Category: Physical Therapy

Mike Wold, originally from Minnesota and now an Arizona resident, is a Vietnam Navy veteran with an interesting career path. After a long career in aerospace engineering, he started his own company in 1997 in leadership, executive leadership coaching and organizational development.

Not one to sit on his laurels in retirement, Mike has a robust volunteer life. He works with the Institute for Healing of Memories, an organization dedicated to using storytelling as a tool to help veterans recover from PTSD. As a volunteer, Mike coordinates five Arizona Institute for Healing and Memories workshops each year. To date, the group has worked with over 240 men and women veterans in Arizona since 2013. He also participates in two local choirs, one of which visits nursing homes to bring joy and music to the residents. Finally, he participates in a book club where military history books are read and discussed.

Mike is married with two grown children and five grandchildren. When Mike speaks about his family, he describes them with enthusiasm and detail, sharing information about their careers, interests, hobbies.

As you can imagine, when Mike injured his shoulder, he didn’t want it to take time away from his volunteer activities or time with his family. After working with a local chiropractor with minimal progress, he was assessed by David Carfagno, D.O., an internal medicine doctor and sports medicine specialist. Dr. Carfagno referred Mike to Brian Gruber, MD, board certified orthopedic physician.

Further testing with Dr. Gruber revealed a rotator cuff tear significant enough to require surgery. The size of the tear was too great to benefit much long-term from the more conservative treatments like cortisone shots and chiropractic work he had been receiving.

“My surgery was arthroscopic and went great,” said Mike. “I was so informed by Dr. Gruber and his team beforehand and knew exactly what to expect.”

Mike had his surgery at Honor Health Piper Surgery Center, which he describes as “like a Hilton hotel with everything so professional and clean.”

One of the things that Mike was especially appreciative of was a block he received prior to surgery from the anesthesiologiststhat blocked pain for about 18-hours post-surgery. “This meant I needed very little strong prescription pain medication post-surgery and was able to switch to standard over-the-counter pain medication quickly,” Mike shared.

After having such a great surgical experience with Dr. Gruber to repair his rotator cuff, Mike continued with Integrated Orthopedics’ physical therapyprogram, which is in the same building and just down the hall from its clinic.

Todd Waterkotte, PT, MPT, director of physical therapy, (who Mike refers to as “the quarterback” of the PT team) and the entire team were fantastic,” said Mike. “They tailored the program for me, and when I was frustrated Todd would always raise me up and provide encouragement and humor.”

Mike added that as with his clinic and surgery experience with Dr. Gruber, the physical therapy team always gave him the facts and information about what to expect and how he was progressing. He said he felt informed all throughout the process and there were no surprises.

Mike is currently at 90% recovery and knows he will continue to see improvement over the next few months, with the last 1% typically coming at the 1-year post-surgery mark. “I can do anything I have to now for my volunteer work and around the house,” he said. “I am very happy with my recovery.”

“Dr. Gruber has set-up an organization with competent people with good morale who do good work,” he stated. “This is not easy to do. He’s created a fantastic culture that most medical practices can’t achieve due to the pressures of the healthcare business.”

Since his surgery, Mike shared that he has recommended Dr. Gruber and his team many times and will continue to do so.


rotator cuff, rotator cuff surgery, rotator cuff physical therapy

Debra Jones pictured here hard at work rehabbing her rotator cuff post-surgery in Integrated Orthopedics’ physical therapy clinic. 

Debra Jones is a recent retiree who is originally from Ohio & California and now resides in Scottsdale. Both Debra and her husband Ted have been long-time patients of Dr. Brian Gruber, board certified orthopedic surgeon.

“We wouldn’t go to anyone else,” said Debra. “He is just really good at what he does. Over the years, I’ve seen Dr. Gruber for several orthopedic related injuries and he never steers me wrong.”

In January 2017, Debra began having shoulder pain. She initially got an injection and did physical therapy with Jessica Tate, PT, DPT, which produced great improvement, but in late February, while walking on some uneven terrain, Debra fell and broke her wrist, which resulted in an emergency ER visit and surgery to repair it.

