Our Services

Physical Medicine and Rehabilitation

A specialty which addresses the diagnosis, treatment, management, and prevention of musculoskeletal, neuromuscular, or neurological disorders and injuries.

What is a chiropractor?

Chiropractic Medicine is a branch of health care which focuses on musculoskeletal and nervous system disorders, and the effects of these disorders on general health.  Chiropractic care is most commonly used to treat neuromusculoskeletal complaints of the spine and extremities as well as headaches.

Chiropractors, or Doctors of Chiropractic, utilize a hands-on approach to treatment. In fact, chiropractic literally means to practice by hand. Chiropractic training incorporates the ordering and study of lab analysis and radiography, including X-ray, MRI, and CT imaging. Doctors of Chiropractic, or DCs, have extensive diagnostic skills, with specialized training in nutrition, diet, lifestyle counseling, and therapeutic and rehabilitative exercises.

Their emphasis is to restore harmony of function between tendons, ligaments, joints, connective tissues, and nerves, so that the body can work as it should without painful limitation.

However, chiropractors are trained to refer to other medical providers when structural problems or disease states indicate that additional work-up or medical care should be prioritized.

What conditions do chiropractors treat?

Chiropractors treat a wide range of health conditions, most commonly neuromusculoskeletal injuries of the spine and extremities, and headaches. Chiropractors treat many painful conditions including disorders of the back, neck, extremities, and headaches. They also treat tingling, numbness, and weakness that can be attributed to dysfunctions among muscles, tendons, ligaments, joints, and nerves.

Chiropractors diagnose and treat pain in the back, neck, shoulder, elbow, wrist, hand, fingers, hips, knees, ankles, and feet. They diagnose and treat pain and symptoms created by trauma, athletic or exercise injury, postural strains, overuse work activities, and some painful states where the reason for onset is not immediately known to the patient.

Common conditions treated include but are not limited to neck and back strains and sprains, rotator cuff tendonitis, whiplash associated disorder, carpal tunnel syndrome, nerve entrapment syndromes, patellofemoral syndrome, and plantar fasciitis.

Doctors of chiropractic also treat people with more widespread disorders including fibromyalgia syndrome, and inflammatory or autoimmune diseases of the spine and/or extremities. The goal of chiropractic care for these conditions is to reduce other contributing factors to the patient’s pain or symptoms. Often patients will have ongoing pain from non-disease sources such as prior injuries – for example a patient with severe widespread fibromyalgia pain may have a substantial amount of neck pain since an accident several years before. This part of the neck pain may not be caused by the fibromyalgia, but may be limiting the patient’s ability to turn the head. The goal of chiropractic care in this case is to treat the neck pain, and restore the range of movement, making it easier for the patient to cope with the limitations of the fibromyalgia. The patient remains with fibromyalgia but has much less pain in the neck. Resolving one more of these overlying conditions can make a huge difference in the lives of people with chronic disease states.

Another frequent goal of the chiropractor in treating patients with more widespread pain and inflammatory disease is to treat and minimize the resulting effect of the disease. These effects often include loss of range of motion or mobility, or physical deconditioning. For example a patient with Lyme’s disease may have experienced substantial joint inflammation and remains with stiffening of the joints and surrounding tissues as a result of the period when they were inflamed. In this case, chiropractic care is aimed at restoring, range of movement in the joints that were stiffened from the inflammatory phase of the Lyme’s disease, so they can recover the ability to walk and bend with less pain.

What types of therapies do chiropractors offer?

The principal treatment modality used by chiropractors is the chiropractic adjustment, also known as spinal manipulation.  Other manual therapies include mobilization of the soft tissues with the goals of improving range of motion (ROM) and reducing inflammation and scar tissue adhesions. These therapies reduce obstacles to healing and pain generators as well as stimulate the healing response.  Many chiropractors also implement electrical muscle stimulation and ultrasound therapies to further assist with management of pain, muscle spasm, loss of joint mobility, inflammation and scar tissue adhesions. Therapeutic and rehabilitative exercises may be performed in-office and instruction for home exercise may be provided, as well as work place and home ergonomic counseling.

