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Manual Therapy Services - Industrial Sports Medicine Services - Athletic Training Services

ATCare offers the most powerful assessment and proactive tools compared to any pharmaceutical drug or any technically advanced therapeutic modality machine. John’s vast manual skill base provides a personal plan of care that accelerates recovery in a safe matter.

John Bray - Work Environment Approach - Lecture about the spine

Manual Therapy Services

By definition, “manual” refers to the hands, especially work done by the hands. Within the purview of athletic training, Houglum (2000, p. 154) sets forth the following definition: “Manual therapy is the use of hands-on techniques to evaluate, treat, and improve the status of neuromusculoskeletal conditions.” In the past few decades athletic training as a profession has become enamored with the large variety and apparent effectiveness of modalities that are more technologically advanced than human hands. However, as Denegar (2000, p. 176) notes, “the hands of the athletic trainer are powerful assessment and treatment tools.” Manual therapies are time-consuming in the light of the simple task of hooking an athlete to a therapeutic machine. However, manual therapy tools are recognized as important techniques in controlling pain, restoring normal range of motion and strength as well as proper alignment, which allows a faster and more productive return to activity.

Be Pain Free – No Drugs! Manual therapy is not a painful treatment; in fact, manual therapy is more effective in relieving pain than non-steroidal anti-inflamatories (NSAID), muscle relaxants, or painkillers. (view the study) Additional studies show that manual therapy is faster and more effective than physical therapy alone (see the study) to enhance neuromusculoskeletal body dysfunctions, which increases flexibility, balance and strength.

Manual therapy services provided by ATCare include Muscle Energy, CranioSacral, Strain-Counterstrain, Myofascial Release, Functional Release, and Still’s Techniques, Applied Kinesiology and Neurolymphatic / Neurovascular Reflex Releases. Each of these has its own uses as a proactive manual technique, although there is a high degree of mutual utility among them. However, Applied Kinesiology is used as an effective baseline muscle testing evaluation to determine restrictions as well as a successful management outcome. Specific modalities are appropriately designated as they relate to the beneficial effects of the proactive action delivered on a manual basis. Following are manual technique services and definitions:

Muscle Energy Techniques (MET’s)

MET’s is a direct hands-on method originally developed by Dr. Fred Mitchell, Sr., Osteopathic physician and continued by Dr. Fred Mitchell, Jr. It may be an alternative to high velocity thrust techniques, which may be contraindicated. MET’s is one of the most effective and valuable manual techniques for the identification and correction of spinal dysfunctions and hypomobility (muscle joint tightness). MET’s is a gentle, non-invasive spinal management fully controlled by the client or athlete as a positional muscle stretch-contraction-relax technique (fine spinal postural muscles). MET’s corrects neuromusculoskeletal dysfunctions by normalizing body mechanics, increasing circulation, increasing the range of motion, increasing strength and proprioception, which improves performance and promotes relaxation.

Who Benefits from Muscle Energy Techniques?

  • People who are restricted in their movements. Conditions include back pain, headache, scoliosis, sciatica, one leg longer than the other, one hip higher than the other, and one shoulder higher than the other as well as other joint related tightness.
  • People who have experienced trauma lately or in the past may also benefit.
  • In general, most everyone can benefit from this method.

CranioSacral Techniques (CST)

CST is a gentle, noninvasive, hands-on method of evaluating and enhancing the functions or physiological body system (Primary Respiratory Mechanism - PRM) developed by Dr. William Sutherland. The brain determines motion of the body including self correcting around any body dysfunctions (injury, post surgery, etc.). Dr. Sutherland discovered that the 23 bones of the cranium (Skull) have subtle movements or independent rhythm (PRM) involving a network of interrelated tissues and fluids including cerebrospinal fluid (“sap of a tree”), central nervous system (CNS) and tension membranes (Dura) that surround the CNS and sacrum (Tailbone) as well as muscle attached to the skull. Overall, since the brain and spinal cord are contained within the CNS, it is easy to see that the craniosacral system has powerful influence on the body as a whole.

Dysfunctions can occur within the craniosacral system in which the brain will adjust around these restrictions causing secondary restriction throughout the body. Dr. Fred Mitchell, Jr. stated fifteen percent of back pain, especially the ones who do not get better, could have a cranial restriction. One common skull restriction affecting the lower spine region is tight/restricted Dura membrane. The Dura is like a fibrous balloon surrounding the brain and is attached to the inner skull at the sutures (Skull bone attachment joints). The Dura continues down the spine initially attaching to the first vertebra, sometimes the second vertebra, before ending its attachment at the tailbone (sacrum). The Dura membrane is like a rope attaching the skull, spine and tailbone; therefore, any Dura tightness tugs on the spine/tailbone causing a secondary restriction in the spine/tailbone as well as related tissue. 

