Download IMPACT Website Services and diagnosis treated This is a partial list

IMPACT Website
Services and diagnosis treated
This is a partial list of our services and diagnosis we treat:
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Medical evaluations by a Physical Medicine specialist
Pain management
Injection therapies
Aquatic therapy
Postural restoration
Prolotherapy
EMGs
MEDX spinal strengthening
Physical therapy
Occupational therapy
Ergonomic assessment and training
Foot orthotics
Post (and pre) surgical rehab
Kinesio taping
TMJ therapy
Connective tissue therapy
Protonics evaluation and fitting
Home exercise training and development
Gait training and analysis
Neuromuscular reeducation
FCEs
A partial list of diagnosis treated:
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Musculoskeletal dysfunction/pain
Low back
Neck
Hip
Shoulder
Leg
Knee
Foot
Hand
Whiplash injury
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Fibromyalgia
Carpal tunnel
Arthritis
Scoliosis
Repetitive motion injuries
Doctor Information
Insurance Plans
Medica
BCBS
Health Partners
Preferred One
UHC
UCare
Medicare
Medical Assistance
And many others
Call (651) 646-7246 for answers to any insurance coverage questions
Insurance Information
Orthotics
IMPACT has the facilities and equipment to produce high-quality foot orthotics onsite in our clinic.
Custom foot orthotics are important tools for treating many biomechanical problems such as low back
pain. Also, orthotic treatment of common foot disorders, such as plantar fasciitis, has been amply
documented in leading medical journals.
IMPACT offers the most versatile foot measurement system in the world. Our system holds several
orthotic patents for its ability to scan, produce, and adjust to individual patient needs.
Whether foot orthotics are medically necessary or needed for athletic performance, we can produce
high-quality, custom-made, foot orthotics quickly and economically.
Appointment times are available on a daily basis so that we can quickly accommodate patients desiring
custom foot orthotics.
Insurance Information
Functional Capacity Evaluations (FCEs)
FCEs or Functional Capacity Evaluations (sometimes called Functional Capacity Assessments) are a way
to objectively measure a person’s work capacity and/or functional abilities and limitations. Typically an
FCE is done after a severe injury or accident to determine one of the following:
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Is it safe to return to work?
What can the person do (or not do) at work or home?
Are there restrictions on the person’s abilities?
Does the person have the capacity to perform a given job?
IMPACT uses the format for FCEs developed by Dr. Leonard Matheson of California. Dr. Matheson is a
leading researcher in the area of Functional Capacity Evaluations and IMPACT is one of a small number
of providers in Minnesota using the computer software and following the procedures developed and
taught by Dr. Matheson.
IMPACT is also one of a limited number of facilities that not only does “full” functional capacity
evaluation but also does “limited” functional capacity evaluations. Limited functional capacity
evaluations are designed to:
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Test the person’s ability to perform a specific task or function
Test a given body area’s function or loss of function (i.e. back or neck testing)
The PRISM Aquatic Center
For years hydrotherapy has been useful in treating of orthopedic injury, both restoring damaged tissue
and reducing pain.
Now IMPACT has combined knowledge from the past with today’s technology to create the
musculoskeletal therapy of tomorrow.
In a coordinated effort with the Postural Restoration Insitute, IMPACT has fashioned the first
therapeutic aquatic center of its kind.
The pool has one general function, to improve the lives of those who use it. But there are so many
applications for this unique new pool that we are devoting a special section to it.
Revisit this space soon to learn more about the uses the PRISM pool is being put to.
Patient Information
The Pain Cycle
Pain begins a cycle that can become debilitating and incapacitating if the cycle is allowed to progress.
The cycle goes like this:
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Injury causes the brain and body to compensate to avoid the pain. For example: if you inure
your right shoulder, you will be careful when using your right arm and you will use your left arm
more frequently to allow your right shoulder to heal.
If the injury heals slowly, this compensation causes other muscles and tendons to be used more
frequently and move in ways not normal or intended.
Prolonged inactivity from the injured area causes the affected area to become even weaker, and
the compensating area begins to hurt because of overuse and unusual movement.
Posture, body movement, and even breathing may become more and more compromised,
causing pain in more and more areas.
