Physical Therapy clinic to expand, hopes to add civilian physical therapist to better serve Published July 28, 2008 By Senior Airman Connor Burkhard 90th Missile Wing Public Affairs F.E. Warren AFB, Wyo. -- The physical therapy clinic here is scheduled to expand in the next few months to better serve the base populace. Due to limited staff, space and equipment, the clinic now only sees active-duty military members and retirees associated with the personal reliability program. As part of the expansion, the physical therapy clinic hopes to add a civilian therapist to their staff, increase the size of the office and set up more equipment. These changes will allow them to treat a broader range of patients. "When we get the other therapist, we will be able to start seeing family members and retirees instead of referring them downtown," said Tech Sgt. Micki Hinnershitz, 90th Medical Operations Squadron, physical therapy element noncommissioned officer in charge. Currently the office has one military therapist and four enlisted technicians. Maj. Evan Kelley, 90th MDOS physical therapist, meets with patients initially to determine an individualized treatment or exercise plan. He also handles monthly follow-up appointments. The physical medicine technicians ensure patients adhere to the treatment plan. "Technicians oversee the treatment and exercise programs," said Sergeant Hinnershitz. "We document any changes and administer the plan, making sure the patient is progressing." The services at the physical therapy clinic are referral-based. Currently, the only walk-in services provided are spinal manipulations for active-duty members. "The majority of the patients we see are post-op," Sergeant Hinnershitz said. "Knee and shoulder injuries are the number one injuries seen." The clinic offers two different types of treatments: modality-based and exercise-based. Modality treatment includes transcutaneous electrical nerve stimulation and electrical stimulation to control pain, therapeutic ultrasound, and mechanical traction, said Sergeant Hinnershitz. Exercise-based therapy is just that - low-impact exercises to help strengthen specific parts of the patient's body. Patients who underwent surgery and were assigned an exercise-based plan are normally seen two to three times a week depending on the type of surgery, while patients with modality-based plans are seen two times a week. The physical medicine technicians here treat many of the patients with an exercise plan as opposed to a modality-base treatment plan. "Modality-based treatment plans are more passive in nature and are good for pain modulation, Major Kelley said. "Exercise-based plans are more active in nature and help to improve overall functions." Exercise plans can include work on treadmills or stairmasters, and also include strengthening exercises with weights, resistance bands, exercises balls, and other specialized equipment. According to Maj. Kelley, "In an active treatment plan, the patient is more involved in the process, and they are also given things they can perform on their own." Major Kelley believes many of the issues he sees can be attributed to a lack of core or trunk strength. "When people lack core strength, it makes it impossible for them to do the things they need to do," Major Kelly said. "We do incorporate core strengthening in almost all our treatment plans due to benefits of core strength." Another treatment used frequently is the fabrication of foot orthotics, which creates custom insoles for running shoes and boots. "Orthotic molds help treat a variety of issues including back and knee problems, and shin splints," said Sergeant Hinnershitz. A patient places their foot on a machine which makes a digital image. From this image, an insole is created to fit the patient's foot and address any biomechanical problems. "Besides basic military training, we are the only base with orthotics capabilities," Sergeant Hinnershitz said. At this time, orthotic fabrication, just like the rest of the Physical Therapy Clinic's services, are offered by referral only.