The Fallacy of Plantar Fasciitis

August 29, 2017 Bare Physical Therapy bunion, Cortizone Injections, foot pain, Manual Physical Therapy, metatarsalgia, Orthotics, plantar fasciitis, Podiatrist laramie arch supports, laramie cranial therapy, laramie foot pain, laramie knee pain, laramie manual physical therapy, laramie manual therapist, laramie myofascial release, laramie myofascial therapy, laramie orthotics, laramie physical therapist, laramie physical therapy, laramie podiatrist, physical therapist tony bare

Plantar fasciitis is such a problem that you can hardly conduct an image search for plantar fascia without returning mostly images of the plantar fascia with a big angry red splotch on the plantar fascia near the heel.

I recently watched a video on Facebook posted by one of my Physical Therapy peers on the topic of plantar fasciitis. I privately messaged him to let him know that I thought his presentation had missed some key points and his reply cited the Clinical Practice Guidelines for plantar fasciitis. There are some issues with that response from my standpoint:
1. The Clinical Practice Guidelines for plantar fasciitis are fairly useless in regards to “what to do” to treat plantar fasciitis and of some limited value in “what not to do”. They very accurately reflect current available research which is of little clinical value in this instance.
2. I’m concerned that my profession is so entranced by Evidence Based Practice (EBP) that they have stopped seeking information or guidance outside of what research has generated, and as a result their patients often suffer through suboptimal care and (pun intended) limp down the clinical plank of failed conservative care, injection and ill-advised surgery. I know this not what the developers of EBP-theory intended, but I’ve seen it just about daily on social media.
3. The research available on this topic is doing very little to help clinicians truly heal their patients of their foot pain. I would dearly love to pitch research ideas for anyone who has faculty connections.
Now off the Soap Box and on to clinical guidance…
– Plantar fasciitis is a misnomer, most of these patients don’t use their plantar fascia at all. A more appropriate term would be “Mechanical Heel Pain”. Typically, the origin of Mechanical Heel Pain is a poor initial contact in stance phase in which the contact is too medial in magnitude and/or duration. The medial aspect of the midtarsal joint, subtalar joint and calcaneus are very neural dense and do not tolerate this increased pressure well and eventually leads to heel/foot pain.

– Unfortunately, a bad initial contact (as described above), has consequences throughout the foot and lower extremity that further perpetuate an inefficient gait cycle. Here are some examples: hallux abductovalgus (painful bunion), metatarsalgia, achilles tendinitis, medial knee pain (pes anserine, plica, etc), lateral hip pain (trochanteric bursitis, piriformis syndrome, etc) and SI dysfunction.
– The good news is that when you treat the cause (improve foot mechanics) and treat the tissue (manual therapy), the patients’ symptoms resolve very quickly…1-4 visits.
If you are a clinician reading this blog and you didn’t delete it from your feed after reading #2 above, you have practiced long enough to be frustrated at heel and foot pain patients’ poor prognoses. Please consider attending a lower extremity biomechanical course, it will completely change your practice. I teach a 2 day course called Thinking on Your Feet. Of course, I’m biased and think mine is best, but there are some other good courses out there. Give one of them a chance and it will elevate your practice above the limitations of the current Clinical Practice Guidelines.
If you are a patient reading this blog, you may have had “mainstream” care for your foot pain which probably included: activity modification, exercises (strengthening/stretching), modalities (heat, ice, ultrasound), massage, shoe inserts, dry needling, injections or surgery. You have probably been nodding your head the whole time, because you know your foot pain isn’t completely (or any) better. Find a clinician with biomechanical training in this topic or contact me directly for advice at Tony@BarePT.com or find out more about my unique practice and skill set at Barephysicaltherapy.com

LTC Tony Bare (ret) DPT, ATC, OCS

Laramie, WY

How to Avoid Foot Surgery

October 11, 2016August 18, 2017 Bare Physical Therapy foot pain, knee pain, Manual Physical Therapy, metatarsalgia, Orthotics, plantar fasciitis, Podiatrist arch support, arch supports colorado springs, custom orthotics colorado springs, foot pain, laramie foot pain, laramie myofascial therapy, laramie physical therapist, laramie physical therapy, laramie podiatrist, matatarsalgia, orthotics, orthotics colorado springs, physical therapist tony bare, physical therapy colorado springs, plantar faciitis, stress fractures, stress fractures colorado springs

Elective foot surgery is expensive, debilitating, time consuming, frequently unnecessary, and patients are often worse pain following surgery. Matter of fact, if you find anyone happy with an elective foot surgery you might also want to go ahead and buy yourself a lottery ticket…the odds are about the same. I always say, “there is NOTHING surgery can’t make worse”. That is especially true in elective foot procedures.