Methods at Washington Medical Group include:

  • Myofascial Therapies: usually hands on treatment of muscles and connective tissues to restore the normal movement and slide of tissues.
    • Active Release Technique® - hands on method of restoring tissue slide where the practitioner contacts tissue that has lost normal slide and the patient moves the involved body part in a specific direction to restore the slide of the tissue and eliminate the resulting pain or symptom.
    • Fascial Manipulation© - hands on method of restoring tissue slide where the practitioner contacts over tissue that has lost normal slide and applies a controlled amount of friction until the tissue slides normally, and resultant pain or symptom is eliminated.
  • Movement Quality Training: This includes methods of improving movement to limit or prevent pain or symptoms which come from less efficient movement and posture. Methods utilized include:
    • Kinesthetic awareness training: often patients have lost or have not adequately developed the ability to feel what body part is doing what, especially in movements and positions that have become consistently painful over time. For example many patients with back pain brought on by bending over, cannot sense that their hips are not moving enough and that the back is bending excessively. Therefore they cannot stop and correct the bending before it becomes painful. Once the awareness is retrained through a series of in-office activities and exercise, the patient can sense the faulty pattern and change it immediately before pain starts. – this process is vital for developing tissue sparing strategies of all kinds – where people are taught how to stop overloading body parts to the point of pain and injury.
    • Exercise therapy: sometimes certain muscle groups lack endurance or strength and fatigue or shut off too soon, leaving a person vulnerable to pain producing movement or activity. Exercise therapies often target these weak links and build the staying power needed for a person to eliminate pain.
    • Coordinated postural and movement training: much of good posture necessary for efficient movement comes from automatic postural reflexes that are not under our voluntary control. This is why is often so difficult to “sit up straight” no matter how hard we try. Stimulating these postural reflexes is often very helpful in jump starting recovery from many painful conditions, where we feel “stuck” in painful postures or ways of moving. There are many methods out there for addressing this element of posture and they are usually lesser known therapeutic approaches. Dr. Pilgrim uses an approach known as Vojta therapy to stimulate improved posture – the patient is placed in specific positions usually derivatives of crawling, and rolling movements, and the clinician uses their fingers and thumbs to contact points on the body, and observe automatic changes in muscle tone, joint position, spinal curves and breathing. Patients usually feel these changes as they are happening. An immediate improvement in pain from specific postures and movements is often experienced after treatment. Exercises are then derived from positions that create the most desirable changes that the patient does at home to keep training the same postural improvements.

What is the difference between Chiropractic and Physical Therapy?

Chiropractors are doctors who are trained to examine and diagnose the condition of the body using physical examination, including orthopedic, neurologic and chiropractic tests, laboratory analysis and radiographic imaging, such as X-ray, MRI and CT scans, which enables them to function as primary health care providers. Chiropractors may refer patients to doctors of other disciplines and to physical therapists based on their expert clinical impression.  Physical therapists are providers that treat patients referred to them by medical, osteopathic and chiropractic clinicians.  Physical therapists treat specific musculoskeletal conditions that have already been diagnosed by, and with treatment plans set for them by the referring doctor.

Chiropractors are both different and similar to physical therapists.

Chiropractors and physical therapists do treat many of the same conditions.

Therefore there is a great overlap in skills between these two groups of professionals. Chiropractors are often type-cast as focusing more on hands on methods for treating spinal pain. This is far from exclusively true. Physical therapists are often conversely type cast as focusing more on reactivating and exercising their patients, but this is also an over-simplification of the skill sets one can find in the physical therapy field. Complicating this issue further are overlapping terms. For example, chiropractors are usually trained and licensed and to perform “physical therapy” but are not physical therapists. Many physical therapists have training in manual therapies which may be the same as those performed in some chiropractic offices, but they are not chiropractors. Both professions have similar scopes of treatment for conditions involving muscles, tendons, ligaments, joints, nerves and connective tissue. The services performed by a given chiropractor and a given physical therapist may be very similar or even the same. Also two given chiropractors or two given physical therapists may practice very differently from each other. The bottom line is that one cannot tell just from the clinician’s professional designation what their specific approach to neuromusculoskeletal problems will include. This must be determined from reading the website, and often from consulting with the clinician directly.

What is the typical length of time needed to treat several common conditions?

