Disorders of the temporomandibular joint, also commonly known as TMJ, affect about 10 million Americans. The condition affects women more commonly than men. TMJ disorders include a variety of conditions and symptoms including muscle pain, joint pain, clicking, occasional joint locking, loss of joint range of motion, headache and difficulty eating.

The TMJ connects the lower jaw to the upper jaw. When the mouth is open, the lower jaw glides downward on an articular disc, which provides a smooth gliding surface and shock absorption. Occasionally, this disc can become dislodged, causing repeated clicking or locking of the joint. The ligaments surrounding the TMJ can become inflamed thus restricting joint motion and causing pain.

The TMJ can develop osteoarthritic changes, resulting in pain, loss of motion and joint crepitus (joint grinding). The muscles involved in chewing can become painful, developing trigger points, resulting in diffuse myofascial pain and tenderness to the touch. These symptoms can become chronic and significantly affect quality of life.

Symptoms are often initially treated with bite guards, which are often marginally effective. The TMJ is largely influenced by postural abnormalities of the cervical and thoracic spine. Poor posture is a major contributing factor to TMJ pain and dysfunction. Forward head posture can cause muscle imbalance and abnormal tightening of the cervical and facial muscles. Loss of normal joint movement in the cervical and thoracic spine can also result in muscle tightening and myofascial pain.  If these conditions aren’t addressed, the chances of successful treatment decline significantly.

Physical therapists are skilled in the evaluation and treatment for TMJ. Joint restrictions of the spine can be addressed with manual mobilization or manipulation techniques. Myofascial pain and trigger points can be addressed through soft tissue mobilization, including dry needling.

Exercises are effective in correcting posture and muscle imbalances while improving endurance and strength for improved function. This includes AROM exercises and instructing in self-mobilization techniques of the TMJ.

Direct manual mobilization to the TMJ can improve joint gliding, decrease joint clicking and locking, and improve TMJ ROM for decreased pain and improved eating. Direct manual mobilization can also restore pliability to the joint capsule (ligaments) when capsulitis causes joint pain and restricted ROM.

Physical therapy offers alternative and more direct treatment options for sufferers of TMJ dysfunction. Improvements often occur within the first few treatments, depending upon the severity of the condition, but more importantly, empowers the individual to learn techniques to manage the condition more independently.

If you’re looking to get relief from TMJ, call us today at 480.289.5502 and we will get you scheduled with one of our TMJ physical therapy specialists.

What is the most common question I am asked?

Over the years, I have been asked many questions covering many different topics. Questions ranging from what pillow or mattress is most recommended, whether to use ice or heat, my opinion on CBD products, and more. The one question I have been asked more than any other is a simple one with a complicated answer: “I have this pain…what stretches can I do for that?”

And the answer: “It depends…”.

The response from the inquirer is usually one of disappointment. Why is this question so difficult to answer? Because there are too many variables involved. As Doctors of Physical Therapy, we take great care in analyzing every aspect of a patient’s complaint to provide the best diagnosis and treatment plan. We all have the same anatomy, yet we are uniquely different structurally, chemically and electrically. What works for some individuals with a certain condition, is not appropriate for all with similar conditions. We use a patient’s subjective information combined with testing, measuring, observing and “feeling” before we can prescribe what treatment interventions and exercises are best.

Many conditions don’t require stretching at all but may need stabilization, strengthening, balance exercises or a combination of all to achieve maximum benefit.

If you have pain, schedule a FREE Pain Assessment with a skilled physical therapist. The physical therapist will understand your pain and provide you with the best options for treating your pain.


The Foothills Sports Medicine Sun City physical therapy location is in the West Valley in Surprise. We are conveniently located on Grand Avenue, just west of Litchfield Road and serve the communities of Surprise, Sun City, Sun City West, Sun City Grand, El Mirage, Waddell, Peoria, Wittman, and Wickenburg.

We are a newly remodeled clinic, sized at 3,400 square feet. Our smaller size allows us to provide a more personal rehabilitation experience. From the first call to each visit thereafter, and through the course of your program, you can expect courteous, professional, and prompt treatment at our office. Our experienced front office representatives will thoroughly explain your benefits in easy-to-understand terms. We will schedule your first visit within 24-48 hours, and many times offer same day appointments.