After her initial follow-up with the ER doctor who repaired her broken wrist, Debra had her case transferred to Dr. Gruber’s office. She completed physical therapy for her wrist with Jessica. Debra’s physical therapy on her wrist produced great results, but as she became more physically active her shoulder once again began to hurt.

X-rays revealed her rotator cuff was not just torn, but was completely separated from the bone. While some rotator cuff cases can be handled conservatively without surgery, for Debra, the only option was rotator cuff surgery.

“Dr. Gruber, who is always open and honest, let me know the recovery and physical therapy could take up to a year.” Debra remarked.

During Debbie’s scheduled arthroscopic surgery to repair her rotator cuff, Dr. Gruber discovered that the screw he originally planned to use to attach the tendon back to the bone would not work due to her bone not being strong enough.

“Dr. Gruber had to open up my arm so that he could attach a bigger screw,” shared Debra. “I had to be in a sling for several weeks to keep the arm immobile so that the bone could grow around the screw.”

After those initial weeks in a sling to begin the healing process, Debra was approved to start physical therapywith Jessica. “We started slowly and worked our way up to weights, and over time we’ve continued to add additional weights. Jessica always keeps a watchful eye during therapy and makes sure I am doing the exercises correctly and also provides lots of encouragement,” said Debra.

Debra added that Jessica is an incredibly skilled therapist who is gifted at knowing exactly what work needs to be done at each physical therapy session. “She also truly cares about her patients and their physical therapy outcomes.”

Debra added that her husband Ted has also been a physical therapy patient of Jessica.

“In addition to Ted’s physical therapy, he has had three PRP injections with Dr. Gruber for a meniscus tear on his knee and also had a PRP injection for a partially torn rotator cuff. “He is delighted with the results. He’s back to power walking on the treadmill, spin classes and using the elliptical at a very high level.  His partially torn rotator cuff is completely repaired.”

Debra has been through a lot with her shoulder and wrist surgeries, but she is pleased with where she is at now in her recovery. “I’m now at 95% and will continue physical therapy though June. I am back to walking again for exercise, and I can do all my daily/weekly household activities – which I could not do before – like cleaning the floors, wiping the countertops and pushing a grocery cart.” said Debra.

Both my husband and I highly recommend Dr. Gruber, Jessica and the entire team at Integrated Orthopedics.  I think they are the best orthopedicand physical therapyteam in the Valley – they have created a wonderful atmosphere and are clinically excellent.”

shoulder surgery

Myra Chait is a busy business owner, wife, mom and grandmother. She is originally from Rochester, NY and has lived in Arizona for 45 years. In her spare time, Myra enjoys gardening, reading and playing with her grandchildren.

She came to see Dr. Brian Gruber, board certified orthopedic surgeon when shoulder pain she was experiencing in both shoulders, which had gotten progressively worse over four years, began to significantly interfere with her daily activities. “It was hard to do simple things like carry a pot of coffee or reach for things, and I was losing range of motion,” said Myra.

Myra was referred to Dr. Gruber by her sister, who had also been his patient and had a great experience with him and his practice Integrated Orthopedics. After doing an initial consult with Dr. Gruber, Myra felt confident he was the right orthopedic doctor for her situation.

“Dr. Gruber is a great diagnostician,” said Myra. “He diagnosed both shoulders as ‘bone-on-bone’ where the cartilage has worn away and said I was a good candidate for a total shoulder replacement on both shoulders.”

Myra shared that Dr. Gruber did not pressure me at all, but just told her the diagnosis and provided treatment options. “He is very bright and definitely knows what he’s doing and has a lot of experience as an orthopedic surgeon,” shared Myra.

Being left-handed and with the left shoulder also in more pain than the right, Myra decided to have total shoulder replacement surgery on the left shoulder first, which Dr. Gruber performed in January 2018.

“I found the surgery to be pretty easy and simple. I only stayed one night in the hospital, was in very little pain and came home the next day,” said Myra. “I followed the doctor’s instructions and started physical therapy within a few days and recovered really well.”

