Endorsement from Amy Fox, DPT

If you’re reading this, it’s probably because you’re considering working at Synergy Healthcare. Let me aid you a little in your decision-making process. I have worked for Synergy just under 2 years and it is by far the BEST clinic I have ever worked for. In hindsight, I wish I would have started my PT career here right out of grad school, but I was not so fortunate. Nonetheless, working at other clinics gave me a greater appreciation for my role at Synergy. What makes it such a great place to work you might ask? I have ten reasons (in no particular order) that easily come to mind.

First, the owner, Shauna Burchett, actually cares about her employees; she wants you to LOVE your job and will work with you to establish an individual contract that works for you. She is very approachable and easy to communicate with. She understands that life comes before work. I’ve never had such a healthy balance between work and life.

Second, each employee at Synergy is valued; we begin staff meetings by going around and stating “our needs.” This fosters communication between staff and leaves no room to fixate on any issues you may have. And did I mention that we have at least one staff meeting per month?

Third, we take a team approach at Synergy and collaboration with colleagues is a given; everyone contributes and everyone’s input is valuable. There is no down playing a colleague’s contribution based on title, degree or experience. Everyone believes that each person brings something unique to the team.

Fourth, our support staff rocks! They are so organized, on top of insurance, authorizations, billing, scheduling, etc. There is great communication between them and with us therapists. They are our patients’ prime advocates throughout the course of their rehabilitation. Not to mention, when I have down time, you will find me at the front chit chatting with them.

Fifth, our quality of care is the absolute BEST in the Northwest (and I’m willing to bet on this)! We are not a mill clinic; we treat one patient per hour because that’s what is ethical and that’s what our patients deserve. No billing four units when you only saw the patient for two. No maxing out a patient’s benefits when they don’t need to be seen as much. Of course, if you deem that a 30-minute treatment session is more appropriate for a particular patient, then treat him or her for 30 minutes.

This leads me to my sixth point, you are practically your own boss. There is no micromanaging. You are trusted to fulfill your role and to do it well. We are comprised of self-starters and motivated people. The office staff will definitely schedule patients for you, but you manage your own schedule. Work the hours you want to work. Take your lunch when you want to. Schedule vacation time when you want to (run it by Shauna first). Don’t feel ashamed to call in if you or your child is actually sick. Your health and well being is actually primary to the patients’ because if you’re not well, you can’t make others well. I’ve never so appreciated the flexibility in work hours as I have while working at Synergy.

Another unique aspect is that each therapist has their own treatment room/office with your own high/low table. It’s your own space to call home, to hang things on the wall, to have access to your books, to document uninterrupted. Yes, spoiled is another word for this!

Now onto point number eight. You will never stop learning at Synergy. We get a good number of the toughest of the tough cases, and we give these patients our very BEST. We use cutting edge interventions and modalities. Continuing education, mentorship, and manual skill sets are high priorities for those who work at Synergy. If you aren’t passionate about learning and don’t want to challenge yourself, this is not the clinic for you; however, on the flip side, if you are a sponge and gravitate towards challenges, you will fit in very well.

Point number nine, if you’ve been a therapist for any length of time, you know that the amount of documentation is on the rise. None of us want to spend our nights and weekends finishing up notes that we could not get to during the work day. Ask Shauna to work with you to set up a reasonable ratio of treatment and documentation time. Remember, she wants you to LOVE your job and no one loves doing documentation on their own time outside of work.

And finally, to point ten, which is really a combination of everything I’ve written above, you will thrive working at Synergy. We all have a lot of fun together. You will enjoy the humor, the laughs, the support from your colleagues and boss. You will definitely improve your quality of life! I can say this because I’ve experienced “the grass on the other side.”

If you’ve made it this far without calling to schedule an interview, now is the time to do it! This clinic is the creme of the crop, a diamond in the rough, a Godsend for patients, and the very BEST place to work! Take my word for it, take a risk, quit your job or start your career at the RIGHT clinic, try something new and grow professionally more than you ever will any place else!

