What We Do
Below are a detailed explanations of the treatments that we offer here at MSK. This is very long so please feel free to skip around using the menu to the right to find what you need. This page will give you information on issues we treat and how we treat them. You will also learn about our practitioners and philosophy.
The seven systems treated at Musculoskeletal Specialists (MSK) practice:
Muscles and fascia
Ligaments, Joints, Periosteum
Nerves, Veins, Arteries
The Brain/Vagus System
Sources of Pain and Treatment Options
This table shows some possible sources of MSK pain and the primary method we will use to treat the pain. Keep in mind we will consider any of the seven MSK treatment systems and acupuncture when doing an evaluation.
Common Source of Pain
Primary MSK Method Used to Treat
Treat source of Trigger point. Nerve, vein and artery releases and postural/stability restoration.
Muscle and fascia work.
Misaligned joint at the location or distant from the pain complaint
Muscle and fascia work, ligament, joint, periosteum, postural/stability restoration
Work related postural causes such as desk work or repetitive use
Muscle and fascia work, ligament, joint, periosteum, postural/stability restoration
Anatomy posture problems. Examples: -Knee pain: source in hip or ankle -Neck pain: source in shoulder or ribs -Mid back pain: source forward head posture or limited liver movement -Low back pain: source in overactive hamstrings, lack of core stabilization, cesarian section, or breathing pattern disorder
Muscle and fascia work, ligament, joint, periosteum, postural/stability restoration. Nerve and Viscera work.
Strained or sprained
Ligament, joint, periosteum. Neural reset
Muscles, fascia, local lymphatic drainage
Systemic Inflammation (dietary sensitivities, thyroid dysfunction, Diabetes, etc.)
Lymphatics, viscera, vagus treatment
Vagus treatment, relaxation treatment, acupuncture
Belief system/intention (pain is part of a person’s identity or self-view).
MSK Vagus Treatment in conjunction with other outside interventions.
Low electrical conductivity to the area of the body due to tension and lack of movement within that system.
Muscles, fascia, local lymphatic drainage
Scars near or within the fascial line or stability system. A scar directly impeding a joint, nerve, or an organ function.
MSK Scar Treatment, muscles, fascia
Strain from distant muscles not neurologically functioning within the system. Examples: -Neck pain from an overactive trapezius with a weak and dysfunctional supraspinatus -Low back pain from weak/underactive gluteal muscles or overactive external rotators of the hip
Breathing Pattern Disorder
Breathing rehab, viscera, muscle and fascia treatment
After oncology release- lymphatics, muscle and fascia focused on recreating glide of the nerves within the fascia.
Unrehabilitated bone break or ligament strain, even many years later. Example: -A forearm break at the age of ten leads to elbow tendonitis at age thirty-five that comes and goes for twelve years until the membrane between the bones is opened and lengthened.
Joints, ligaments, periosteum treatment
Referred pain from viscera (organs and related structures) sending pain signals to other parts of the body. Example -kidneys=glute, back pain -Liver=mid back, rib, right shoulder pain
Referred pain for trigger points in distant muscles
Nerve, Muscle, fascia treatment
Nerves are adhered to nearby structures and cannot glide. Example, Sciatica, trigeminal neuralgia, burning pain at the end range of joint movement.
Confusion of pain reporting from the brain after whiplash, concussion, long periods of having pain. (Example, Fibromyalgia, burning hands or feet, Cranial, nerve, vagus treatment “everything hurts”)
Cranial, nerve, vagus treatment
Limited Lymphatic movement
Muscle, fascia, lymphatics
Periosteum pain-point from excessive muscle tension on boney attachment. Example -Tennis elbow, plantar fasciitis
Muscle, fascia, nerve, periosteum treatment
The area of pain has had a recent trauma
Muscle, fascia, nerve
Headache sourced inside the head
Nerve, vein, artery head and neck, cranial bones treatment
Headache sourced outside the head
Muscle, fascia, postural restoration, liver or other viscera, dura treatment.
What We Do for each of the following:
Allergies: Manual therapy is applied to cranium and sinus release and eustachian tube drainage to relieve sinus pressures and clogged ears. Acupuncture is used to stimulate sinus drainage and stimulate weak organ systems. Acupuncture works well for allergies prevention before the exposure.
Ankle Pain: Chronic Ankle pain can easily be from a hip imbalance. The thigh is turned out or in during walking and the ankle is jammed with every step. For this we treat the ankle to relieve pain, then balance and center the hip and work on proper core stability.