This is why pain in the shoulder becomes pain in the neck and the shoulder. Back pain becomes back,
hip, leg, and even neck pain when the mind and body continue in this fashion, the cycle must be
stopped.
The medical term for what is required is neuromuscular reeducation. Our clinic is expert in
neuromuscular reeducation and our clinical staff is trained to stop the pain cycle. IMPACT is one of a
handful of clinics in the entire country certified in the advanced science of “Postural Restoration.”
These techniques, and others used to stop the pain cycle, create different outcomes from what a patient
has experienced elsewhere. Patients often experience the difference on their first therapy visit. Our skill
in neuromuscular reeducation is one reason why our clinic succeeds when so many others have failed.
Staff Page Info to Come
Mark Temp Page
Meet our medical director
Mark Agre, M.D.
Before joining our team, Dr. Agre was in charge of physical medicine and rehabilitation at United
Hospital for 10 years!
IMPACT is a provider for all major health insurance including
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Blue Cross
Health Partners
Medica
Preferred One
UCare
Medicare
And many others
Providing high-quality medical care is the result of focusing, obsessively, on three things:
1. Having the best medical caregivers possible, and providing them with ongoing training and
continuing education. Click here to meet our staff.
2. Providing the best facility, tools, and equipment for the caregivers. Click here for a view of our
tools.
3. Developing a treatment philosophy and protocols geared towards maximum positive outcomes
while controlling costs. Click here for our clinic philosophy.
All three aspects needed for world-class medical care are present at IMPACT.
The never ending pursuit of “best practices,” and the highest possible quality of musculoskeletal care, is
our passion.
We invite you to witness this passion in action.
Patient Experience
The differences at IMPACT are immediately apparent to patients when they arrive at (and even before)
the first appointment.
It begins with the friendliness of the administrative staff and continues with a waiting room that is more
of a family room in someone’s home than a typical medical “waiting room.”
The experience continues with massage chairs and over 20 varieties of coffee, tea, and cappuccino to
insure the most friendly and positive patient experience possible. It is not uncommon for IMPACT to
have former patients come to the clinic for a cup of coffee and a free massage!
The positive experience doesn’t end there. It continues with the professional staff. At IMPACT, the
provider staff all has superior patient interactive skills. IMPACT simply will not hire anyone, no matter
how talented technically, if their interactive skills are not top-notch.
Patients discover a skilled, talented, medical team that always has the time to smile—an important
therapy all by itself.
For more information on our staff click here.
Our Philosophy
For proper function of the human body, four different body systems/areas need to be working in
harmony.
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Neuromuscular
Postural mechanics
Soft tissue
Strength/conditioning
If any of these areas are not correct, function is or will be compromised. Pain is likely to result. The
patient may then be incapable of carrying on the normal activities of daily living. This pain, if not
corrected, leads to a degenerative cycle that facilities understanding and are able to treat effectively.
IMPACT’s successes are based on an approach that addresses all phases of proper body function.
Most physical medicine facilities focus almost completely on only one of these four areas. There are, for
example, several facilities that focus on strengthening alone to resolve chronic low back pain. If this is a
clinic’s approach, many patients with improper postural mechanics will fail.
Postural mechanics must be corrected before strengthening to achieve maximum patient outcomes. It is
probable that patients receiving a singular approach to musculoskeletal problems will continue to have
episodes of recurrent pain (and additional medical visits), because the underlying problems were not
addressed.
IMPACT’s approach creates superior outcomes and prevents referring clinics from facing recurring visits
with the same patient for the same diagnosis. This potential issue is further addressed by the fact that
every patient’s “plan of care” always includes patient education, patient specific exercises, and selfempowerment techniques to manage their own care and prevent future recurrences.
Communication
A major complaint of referring facilities is bad communication. Vagueness, stoppiness, tardiness.
At IMPACT we hate those things, too!
New referral sources are sometimes shocked when they receive the dictation from a medical
consultation within 24 hours. Always! Our medical director demands a quick response of himself, and
the habit has spread throughout our staff.
Because our clinic is not part of a huge medical complex, all our caregivers are under one roof. We can
therefore communicate with each other all day, ever day, providing better care for patients.
For the same reason, it’s easy for IMPACT to meet the individual communication needs of referring
facilities and patients. We make use of every means of interacting: voice, email. Fax. Internet, electronic
records transfer, etc.