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Strain-Counterstrain for the Nervous System

Strain-counterstrain is a revolutionary technique developed by Dr. Lawrence Jones DO, that uses the connective fascia tissue and an understanding of tender points to relieve pain and increase range of motion. This technique can be used to treat dysfunction in any soft tissue, including the nervous system. The nervous system is essential in maintaining homeostasis because it regulates pain perception and sensory perception in the body, as well as movement, digestion, blood flow, thinking, emotions, and perception of where the body is in space. By decompressing a given tender point a therapist maintains a patient in a pain-free position for 30-45 seconds. This opens the valves of the veins and lymph vessels surrounding the nerves in the area, reducing swelling around the nerves. Brain Tuckey (PT, OCS, JSCCI) pioneered the use of fascial counterstrain for the nervous system based on the theory that if counterstrain worked on other types of fascia, it would also work on the fascia surrounding nerves.

Tuckey found strain-counterstrain to be effective in treating problems of the nervous system including carpal tunnel syndrome, chronic headaches, chronic regional pain syndrome (CRPS) and even idiopathic (unknown cause) peripheral neuropathy, as well as in pinched nerves and the relief of the feeling of numbness. The reason for this interconnectivity between tender points and the deep fascia is based in what Tuckey describes as a protective cocoon that can sense and respond to strain applied to fragile internal structures such as organs, nerves, and blood and lymph vessels. Stress on the fascia surrounding these structures can “call in” a protective response from the muscle system to avoid damage. This level of connectivity may not rise to the level of consciousness, instead manifesting in involuntary muscle spasms or contractions. Even more subtly, an inflamed nerve can change a joint’s resting position by increasing the tone of skeletal or smooth muscle or creating weakness through pain inhibition, neural compression, or skeletal muscle reciprocal inhibition.

When traditional strain techniques are used on tender points that are not responding, this new method of counterstrain resulted in an immediate response in which the surrounding tissue relaxed and a faint “therapeutic pulse” or vascular release could be felt in the surrounding tissue. Both strain and counterstrain techniques together are effective tools at limiting and managing chronic pain. The strain-counterstrain approach allows practitioners to identify and treat the true source of pain or disability. Ask your therapist how we can use this groundbreaking technique to help you and your loved ones.

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Clinician Chat: A Different Point of View

Q: You’ve mentioned that your treatment perspective is little different than some providers, can you explain how your point of view differs?

Synergy Therapist: Simply put I look at the body as a whole. Instead of focusing on the area in pain I look at how the body moves. Is it balanced? Where are the restrictions in the movement? Are there posture problems which would affect other parts of the body? This is different because traditionally providers only look at the affected area.  That means that the underlying issues (see a picture of the out-of-whack skeleton) may not be addressed.

pelvic tilt

Classic example: you come in with shoulder pain unless your underlying postural issues are addressed the shoulder pain may come back.

Q: Let’s just say a person came to you with shoulder pain, how would you start your evaluation?

Synergy Therapist: First I look at three basic things- how the person sits, stands and walks. Most people don’t know that you should sit the way you stand- with a natural “S” curve to your back. If you sit incorrectly (see a picture of cute kid) your body will have to compensate in other areas which will eventually affect the way you stand and walk. In a standing position, I can assess the symmetry of the body and trace patterns of dysfunction. Walking provides me insight into how the body moves against gravity. After all the body is designed to move so why not look at what it’s supposed to be doing?

Q: Why do you think this perspective is so rare?


Poor posture puts your spine into a “C” shape instead of the naturally stronger “S” shape.

Synergy Therapist: People learn by comparing new information to things they’ve already learned. Sometimes the things we see don’t fit into the box and then we’re faced with a choice. Do we discard it as being impossible or do we take the chance and try to learn something new? Most past medical studies were done on cadavers, which is great for a start but it has a flaw… cadavers don’t move! Fortunately, there is research being done that focuses on how the body moves with living people. I am continually learning from the people I treat and from the research of others- the body is amazing and our understanding of it has just begun!

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Valve Exercises


1. DJ V
Valve (Duodenum/ Jejenum)
: DJ is left sided.

-Lying on back with knees bent, move knees 2” toward right.