Myra also completed her physical therapy at Integrated Orthopedics’ physical therapy clinic and her therapist was Jessica Tate, PT, DPT. She shared that she had a wonderful experience with Jessica. “I did everything Jessica told me to do and went to all of my therapy sessions,” Myra commented. “Jessica was impressed with how quickly and well I recovered.

Even though Myra’s surgery was less than 3 months ago, she was recently able to go on a Caribbean cruise pain-free in her left shoulder and had a wonderful time. “I had a great time and felt great,” said Myra.

Myra shared that Dr. Gruber has great people skills in addition to being a great diagnostician and surgeon. “Because he does so many surgeries, he is very skilled and experienced,” she noted.

“The team at Integrated Orthopedics is an all-around great team – from my therapist Jessica to the front desk staff who always greeted me warmly and knew my name,” said Myra. “They are all on the same page and have really coordinated the care and communication – everyone knows what everyone else is doing.”

Myra noted that the level of communication and care coordination at Integrated Orthopedics is rare and that few doctor’s offices operate that way. “I don’t know what Dr. Gruber’s formula is for the high level of communication and keeping everyone on the same page about a patient’s care is, but it works,” she said.

Myra is waiting to do her right shoulder, which will also eventually need a total shoulder replacement, but when she is ready she will definately have Dr. Gruber perform the surgery.



March is national athletic training month, a great time to explore the important role of Athletic Trainers in an orthopedic practice. Our team’s ATs work in our Physical Therapy clinic and help get our patients back up-and-running as quickly as possible. They are an integral part of our care team.

NATM, athletic training month, athletic training

Hammertoes is a very common condition. Learn all about it in this month’s featured infographic. Dr. David Larson, Fellowship Trained Foot & Ankle Surgeon at Integrated Orthopedics, specializes in all forms of foot and ankle injuries and surgeries, including hammertoe.

hammertoes, podiatrist, podiatrist phoenix, podiatrist scottsdale, foot surgeon, ankle surgeon

At the start of the New Year, many people decide to start a running program. We treat a lot of runners in our orthopedic and sports medicine practice and see a lot of the more common running injuries, with both new and long-time runners.

Running is a fantastic cardio workout, but if you’ve never run before – or are getting started again after an injury or break – it’s good to be aware of the more common running injuries.

Foot Mechanics & Running

During running, the foot is active in both the landing and push-off phase. It absorbs the shock of impact when landing and controls the forces generated by running during push-off. Most running injuries can be linked to one of these two functions.

Common Running Injuries

Here are the most common injuries runners experience and tips to prevent these injuries from occurring:

Plantar Fasciitis:
This is probably the most common running injury. It is usually due to overtraining, especially hill work and speed work; and not stretching the calf muscles. The plantar fascia – a think band of tissues that stretches from the toes to the heel – is prone to tearing when overworked. This tearing results in inflammation. The slow blood supply to the fascia hinders healing and results in a chronic condition.

To prevent plantar fasciitis, follow these tips:

  • Wear the right shows with good arch support and heel cushioning
  • Stretch the Achilles tendon regularly
  • Keep at a healthy weight
  • Increase your running gradually and alternate running with other activities
  • Try to minimize going barefoot at home which puts stress on the feet

Achilles Tendinitis:
This large strong tendon runs from the heel to the calf and propels you forward while running. Overworking the Achilles tendon results in inflammation.

A couple good ways to ward off Achilles tendinitis are:

  • Tennis ball roll: Loosen your plantar fascia by rolling a tennis ball under each foot. The muscles and tendons along the bottom of your foot exert pressure from below on the Achilles. This exercise helps keeps things loose.
  • Foam roller: You can increase the flexibility in your lower legs with a foam roller, rolling it over the front and back of the lower legs. This release tightness and tension.

Stress Fracture:
The most common runners’ stress fracture is to the tibia, or shin bone. This type of fracture occurs with issues related to the landing or push-off phase of running.