IMPACT’s new, state-of-the-art, electronic records system brings an even higher level of communication
to an already superior communication system.
We treat the aches and pains of life, accidents, and injury.
I is for “integrated”
Integrations means you no longer have to drive all over the Twin Cities to meet your personal care
needs.Under one roof we offer medicine, physical therapy, occupational therapy, pain management,
orthotics, chiropractic, acupuncture, and rehabilitative care both on land and in water. No single clinic
offers the breadth and quality of services that you will find at IMPACT. Integration also means a
relationship with other experts in musculoskeletal care. This extends from our relationships with the
various care systems and insurance companies to weekly meetings where we participate and review
patient cases with surgeons, radiologists, neurologists, anesthesiologists, and other care providers. The
bottom line is, we either have the internal resources to assist you or we will work with you to find the
health care providers needed to assist in meeting your medical needs.
M is for “movement and motion”
Improper musculoskeletal motion and movement is the most common cause for patient pain. We are
experts in restoring function. This is done by restoring proper motion and movement to your bodies
affected areas. Movement, motion, function, and pain relief are all tied together. The possible
interventions needed are many and each case is treated individually. At IMPACT you are never given a
“cookie cutter” approach to your care. An individual treatment plan will be developed at your first
clinical visit. Together we can, and will, improve your movement, motion, and functional abilities.
P is for “physical medicine”
Physical medicine is what we do. Why we are so good at physical medicine is another “P”. That “P”
stands for providers. Medicine is a science but ultimately the skill of the person providing the science
means everything. In terms of physical medicine, no single clinic can match our skill or the experience of
our clinical staff. The combined experience of our clinical staff is over 150 years! The average individual
experience level is over 10 years! From our medical director, Dr. Mark Agre, to our team of occupational
and physical therapists, each has the experience and advanced training to help every patient
individually. Additionally, we are one of the small number of clinics in the Unites States to become a
“certified” by the Postural Restoration Institute. Quality providers with advanced training and
equipment create quality patient outcomes. You deserve the best provider available in musculoskeletal
care and we assemble a team second to none.
A is for “aquatic therapy”
Although no one questions the efficacy of aquatic training, there are very few therapy pools in the
metropolitan area. The reason is simple—therapy pools are expensive to build and maintain. In our
obsession to provide the finest care possible for our patients, no cost was spared to build the best pool
possible. IMPACT physical medicine and aquatic center has built the world’s first “PRISM” pool. Our pool
was over three years in the design and construction. The pool is not a swimming pool, it was designed by
the Postural Restoration Institute for one purpose—to advance the medical science and outcomes
associated with aquatic therapy. The pool is not just another therapy pool—it is literally the world’s
most advanced therapy pool! We invite you to come see for yourself!
C is for “comprehensive”
We offer all the common modes of musculoskeletal treatment but we do not stop there. The
completeness of our range of advanced treatment options is simply not available elsewhere. From our
MEDX spinal strengthening equipment to our “PRISM” pool to our certification in the advanced science
of Postural Restoration, we have treatment options and approaches many clinics have never ever heard
of. In medicine one size does not fit all. This is especially true with complex and chronic cases. When
cases are chronic or complex, one or two treatment options may not be enough. Each patient must be
treated individually in these situations to ensure the best possible outcomes. Our comprehensiveness
reaches beyond the walls of our clinic and into the medical community at large. This means that we are
networked to an even larger core of medical providers to provide services such as surgical procedures
that we cannot provide. Comprehensiveness is an important reason for coming to IMPACT.
T is for “technology”
Technology advancements happen continuously in medicine. IMPACT is committed to bringing the finest
in technology to our patients. Medical equipment is not all the same. We have invested in the best
technology, equipment, and training. Examples are our MEDX spinal rehab equipment, our top of the
line Nautilus equipment, our in-house orthotics fabrication equipment, our “PRISM” pool and even our
“soft bed” treadmills. We believe it is our obligation to provide you with the best equipment possible,
and to put that equipment in the hands of the best care givers possible. You deserve nothing less!
MEDX
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Medical REHABILITATION
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Physical fitness
Sports/strength training
Thoroughly researched, scientifically designed
Over 100 refereed journal articles and international meetings reported the effective non-surgical
treatment of spinal and knee problems with MEDX equipment.
