are captured in real-time, they can show structure and movement, such as the shoulder tendon gliding under the impingement site or the wrist nerve being compress at different positions of the wrist. Ultrasound also can image blood flowing through blood vessels.

Ultrasound images of the musculoskeletal system provide pictures of muscles, tendons, ligaments, joints and soft tissue throughout the body. At FORMA, our medical and rehabilitation team members use ultrasound systems to:

  • Detect joint swelling and cartilage damage
  • Evaluate and differentiate between acute and chronic tendon and ligament injuries.

Fluoroscopy is a special type of x-ray used to project live images onto a monitor, and is commonly used by our medical team to obtain real-time images of the internal bony structures.

With fluoroscopy x-rays, we always use the lowest dose rates during procedures. The C-Arm Fluoroscope at FORMA provides the ability to reposition the fluoroscope (not you — the patient) to obtain the best guidance in multiple planes.

Most fluoroscopic procedures would likely require contrast dye to highlight a particular target area of the body (such the epidural space) to confirm the dispersion pattern prior to the injection of the intended medication. Our patients with iodine allergy (including shellfish intolerance) should discuss the risks and benefits of using contrast prior to their procedures. Pregnancy is a contraindication to x-ray radiation. Thus, fluoroscopy and CT scans are also contraindicated outside of carefully considered and emergency situations.

Having image guidance allows not only precision in many procedures, but the ability to use the thinnest needle available.  This reduces post-procedure soreness and increases safety by allowing direct visualization.

Medical Evaluation & Consultation

One of the many services we provide here at FORMA is Medical Evaluation and Consultation. In order for our team of medical and health professionals to work with you, we must first evaluate your current state of health and wellness. With that in mind, here’s what to expect during your first visit to our office.

During your initial appointment with our practice, your FORMA doctor will ask about your past medical history and you’ll receive a thorough physical exam. Make every effort to bring any past x-rays or test results related to your condition when you come for your first visit.

It is also very important for you to inform the doctor about other treatments and medications you have tried, as well as medications you are currently taking for any other health condition. That includes over-the counter medications and ALL NUTRITIONAL SUPPLEMENTS. Be sure to mention alternative therapies you may have participated in, such as acupuncture or massage.

As you would expect, your present condition will be discussed, including where your pain is located, its severity, when it occurs, and if you are experiencing other symptoms related to that pain.

Before any treatment is initiated, your FORMA doctor will discuss and possibly recommend additional diagnostic tests to confirm the suspected diagnosis and to evaluate for other conditions that may present similar symptoms. In case you’re wondering, these tests may include x-rays, MRI, Ultrasound, Electrodiagnostics and possibly blood tests.

A thorough physical and diagnostic evaluation allows your medical information to be carefully analyzed. The result enables our team of specialists to design a comprehensive physical rehabilitation program specifically for your condition and your needs.

Once the treatment plan has been determined, our doctors will coordinate your physical rehabilitation therapies. By conducting “team meetings” with the other members of the FORMA Team to discuss your diagnosis and plan of care, everyone treating you is brought into the fold and has a chance to hear from the doctor first-hand everything they need to know before your treatment begins.

Important Note: Be sure to discuss your availability to follow your medical and physical rehabilitation plan. Full participation in your treatment is important for a successful outcome.

Physical Rehabilitation Therapy

Physical Rehabilitation Evaluation

Following your initial medical work-up and with your pain under control, our team can progress you through FORMA’s rehabilitation program. It is here that our staff taps into the specialties of physical therapy, chiropractic and exercise physiology to further determine the breakdown of your body’s systems.

Examples in the runner might be that knee pain is actually the result of a weak or deconditioned hip. For the patient with a shoulder problem, it may be from an undetected neck problem leading to poor positional control over the shoulder and upper back.

Whatever the reason for your pain — obvious or not — our team of talented and experienced medical professionals and health specialists will ensure your physical rehabilitation evaluation is conducted thoroughly and accurately.

If you’ve never heard of spine or joint mobilization/manipulation treatment, you’re not alone. The terms “mobilization” and “manipulation” in our clinic are often used interchangeably. Generally speaking, mobilization is a manual therapy technique performed by one of our physicians, chiropractors or physical therapists.

