A sample text widget

Etiam pulvinar consectetur dolor sed malesuada. Ut convallis euismod dolor nec pretium. Nunc ut tristique massa.

Nam sodales mi vitae dolor ullamcorper et vulputate enim accumsan. Morbi orci magna, tincidunt vitae molestie nec, molestie at mi. Nulla nulla lorem, suscipit in posuere in, interdum non magna.


Gary Gales, DPT, CMP of Alpine Physical Therapy for 11 years recently earned international certification as a Certified Mulligan Concept Practitioner (CMP). Having attained this advanced training, Gary expertly applies hands on care using the Mulligan approach to help patients move and feel better. Notably, Gary is one of two Mulligan Concept Practitioners in the Missoula area. Contact Gary at Alpine’s south clinic at (406) 251-2323.  


Special thanks to star physical therapist Brace Hayden, DPT, CSCS of Alpine Physical Therapy for providing this write up on a recent article from Spine.


Low back pain with radiating leg pain or sciatica is a common problem in the United States and often highly expensive to manage. Conservative treatment by general medical practitioners, or the non-surgical approach of patient education, pain medicine and rehabilitation cost upwards of $55,000 per case, per five years. One in ten cases of low back pain have an irritated nerve root or radiculopathy that radiate pain down the leg past the knee. This type of back pain with sciatic leg complications from a bulging disc defined in this paper as “lumbosacral radicular syndrome”, often takes a large financial toll, as there is lost time from work and expensive medical costs.

Shortening the painful, acute phase of lumbosacral radicular syndrome using a steroid shot to the level of the bulging disc is a widely-accepted and often effective treatment. Dr. Spijker-Huiges and her team of Dutch researchers assessed the costs of possibly shortening the duration of this injury and the medical costs to provide it. The study used a randomized control design where half of the 73 subjects received “care as usual” treatment from their provider and the other half were given a steroid shot to the back at the injured level and the usual medical care. The Dutch providers used the nationally recommended guideline for back pain treatment that includes pain medication, recommendations to maintain normal daily activities as much as they are able, and referrals for other rehabilitative treatments as necessary.


This study found small, but significant differences in many of the research variables they measured over the course of a year in the subjects in both the control and steroid intervention group. Interesting findings turned up less expensive and more cost-effective treatments in the steroid intervention group.  The addition of a steroid shot cost $259 or 191 Euros, but saved the individual the costs of lost work wages, increased total medication use, and increased time in physical therapy and other alternative therapies. Intervening with a steroid shot during the acute phase also had a small, but clinically measurable effect on reducing the individual’s initial pain and disability scores.

The authors noted that careful selection of patients during the acute phase (less than six weeks in duration) of this low back injury is important, as longer durations of radiating back pain do not respond as well. They concluded that implementing steroid injections is a win-win medical treatment for this disabling back injury with few negative side effects and many cost-saving benefits to society over the typical medical care. The patient’s pain and return to work time are also improved; thus, their productivity and income are increased.


Spijker-Huiges A., MD, et al. Costs and Cost-effectiveness of Epidural Steroids for Acute Lumbosacral Radicular Syndrome in General Practice. An Economic Evaluation Alongside a Pragmatic Randomized Control Trial. In SPINE. Nov. 2014. Vol. 39, Pp. 2007 – 2012.

For more information on this topic, view our clinical module on steroid injections for back and sciatic pain by clicking here.


Alpine Physical Therapy Announces our New Oncology Program

We’d like to announce the Oncology Rehab Program at Alpine Physical Therapy. Our team, which includes Josie Sweeney, DPT, Antara Quinones DPT, CLT-LANA, and Jessica Kehoe DPT, want to bring to everyone’s attention that October is National Breast Cancer Awareness month.  We will surely all see lots of pink stuff this month in sports and in the news honoring this month, but we really want to remind everyone that the reason for all this media is to encourage early detection. 

Statistics show that nearly 1 in 8 women will be diagnosed with breast cancer in her lifetime.  Early detection is the BEST way to beat this disease, and both the 5 year and long term survival rates drastically improve with early detection.

We encourage all women to talk about early detection with their friends and family.  If you are a woman aged 40-49 talk to your doctor about when and how often to begin getting mammograms.  If you have had a close family member with breast or ovarian cancer you are at a slightly greater risk, so no matter your age, be sure to talk to your doctor about your options for early detection.  Join us in vowing to start, or get back to, your early detection plan.

We’d like to share some great resources to help you.

The American Cancer Society (early detection).

The National Breast Cancer Foundation (early detection).

The National Cancer Institute (risk calculator).

The Oncology Rehab Team at Alpine Physical Therapy is now providing Missoula and surrounding communities with the following services:

  • Rehabilitation from surgeries, radiation, and chemotherapies
  • Certified Lymphedema Therapist
  • Certified Cancer Specialist
  • Expert swelling prevention, reduction and management
  • Compression garment fitting

For more information, be sure to visit our Oncology Rehabilitation webpage.

Alpine PT Introduces Mary Mischke, PT, DPT, OCS

Mary Mischke, PT, DPT, OCS has joined Alpine Physical Therapy, enlarging our team to 18 physical therapists. Mary graduated from Duke University with her Doctor of Physical Therapy degree in 2010. Mischke is a board-certified orthopedic clinical specialist and is certified in applied functional science.

Her specialty areas include general orthopedics, female athletes, running injuries and prevention, post-operative care, and functional exercise.

Mary can be reached at our downtown clinic at 549-0064.

Kristi Moore Completes Dance Medicine Rehabilitation Certification

Kristi Moore, MSPT of Alpine Physical Therapy completed her Dance Medicine Rehabilitation Certification in September 2015 through Westside Dance Physical Therapy in New York City. 