Foothills Sun City is staffed with experienced, knowledgeable clinical staff including three physical therapists, one physical therapist assistant, and five physical therapy technicians. Our physical therapists hold a Doctorate of Physical Therapy degree and offer many specialty treatments to better serve the varied needs of our patients. Each of our physical therapy technicians holds at least a Bachelor’s Degree in the fields of Exercise Science or Health and Wellness, providing close and experienced instruction during exercise programs.

Our physical therapists will evaluate and create an individualized treatment plan tailored to the unique needs of each patient and treat many conditions including but not limited to all orthopedic diagnoses, TMJ dysfunction, vertigo/vestibular disorders, all joint replacement surgeries, complex conditions of the spine, chronic pain, headaches, myofascial pain, and complex neuromuscular disorders.

Meet Our Staff:

Jim Kester PT, DPT, Cert. SMT, Cert. DN, Dip. Osteopractic: Clinic Owner/Director with 23 total years of experience. Specializing in spinal manipulation, peripheral joint manipulation, and trigger point dry needling. ASTYM certified.

Max Mangabat PT, DPT: Graduate of Franklin Pierce University. Specializing in dynamic and static cupping techniques and IASTM (instrument assisted soft tissue mobilization).

Joshua Niesen PT, DPT: Graduate of Franklin Pierce University. Certified provider of LSVT Big and Rock Steady Boxing programs for the treatment of Parkinson’s Disease.

Heather Goff PTA: 27 years of experience in outpatient orthopedics and treatment of neuromuscular disorders.

If the Sun City location isn’t convenient to work or home, we have plenty of other locations to choose from. Come visit us at one of our Foothills Sports Medicine Physical Therapy locations throughout the Phoenix Valley!

Lower back pain is a common occurrence in our society with an estimated 80 percent of all adults being afflicted at some point in their lifetime. Of those, approximately 10 to 20 percent will also experience sciatica symptoms. If you’re a sufferer of sciatica, it is necessary to understand sciatica and discover the root cause in order to achieve the best results while receiving physical therapy for back pain.

Sciatica can manifest in multiple ways, ranging from aching pain, shooting pain, numbness and tingling, burning, and occasional weakness of the affected lower extremity. The symptoms may travel to the thigh, lower leg, and the foot. Depending on activity level and lifestyle of the individual, the symptoms can be constant or intermittent. Some suffers experience symptoms for years, and some only suffer short-term. Intensity of symptoms in different individuals can vary from annoying to debilitating.

So what exactly is sciatica? Sciatica is most commonly understood to be a pinched nerve in the lower back. Many clinicians think of sciatica as a vague diagnosis because it does not truly describe what the cause of the symptoms is. In order for the patient to be treated effectively, a cause must be found.

In most cases, sciatic symptoms are the result of compression of a peripheral nerve root in the lumbar spine. However, sciatica can also be caused by other conditions like spinal stenosis, lumbar disc bulging, degenerative disc disease, and advanced arthritis.

Spinal stenosis is the narrowing of the bony opening the nerve passes through. Lumbar disc bulging (LDH), or disc herniation, can push the nerve against the surrounding bone. Degenerative disc disease (DDD) results in excessive vertical compression and loss of the spacing between vertebrae. Advanced arthritis of the spinal joints (spondylosis) may result in bony compression or the formation of bone spurs that push against the nerve.

The severity of symptoms is dependent upon the degree this compression or “pinching.”

All sciatic symptoms cannot be treated with the same approach. Understanding the true cause is a priority if the condition is to be treated effectively. LDH must be treated differently than DDD, which must be treated differently than spondylosis, or stenosis. A thorough evaluation by an experienced clinician often will provide a good working diagnosis for treatment. Standard X-ray, MRI, or CT scans can provide additional information and support the findings of the evaluation, though it should be noted they are not always necessary for an accurate diagnosis.

But what about those situations when sciatica is present and imaging shows a relatively normal spine? There are many other conditions that can mimic sciatic pain: dysfunctions of irritation of the sacroiliac (SI) joint, piriformis syndrome, myofascial trigger points within the gluteus medius muscle, illiotibial band syndrome (ITB), and osteoarthritis of the hip.