How CST Works and Contraindications:

CranioSacral technician’s goal is to enhance the brain’s normal, self correcting system to overcome restrictions not capable to correct on its own and avoid as well as correct secondary restrictions. Using a soft, gentle, indirect, touch approach the method cultivates an extremely safe and effective outcome. The few contraindications to CST are aneurysm, intracranial hemorrhage and other conditions where altering intracranial fluid is not recommended.

CST Benefits:

By complementing the body’s natural healing process, CTS is increasingly used as a preventative health and wellness measure to enhance performance or productivity as well as bolstering the autoimmune system. CST is effective for a wide range of medical problems associated with pain and dysfunctions including:

  • Migraine Headaches
  • Chronic Neck and Back Pain
  • Motor Coordination Impairments
  • CNS Disorders
  • Orthopedic Problems
  • Scoliosis
  • Chronic Fatigue
  • Stress and Tension Problems
  • Temporomandibular Joint Syndrome (TMJ)
  • Post Surgical Dysfunctions
  • Eye Problems

Strain-Counterstrain Techniques

Originally developed by an osteopathic physician, Lawrence Jones, DO, FAAO, strain-counterstrain technique is a method for reducing chronic and/or acute muscle spasms anywhere in the body. The big advantage of this technique is its extreme gentleness to the client. The client often wonders how this technique can work when the manual therapist does not seem to be “doing anything.”

How It Works – The Technique

The manual technician identifies the muscle spasm. The muscle can be an invisible or palpable spasm or can be identified by tender points. The manual technician positions the body so the muscle is in a shortened position and holds the position for at least 90 seconds. At times, the position is held greater that 5 minutes waiting for changes in muscle and fascia (tissue surrounding muscle and organs).

The manual technician monitors tissue change and waits for optimum improvements to occur. The shortened position of a muscle is a non-threatening position for a muscle in spasm. The communication from the muscle to the nervous system at this time is one of relaxation. The nervous system no longer receives the excessive feedback from the muscle and instructs the muscle tone to change from spasm to a resting tone. Relief and restoration of motion is often immediate. By disarming muscle spasm in major muscle groups the body is able to return to pain free function and pain free movement can be restored and built upon with exercise.

This technique lays the groundwork for management of any painful condition and is best used for:

  • Spasm in any area of the body
  • Post surgery in any area of the body
  • Restoring more upright posture (tightened muscles can pull you into poor posture)
  • Chronic pain
  • Used in combination with other manual techniques to reduce post lingering symptoms or used as a pre soft tissue relaxation tool allowing for more effective manual management techniques outcome.

Myofascial Release

Myofascial Release is a highly specialized stretching technique used by manual technicians to manage people with a variety of soft tissue problems.

To understand what Myofascial Release is and why it works, you have to understand a little about fascia. Fascia is a thin tissue that covers all the organs of the body. This tissue covers every muscle and every fiber within each muscle. All muscle stretching is actually stretching of the fascia and the muscle (myofascial unit). When muscle fibers are injured, the fibers and the fascia which surround it become short and tight. This uneven stress can be transmitted through the fascia to other parts of the body, causing pain and a variety of other symptoms in areas you often wouldn’t expect. Myofascial Release manages these symptoms by releasing the uneven tightness in injured fascia.

Myofascial Release is highly effective in managing people with the following complaints:

  • Back strain, chronic back pain, low back pain, thoracic back pain
  • Carpal tunnel syndrome
  • Chronic cervical pain
  • Complex pain complaints
  • Dizziness, vertigo
  • Fibromyalgia
  • Fibrositis
  • Headache
  • Myofascial pain dysfunction
  • Plantar fasciitis
  • Post-Polio symptoms
  • Thoracic outlet syndrome
  • TMJ dysfunction
  • Trigger points, tender points*
  • Whiplash

*Trigger Points and tender points cause different types of pain. For example, a Trigger Point in the neck muscles can cause headaches, the sensation of your throat closing or eye pain. Pressure on a Trigger Point causes increased pain at the site and radiating pain in other apparently unrelated parts of the body. Pressure on a tender point causes increased pain only at the tender points itself.