Has your surgeon told you that you need surgery for the following?

Neuroma
Bunion
Hammertoe
Plantar fasciitis
or maybe because you had advanced degenerative Osteoarthritis?

Trust me, the surgery will not address the cause of any of the above pathology. If you fuse, remove, dissect, or realign something in the foot without addressing the cause, you are just kicking the can down the road until you need surgery #2, #3, etc.

A brief bio on me to provide credibility on this subject: I became the Army’s expert in lower extremity biomechanics and foot/ankle treatment specialist in 2000 and was honored to hold that position until my retirement in 2013. I’ve attended 120 hours of continuing education in biomechanics and have taught courses all over the country. I have also successfully treated thousands of patients in my career, relieving their pain and in countless circumstances, avoided the above mentioned surgeries.

The BARE NECESSITIES Do’s and Don’ts of foot pain…

The Don’ts

Don’t see a podiatrist. Podiatrists are foot surgeons and they have little knowledge or inclination toward conservative treatment options.
Don’t let anyone inject your foot. Cortisone injections are somewhat effective in treating foot pain, BUT they do NOTHING to address the cause of foot pain. As a result, when the steroid wears off the foot pain often returns worse than before.
Don’t let anyone sell you a hard plastic arch support. Your foot was designed to bend and flex during the stance phase of gait, and it can’t perform correctly with a hard piece of plastic wedged under the arch. These “custom” arch supports are also expensive and rarely covered by health insurance.
Don’t let anyone convince you that you just need to “stretch” more. Typically the most common cause of foot pain is an underlying instability… instabilities get WORSE with stretching even though it can feel a bit better short term.

The Do’s

Do try a change of shoe. Many times replacing a worn out, or poorly fit shoe will be enough to start the healing process. If possible get advice on footware from a reputable shoe dealership (none of the chains) or medical professional with significant foot/shoe experience or training. If you are on your feet a lot (work, home, sports), don’t skimp on your shoes. You don’t need to spend a fortune, but the shoe market is competitive and you do get what you pay for.
Do try a full length off-the-shelf shoe insert that you can usually get in a running shoe store for $40-$70. This is a semi-rigid arch support and will still allow your foot to flex and bend as it’s intended to, but will still provide some support.
Do find a good manual therapist (Massage or Physical Therapist) to break up the adhesions that are likely contributing to the pain in your foot. If your therapist tries pushing “exercise” as the cornerstone of treatment and does no or very little manual therapy, go find a different provider. This condition cannot be fixed with exercise, though exercise can be a component of recovery…the main emphasis should be on manual therapy (not dry needling) to both lower extremities.
If all else fails…Do find a biomechanical specialist to construct a custom biomechanical corrective orthotic (shoe insert) to address the underlying cause of your foot pain. These professionals are few and far between. I noted above how I became a specialist in this field, and here is a link to my website. You will find information on the difference between arch supports and biomechanical orthotics as well as examples of what I would need to conduct an assessment on you (video and other) if you happen to not live close to Colorado Springs.

Lastly, if you happen to find this blog AFTER you already had a surgery (or 4)…there is still hope. Follow these same do’s and don’ts and you will be amazed at your recovery!!

By LTC Tony Bare (ret), DPT, OCS, ATC

The Courses I’ve Taken and Taught on Biomechanics and Running

October 19, 2015October 19, 2015 Bare Physical Therapy Arch Support, Orthotics arch supports colorado springs, cranial sacral therapy colorado springs, cranial therapy colorado springs, cranial therapy for toddlers, cranial therapy tony bare, custom orthotics colorado springs, knee pain colorado springs, manual phyiscal therapy colorado springs, myofascial release colorado springs, orthotics colorado springs, physical therapist tony bare, physical therapy colorado springs, stress fractures colorado springs

I recently returned for a Continuing Education Course on biomechanics of gait, running and rehabilitation titled: Running Rehabilitation and after this weekend my total hours of continuing education on gait stands at 120!!