A sprained ankle can remain dysfunctional many years after the pain is gone. When the ankle is pulled hard to one side, the position of two leg bones, tibia and fibula, are compromised. Usually, the fibula (the bone on the outside) gets pulled downward. This unbalances the knee and disturbs the brain’s communication to the knee, lower leg, and foot. At the ankle, on the opposite side of the sprain there is a recoiling effect that contracts the fascia around the nerves, veins and arteries. This also can remain for years after the sprain. Our ankle specific manual therapy, opens nerve conduction and blood flow to the lower leg and foot, opens the membranes around and between the tibia and fibula, balances the fibula back to the knee. We also check and center any bones of the foot that may be out of alignment.
Exercises are custom for you, but usually involve brain to foot neural communication to restore proper balance and function.
Back Pain: Chronic back pain is usually rooted in improper core stability and muscle imbalances. We evaluate the strategy your body uses to hold itself up and rebalance those overactive and underactive muscles with therapeutic exercises. We also do an evaluation of the nervous system of the lower body. For example, often time tight hamstrings are actually an overactive strained sciatic nerve and this nerve is strained from a dysfunctional core stabilization strategy. Our exercises return the core to the way it functioned when you were 6 years old. It has very little to do with muscle strength, as the core is actually a pressure system working from the diaphragm.
Our manual therapy also works on all of the intervertebral disks and ligaments of the spine to increase mobility of each spinal level.
Carpal Tunnel Syndrome
Carpal Tunnel Syndrome: The actual problem with carpal tunnel syndrome is rarely singularly rooted in the hand. There is usually two or more locations somewhere between the neck and hand that are impinging on the medial nerve causing the issue. Our carpal tunnel treatment is a full treatment of the nerves, muscle, fascia, from the neck to the fingertips. We also treat the root cause of this problem to prevent reoccurrence. If there is no event that caused the issue, carpal tunnel syndrome is almost always a symptom of musculoskeletal problems elsewhere. This treatment usually involves a postural correction component.
Elbow- The elbow is the tightest joint in the body, think “machined fit”. The first thing we do is check boney alignment and function of the elbow and wrist. We will then release muscle/fascia tensions directly to the elbow pain point. Often neglected with elbow issues is nerve dysfunction at the neck that may be the root cause of elbow pain. We do an evaluation of the brachial plexus nerves from the neck to the hand and treat the entire system. We will also evaluate stronger distant muscles that may be putting abnormal tensions to the elbow. After the muscle and nerve work, we ensure that all the joints of the elbow, shoulder, and wrist are aligned and have full range of motion and blood flow in and out is open. Tennis Elbow/Golfers Elbow is tendonitis of the elbow with irritation at the boney attachment and can be from an arm break many years before, or any of the issues listed above. Homework exercises are usually assigned for tendonitis of the elbow.
For the Baby
For the baby: In addition to treating the mothers, we can also teach mom how to do infant massage on her baby. This can be very beneficial for bonding and offer pain relief as the baby grows. Also, we are happy to check babies for fascial/dura imbalances and uncentered joints, limited organ and cranial movement. Any dysfunction in these can be irritating for baby, cause crying, and prevent sleep for everyone. Treating an uncomfortable baby usually takes no more than 5-10 minutes and is our priority. Just tell our front desk what you need and we will make a special time to get this done, usually the same day.
General Body Pain
General body pain: Generalize body pain could be sourced from many causes including systemic issues (such as food/environmental sensitivities), lymphatic flow dysfunction (such as breathing pattern disorder), sympathetic nervous system dominance (fight or flight), or a brain-vagus communication issue. For systemic or lymphatics, we do a full body treatment that moves the lymphatics in a way that pushes out dirty waste fluids from the systems and pulls in new clean fluids. We also evaluate the four main nerve plexuses of the body to balance between the neck, back, hips and legs and reverse the sympathetic dominance. We will release and center the joints of your neck, back, hips, shoulders, feet and increase mobility of these joints. We will treat the breathing pattern disorder with fascia balancing,
diaphragm direction alignment and if necessary visceral releases. Finally, a vagus treatment to relieve the body’s response and chronic tension to latent traumas within may be indicated.