Functional Release Techniques

Functional Release is similar to the strain-counterstrain approach (shortening the soft tissue); however, the tissue focus is on vertebral segments. The key restrictor is in the middle of three vertebrae group that behaves exactly the opposite of the segments above and below. Once the dysfunction is identified, the vertebral segment is position in neutral or the point ease arrangement. After neutral is established, other motions are added or stacked as the technician monitors the tissue texture response. Instead of using pain/tenderness as in strain-counterstrain, resolving tissue texture change is the goal. Also, once the point of ease is found and motions stacked, a small amount of compression or traction is added as well as respiration phase (exhale or inhale) towards ease and held for 3-5 seconds and reassessment is made.

This technique is very gentle, nontraumatic, quickly applied and can be used as a pre or post combination practices with other manual therapy methods especially to reduce lingering symptoms.

Still’s Techniques

It is a conservative form of hands-on manual technique for the musculoskeletal system and indirectly for underlying visceral systems; developed by Andrew Taylor Still, M.D. father of Osteopathy. It is used to manage a variety of musculoskeletal problems ranging from simple restrictions to strains and sprains and even ankylosis joints. Unlike most osteopathic techniques, Still’s Techniques places the restricted tissue in a point of ease and applying a small vector force (traction or compression) of less than five pounds as practitioner carries the issue through its range of motion towards and through the restriction.

Applied Kinesiology

Applied Kinesiology is a unique system of assessment and treatment that utilizes a basic tool of manual muscle testing to determine the underlying factors responsible for the neuromusculoskeletal dysfunction. The manual muscle grading system is based on a “break test technique” method described by the Institute of Sports Medicine and Athletic Trauma. The bottom-line, manual muscle system is the most objective muscle testing system compared to subjective muscle grading systems (Kendall and Kendall Muscle Manual Test), therefore, reducing human error by the assessor.

This technique has been evolving for 40 years by founding father Dr. George Goodheart. Each muscle has a correlation with other body parts including organs, acupuncture/pressure points, reflexes (Neurolymphatic/Neurovascular Reflex Releases), nutritional requirements and cranial stress receptors (Skull Pressure Points).

What are the Benefits from Applied Kinesiology?

  • Find exact weakness patterns underlying complaint.
  • Helpful in addressing chronic or recurring dysfunctions.
  • Muscle and organ dysfunction concept.
  • Muscle and spinal level relationships.
  • Muscle, spinal and organ relationship.

Neurolymphatic Reflex Release

Frank Chapman, D.O. discovered the “Chapman reflexes” in the 1930’s. He collated the reflexes with specific organs and glands with different types of health problems. The Chapman reflexes are now called neurolymphatic (NL) reflexes, which Dr. Goodheart later discovered specific muscle association per NL reflex. Upon successful stimulation of the NL reflex, there would be a dramatic muscle strength improvement and would be long lasting if there are no other health factors causing NL reflex reactivation.

How It Works – The Technique

Muscle testing (AK) isolates weaknesses to specific muscle and each muscle has a specific NL reflex. Treatment of the NL reflex is accomplished with a heavy, deep and rotatory massage, sometimes for prolong periods, to clear the reflex. Upon successful treatment a weak muscle becomes strong; therefore, part of the home exercise program will include NL reflex releases.

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Industrial Sports Medicine Services

If you use your body to earn a living then you are considered a professional athlete (Industrial Athlete). To be successful you must take care of your body, which is your only source of income and satisfaction. Poor personal fitness leads to more injury problems and poor recovery. Tendonitis, CTS, neck pain and other problems in the neck-arm-hand (postural dysfunctions) have become common, especially in job settings; these groups of injuries are called CUMULATIVE TRAUMA DISORDERS (CTD’s). 

The fastest growing work related injuries in America leading to higher healthcare cost/worker’s compensation claims, absenteeism and decreased productivity, in the job force, are:

  • Back/spine injuries (restrictions): See Dr. Phillip E. Greenman’s “The Dirty Half Dozen” in The Failed Lower Back Syndrome (Study).
  • Thoracic Outlet Syndrome (TOS) related injuries (a region of the neck and shoulders that incases the blood vessels and nerves of the arms). Tight muscles, spinal/rib dysfunctions and poor posture can lead to a neurovascular pathway compression called TOS. Carpel Tunnel Syndrome (CTS), Tennis Elbow, Golf Elbow, shoulder/upper extremity pathologies, etc. are secondary injuries as a result of this syndrome.