1996 Locomotor Biomechanics (8 hrs)
1997 Orthotic Reaction (22 hrs)
1998 Grinders & Glue (16 hrs)
1998 Landing on Your Feet (8 hrs)
1998 Current Concepts in Biomechanics (22 hrs)
2000 When the Foot Hits the Ground (Lv2) (15 hrs)
2001 The Running Course (15 hrs)
2015 Running Rehabilitation (14 hrs)

I certainly learned a couple things from my most recent course. First, the science of running has certainly evolved in the last 14 years but the course also validated that all the work I invested to become a Subject Matter Expert in Biomechanics has certainly paid off. To summarize that work I thought I’d list my teaching experience…

1999-2000 I re-wrote 32 hours of gait and biomechanics for the Army-Baylor Physical Therapy Program.
1999 University of Texas Health Science Center, Normal Gait (4 hours)
1999 Balboa Naval Medical Center (Tricare Region IX), Lower Extremity Treatment Options (15 hours)
2000 Etiology of Foot Pain, Health Care Providers in Bosnia (8 hours)
2000 Army Orthopedic Physical Therapy Residency, Normal Gait and Malalignments (15 hours).
2002 Army Orthopedic Physical Therapy Residency, Normal Gait and Malalignments (15 hours).
2002 Colorado Springs Air force and Army Cont. Ed. Normal Gait, Malalignments and Orthotic Prescription (15 hours)
2003 Hawaii APTA, Normal Gait, Malalignments and Orthotic Fabrication (15 hrs)
2003 Army Sports Medicine Physical Therapy Residency, Normal Gait, Malalignments and Orthotic Prescriptions (15 hours).
2005 Hawaii APTA, Normal Gait, Malalignments and Orthotic Fabrication (15 hrs)
2007 Operation Iraqi Freedom Deployment Cont Ed. Foot Pain Management in a Deployed Setting. (8 hours).
2009 Kentucky APTA, Normal Gait, Malalignments and Orthotic Fabrication (15 hours).
2010 Texas APTA, Normal Gait, Malalignments and Orthotic Fabrication (15 hours).
2011 Washington APTA, Normal Gait, Malalignments and Orthotic Fabrication (15 hours).

That is a total of just over 200 hours of teaching to hundreds Physical Therapy students, graduates and and post graduate specialists. I don’t proclaim this accomplishment to brag about what I’ve done, but to give God glory for the opportunities He’s afforded me. I’m also realizing I haven’t taught a course in 4 years…I need to get off my butt and put on another conference!! 🙂

Gait Analysis for FIT4MOM Front Range Half Marathon Trainees

August 23, 2015August 23, 2015 Bare Physical Therapy Orthotics arch supports colorado springs, custom orthotics colorado springs, hip pain colorado springs, knee pain colorado springs, manual phyiscal therapy colorado springs, orthotics colorado springs, physical therapist tony bare, physical therapy colorado springs

Amy here!

Tony and I are getting married THREE weeks from today! Here’s an engagement photo since I love it so much

Tony and I had the honor of seeing about 35 of the FIT4MOM Front Range half marathon trainees this last month. I own the FIT4MOM Front Range franchise. We offer fitness for all stages of motherhood from Parker to Fort Collins. We have nearly 30 instructors and several hundred moms attending our classes, making up an amazing community of support, fitness and the village it takes to raise kids AND moms. Tony and I are able to combine our professions in order to serve these moms even better.

We have been offering 5K, 10K and half marathon training for the last several years with great success. In 2015 we had over 200 moms go through our running training programs. I’m a marathoner myself so this is definitely a passion of mine and since Tony is a biomechanics expert and one of only a few people in the country fabricating orthotics the way he does I wanted to make sure our moms were given the opportunity for an evaluation with him. I’m always looking for ways to improve our programs and add value so it only made sense to incorporate Tony into the program.
As part of the fall half marathon training we offered a free gait and shoe evaluation with Tony for each registered participant. Each mom that signed up got 15-20 minutes one on one (well, two on one since I was there too) with Tony. He evaluated feet, marked them, watched them walk, checked out shoes and gave recommendations. Some were as simple as ‘keep doing what you are doing’ while others needed shoes changes and some were offered a custom orthotic. We really tried to educate each mom on her mechanics, her body, her shoes and to answer any and all questions. The main goal was to reduce injury and provide them with the resources to run a successful and easy half marathon.