Medical outcomes data along with extensive research performed both clinically and academically
demonstrate the efficacy of MEDX technology for the rehabilitation of soft tissue injuries. Our medical
machines are utilized in progressive rehabilitation centers in the United States and throughout the
world.
As a functional testing tool, each machine tests range of motion and force output at multiple joint
positions. The MEDX line includes machines that evaluate the musculature involved in Lumbar
Extension, Cervical Extension, Cervical Rotation, Torso Rotation, and Knee Flexion/Extension.
As a dynamic exercise rehabilitation instrument, each machine strengthens the involved muscles,
increases pain-free range of motion, and enhances muscular endurance. These benefits normally result
in pain reduction or elimination, and restoration of normal function. Chief beneficiaries are individuals
suffering from chronic injuries.
Advanced research and training has been conducted at The University of California at San Diego.
MEDX
rehabilitation instruments feature state-of-the-art computer technology that enhances decades of
strength training expertise. Computer readings record angles of motion and correlate force outfit with
multiple joint angles. Both total functional torque and ntuscular torque are recorded.
Equipment features pioneered by MEDX include:
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Stabilization for muscle isolation
Counteracting gravity’s effect for accurate torque measurement
Short stroke length weight stacks during dynamic exercises
Isometric testing at multiple joint angles
Non-muscular torque assessment
The patient-adaptable equipment features seat positioning, range of motion, counterweights, and
restraint systems that all adapt to the unique physical requirements of each patient. The equipment
provides resistance for rehabilitation exercises in small weight increments allowing individualized levels
of resistance for any rehabilitative regimen. The computerized diagnosis provides updated results of
training, strength evaluation, and rehabilitation of musculature. Counterweighting the patient’s body
enhances testing accuracy by removing the weight of the torso, head, and arms. IMPACT personnel are
fully trained to operate and handle all aspects of MEDX testing and rehabilitation.
MEDX
standardization makes testing accurate and reproducible. Computerized testing measures and plots
muscle function. Typical extension curves are seen to the right. Both normal and abnormal lumbar
extension curves are shown for comparison.
Four vital factors influence testing:
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Muscle Isolation:
The muscles tested must be pinpointed. Assistance from surrounding musculature skews
test results.
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Use of static force
Motion generates friction and produces force, each of which interferes with measurement of
muscular torque. Static testing allows for true maximal measurement of voluntary effort and
accurately correlates position and torque.
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Measurement of angular position
Strength output varies according to joint angular position. The joint angle must be
determined precisely at each point along full-range movement.
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Measurement and deduction of non-muscular torque
Compression of soft tissues, and the elasticity of stretched tissues, creates torque. Gravity and
friction must also be measured to correctly assess net muscular torque.
MEDX
rehabilitative instruments return unparalleled results in the treatment of spinal and cervical dysfunction.
IMPACT uses MEDX to extend both the lumbar and cervical range of motion.
Lumbar Extension:
The MEDX lumbar extension machine provides functional testing and spinal therapy. A unique system of
pelvic stabilization provides true isolation of the deep muscles of the lumbar spine. Weakness of these
muscles can be responsible for chronic disability and persistent or recurring pain.
Cervical Extension:
The MEDX cervical extension machine is highly reliable and specific for the quantification of isometric
cervical extension and dynamic resistance training. Because cervical muscles must continually support
the weight of the head, headaches and neck pain are common clinical complaints.
Patient Information
Postural Restoration
Postural restoration is an approach to treatment developed by the Postural Restoration Institute. This
advanced treatment approach is designed to restore proper body mechanics to patients with
musculoskeletal problems.
The approach involves manual and non-manual techniques to restore the body to its neutral or correct
position. Orthopedic and neurologic concepts are combined to address the underlying causes of the
patient’s pain and dysfunction.
IMPACT’s skill at restoring proper body mechanics through Postural Restoration is a major reason for
our successful outcomes. The IMPACT clinic is one of a handful of clinics in the Unites States certified in
Postural Restoration.
IMPACT also has the world’s first PRISM pool incorporation these advanced techniques into the design.
Typically, a patient will notice the difference in our approach on their very first visit, and better
understand how IMPACT can help!
Click here for a more advanced explanation of Postural Restoration.