Once the true cause has been determined, treatment for sciatica can vary widely. While receiving physical therapy for back pain, postural education and an appropriate exercise program are essential in long-term management of symptoms, regardless of cause. Other treatment interventions can include spinal manipulation or mobilization, myofascial release, trigger point dry needling, or spinal traction. Education on lifestyle changes and maintaining an ideal body weight are also important aspects in ongoing treatment of sciatica.

There are no quick fixes for sciatic pain. Most often, the condition develops slowly over time and symptoms can begin gradually or suddenly. Sciatica is a complex and unpredictable diagnosis and affects each individual very differently. An experienced physical therapist can accurately diagnose and treat sciatica, whatever the cause may be, minimizing symptoms, restoring function, and educating on long-term management. Schedule an appointment with us today to meet with one of our physical therapists and learn how physical therapy for back pain can help you get back to the activities you love.

Osteoarthritis (OA) of the knee is a progressive disease common among the aging population and a leading cause of disability. It is typically categorized as excessive ‘wear and tear,’ with symptoms including joint stiffness, joint swelling, limited range of motion, eventual lower extremity malalignment, and pain ranging from barely perceptible to debilitating.

There are over 100 forms of arthritis, and OA is the most common and most often leads to chronic disability. Costs associated with knee OA are very high considering treatments, adaptations in activity level, and lost productivity at work. This painful disease affects millions of patients; about 13% of women and 10% of men aged 60 years and older have symptomatic OA of the knee.

Due to the prevalence of the condition, there are numerous treatment options for managing OA. These options include over-the-counter anti-inflammatories, prescription nonsteroidal anti-inflammatory drugs (NSAIDs), application of ice or heat, hyaluronic acid injections, corticosteroid injections, bracing, arthroscopic surgery, or total knee replacement surgery.

A lesser-known treatment option for knee OA is dry needling therapy. Increasing evidence has shown this procedure to be effective in reducing pain and disability in the osteoarthritic knee, and studies have shown it can increase arterial pressure around the knee by up to 40%. Studies have also indicated it causes specific physiological responses that increase blood levels of beta-endorphins, which produces a pain relieving effect. This can help patients reduce their reliance on analgesic or anti-inflammatory medications. Needling therapy has also been shown to activate the hypothalamus and deactivate the limbic system in the brain, both of which can alter our perception of pain.

Dry needling involves the insertion of acupuncture needles at 9 different points around the knee, specifically to stimulate an increase in blood flow around the joint. The insertion of needles can feel uncomfortable, but it is not typically painful. Once the needles are inserted, they are often gently twisted to cause an internal stretch in the tissue. The needles are then left in place for up to 30 minutes, and the treatment is sometimes combined with low-frequency electrical stimulation using a device specifically designed for acupuncture. Occasionally some tenderness, bruising, or mild hematomas may develop post-treatment, but these are minor and temporary conditions. The risk of infection is also extremely low at about 1 in 10,000. Typical treatment frequency is 2-3 times per week for a duration of 6-8 weeks. When combined with an appropriate supervised exercise program, pain and functional impairments were significantly improved for the majority of patients.

Although dry needling isn’t a common treatment alternative in the U.S., it is frequently used in other countries. In the United Kingdom, dry needling is used to manage OA knee pain for patients awaiting joint replacement surgery. As a physical therapist certified in dry needling, I have performed the treatment on a number of patients not only for OA knee pain but also for patients with anterior knee pain caused by patellofemoral dysfunction. Anecdotally, all patients I have treated reported significant reductions in knee pain in as little as two weeks, and no other manual therapy or modality interventions were used. These patients also reported a decreased intake of pain medication and a significant increase in activity levels.

Dry needling therapy is safe and accompanied by very few precautions or contraindications. There is both research support and anecdotal evidence showing its effective use in the treatment of knee pain. Treatment time is relatively short, ranging from 10 to 30 minutes for each session. The cons are only slight discomfort during needle insertion, possible bruising, and the 4-12 weeks it takes to get results.

While no single treatment works for every patient dry needling may be right for you, especially if other options have not worked and you wish to postpone knee replacement surgery. For more information on dry needling from certified specialists, contact your local Foothills Sports Medicine Arizona physical therapy clinic today!