We spent two days in Loveland and saw 17 Fort Collins and Greeley group moms and a day in Denver seeing another 18. It was pretty awesome to meet all these moms face to face and to hear their stories, their struggles, their progress and their goals. We are looking forward to incorporating the evaluations into each running training that we have moving forward. Tony and I really enjoyed being able to work together on something that we both are very passionate about but it was a really fun time seeing all the moms.

Thank you to all the moms that came to see us!

Examining and marking the foot

The two of us watching mom walk to analyze gait

Tracing for measurements and prescription

BONUS! Mama Cameron was injured so she came to see us!

If you want to know more about Tony’s experience and background with orthotic fabrication go HERE

Read more about orthotics and the Fallacy of Arch Supports

My Orthotic History and Experience

August 22, 2015May 23, 2017 Bare Physical Therapy Orthotics arch supports colorado springs, custom orthotics colorado springs, hip pain colorado springs, iliotibial band syndrome, knee pain, knee pain colorado springs, laramie arch supports, laramie foot pain, laramie manual physical therapy, laramie myofascial therapy, laramie orthotics, laramie physical therapy, laramie podiatrist, manual phyiscal therapy colorado springs, matatarsalgia, orthotics colorado springs, physical therapist tony bare, physical therapy colorado springs

In 1996 I had been a physical therapist for 2 years and I left my assignment at Ft. Campbell, KY to attend a 2 week continuing education course at Ft Sam Houston, TX. During the course a man named Michael Cane taught 8 hours on gait, biomechanics and orthotics. It was completely over my head. I was so angry that Physical Therapy school had completely failed to teach anything useful on the subject, that I was on a mission to remedy the situation. I took a Michael Cane’s 3 day course, another 3 day course taught by a Podiatrist and another by an Orthotist. I took another 3 courses and dove into the research…in 1998 I re-wrote the curriculum of lower extremity biomechanics, gait and orthotic treatment for Baylor University. By 2001 I had become the Military’s gait and biomechanics expert (across all services) and was a guest instructor in 2 different Graduate PT programs and 2 different clinical residencies. I developed my own 3 day continuing education course and I have taught it all over the country.

Bosnia, Camp Eagle, 2000

God provided a perfect environment for me to become the expert described above… I grew up working for my dad as a machinist, so I had a comfort level with building and machine work. The Army provided me with an endless supply of Soldiers not biomechanically designed to run or march. I had access to some of the best orthotic labs in the nation, mentoring by orthotists with decades of experience and plenty of supplies. My skills were honed and I still learn from every patient I evaluate and treat. Every patient is so very unique. I’ve made over 5000 pair of orthotics. I’ve made orthotics for patients as young as 6 and as old as 96, patients who are Olympic track and field athletes, recreational and high school athletes and patients just struggling to walk without a cane or crutches.

Do you have pain in your back, hips, knees, shins, ankles or feet? Have you a bag full of orthotics that didn’t help your pain in the past? If I evaluate you, you will see my evaluation will be comprehensive, I will explain to you what is working and not working throughout your stride and if an orthotic can help you. I will provide a comfortable and affordable device and you will have the chance to finally turn that page in the chapter of your life.

Want more information?
See my Fallacy of Arch Supports article

LTC Tony Bare (ret) DPT, ATC, OCS
Physical Therapist
Colorado Springs, CO

Custom Orthotics By Providing Video Gait Analysis

June 1, 2015August 31, 2017 Bare Physical Therapy achilles tendonitis, Arch Support, bunion, foot pain, knee pain, metatarsalgia, Orthotics achillis tendonitis, arch support, arch supports colorado springs, custom orthotics colorado springs, foot pain, hip pain, hip pain colorado springs, iliotibial band syndrome, knee pain, knee pain colorado springs, laramie arch supports, laramie cranial therapy, laramie foot pain, laramie knee pain, laramie manual physical therapy, laramie myofascial release, laramie myofascial therapy, laramie orthotics, laramie physical therapist, laramie physical therapy, laramie podiatrist, matatarsalgia, orthotics colorado springs, physical therapist tony bare, physical therapy colorado springs, shin splints

I’ve had a lot of interest in my Bare Necessities Custom Orthotics (arch supports or shoe inserts) from people across the country and I’ve had good success making them based off the information below. If you’ve read my post on the Fallacy of Arch Supports, you know that one of the components of my exam that makes the orthotic successful is the dynamic gait analysis, so if I’m provided the video footage I’ll have great insight into your biomechanics and if they need any help or correction.