Such conditions can cost well over $250,000 per serious case after surgery, compensation, legal, administrative and loss of production costs are tallied.  Progressive companies are proactively intervening to care for their most important asset in order to keep their workforce productive in this competitive global economy.

ATCare (Owned and operated by Health & Fitness Prescription, Inc.) offers an economically effective, no nonsense and proactive injury prevention program for the workforce. The bottom-line is a successful preclinical plan that dramatically aids in preventing or reducing injuries. This is the same approach that was recognized as a Global Model Program by Pfizer Pharmaceuticals in 2006.

Work Environment Approach

The proactive program is a carbon copy of the award winning “Global Model Program” at the world's largest pharmaceutical company. For many years John L. Bray managed a team of healthcare professionals at Pfizer who designed, implemented, and effectively managed the program with a savings to the company of over $2.5 million per year. John has applied the same successful ingredients with a major Michigan utilities company from 2008 to present (Testimonials).

John’s main focus is avoiding expensive clinical visits by addressing initial symptoms that left ignored could affect job duties, which may lead to OSHA recordable injuries. John uses his proven manual skills to reduce skeletal restrictions by stretching tight postural muscles to allow proper body alignment. (OSHA does not classify stretching as a physical therapy protocol therefore is not a recordable occurrence.)   In addition to John’s ergonomic certification, he is also skilled in proven CTD injury protocols:

  • Injury Prevention Talks (Presentations): Persuasive talks to enhance worksite safety.

    • Healthy Back
    • Healthy Shoulder
    • CTD Prevention

  • Productivity/Injury Prevention Stretches:

    Postural alignment stretches combined with muscle imbalance system of tightness/weakness prone muscle pattern (tightness prone muscles inhibit key muscles involved with low back core strength and shoulder stabilization) completed prior to work.
  • Team/Crew Stretches:

    Postural alignment group stretches completed prior to work.

  • One-on-One Consulting Program:

    • Skeletal Alignment Screening: The three step screening process takes less than two minutes to assist in identifying primary tight muscles restricting joints.
    • Manual Skeletal Alignment Stretches: Specialized hands-on positional stretches fully control by employee. The session is completed on a portable massage table with employee privacy (conference room) but also can be completed within a safe zone at worksite.  Uniquely, the hands-on stretching can be successfully completed through the work clothes (no embarrassing or uncomfortable clinical gown).
    • Self Adjusting Stretches: Personalized postural stretches, based on muscle restrictions, completed less than five minutes.

  • Ergonomic Analysis:
    John’s ergonomic certification in combination with the vast medical anatomy background provides a cost efficient approach to reducing injuries/reinjures. The initially skeletal screening can also assist in identifying possible worksite injury mechanisms affecting a safe work zone.

The Bottom-Line

John’s unique and proven approach not only focuses on your assets but it is also an excellent program to enhance the individual’s quality of life. John’s assessment and proactive plan can improve joint mobility to alleviate pain and restrictions. This includes neck, back and hip pain. In addition to these, the techniques can assist in overcoming extremity restrictions, breathing restrictions, muscular and proprioception weaknesses, body stressors and headaches.

This restorative functional program prevents or reverses stiff joints and poor flexibility that pull the body into stressful postures requiring more effort to move, which increases tissue fatigue and damage. Scientific studies agree that flexibility is an important ingredient for a vital working body. Lack of flexibility causes the body to work harder. Stretching allows ease of movement, promotes good posture, and provides adequate neurovascular circulation to working tissues.

The main goals are a proactive injury prevention program to enhance a faster return to work/activities, become more productive, and enjoy a better quality of life. John will guide the individual or team to take an active and responsible role for their recovery. The bottom-line is the program effectively builds an ownership towards prevention or recovery because the worker/athlete takes control with a tailored five minute home/worksite exercise program. These programs are a life-long plan to keep the individual successful, happy, and healthy as a professional industrial athlete!