There are different “types” of mobilization, each having a specific use with a particular condition, need and clinical indication. Here at FORMA, we use a technique (or a combination of techniques) that will be the most effective for you — our patient.

Simply put, mobilization treatment incorporates the application of light force with rhythmic movements at the beginning of range, to sustained movement at the end of range. At times, a “thrust technique,” which may be accompanied by a popping sound, may be also used if clinically indicated.

The benefits of spine and joint mobilization are many, including:

  • Pain reduction and control
  • Re-establishes proper range of motion
  • Increased body awareness of position and motion
  • Synovial fluid (joint fluid) movement (which improves joint health)
  • Increase flexibility and response of the connective tissue of the joints

In a typical physical rehabilitation program, mobilization is used to incorporate and enhance the effectiveness of therapeutic exercises. Here at FORMA, we have observed that restoring the joint range and quality of motion beforerecruiting and coordinating movement of the body provides faster and lasting results. We have also seen that patients who receive manipulation plus exercise show more and faster improvement than those who received stabilization exercises alone.

Here, we use therapeutic modalities — such as ultrasound, various electrical stimulation, moist heat and cold compress — for pain control and/or recovery after therapeutic exercises. Biomechanical taping or strapping is also used to ensure proper mechanics during functional training.

At FORMA, our Rehabilitation Exercise Treatment program focuses on exercise instruction and monitoring in non-painful positions. As you might expect, this approach allows your body to adjust to training, establish control, and accept more demanding exercises as time goes by. During this form of treatment, we also find and work on weak links that often keep people from feeling better and achieving peak performance.

After completing a personalized rehabilitation program, we prescribe a “self-care plan” to manage and keep any weak links from resurfacing, and to maintain and advance your overall physical health and wellbeing.

Performance Training

is a big part of what we do…

Use this page to learn about our work with Functional Movement Screening and Sport Specific Performance Training.

Functional Movement Screening

Once your core is cleaned up and healthy enough for performance exercise, you might be a given a Functional Movement Screen (FMS), which is a ranking and grading system that documents movement patterns that are key to normal function. By screening these patterns, the FMS helps FORMA’s staff readily identify functional limitations and asymmetries (i.e., issues that can reduce the effects of functional training and physical conditioning and distort body awareness).

The FMS generates a score, which is used by FORMA staff to target problems and track progress. This scoring system is directly linked to the most beneficial corrective exercises to restore mechanically sound movement patterns.

We monitor your FMS score over time to track progress and to identify those exercises that will be most effective to restore your proper movement and build strength.

Sport Specific Performance Training

At FORMA, when it comes to Performance Training, we have a simple philosophy that somehow has been forgotten in our fast-paced lives: We condition you — the athlete — to perform your sport of choice instead of just conditioning you — the individual — by performing your sport or activity.  This approach allows for  safer and better performance.

Pain Management Procedures

For that sudden pain and for those with chronic pain, finding relief can be a difficult and time-consuming process. Sometimes patients are sent back and forth from their primary care physicians to specialists and therapists of all kinds in search of a solution to their pain problems. Interventional pain procedures can be extremely helpful for those who continue to experience unresolved painful conditions after sometimes-exhaustive treatment methods.

Here at FORMA, interventional pain procedures are used for both diagnosis and for the treatment of many conditions. The goal of our interventional procedures is to identify the pain generators, then relieve or reduce the pain response and intensity. Once your pain is controlled or managed, you will most likely succeed in participating in a comprehensive rehabilitation program and improve your overall quality of life.

Interventional pain procedures at FORMA are minimally invasive techniques, and most of the procedures are image-guided by ultrasound or x-ray fluoroscopy. In some cases, electromyography (EMG), or nerve stimulator, is used to provide additional guidance for increased accuracy.

By concentrating on the cause of your pain, our interventional procedures deliver medications directly to the target site of your pain, which helps you return to your physical rehabilitation activities quickly and with a decreased reliance on medications.

Here at FORMA, we offer the following pain management treatments and procedures:

For the neck, mid-back and lower back (this is a very different procedure from the epidural anesthesia a woman receives during labor): the use of anesthetic (for diagnosis) and steroid medications (anti-inflammatory) injected into the epidural space to relieve pain or diagnose a specific part of the spine that is the cause of the pain.