80% of the population over 40 years old have a herniated disk somewhere in their spine. Herniations are only troublesome when they touch a nerve and prevent glide of that nerve. Studies also show that herniations come and go completely on their own with no therapy. When a disc herniation touches a nerve, the symptoms are called radiculopathy. This is numbness, tingling, or pain following certain pathways down the arm and legs that are related to a specific spinal level where the nerve is impinged. See a dermatome chart online to see the pathways. Disc herniations are a simple biomechanical problem, there is an object pressing on the nerve. MSK manual therapy works to both loosen the nerve tension on the disc and work the herniation itself away from the nerve. We have a series of tests to look at your core stability system that can quickly determine why the herniation happened in the first place and we rehab this issue with stability exercises. For patients that followed the homework and treatment plans, MSK is more than 95% successful in rehabbing herniations in a way that the patient avoided surgery.
Hip Pain: Chronic hip pain can come from multiple sources. There is usually a core stability issue contributing to the problem. Sometimes hip pain can actually be coming from a problem in the low back. We check and treat all of these. Two nerves, the sciatic and femoral, may also be irritated and contribute to the pain. We use manual therapy and therapeutic exercises to address these issues. If your hip feels like it is jamming in certain positions, we address these by releasing the associated nerves, releasing the muscles and fascia of the hip and then gently center the joint with movement under traction to restore better range of motion. Custom exercises are given to hold this treatment.
Knee Pain: Chronic knee pain is almost always rooted in a ankle or hip problem. The knee is a tight joint between two long bones with very mobile joints: the hip and ankle. When the hip or ankle are not centered or working properly the knee can become irritated and over time damaged. We will use specific manual therapy on the fascia and ligaments on the knee joint to increase full mobility, nerve conduction, and blood flow. However, this treatment can make your knee feel great, we must address the root cause at the ankle or hip to prevent reoccurrence. We can also, never treat a hip and ankle without checking the knee.
If you know when and where you hurt your knee, the knee treatment alone is usually enough to restore function. This is also a great manual therapy treatment to be done 6 weeks to many years after knee surgery. All joints operate on fluid tensions within. The genu articularis is a deep muscle of the knee that controls fluid pressure within the knee. This muscle can go offline post-surgery and may need a
neurological reset for the knee to properly work. This is one of the many checks we do post-surgery. We do manual therapy for postop knees; you must see a physical therapist for your doctor prescribed exercises.
Lymphatic Drainage: Lymphatics is the fluid system of cellular waste out and nutrition in. When lymphatics are not moving, the fluids around the cells becomes septic with waste products. The nerves are also bathed in these septic fluids and they respond with pain signals. Movement is your main lymphatic pump system. It’s a muscle pump system with the diaphragm as the primary pump. We use very specific muscle pumping and movement techniques that very effectively move lymphatics.
Lymphatic techniques are included in every maintenance treatment. Your practitioner will customize/modify your treatment as needed.
Migraines/Headaches: Tension headaches (cervicogenic headaches) are easily relieved by releasing neck tension and applying manual therapy to the cranium and jaw. Migraines leave residual tension on the neck, cranium, and jaw which makes the next migraine easier to occur. We relieve this prestress on the cranium which has successfully lessened the occurrence of chronic migraines. Limited blood flow through veins and arteries of the neck and head are big contributors to headaches. We check the vessels and open the blood flow. Any irritated cranial or nerve of the neck can lead to headaches through muscle guarding (tightening) action. We test the nerves and relieve the irritation. Viscera, such as the liver, can also be a big contributor to headaches. We will look at how the organs are moving, their blood flow systems, and ligaments and make any corrections needed. Headache pain is in the dura mater. This is the membrane around the brain and spinal cord. We will check and correct the dura itself and any spinal nerve tensions on the dura that can translate to tension on the brain. Lymphatic drainage also helps with migraine, occurrence. Lastly, we may do postural corrections that could be leading to undue tension on the back of the head leading to the cervicogenic (from the neck) headaches (common tension headaches). See our headache video for more information.
Chronic Neck pain is usually from dysfunctional nerves and poor head and shoulder posture long before the bones change shape with stenosis and bone spurs. These nerves can become irritated and hardened and stay that way for years. We address posture and nerve irritation with manual therapy and therapeutic exercise for posture.
Neck pain with radiating pain in the arms can be from nerve entrapment/irritation at the exit point of the vertebrae as is the case with stenosis. We use neck nerve/muscle/fascia releases with traction and then use a nerve specific technique to get the nerve to glide in and out of the exit point of the vertebrae. We also do not ignore the rest of the neuropathway into the arms. We treat the entire nerve pathway from neck to hand. We have great results with these techniques. After the acute pain phase is over, we then chase down the root cause of the problem that started the neck pain in the first place. This is usually lack of core stability, shoulder positions, mid back and head positions. All of these can strain the neck and cause problems years down the road. If the patient’s work is primarily desk work, we may recommend monthly maintenance to unwind the forward head position that occurs with hours at the computer.