Here are a few tips to prevent shin fractures:

  • Do exercises to keep calf muscles healthy – do calf raises to strengthen them and stretches the loosen these muscles
  • Avoid muscle fatigue in the legs – when muscles fatigue, weight distribution shifts and the bone takes increased weight and impact
  • Don’t shift from soft trails to hard surfaces rapidly
  • Wear shoes with good shock absorbance

Runners Knee:
When the foot is not stable and lands in an uncontrolled way, runner’s knee can develop. It can also be caused by a biomechanical issue such as the patella being larger on the outside than it is on the inside, or a patella that easily dislocates. Worn cartilage in the knee joint also reduces shock absorption. High-arched feet can be a culprit as well as flat feet.

To prevent runner’s knee, follow these tips:

  • Run on soft surfaces
  • Do not increase mileage more than 10 percent per week
  • Gradually increase hill work
  • Go to a specialty running shoe store to get fitted for the proper shoes for your foot and gait
  • Incorporate exercises that strengthen the quadriceps muscles to improve patellar tracking
  • Stretch your hamstrings and calves to prevent over-pronation (too much inward rolling of the foot)

For many, losing weight – especially those extra holiday pounds – is a New Year’s resolution. Here’s some information to consider on obesity’s impact on knee health from a recent study.

knee health, knee pain, knee doctors, knee doctors phoenix, knee doctors scottsdale

Always warm-up before jogging or injury occurs…

Faron Kostyk – an investor originally from Alberta, Canada – came to see Brian Gruber, MD, MBA, board certified orthopedic surgeon, for knee pain that had been ongoing and progressively getting worse. He was unable to continue to participate in activities he enjoyed such as skiing and running.

“I was referred to Dr. Gruber by my regular doctor, who felt that my injury could best be addressed by an orthopedic surgeon,” stated Faron.

Upon physical exam and testing, Dr. Gruber diagnosed Faron with a torn meniscus and anterior cruciate ligament (ACL) injury. While some meniscus and ACL injuries can be treated conservatively, in Faron’s case surgery was the best option to achieve the results he was seeking.

Upon completing surgery and physical therapy, Faron hoped to have significantly better knee health and a return to the activities he enjoyed doing.

“Surgery definitely improved the quality of my life and improved my knee health,” said Faron. “My daily activities are better now, including walking and kneeling.

Faron completed physical therapy at Integrated Orthopedics’ in-house physical therapy clinic. The goal of offering onsite physical therapy to Integrated Orthopedics’ patients is to provide them with the most coordinated care possible. Team physical therapists meet regularly with Dr. Gruber and the other physicians in the practice to review a patient’s progress. This model ensures that the physicians are kept in the loop on a patient’s physical therapy progress at each step of the way.

“Our model integrating physical therapy with our orthopedic clinic and surgery ensures our patients receive not only highly coordinated care, but optimal recovery times,” said Brian Gruber, MD, MBA, board certified orthopedic surgeon and founder and lead physician of Integrated Orthopedics. “If there are challenges or issues with physical therapy, we identify and troubleshoot them immediately.”

“The physical therapy team at Integrated Orthopedics is fantastic,” said Faron. “From PT to the entire office staff, everyone is compassionate, friendly and professional.”

Faron is now back to doing many of the activities he enjoys. He is grateful for Dr. Gruber’s technical skills as a surgeon. “Dr. Gruber is a great communicator and genuinely cares about his patients. He and his team have changed my life,” he shared.

About Meniscal Tears

Meniscus tears are among the most common knee injuries. Athletes are most at risk for these injuries; however, anyone at any age can tear a meniscus. Sudden meniscus tears often happen during sports. Often squatting and twisting the knee cause the tear, or direct contact, like a tackle.

Older people are more likely to have degenerative meniscus tears rather than a sports-related tear. Cartilage weakens and wears thin over time and aged tissue is more prone to tears. Just an awkward twist when getting up from a chair may be enough to cause a tear.

About Anterior Cruciate Ligament (ACL) Tears

Another common knee injury is an anterior cruciate ligament (ACL) sprain or tear.

Athletes who participate in high demand sports like soccer, football and basketball are more likely to injure their anterior cruciate ligaments. The anterior cruciate ligament can be injured in several ways:

  • Changing direction rapidly
  • Stopping suddenly
  • Slowing down while running
  • Landing from a jump incorrectly
  • Direct contact or collision, such as a football tackle