Common Conditions treated at Apex Physical Therapy
Choose a condition below to view more information:

Lower Back PainSciatica
Neck Pain - WhiplashHerniated & Degenerated Discs
Muscle Strains & InjuriesLigament Sprains
Frozen Shoulder/Adhesive CapsulitisRotator Cuff Pathology
Epicondylitis and TendonitisPlantar Fascitis
Patellofemoral DysfunctionSI Joint Pathology
TMJ DisorderCervico-genic Headaches
Carpal TunnelThoracic Outlet Syndrome
All Orthopedic and Musculoskeletal Surgical cases


The spine is composed of vertebrae, nerves, muscles, discs, ligaments and the spinal cord. There are 7 cervical, 12 thoracic, 5 lumbar, 5 sacral and 3 to5 coccygeal vertebrae. In between each cervical, thoracic, and lumbar vertebrae there are intervertebral discs. Discs consist of two portions, an outside fibrous connective tissue layer (annulus fibrosis) and an inner gelatinous layer (nucleus pulposus).

The annulus fibrosis allows pressure to be distributed evenly throughout the disc and the nucleus pulposus acts as a shock absorber for the spine.

A recent study stated that over 8 million Americans went to the hospital for non-specific spine pain in 2006. Other studies suggest that 80% of Americans will seek medical treatment for spine conditions at least once in their lifetime and 15-20% of all people experience some degree of low back pain at any given time period.

Most back pain is caused from improper posture, overuse, repetitive motions, improper lifting or lifting something too heavy, poor muscular support, trauma, genetic factors and degenerative conditions.

Common Pathologies of the Spine may include:

  • Injuries to muscles, ligaments, joints, intervertebral disc, spinal cord and vertebrae fractures.
  • A herniated/bulged disc occurs when the outer layers of the disc tear/stretch and can allow the inner gelatinous material to press or seep outward. This can lead to pain, electrical sensations, numbness/tingling, muscle weakness and fatigue, range of motion limitations and bowel/bladder dysfunctions.
  • Osteoarthritis is the process of degeneration of bone and cartilage over time which breaks down and irritates joints and the underlying soft tissues.
  • Spondylolisthesis is a term used when vertebrae are shifting forward, above or below adjacent vertebrae. There are varying degrees of spondylolisthesis and the most severe may result in spinal instability, joint/disc destruction, or even spinal cord damage.
  • Spinal stenosis is a genetic or age related change in soft tissue and bone structure causing narrowing of the spinal canal (the structure that houses the spinal cord) or foramina (holes where the nerves exit from). The shrinking of canal diameter can lead to increased pressure on nerves during upright activity causing back and leg pain.
  • Osteoporosis is a condition that causes a loss of bone mass/density and may lead to fractures or other bone related problems. This is found most frequently in older Caucasian and Asian female populations.
  • Spinal deformities such as scoliosis (excessive or incorrect curvature of the spine) may be acquired or congenital and can cause both back and leg pain.

Because of the complexity of the spine, physical therapists need to evaluate each individual to determine the patient’s level of function and what treatment approach would be most beneficial. This may include a combination of exercise, hands-on techniques, joint mobilizations, stretching, and modalities (ice, heat, ultrasound, traction, electrical stimulation, etc).


The knee is a lower extremity joint connecting the femur, patella (knee cap), tibia, and fibula. This joint is vulnerable to both acute and chronic injury as well as the development of osteoarthritis.

The major muscles that cross the knee are the quadriceps, hamstrings and calf (gastrocnemious) muscles. Ligaments help to control external stresses and are placed across the knee joint in many directions.

The anatomy of the knee is very complex. The shock absorbing structure of the knee is called the meniscus. The meniscus is a C-shaped cushion of cartilage which lies between the tibia and femur. It is intended to protect the joint and allow increased contact between the joint surfaces during activities such as walking, bending, or jumping. Injury to the meniscus can cause locking, popping, pain, and giving way of the knee.

There are two cruciate ligaments located in the center of the knee, the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL). There are also two outside ligaments known as the collaterals; they are the MCL (medial collateral ligament) and the LCL (lateral collateral ligament). These are located on the inside and outside of the knee. These 4 are the major stabilizing ligaments of the knee and prevent the knee from injury during excessive twisting, bending, and straightening (hyper-extension).

The knee joint is lubricated by small bursa, or fluid filled sacs, that help separate tendons from bones and allow muscles and tendons to freely move with minimal friction. The most common knee injuries seen in physical therapy are ligament and meniscal tears, degenerative changes (osteoarthritis), soft tissue inflammation/tendonitis, and those due to muscle weakness/imbalance, such as patella-femoral syndrome (PFS).


The shoulder is the most mobile joint of the body and is thus the most susceptible to injury. The shoulder joint is made up of three bones: the humerus (upper arm bone), scapula (shoulder blade), and clavicle (collarbone), as well as muscles, bursas, ligaments and other soft tissue structures. It has to have an adequate balance of both strength and range of motion in order to perform a wide variety of activities.

The shoulder moves in many directions, including: flexion (forward motion), extension (backward motion), abduction (arm moving away from your body), adduction (arm moving toward your body), internal rotation (hand moving behind your back), and external rotation (hand moving behind your head).

The anatomy of the shoulder is very complex due to the large range of motion and the structures needed to stabilize it. The rotator cuff muscles (supraspinatus, infraspinatus, teres minor, subscapularis) act to stabilize the shoulder by compressing the long bone of the upper arm (humerus) into the cavity of the shoulder (the scapula). Due to the extensive usage of our upper extremities, the rotator cuff is a common site of injury. Cartilage (labrum) acts to deepen the socket of the shoulder, thus providing stability to the shoulder joint. Lastly, bursa separate tendons from bone and allow motion of the shoulder joint to be more fluid.

Given the complexity of the shoulder, its large range of motion, and its strength requirements, the shoulder can be injured in a wide range of ways including: trauma, overuse, muscle imbalances/weakness, postural changes, and genetic factors. The most common shoulder conditions treated in physical therapy include: rotator cuff tears, impingement syndrome, tendonitis, adhesive capusulitis (frozen shoulder), and labral tears. Physical therapy can help to improve range of motion, strength, function, and decrease pain.