Nerve pain: Nerve pain is usually rooted in a lack of glide somewhere along that nerve. For nerve pain we treat the entire neural pathway, check all major nerves of the body for contributing tensions, check the dura (membrane around the spine and brain), and any scars that may have migrated to encapsulate a nerve. We have precise nerve testing and treating techniques for nerve pain.
Cranial nerve pain is not outside of our reach. We have techniques to reach the nerves within the head. We have seen trigeminal neuralgia patients and have successfully relieved their symptoms in one or two treatments.
Pelvic Pain: Pelvic pain can be from many sources. These can include nerve irritation, limited core stability, trauma, surgical scars, breathing pattern disorders, etc. When there is dysfunction of the pelvic floor, painful trigger points (muscle knots) emerge within the body. If the root of the problem is not addressed, simple release of internal trigger points do not seem to hold and they have a high likelihood of their returning. The internal trigger points tend to relax once the root cause is reversed and exercise and movements are performed. Some patients need a complete vagus treatment for these tensions to finally release. Patients may receive self-treatment homework to enhance the therapy. We release the fascia, ligaments, and nerves of the pelvis, sacrum and coccyx, coordinate the pelvic floor to the diaphragm to restore function and stability, and work to restore the hips and backs coordination to the pelvis, then tie all of these back to the core. Most female pelvic floors are overactive, not underactive. The muscles are too tight to contract properly and timely and then there is a loss of control. If the pelvic floor is not coordinated with the diaphragm and there is great downward pressure, as in a sneeze, the pelvic floor fails to timely tighten and accidents happen. At MSK woman with pelvic floor issues will be treated only by a woman. This is also part of our postpartum program. If internal work is required, such as scar release of the perinium or cervix, exact uterus-sacral/coccyx ligament releases, etc., we recommend Kalena Chan, PT in Albuquerque (505) 221-6475. Kalena Chan has participated in MSK staff trainings and has contributed a great deal of knowledge to our treatment systems, particularly with the female pelvis and pregnancy treatment. She is also qualified to perform the MSK Vagus treatment to release bodily trauma if needed during her work. Patients looking for pelvic health, postpartum or pregnancy work in Albuquerque should see Kalena Chan, PT for a gentle, but highly effective treatment. She is an amazing therapist.
Men with pelvic pain is usually a low back or sacral nerve issue. We can usually treat these nerves through the cloths. For men, we will treat the nerves, release the fascia and nerves of the low back, sacrum, and coccyx, loosen and center the hips, release any scars, and restabilize the core with diaphragmatic breathing. The vagus treatment may be necessary for full resolution depending on patient history. For pain within the genitals, such as common vasectomy scar pain, we can coach you to self release the scar, or treat it if your are comfortable.
Plantar fasciitis is foot or heal pain that is usually caused by the larger muscle
attachments higher up the leg and rarely is resolved at the level of the foot. The leg muscles can be overactive and tight from sciatic nerve irritation, an overuse event, or improper core stability. We will release the tension on the legs down to the ankle and foot, relax and glide the nerve and teach core stability as required. Customized homework will be given based on findings. Pain usually resolves between a week to ten days, but may take up to six weeks or more if rest is not possible. These custom exercises can help keep plantar fasciitis from returning if done preventively. If you can’t come into the clinic, our advice for treating planter fasciitis from home is to not stretch the attachments because these cells need to touch to heal and stretching pulls them apart. Instead try foam rolling the calves and release the hamstring with a lacrosse ball 6 times a day for a week.
Pregnancy and Postpartum Recovery
Pregnancy and postpartum recovery: We have mothers treating mothers. This program is everything these moms wished they had when pregnant and recovering after giving birth. While pregnant, low back and pelvic pain is the chief complaint. Realigning the pelvis and sacrum is usually quick and easy during pregnancy.
Giving birth is not only an athletic event, it greatly involves the act of letting go. The pelvis and sacrum needs to be able to relax and open to accommodate the baby, the ribs need to be as wide and mobile as possible for breathing with the baby in the breath space, and the uterus and all associated ligaments need to symmetrically balanced. It is the diaphragm that acts as a piston and finally pushes the baby out. We coach proper diaphragmatic function and balance the tensions above and below the diaphragm for full function to coordinate the optimal push direction.
Near the end of the last trimester the joints of the pelvis need to be as mobile as possible to open. A stuck sacrum can lead to hard labor.