Jim Kester is a PT, DPT, Cert. SMT, Cert. DN, and owner from our Sun City facility with 18 years of clinical experience. He is here to explain what an osteopractor is and what they can do for you:

In the competitive market of today’s healthcare providers, patients are more informed. They’re shopping around for a provider who can meet their needs and yield effective results, in a shorter period of time. The days of treating patients with a multitude of passive modalities that produce no significant physiological changes are over. It is becoming more important to master manual therapy techniques, and not only give patients the one-on-one attention they seek, but also to produce greater results in a shorter time period.

As healthcare continues to evolve, physical therapists find themselves in competition with many different providers, all looking to capture the “healthcare dollar.” Physical therapists are competing with chiropractors, acupuncturists, massage therapists, and personal trainers to capture the patient who wants to live a more active, pain-free lifestyle. While all of these healthcare professionals certainly have a role in patient treatment, physical therapists are more qualified to enhance overall lifestyle through injury rehabilitation, strength training and functional movements than these other providers.

Our scope of practice is broader, extending to many areas including, but not limited to, manual therapy techniques, gait analysis and training, balance training, therapeutic exercise, work conditioning, and ergonomic and postural assessment. In particular, manual therapy techniques encompass a wide variety of hands-on treatment: massage or soft tissue mobilization, joint mobilization, spinal manipulation, dry needling therapy, and others.

The Diploma in Osteopractic (Dip. Of Osteopractic) is a relatively new credential, trademarked by the American Academy of Manipulative Therapy and Spinal Manipulation Institute. The term osteopractor literally translates to “bone practitioner”, and osteopractors are trained in treating musculoskeletal disorders. The diploma is given only to physical therapists who have completed a rigorous, evidenced-based series of courses including:

  • Certification in Spinal Manipulation or Cert. SMT (series of four courses)
  • Certification in Dry Needling or Cert. DN (series of two courses, fifty-four total hours)
  • Extremity Manipulative Therapy
  • Instrument Assisted Soft Tissue Mobilization (IASTM)
  • Differential Diagnosis & Multi-Modal Management of Upper and Lower Extremity Spine-Related Pain Syndromes.

Manipulation of the spine and/or extremities, Instrument Assisted Soft Tissue Mobilization (IASTM), and Dry Needling (DN) therapy are proven techniques in facilitating tissue healing, reducing joint dysfunction and minimizing pain. When combined with an effective therapeutic exercise regimen, these treatment interventions are powerful tools in eliminating functional impairments and reducing disability.

An osteopractor is very distinct from, and should not be confused with, a chiropractor or Doctor of Osteopathy (DO), as neither of these are physical therapists. The osteopractor credential distinguishes those physical therapists who have achieved a level of highly skilled, hands-on manual therapy techniques. As mentioned previously, all physical therapists are trained in manual therapy techniques as part of the core curriculum of every physical therapy program.

My goal is to be much better than the average physical therapist, and to be able to provide exceptional, not just good, manual therapy treatment. To date, I will have completed all requirements for the Dip. Of Osteopractic by June 2015. Through the achievement of this important goal, patients can be assured they are receiving care from a highly-skilled healthcare provider who has dedicated his time and resources to administering this new standard of physical therapy treatment.

Currently, at Foothills Sports Medicine Physical Therapy Sun City, I am utilizing these skills daily on many patients. Dry Needling is an effective tool in reducing musculoskeletal pain and osteoarthritis of the knee. It is especially more effective when combined with low frequency electrical stimulation. Thrust manipulation of the cervical, thoracic and lumbar spine and lumbopelvic joints is an excellent technique in improving joint range of motion, reducing pain and minimizing joint dysfunction. More recently, I have had success treating shoulder, elbow, knee and ankle stiffness and pain with manipulation techniques of the extremities. Through the use of these advanced techniques, patients are seeing measurable changes earlier in their treatment programs.

If you are struggling with pain, contact Foothills Arizona physical therapy experts to make an appointment today! To learn more about Foothills Sports Medicine Physical Therapy Sun City, and what our certified experts can do for you, check out our blog.