Kristi is the only physical therapist in Montana to complete this level of education specific to dancers. 

She is excited to bring her specialty to Missoula’s dance community and provide individualized treatment for injury prevention and rehabilitation from injury to keep dancers doing what they love.  

For more information, visit our Dance Medicine webpage by clicking here.

Kristi can be reached at Alpine’s North clinic at (406) 541-2606.

Guest Chiropractor Shares Insights for Improved Health

Special thanks to Dr. Liz Walker of Primal Practice for sharing her insights on the work she does to help patients on their health journey




As a chiropractor I hear many reasons why people don’t believe in chiropractic. One of them is that there are no scientific studies to prove that adjustments are effective. Another is that they don’t like the popping or cracking that occurs during an adjustment. Today, I want to speak to both of these.


Hippocrates said “look well to the spine for the cause of disease.” The research is proving this to be true. If you don’t take care of your spine the rest of your body will not and can not function as well as it should, and this is not limited to your musculoskeletal system but all your systems. Roger Sperry, a nobel prize winner on brain research, said “90% of the stimulation and nutrition to the brain is generated by movement of the spine.” Chiropractic adjustments keep your spine healthy and functional to keep your brain nourished and stimulated.


The research is also showing that a single chiropractic adjustment inhibits the sympathetic tone of the nervous system (this is the part of your body that makes you stressed), decreases salivary amylase (an indicator of the decreasing stress), changes regional brain metabolism and decreases muscle tone and pain intensity. Another study that occurred over 7 years and 800 participants showed that those people using their chiropractor as their primary care provider had 60% less hospital admissions, 62% less surgeries, 59% less days in hospital, and 85% less pharmaceutical costs.


Maybe I have changed your mind about the effectiveness of chiropractic care but you still are hesitant about having your neck popped and your back cracked. There are many ways to perform an adjustment with many of them not requiring a noise to be made. At Primal Practice we always respect your preference when performing an adjustment so it is as comfortable for you as possible.


If you are ready to see how Chiropractic can take your health to a whole new level don’t hesitate to contact the office: call (406) 549 8969 or email




Link to Primal Practice:



Alpine Congratulates Antara Quinones on Certification

Antara Quinones, doctor of physical therapy, of Alpine Physical Therapy earned her certification with the Lymphedema Association of North America as a certified lymphedema therapist in August 2015.

By completing the 135 hours of coursework and her national board exam, she is qualified to treat a host of patients with edema issues, including those affected by cancer treatment, venous system failure, or surgery. Contact Antara at Alpine’s North clinic at 541-2606.


Kick the Tires of Your Physical Therapist

Know that choosing a physical therapist is first and foremost your choice. So take some time to kick a few tires before simply “going to PT.”

All legally practicing physical therapists in Montana are licensed. That’s great. And there are a lot of quality PTs out there.

Some, however, have gone the extra mile to specialize in areas that may dramatically improve your situation.

At Alpine Physical Therapy, we have specialists in manual therapy, women’s health, spine care, jaw and face pain,vestibular and balance disorders, along with various sports experts in climbing, court sports, soccer, cycling, and running.

Of our 18 physical therapists at Alpine, 12 have doctorates, 4 are board certified through the American Board of Physical Therapy Specialities, and we hold 11 advanced and prestigious national certifications.

More people have kicked the tires of Alpine’s physical therapists and resoundingly say they are glad they did.

Click here to learn more about the advanced specialties of each of Alpine’s expert team members.


Alpine Physical Therapy’s “C-Leaguered” Summer Soccer Team Kicked Grass!

Fortunately, for Alpine PT’s ‘C-Leaguered’ soccer team, the season over. This year was not your typical 9 weeks of after-work-recreational fun with co-workers and friends. Alpine’s team had an inordinate amount of challenges: a multitude of injuries, a mid-season divorce between two team mates, a red card for fighting, and more losses than wins. As the captain, this made for an inordinate amount of weekly challenges getting 11 people on the field for 9 weeks in a row. Fortunately, we expanded the team to 27 players (15 of which were new to our typical field squad) to account for a chronic shortage of players throughout the summer vacation/divorce/work demands/pregnancies /sickness & injury-prone season.  We are also pleased to welcome a healthy baby to a lovely set of new parents/old friends on our team. Congratulations Brett and Katie Cuniff, on the new addition, Connor Patrick stepping into this world at 10 lbs 4 oz. 21″ long. 

Missoula summer soccer, you gotta’ love it!  Despite the experienced player shortages, we brought a lot of new adult players out for “true” C-league soccer that hadn’t kicked a ball since grade school and had a fantastic time meeting and recreating after work. 

We thank Alpine PT for sponsoring our stellar team again this summer. This is the 5th year Alpine PT put together a fine group of PT’s, PT aides, lawyers, grad students, fire fighters, dental hygienists, etc to come out for an after-work kick in the grass. We will look forward to a better summer next year with a few less challenges. 


Alpine Physical Therapy Extends its Reach to Dancers In Western Montana

Kristi Moore, MSPT just completed the course work portion of her Dance Medicine Rehabilitation certification in New York City with Westside Dance Physical Therapy.  She will complete the certification process by August 1, 2015.  She is excited to bring her specific knowledge about dancers back to Missoula’s dance community. 

These last 2 modules covered dancers throughout the life span (adolescents to the older dancer) and the foot/ankle/knee.  

Kristi is currently the only physical therapist in Montana to have completed this level of education specific to dancers.  She truly enjoys working with this unique population by working on injury prevention and rehabilitation from an injury to keep dancers doing what they love!


For more information on our Dance Medicine outreach at Alpin Physical Therapy, please visit our clinic webpage on this topic by clicking here.