Treatment FAQs

Here are answers to some of the frequently asked questions we receive from patients who are interested in learning more about our approach.

  1. What causes inflammation and adhesive scar tissue to form?
  2. What is Dermal-Fascial Restoration℠ (DFR℠)
  3. How does DFR work?
  4. What studies have been done?
  5. Is DFR safe?
  6. How involved is the treatment process?
  7. Who on your staff will be treating me?
  8. How will I know if it is working?

What causes inflammation and adhesive scar tissue to form?

Small repetitive injuries over time, as well as major trauma can cause inflammation. Inflammation can lead to the development of adhesive scar tissue. In addition, a sedentary lifestyle can also lead to inflammation of the soft tissue.

What is Dermal-Fascial Restoration℠ (DFR℠)?

Dermal-Fascial Restoration (DFR) is a new manual approach for addressing the effect of inflammatory processes on the muscular-skeletal system. Recent advances in ultrasound diagnostic technology in the field of internal medicine, clinical dermatology and more recently, physical therapy, are helping understand this process and why this advanced manual therapy (DFR) is so effective at restoring health to the dermis and underlying myofascia.

How does DFR work?

By applying focused, high levels of tension on the adhesion, the physical therapist is able to restructure the adhesive scar tissue (collagen) within the connective tissue without causing further inflammation or injury. This release allows the intricate network of connective tissue to perform their specific and intended functions, resulting in improved function and reduced pain. Through real-time High Frequency Shear Wave Elastography (HFSWE) imaging, Dr. Mettler and his associates have been able to confirm how DFR systematically and progressively frees skin and myofascia stiffness or adhesions caused by tissue inflammation.

What studies have been done?

Studies performed using a standardized physical therapy outcome analysis demonstrate an superior level of patient response with improvement in pain and function following DFR in combination with standard therapies to other treatments without DFR.[1] Results varied from nearly 20–75% improvement in both pain and range of motion for the the DFR group over the comparison groups depending on the study patient group used. (actual results: 17%, 24%, 32%, 59%, 72%)

Is DMR safe?

Some patients have experienced minor skin irritation in the area that is being treated. These minor skin irritations clear within a day.

How involved is the treatment process?

Treatment typically consists of 8 to 15 sessions (lasting 30 to 60 minutes each) over a 2- to 3-month period.

Who on your staff will be treating me?

All patients are treated by Doctors of Physical Therapy rather than by aides or associates.

How will I know if it is working?

Patients typically experience relief from pain in as little as 2 to 3 visits with increased range of motion and muscle function following this.

Still have a question?

If you still have a question, please contact us.

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1. A randomized sample of new Mettler patients treated from 2009–2012 using the Oswestry, DASH, NDI and LEFS self-report outcomes scoring systems with a comparison to the following studies:

Low Back (Oswestry)

  1. Nunn N. Practical challenges and limitations using the Oswestry Disability Low Back Pain Questionnaire in a private practice setting in New Zealand. A clinical audit. New Zealand J of Physiother. 2012;40(1):24-28.
  2. Unsgaard-Tøndel M, Fladmark A, Salvesen &, Vasseljen O. Motor control exercises, sling exercises, and general exercises for patients with chronic low back pain: a randomized controlled trial with 1-year follow-up. Phys Ther. 2010;90(10):1426-1440.
  3. Unlu Z, Tasci S, Tarhan S, Pabuscu Y, Islak S. Comparison of 3 physical therapy modalities for acute pain in lumbar disc herniation measured by clinical evaluation and magnetic resonance imaging. J Of Manip & Phys Therapeutics. 2008;31(3):191-198.

Upper Extremity/Shoulder (DASH)

  1. Camargo P, Haik M, Ludewig P, Filho R, Mattiello-Rosa S, Salvini T. Effects of strengthening and stretching exercises applied during working hours on pain and physical impairment in workers with subacromial impingement syndrome. Physiotherapy Theory & Practice. 2009;25(7):463-475.
  2. Badke M, Wooden M, Fly K, Boissonault W, Ekedahl S. Patient Outcome Following Rehabilitation for Rotator Cuff Repair Surgery: The Impact of Selected Medical Comorbidities. J Orthop Sports Phys Ther. 2007;37(6):312-319.
  3. Brennan G, Parent E, Cleland J. Description of Clinical Outcomes and Postoperative Utilization of Physical Therapy Services Within 4 Categories of Shoulder Surgery. J Orthop Sports Phys Ther. 2010;40(1):20-29.

Cervical/Neck (NDI)

  1. Fritz J, Brennan G. Preliminary examination of a proposed treatment-based classification system for patients receiving physical therapy interventions for neck pain. Physical Therapy. 2007;87(5):513-524.
  2. Dunning J, Cleland J, Waldrop M, Arnot C, Young I, Turner M, Sigurdsson G. Upper Cervical and Upper Thoracic Thrust Manipulation Versus Nonthrust Mobilization in Patients With Mechanical Neck Pain: A Multicenter Randomized Clinical Trial. J Orthop Sports Phys Ther. 2012;42(1):5-18.
  3. Young I, Michener L, Cleland J, Aguilera A, Snyder A. Manual therapy, exercise, and traction for patients with cervical radiculopathy: a randomized clinical trial. Phys Ther. 2009;89(7):632-642.
  4. Ask T, Strand L, Skouen J. The effect of two exercise regimes; motor control versus endurance/strength training for patients with whiplash-associated disorders: a randomized controlled pilot study. Clin Rehab. 2009;23(9):812-823.

Hip, leg, knee, foot and ankle (LEFS)

  1. Abbott J, Kidd M, Stockwell S, Cheney S, Gerrad D, Flynn T, Cleland J. Manual Physical Therapy and Exercise Versus Electrophysical Agents and Exercise in the Management of Plantar Heel Pain: A Multicenter Randomized Clinical Trial. J Orthop Sports Phys Ther. 2009;39(8):573-585.