-3 finger widths in an upward 45 degree diagonal on left is sphincter. Next put 3

fingers of right hand over that spot and help with left hand over right and push

inward toward spine and then move counterclockwise (CCW) ⅛”.

2. IC Valve (iliocecal Valve): IC is right sided.

-knees bent and move 2” left

-find the spot between belly button(BB) and corner of pelvis and draw a line. Go

⅓ of way from inside corner of pelvis up that line and that is the spot of the

-Now put 3 fingers on that spot. Push down and turn CCW ⅛”.

-Do 1 minute

-Do 3 times a week.

3. GES (gastroesophageal valve) is left sided between esophagus and stomach. (Do 3 times per week if you have digestive problems.)

-Find the “V” of bottom part of rib cage and put 3 fingers over it.

-Knees bent and move knees to right 2”

-Push 3 fingers downward toward spine and turn CCW for 1 minute.

4. Pyloric Valve (between stomach and intestines): is left sided.

-bend knees and move them 2”toward right.

-Find BB and go 4-5 finger widths directly upward toward head from the BB and

the valve is here.

-Put 3 fingers of the right hand over that spot and then put left hand over right to

help and push downward toward the spine and turn fingers CCW ⅛”.

-Do this for 1 minute.


Do these exercises 3 times a week. These areas could be flared up from certain foods. If you have pains do the exercise to clear it up.


  1. Sphincter of Oddi is a right sided valve.

-Lying on back with knees bent, move knees 2” toward left.

-3 finger widths in an upward 45 degree diagonal on right is the sphincter. Put the

pads of 3 fingers over that spot. (The sphincter is only the size of a dime or


-Next push inward toward spine and CCW ⅛”.

-Do this for 1 minute.

-Do up to 3 times a week for digestive problems or do if you have right shoulder

blade or upper traps pain.


6. Upper gastroesophageal(UES) can either be right or left sided. This is for acid reflux.

-You will move your knees 2” of opposite side of problem.

– Head on 1-2 pillows.

-Right arm is bent at elbow and back of hand is propped on pillow.

-With left hand grab windpipe/esophagus area and gently pull downward toward


-Do this for 1 minute.


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Lymphedema Stage 0 and 1

Water-drop for Lymph drainageSynergy Healthcare is pleased to let you know that we now have 2 certified lymphedema practitioners to assist your patients with their recovery and attainment of optimal function. Here follows a brief summary of stage zero and stage one lymphedema. It is important to recognize these early stages as this condition is still reversible if addressed early. Without proper care, the vast majority of stage one cases progress to stage two, which can be managed but not cured.

Lymphedema is a very common and serious condition, affecting at least 3 million Americans. Estimated incidence of lymphedema in the United States includes 1-2 million cases of primary lymphedema and 2-3 million cases of secondary lymphedema. In these cases, the swelling may affect limbs, face, genitals and trunk. The highest incidence of secondary lymphedema in the United States is observed following breast cancer surgery, particularly among those patients who underwent radiation therapy following the removal of axillary lymph nodes.

Primary lymphedema is caused by a developmental abnormality of the lymphatic system, which is either congenital or hereditary. Swelling in primary lymphedema generally affects the lower extremities. Complete Decongestive Therapy (CDT) is a non-invasive, multi-component approach to effectively treat and manage lymphedema and related conditions. Numerous studies have proven the effectiveness of this therapy, which has been well established in European countries since the 1970’s and in the United States since the 1990’s.

Currently there is no cure, or permanent remedy for lymphedema once it reaches stage two. If lymphedema is present, the lymphatic system is mechanically insufficient, which means that the transport capacity has fallen below the normal amount of lymphatic load. The transport capacity in the damaged lymph vessels cannot be restored to its original level.

Although the swelling may recede somewhat during the night in some early stage cases, lymphedema is a progressive condition. Regardless of the cause, lymphedema will in most cases gradually progress through its stages if left untreated

Stage 0 

This stage is also known as the sub clinical, pre-stage, or latency stage of lymphedema.