The good news is that I’ll assess your videos FREE!! All I need is 10 second clips of you walking barefoot on the treadmill from behind and from each side. Just do your best to walk on the treadmill at your comfortable walking pace. Take video footage of the following angle/level (including both sides/foot):

I’ll need a tracing of your foot next to a ruler. See picture below (it doesn’t have a ruler but you’ll need a ruler next to your tracing). The tracing will let me know what size of orthotic to make and I’ll have an idea what adaptations your biomechanics have forced your foot to make and that will be even more information helping to guide my orthotic prescription.

The orthotics themselves are only an average cost of $85 plus $10 shipping and handling, so send me your videos and get on the road to pain free walking or running.

Now that we are relocating to Laramie, WY please refer your Colorado Springs friends to this post.

Please email me your video and foot tracing to tony@barept.com

LTC Tony Bare (ret), DPT, ATC, OCS
Physical Therapist
Laramie, WY

Knee Pain

May 13, 2015May 28, 2015 Bare Physical Therapy knee pain, Orthotics custom orthotics colorado springs, iliotibial band syndrome, knee pain, knee pain colorado springs, orthotics, orthotics colorado springs, patella femoral pain, patellartendonitis, physical therapist tony bare, physical therapy colorado springs

Anyone remotely athletic usually has some degree of knee pain…why? Well, putting aside traumatic injuries, there are a couple of reasons the knee is so susceptible to general non-traumatic or over-use pathologies.

The knee is a the largest moving joint (surface area) in the body and
It is located between the two longest levers in the body (femur and tibia)…the combination creates a great deal of potential torque through the knee-joint and caught in the middle of it is the knee cap (patella).
The knee is really well designed to move forward and backward, but rotation and sideward motions create a real issue for your knee due to the leverage and torque noted above.

Now you are probably thinking…”That makes sense for basketball players who are pivoting and changing direction all the time…but I just walk for exercise…or jog…I’m just moving straight ahead…why do I have knee pain if the knee is designed to move straight ahead?”

The answer is all about biomechanics…my field of expertise. Even though you are moving forward there are subtle sideward and rotational movements that occur in your knee…this puts a lot of stress on the structures designed to control, decelerate and limit those motions (plica, pes anserine, IT band, the patellar tendon and the entire patella femoral joint).

You’ve probably heard the term pronation; well pronation doesn’t stop at your feet. Pronation in the foot is translated into rotation of the tibia and to make matters worse the femur starts rotating the opposite direction during the stance phase of gait. Now picture all those structures I listed above being pulled in both directions and you can understand why your knee hurts when all you do is walk for exercise.

Common Treatment of Knee pain:

Self-treatment: anti-inflammatory medications, ice, rest, knee sleeves, sports creams…these will all help your knee “feel” better…but will not treat the cause of your knee pain… so often times your symptoms will recur. There are a couple of things you can do to address the cause of your knee pain all yourself!! First of all, improve your walking/running surface. The more flat and level the less of those pesky accessory motions affecting your knee. Secondly, better shoes. Some biomechanical issues can be addressed with shoes alone; not a specific brand but a general type of shoe. How can you know what kind of shoe you should wear? You should receive a biomechanical evaluation…and I do that for only $20!!

Physician treatments: stronger anti-inflammatory medications, injections, more expensive braces and hopefully a physical therapy consult.

Physical therapy treatments: Modalities (ultrasound, ice, heat, LASER, electric stimulation), exercises and manual therapy (massage, myofascial release, trigger point needling, etc). You already know the modalities by themselves won’t do much better than what you could do for yourself. Please don’t ask me why every physical therapy student is taught to treat knee pain with exercises…mainly quadriceps strengthening and hamstring stretching…both those muscle groups work largely in the forward plane of movement. The knee ALREADY moves really well in that plane. The bottom line is that the body doesn’t have very many muscles that are even well designed to control lower extremity movement in sideward or rotational plane of motion and believe it or not, you probably don’t need any more strengthening of those muscles…you know why? Because they are really strong already!!! You know why? Because your biomechanics make them work extra ALL THE TIME (every single step). Because they work more than they should…and probably have for years…the muscle itself may be short circuited a bit and have fibrotic knots and ropes running throughout it. If that’s the case…those muscles would benefit from manual therapy (myofascial release) and combined with modalities and exercise you can have your dynamic pronation stabilizing muscles firing on all cylinders before you know it!! Once you combine that with a better walking surface and shoe…you may actually have resolved your knee pain!!