A chiropractor may provide treatment for acute or chronic conditions, as well as preventive care thus making a certain number of visits sometimes necessary. The nature and severity of the condition, the overall health of the patient, pre-existing conditions, patient lifestyle, compliance with established treatment plan and a myriad of other factors determine the length and frequency of treatment.  Some conditions require a few treatments, whereas other more severe scenarios require ongoing treatment for 2-3 months.  Examination findings coupled with response to treatment are strong indicators for expected treatment length.  This expectation is a component of the clinical impression, which is fluid and may change as the patient's condition changes.

For example, back pain brought on by an unusually high amount of gardening, will likely get better on its own within a few days of no gardening and then a gradual return to regular amount of gardening for that person.

But if the person above with back pain brought on by gardening has a prior history of for example, previous back pain in a car wreck, a monthly sore hip and 2 previous nasty ankle sprains in Volleyball back in high school that never quite recovered, they may take longer to recover from the low back pain, may not recover fully, or may struggle with recurrence of pain.

Both examples of low back pain seem the same initially, but one will get better on its own and the second example will likely require the care of one or more chiropractors, physical therapists or other physicians.

Therefore it is very difficult to tell just from the name of the condition how long it will take to resolve in a given case. Most of us know people who struggle with persistent plantar fasciitis, rotator cuff tendonitis or neck pain, where nothing seems to be effective, and we also know people with same conditions who get better on their own or respond quickly to some form of chiropractic, physical therapy, or medical care.

Washington Medical Group chiropractors often set up treatment courses in the range of 3 to 10 visits over a period of 2 to 6 weeks. Since some patients respond very quickly, the courses are often shortened, and the patient is discharged. Sometimes the courses are lengthened if patients cannot come in frequently enough, or if other factors are identified in the course of care which indicate that additional treatment would be beneficial.

What is functional restoration therapy?

Functional restoration therapy (FR) is a team-approach designed to break the vicious cycle of pain, physical deconditioning or disability and depression associated with chronic, persistent pain. When pain medications, conventional physical therapy, or surgical interventions as stand-alone treatments fail to provide sustained relief from pain, activity level becomes severely limited and physical condition deteriorates. The resultant frustration and helplessness often give rise to depression, anxiety and even anger. The downward spiral of this vicious cycle of pain, physical deconditioning and depression often leaves patients feeling progressively worse. Functional restoration is a method used to break the vicious cycle, focusing on improving physical capacity quality of life, and emotional condition.

Functional restoration is focused on improving pain coping mechanisms and physical capability as many of the patients who are engaged in FR are those who have had chronic, persistent pain, unresponsive to conventional pain management techniques.  FR team members may include medical doctors, chiropractors, psychologists, physical therapists, occupational therapists.

Can chiropractors assist with preventative strategies to improve posture and general conditioning?

Chiropractors have extensive diagnostic skills, with specialized training in nutrition, diet, lifestyle counseling, and therapeutic and rehabilitative exercises.  This includes ergonomic recommendations which may also help address posture.

Many people are not taking advantage of simple, inexpensive work station modifications to reduce tension in the body which can lead to pain. Chiropractors can work with patients on an individual basis to target problems in their work space set up. Also chiropractors can advise on “spine-safe” postures for specific activities to help prevent injury from those activities.

Why a WMG chiropractor?

We have an excellent combination of experience, education and expert technique regarding a wide range of physical conditions and injuries and we are part of a larger interdisciplinary team which is unparalleled in its ability to co-treat patients.

The WMG chiropractors believe that two heads are better than one. The doctors continue to develop different complimentary skill sets, so that patients have access to a greater variety of interventions than they would in a clinic specializing in only one or two treatment techniques. Between the two doctors, they are able to provide a wide range of advice, spinal and joint manipulation, myofascial therapies, movement and postural rehabilitation that is far greater than either could provide themselves. In addition, the chiropractors at WMG confer regularly regarding patient care, speeding and simplifying the process of referral from one practitioner to another when patients are better candidates for a specific therapy not provided by the current treating chiropractor. WMG chiropractors provide their care in a multidisciplinary medical clinic and have many years of experience in referring patients when indicated to staff primary care practitioners, neurologists, neuropsychologists and psychologists. They also maintain close ties with area orthopedists and physical medicine professionals. Patients benefit from smooth and informed transition between providers of many specialties. This is of particular benefit for patients suffering from multiple injuries post-accident, or for patients with more complicated chronic conditions who require care from more than one type of doctor at the same time.