In this stage the transport capacity of the lymphatic system is subnormal, yet remains sufficient to manage normal lymphatic loads. However, this situation results in a limited functional reserve of the lymphatic system.

Stage I

This stage, also known as the reversible stage, is characterized by soft tissue pliability without any fibrotic changes. Pitting is easily induced and the swelling retains the indentation produced by the (thumb) pressure for some time. In early stage I, it is possible for the swelling to recede overnight. With proper management in this early stage, the patient can expect a reduction of the extremity to a normal size (compared to the uninvolved limb). Without proper care, progression into stage II in the vast majority of the cases is inevitable. It is difficult to distinguish stage I lymphedema from edemas of other origins. The clinician needs to rely upon the history and whether or not the swelling resolves with conventional management such as compression and elevation.

Anyone who had a surgery involving the lymphatic system or trauma and DOES NOT develop visible lymphedema, is considered to be in a latency stage (hidden lymphedema). Notably, 42% of women present with some degree of visible lymphedema one year post-mastectomy; the other 58% are considered to be in a latency stage.

Patients in a pre-stage are “at risk” to develop lymphedema. The reduction in functional reserve results in a fragile balance between the subnormal transport capacity and the lymphatic loads. Any added stress put on the lymphatic system, such as extended heat, or cold, injuries, or infections may cause the onset of lymphedema. Patient information and education, especially following surgical procedures, can dramatically reduce the risk for developing lymphedema.

The importance of having early preventative treatment during this phase shouldn’t be understated. We have discussed the relevance of manual lymphatic therapy, but Synergy also has the skills to mediate scar tissue, lack of range, and weakness that patients experience post surgically. Education and self-lymphatic techniques are provided to patients to teach them to maintain their health and prevent further progression.

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Lymphedema treatment

Lymphatic Therapy touches the waters of the body

How is Lymphedema Treated?

Complete Decongestive Therapy (CDT) is the therapy of choice for most patients suffering from primary and secondary lymphedema. CDT is a non-invasive, multi-component approach to treat lymphedema and related conditions. Numerous studies have proven the scientific basis and effectiveness of this therapy, which has been well established in European countries since the 1970s. The goal in lymphedema management is to reduce the swelling and to maintain the reduction by removing excess plasma proteins and water from the tissues, utilizing remaining lymph vessels and other lymphatic pathways. Additional goals are prevention and elimination of infections and the reduction and removal of fibrotic tissues. CDT with its four components Manual Lymph Drainage (MLD), compression therapy, decongestive exercises and skin care, is designed to achieve this goal.
CDT is applied in two phases. In phase one (intensive phase), the patient is treated by a skilled and specially trained therapist on a daily basis until the swollen extremity is reduced to a normal or near normal size. The end of phase one is determined by the results of circumferential or volumetric measurements on the affected extremity. Depending on the stage of lymphedema, the involved extremity or body part may have reached a normal size at the end of the intensive phase, or there may still be a circumferential difference between the involved and the uninvolved limb. If treatment is initiated in the early stage of lymphedema (stage one), which is characterized by a soft tissue consistency without any fibrotic alterations, limb reduction can be expected to a normal size (compared to the uninvolved limb). If intervention starts in the later stages of lymphedema (stages two and three), where lymphostatic fibrosis in the subcutaneous tissues is present, the edematous fluid will recede, and fibrotic areas may soften. However, in most cases the hardened tissue will not completely regress during the intensive phase of CDT. Reduction in fibrotic tissue is a slow process, which can take several months or longer and is achieved mainly in the second phase of CDT.
In the second phase of CDT (self-management phase), the patient assumes responsibility for managing, improving and maintaining the results achieved in the first phase. To reverse the symptoms associated with later stages of lymphedema, good patient compliance is indispensable. Compression garments have to be worn daily and bandages have to be applied during the night. This self-management phase is a lifelong process and includes self- Manual Lymph Drainage, self-bandaging (during the night) and decongestive exercises; regular check-ups with the physician and the lymphedema therapist are necessary.

Nora Graebner is a certified Lymphedema therapist who can assist you with this issue.

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