However, often times a shoe is not a great enough correction…or maybe you don’t want to spend the rest of your life confined to walking and running on a treadmill. In either case, please contact me…read my testimonials!! For only $20 I will do a biomechanical assessment on you and let you know if your mechanics can be improved with shoes alone…and what type of shoes you should wear. I’ll also let you know if I feel a custom orthotic would help your mechanics (please read why my orthotics are unique)…and the average cost of the custom orthotics I hand make is typically only another $80!!!

LTC Tony Bare (ret), DPT, ATC, OCS
Physical Therapist/Owner
Colorado Springs, CO

The Fallacy of Arch Supports

May 9, 2015October 16, 2017 Bare Physical Therapy achilles tendonitis, Arch Support, bunion, Cortizone Injections, foot pain, knee pain, metatarsalgia, Orthotics, plantar fasciitis, Podiatrist, shin splints achillis tendonitis, arch support, arch supports colorado springs, cortizone injections, custom orthotics colorado springs, foot pain, hip pain, hip pain colorado springs, knee pain, matatarsalgia, physical therapist tony bare, physical therapy colorado springs, plantar faciitis, shin splints, stress fractures, stress fractures colorado springs

Have you been told you need foot surgery? Have you been failed by physical therapy? Orthotics (shoe inserts)? Podiatry (cortisone injections)? Have you been told surgery is your last option?

Please let me share three things I’ve learned as a 15 year military expert on foot mechanics, pain and dysfunction:

There is nothing a foot surgery can’t make worse
You can’t “unsurgery”
Foot surgery is like a potato chip….hard to stop at one

Step 1
Why did conventional physical therapy fail you?
You were treated with modalities (ultrasound, heat, electrical therapy), stretching, strengthening and balancing exercises…you may have received massage or myofascial release. You probably did get some relief but never complete and always temporary….why?
NONE of the above treatments addressed the cause of your pain….just the symptoms. Once your cause is addressed all of these treatments become amazingly effective!

Step 2
Next, you receive a cortisone injection. You may have felt great for hours, days or maybe months but gradually your symptoms returned and you were ready for your next injection and the next and the next. There are consequences to a single cortisone injection let alone multiple injections. Please do your research!

Lastly, this injection also fails to address the cause of your foot pain, the reason why your symptoms return eventually.

Step 3
Orthotics (shoe inserts)
these may be included as a part of physical therapy or podiatry treatments. Why have they failed you?

Failure 1: Your assessment

How detailed was your orthotic evaluation? Were your feet glanced at?
Maybe your health care provider watched you walk back and forth across a clinic floor. Maybe you just stepped in a foam box or had your foot casted.

My evaluation includes detailed assessment of your:

Current shoes and any inserts that either came in your shoes or were purchased separately
Static standing posture of your leg/ankle/foot. Static prone posture of your leg/ankle/foot
Dynamic (treadmill) barefoot multi directional gait analysis

Failure 2: Your orthotic construction/development
The most common error? You’ve been fitted with an arch support. Your arch was NEVER designed to be a primary weight-bearing structure. An arch support does very little to correct the mechanics of your foot and that’s what has led to your foot pain, leg pain, knee pain or hip pain. To make matters worse the forced correction into your arch can be so uncomfortable that you won’t even wear them. On the rare occasion that your orthotic has a mechanical correction, it’s often based on a faulty or incomplete assessments. See Failure 1 above.
Lastly, your orthotic has been constructed of a rigid unforgiving plastic shell. This shell does not allow your foot to flex, adapt and function normally and can create another series of issues.

Step 4: Surgery
Don’t go here! Please let me see you first. My assessment is free . If I feel I can help you with orthotics, my average cost is only $85. Please read my testimonials on this website and Facebook.

LTC Tony Bare (ret), DPT, ATC, OCS
Physical Therapist
Laramie, WY

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