Injections done to determine if a specific spinal joint is the primary source of pain.  Blocks also can be used to reduce inflammation and pain. For more information please click here.

A minimally invasive procedure that disables the medial branch nerves for six to nine months and prevents them from transmitting pain signals from the posterior column (facets). These are done after confirmatory diagnostic blocks to the target medial branch nerves are performed.

Electrodes placed near the nerves of the spinal cord that uses of electrical impulses to block pain from being perceived in the brain.

This injection block is used for diagnosis and treatment of piriformis muscle, which is possibly responsible for sciatic nerve irritation (sciatica pain).

The sacroiliac joint (a large joint in your buttocks region) can cause localized pain or it can refer pain into your groin, abdomen, hip, buttock or leg. A sacroiliac joint injection offers immediate pain relief, which will help confirm the joint as a source of pain. It can also allow for treatment of recalcitrant buttock and leg/hip pain.

A particular nerve may be the major sensory supply to a body area or specific joint, such as shoulder joint pain (suprascapular nerve), lateral hip crest pain (cluneal nerves) or headaches (occipital nerves). By injecting medications, including anesthetic and steroids on occasion, precise diagnostics can be derived and pain-reduction treatment can be performed.

Anesthetic injections targeting muscles, which have unresolved tenderness and are in painful spasms. These injections are normally performed with anesthetic solutions, allowing the interruption of spasms and pain.

Here, we use a “proliferative” solution (mostly dextrose or sugar water), which is injected into the ligament or tendon where it attaches to the bone. This causes a localized inflammatory reaction to increase the blood supply and flow of nutrients to stimulate the tissue to repair itself. Platelet Rich Plasma (PRP) is done by the injection of growth factors into injured areas, which are extracted from one’s own blood to stimulate healing.

Botox functions by temporarily blocking the neurotransmitters that tell muscles to contract. Thus, it decreases severe muscle spasm and pain for three to six months.

Botox is no longer just for celebrities — if you have chronic back and neck pain you may want to consider it as an option. The same injection that works to smooth out wrinkles just may work to relieve persistent, life-inhibiting pain caused by muscle tension.

The FDA originally approved Botox in the late 1980s to treat severe muscle contractions that caused strabismus (crossed eyes). It was then approved to treat painful spasmodic neck conditions such as cervical dystonia. In short, Botox was found to help relax the treated muscles because it functions by temporarily blocking the neurotransmitters that tell muscles to contract.

Interventional Pain Management Specialists use Botox as a very specific treatment for selected patients with chronic localized pain, such as specific types of headaches, facial pain, lower back, middle back and neck pain, which have associated chronic muscle spasms.

Since the drug is administered locally, there aren’t the systemic side effects such as fatigue and sedation that often accompany orally administered muscle-relaxant medications. Botox injections sometimes have to be repeated every three to six months to maintain a therapeutic effect if the problem is not significantly improved or resolved by a physical rehabilitation program.

Botulinum toxin A (Botox) has recently been studied as a treatment option for chronic low-back pain with promising results.  Unfortunately, due to the lack of FDA approval for the treatment of pain, the procedure is not covered by insurance.

At FORMA, Botox is used to decrease severe muscle spasm and pain in order to facilitate the re-education of important movement patterns through a physical rehabilitation treatment program, with the aim of achieving long-lasting results.

These are used to treat the inflammation of a bursa (bursitis), a tendon (tendonitis), or a joint (arthritis).  Systemic corticosteroid injections are also used for conditions such as allergic reactions, asthma and nerve inflammation.

Used to treat osteoarthritis of the knee with viscosupplementation medications injected directly into the joint.  These medications can help reduce pain in a joint affected by osteoarthritis, thus increasing mobility and allowing for maximization of your rehabilitation.

Note: At FORMA, we believe any interventional treatments need to be part of a comprehensive approach that may include the use of oral medications and a multi-disciplinary physical rehabilitation therapy program, with the ultimate goal of improving your overall physical performance and quality of life.

Regenerative Medicine

Anti-Aging Medicine

To get started on your journey to optimized health, call us at (949) 999-0777 to schedule an appointment or consultation.

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