Postural Restoration
Mission
The Postural Restoration Institute was first established to explore and explain the science of postural
adaptations, asymmetrical patterns and the influence of polyarticular chains of muscles on the human
body. Our mission is based on the development of an innovative treatment approach that addresses the
primary contribuation of postural kinematic movement dysfunction.
We are dedicated to clinical education, research, and the ongoing search for improved pathways of
physical medicine. Together we are creating resources, education opportunities, research, and patientcare programs to assist those who wish to maximize their assessment and treatment skills in the areas
of respiration, myokinematics, neuromuscular applications, and postural imbalances.
What is posture?
Posture is a reflection of the position of many systems that are regulated, determined, and created
through limited functional patterns. These patterns reflect our ability and inability to breathe, rotate,
and rest, symmetrically with the left and right hemispheres of our axial structure.
“Limited functional patterns” refers to movement that is restricted in directions, planes, or normal
boundaries of functional range, as a result of improper joint, muscle, and mediastinum rest position.
Function is therefore limited because soft tissue and osseous restrictions prevent one from using
muscles and joints in their normal range. Adaptation and compensation for these limitations require
neuromotor encoding and hyperactivity of muscle that is placed in improper positions that exceed
normal physiological length, or in positions that make them a mover or counter-mover in planes and
directions that are not observed when one is in a neutral or more symmetrical state of rest. This
compensatory activity and hyperactivity usually becomes dysynchronous in the accessory muscles of
respiration and at the appendicular flexors and axial extensors, thus limiting functional rotation at the
trunk and through the lumbo-pelvic-femoral and cranial-mandibular-cervical complex.
Postural Restoration
The Science: Polyarticular Chain Description
Temporomandibular cervical chain (TMCC)
Muscles: Temporaliz (ant. Fiber), Masseter, Medial pterygoid, Rectus capitis, posterior major, Obliquus
capitis, Rectus capitis anterior, Longus capitis, Longus colli
BRACHIAL CHAIN (BC)
Muscles: Anterior-Lateral Intercostals, Deltoid-Pectoral, Sibson’s Fascia, Triangularis Sterni,
Sternocleidomastoid, Scaleni, Diaphragm.
There are two brachial polyarticular muscular chains lying over the anterior pleural and cervical area.
These chains influence cervical rotation, shoulder dynamics, and apical inspirational expansion. They are
composed of muscle that attaches to the costal cartilages and bone of ribs 4 through 7 and xiphoid to
the posterior, inferior occipital bone, anterior, inferior mandible and coracoid process of scapula. These
two tracks of muscles, one on the left side of the sternum and one on the right, are anterior to the
medial and upper mediastinum and upper thoracic cavity and are composed of the triangular sterni,
sternocleidomastoid, scalene, pectoralis minor, intercostals, and muscles of the pharynx and anterior
neck. They provide the support and anchor for cervical-cranial orientation and rotation and rib position.
The right brachial chain muscle is opposed by the right posterior back muscles (PEC), lower trap, serratus
anterior, and external rib rotators, in addition to the left internal abdominal obliques. The brachial chain
muscle on the left is opposed by the left posterior back muscles (PEC), lower trap, serratus anterior,
external rib rotators, and right internal abdominal obliques.
ANTERIOR INTERIOR CHAIN (AIC)
Muscles: Diaphragm, Iliacus, Psoas, TFL, Vastus Lateralis, Biceps Femoris.
There are two anterior interior polyarticular muscular chains in the body that have a significant
influence on respiration, rotation of the trunk, ribcage, spine, and lower extremities. They are composed
of muscles that attach to the costal cartilage and bone of rib 7 through 12 to the lateral patella, head of
the fibula, and lateral condyle of the tibia. These two tracts of muscles, one on the left side of the
interior thoraco-abdominal-pelvic cavity and one on the right, are composed of the diaphragm and the
psoas muscle. With the iliacus, tensor fasciae latae, biceps femoris, and vastus lateralis muscles this
chain provides the support and anchor for abdominal counter force, trunk rotation, and flexion
movement.