Industrial Sports Medicine Recommendations:

"Our company has had a Certified Athletic Trainer on site since 2000 and since that time we have recognized the tremendous upside in the tangible and intangible benefits of this addition, including a savings of more than $245,000 in just 2002 alone in health care-related expenditures. We have also experienced a decrease of 67percent for health care costs related to the low back. Additionally, our days away from work have decreased by 60 percent in the last three years. In the industrial setting these results can be best accomplished by an individual with the medical knowledge and training of an athletic trainer. We wouldn't have it any other way and will continue this program for the long term."
- James E. Marotz, DO, Corporate Medical Director at Appleton Papers, Appleton, WI

"The Certified Athletic Trainer is my first choice for on-site health care for our insured. The clinical skills for treating MSD, first aid knowledge and ability to develop health/wellness programs make the AT extremely valuable. Maybe most importantly, the AT understands motivation and the psychology of performance. That seems to make a big difference. I'm designing risk control strategies based on the Sports Medicine model, and the AT is central to that model."
- Benjamin Atkinson, Worker Compensation Director Risk Control, CNA Insurance, Chicago, IL

Some companies that currently employ certified athletic trainers:

Allison Engine, American Axial, Appleton Papers, Coca-Cola, Consumers Energy, Dana Corporation, Delta Faucet, Daimler-Chrysler, DuPont, FedEx, Frito-Lay, General Electric, General Motors, International Paper, John Deere, Johnson & Johnson, Kodak, MeadWestvaco, Navistar International, Quad/Graphics, Roadway, SquareD Company, Subaru-Isuzu, SUPERVALU Distribution

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Athletic Training Services

As a highly qualified, allied health care professional John Bray provides athletic training (ATC) in the traditional sports settings. John’s athletic training experiences include the National Football League (Green Bay Packers), collegiate athletics (University of Wisconsin – La Crosse), and head athletic trainer for the AAU World Wrestling Championships and the AAU Basketball National Championships. He also provides multi-sport athletic training for high school, junior high and youth sports programs. John’s comprehensive service is designed to meet the needs and interests of the entire sporting family.

What separates John from traditional athletic trainers is his ability to offer manual therapy and industrial sports medicine services (CTD’s) that allow enhanced performance outcomes, highest athletic potential achievement, in addition to developing and maintaining a safe environment.

As an athletic trainer, John works under the supervision of a licensed physician and in cooperation with other health care providers. This supervision ranges from discussing specific injuries and treatment options with a physician to performing evaluations and treatments as directed by the physician.


The following services and programs are provided through Health & Fitness Prescription, Inc:
Injury Prevention through the following:

  • proper conditioning, strengthening, and flexibility programs
  • proper selection, care and fitting of equipment and supplies such as helmets, shoulder pads, shoes, and mouthpieces
  • protective padding, taping, splinting, and bracing
  • recognition of pre-existing conditions in pre-participation physical examinations.

Injury Recognition, Evaluation, and Referral by the following:

  • communication with the athlete about the history of the injury (how, when, where, and what happened)
  • specific questioning about pre-existing problems and conditions before the injury
  • modern "hands on" examination and evaluation techniques
  • utilizing best practice standards of care and recognizing the indications for referring athletic injuries to the team/family physician or appropriate sports medicine specialists.

Injury Management and Treatment by means of the following:

  • modern primary care techniques utilizing ice, compression, elevation, support and requisite rest
  • working with the local family/team physicians in day-to-day treatment protocols
  • regular re-evaluation of signs and symptoms to insure appropriate management
  • secondary care techniques of cryotherapy, exercise, compression, heat, massage, support, taping, and wrapping.

Injury Rehabilitation utilizing the following:

  • modern and safe techniques using appropriate exercise to maintain or improve range of motion, flexibility, muscular endurance, muscular strength, proprioception and cardiovascular fitness
  • specific protocols, designed for specific injuries and conditions
  • regular re-evaluation of progress to insure changes in the rehabilitation program as indicated.

Organization and Administration of Athletic Training Programs including the following:

  • setting up and organizing pre-participation physical examinations
  • guidance in designing a new facility or renovating existing facilities to accommodate athletic training services and/or the athletic trainer
  • working with local physicians as appropriate in securing a team physician
  • guidance in the selection of athletic training supplies and equipment.

Education and Counseling which encompass the following:

  • guidance to athletes, coaches, and parents in the areas of conditioning, flexibility, diet/nutrition, and related areas
  • both accredited and non-accredited workshops in the area of athletic training and sports medicine
  • serving as a resource center for information and advice regarding athletic healthcare
  • providing athletic trainers, physicians, and other qualified personnel to speak to parent/teacher groups, boosters, and service clubs
  • CPR and First Aid instructor certification classes modified for sport specific emergency care, treatment and prevention skills.

Whether you are a “weekend warrior” or regular participant in competitive sports, John can help. ATCare (Owned/Operated by Health & Fitness Prescription, Inc.) is a small, locally owned and operated company committed to providing competent medical care with your athlete’s best health interest in mind. John’s caring integrity and prompt attention to your needs are a reflection of his commitment to the health of every athlete.

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