Baby positioning and the ability for baby to move is important. For this, we balance asymmetrical tensions on the uterus and the associated ligaments, clear nerves causing muscle tensions, and relieve visceral tensions within the abdominal
cavity. This will help release any tight tension lines that may be impeding the baby from turning from posterior to anterior or from breech. We have had success getting the baby to turn by simply giving baby the room to move and optimally positioning the mother. Homework is customized to you and your baby's position.
Postpartum- New Moms, PLEASE take after birth rest seriously. The number one reason a patient needs complex rehab is because mom returns to normal life too soon. Mothers, after birth there is wound the size of a dinnerplate inside of you from the placenta, your stability system is completely nonexistent due to the lack of abdominal tension, your ability to maintain your organ position from below is absent, and your body has been through many changes, physically and hormonally throughout the last 10 months. You need to rest to return to prebaby function. The most practical after birthing advice is to spend 5 days in bed, 5 days around your bed, and 5 days near your bed avoiding lifting and extended standing for these 15 days. Do your best, and rest as soon as you feel any pelvic discomfort. We highly recommend using Benkunk Belly Binding which must be wrapped from the bottom up to work properly for organ and pelvic support. There are many YouTube videos on how to do this. We do not recommend Kegel exercises because they create asymmetrical tension in the pelvic floor and do not promote systematic stability function. Kegels over-tighten one muscle (lavator ani) and tight muscles are not functional muscles because they cannot let go and recontract as needed. During your postpartum visit, we work to retore your stability viscera (organ) and pelvic floor function. We look at your posture and offer manual therapy and exercises to help prevent neck and shoulder pain from nursing and carrying the baby. We also teach how to hold baby in a way that doesn’t
strain the neck and shoulder or miss align your hips.
Post partum rehab can begin anytime, but 3 months after birth is a good time to begin bringing back normal function. We do not mind if you bring the baby to this appointment or need to nurse. By three months you'll know if this is possible for your child. Your postpartum therapist is also a mother.
If a caesarian section has occurred, we do direct work on the scar to prevent limited mobility, and adhesions to adjacent structures. We will teach you how to maintain the scar to avoid future problems. This treatment includes resetting the brain-vagus communication to and from any surgical sites or traumas developed in the body from your birthing process.
Sport Specific Pain
Sport specific pain: If chronic pain occurs from a sport, we will do immediate corrections with manual therapy, then we will take you through the movements of that sport in a slow anatomical way to find where your body’s weakness is in those movements. We will then treat any lack of mobility or weakness
with custom exercises for stability. This stability results in greater strength applied to where and when you want it and improved performance.
We find that during competitive sports it is better to get maintenance and corrections before the body breaks down. Usually, sport injuries require rest for true recovery which means missing events and practice or underperforming. It is far better to have a planned intelligent care regime throughout your season to limit injuries from repetitive movement.
TMJ Dysfunction: Jaw pain and misalignment is addressed by balancing asymmetrical muscle balance on the jaw. The musculature of the neck and poor head and shoulder posture can also contribute to jaw pain. Jaw pain can also be from clinching the teeth at night. This can be from over stimulated cranial nerves or response to unconscious stressors. For this we do an evaluation of the trigeminal nerve, vagus nerve, and the sympathetic nerve ganglia down the spine for compressions or over activity. A vagus treatment may be considered to help the body’s reaction to unconscious stress that leads to bruxism (clinching). We will treat any nerve dysfunction found. This TMJ/cranial treatment is recommended to be done after any major dental surgery such as implants or tooth extraction to ease the trauma of the surgery. It is especially effective after adjustments of braces to help the oral fascia of the mouth and fascia of the skull adjust to the new tensions placed on it. This can help relieve the pain from the process of adjusting braces and help the cranium accept the new position.
Whole Body Maintenance
We offer maintenance treatments to help hold our original treatments and prevent reoccurrence of pain. This treatment moves your lymphatics, mobilizes the discs and ligaments of the spine, loosens and stretches tight muscles, balances the neck, shoulders, hips, works the arms, hands and feet. We set aside time during this treatment to address your specific complaints and review/change your exercises. You can use the maintenance treatment to supplement your athletic/exercise program, prevent return of symptoms, unwind your body from deskwork, relieve stress, correct your posture, knock your pain levels back down, etc. Usually, maintenance treatments are done between 4 to 8 weeks. This depends on your lifestyle and the amount of self-care you do at home. We have found it is better to do maintenance to control pain levels than waiting until the pain is at the point it was at your first visit. In this case, we may have to start all over again as if you were a new patient. It is easier to hold symptoms at bay than start all over with multiple visits.