Postural Restoration
THE LEFT AIC & RIGHT BC POLYARTICULAR PATTERN
Individuals experiencing symptoms at the knee, hip, groin, sacral-iliac joint, back, top of shoulder,
between the shoulder blades, neck, face, or TMJ, will demonstrate inability to fully adduct, extend or
flex their legs, on one or both sides of their body. They usually have difficulty in rotating their trunk to
one of both directions and are not able to fully expand one or both sides of their apical chest wall upon
deep inhalation. Cervical rotation, mandibular patterns of movement, shoulder flexion, horizontal
abduction, and internal rotation limitations, on one or both sides, will also compliment the above
findings. Postural asymmetry will be very noticeable, with one shoulder lower than the others, and
continual shift of their body directed to one side through their hips.
The pattern that is most often prevalent involves the left anterior interior chain, the right brachial chain,
and the right posterior back muscles (PEC) of the body. The left pelvis is anteriorly tipped and forwardly
rotated. This directional, rotational influence on the low back and spine to the right mandates
compulsive compensatory movement in one or more areas of the trunk, upper extremities and cervicalcranial-mandibular muscle. The greatest impact is on the rib alignment and position, therefore
influencing breathing patterns and ability. It is very possible that respiratory dysfunctions, associated for
example with asthma or daily, occupational, repetitive work positions can also influence pelvic balance
and lead to a compensatory pattern of an anteriorly tipped and forwardly rotated pelvis on the left.
Other common, objective findings secondary to compensatory physical attempts to remain balanced
over this unleveled pelvis include elevated anterior ribs to the left, lowered, depressed shoulder and
chest on the right, posterior rib hump on the right, overdeveloped lower right back muscle, curvature of
the spine and asymmetry of the head and face.
Postural restoration
This particular pattern of neuromuscular imbalance is enhanced and generated usually at early ages of
development in the pre-adolescent and adolescent years. Since the fibers from our diaphragm that
attach to the front low spine and our diaphragm is generally stronger on the right, we all have the
tendency to shift and rotate our spine to the right sooner and more often than to the left. The liver also
assists this directional pull on the spine and pelvis because it keeps the right larger diaphragm better
positioned for respiratory activity. We do not have a liver on the left side. The left diaphragm leaflet is
much smaller and does not have the advantage to pull the ribs up and out upon exhalation, so there is a
tendency to relax the left abdominal wall. Consequently, these abdominal muscles on the left become
weak.
This pattern compliments our right dominance of extremity use, our daily shifting of weight to the right
and overcompensating patterns of activity above and below our pelvic floor. Airflow for example, will
generally move more easily into the left chest wall than in to the right because of the rotational
influence on the ribs, as previously described. Lack of underlying structural support exists on the right
that does not exist on the left due to pericardium position. Rotation of the upper trunk to the left will
generate less activity on the neck when in this pattern because of the dynamic respiratory, structural
phenomena. However, rotation of the upper trunk to the right limits air movement into the left chest
wall. This created torque on soft tissue, secondary to movement on an imbalanced foundational
structure, usually results in chronic muscle overuse, inflammation, and pain, such as one would see in
someone diagnosed with fibromyalgia.
Doctor Information
Postural Restoration
Postural Restoration is a unique approach to physical medicine developed and taught by the Postural
Restoration Institute of Lincoln, Nebraska.
IMPACT is one of a handful of clinics in the country certified in these advanced training techniques that
seek to address biomechanical problems leading to pain and dysfunction.
IMPACT also has the world’s first PRISM therapy pool which incorporates the treatment concepts of
Postural Restoration into an aquatic environment.
The principles of Postural Restoration draw together traditional orthopedic and neurologic teachings
into an updated approach to restoring proper body function.
Some of the concepts of Postural Restoration include:
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All people are all-right dominant (even left handed people). This dominance exists because our
lungs and the large organ of the liver on the right have three lobes on the right compared to two
on the left.
Overuse, injury, age, and genetics cause this right-dominance to create biomechanical problems.
There are chains of muscles that must work together for correct body function.
Patients with incorrect body mechanics will exhibit patterns that are identifiable upon
examination
Treatment consists of manual and non-manual techniques, patient education, and exercises to
“turn on” musculature that isn’t correctly firing and to “turn off” musculature that is being over
utilized.
Based on the principle of Postural Restoration, IMPACT treats musculoskeletal problems within the
context of the complete neuro-musculoskeletal system.
This approach answers, explains, and treats many of the issues that stymie other practitioners of
physical medicine.
For more information regarding Postural Restoration click here.