What is Myofascial Decompression and Instrument Assisted Soft Tissue Mobilization?

Myofascial Decompression (MFD) is the western medicine version of cupping. It focuses on providing a lifting force on tissue that with everyday life gets compressed. Cupping is a passive set it and leave it technique. MFD involves movements of the tissue to normalize body mechanics and tissue movement. Instrument Assisted Soft Tissue Mobilization (IASTM) commonly referred to as scrapping, HawkGrips or Graston uses surgical grade stainless steel tools to break up fascial adhesions and scar tissue that build up within the tissue from stress on the body through working out. Hawkgrips is the current industry standard and are the tools that we use. Click here for more information on HawkGrips.


What is the diffrence between MFD and Cupping?

“MFD is based on assessing and correcting movement inefficiencies. Backgrounds in biomechanics, kinesiology, and functional anatomy are essential to identify and treat ROM restrictions and muscular imbalance.  Interventions include neuromuscular re-education, AAROM, and PNF, making the patient an active participant in their treatment.  Traditional cupping does not include active movement, and often is targeting energetic imbalances from a traditional Chinese medicine perspective.  MFD is a novel approach to musculoskeletal treatment, utilizing negative pressure tools and western medicine based movement paradigms and algorithms.  These applications are very effective for orthopedics, sports medicine, contractures, post-op recovery, overcoming dominance strategies, postural syndromes, hand therapy, neuro re-education, and scar mobilization.” – cuptherapy.com


Why should I see a PT?

As a Physical Therapist, I pride myself in having multiple techniques including soft tissue work, joint manipulation, kinesiology taping and using Instrument Assisted Soft Tissue Mobilization (IASTM) tools and Myofascial Decompression Cupping to treat the various issues I see. I focus on normalizing movements, through hands on techniques as well as give you the power and knowledge to continue the healing once you have completed your sessions.


What do I need for my first appointment?

Each appointment is tailored to the individual. A typical initial session will consist of the first 10-15 minutes of discussing current and past conditions and your goals. The next 30-45 minutes will be spent with hands on one-on-one treatment to normalize body mechanics and decrease pain. The remainder of the visit will be spent going through specific movements to improve and maintain those movements.

Please wear workout clothing with the ability to reach the skin of the area to be treated for all treatment sessions.


Do I need a referral to be seen at Surf and Shore PT?

You do NOT need a referral from a Physician to be seen at Surf and Shore PT.

A referral from a Physician may be needed to in order to get reimbursed if you plan to submit them to your insurance company. Please contact your insurance provider for specific details on their out of network policies and reimbursement rates. Click here for referral form.


What does Out-of-Network mean?

Surf and Shore PT is an Out-of-Network clinic due to our treatment philosophy. We believe in providing the highest standard of care which involves one-on-one treatments with a Doctor of Physical Therapy and no oversight and treatment limitations by insurance companies that are throwing darts at a board to decide number of treatment sessions you need. Number of visits are not based on Physical Therapist or Physician recommendations unless they are directly paid by the insurance companies. Many insurance Physical Therapy clinics are seeing 3 or more patients an hour per PT in order to make a profit due to the limited reimbursement and high insurance co-payments. Click here for more info.


Can I submit for reimbursement from my insurance company for my out-of-pocket expenses?

This answer depends upon the type of insurance you have but with some insurances, Yes. We are currently out-of-network with HMSA PPO, UHA, HMAA, and TriCare. Please inform us if you plan to seek reimbursement. So we can better assist and provide a form that contains specific information in order to get reimbursed. It is best to contact your insurance company prior to starting to ensure that no pre-authorizations needed before starting.


Do you only treat CrossFit Athletes and Surfers?

No. We welcome all active individuals at Surf and Shore PT! Although we pride our selves in specializing in treating CrossFit Athletes, Triathletes and Surfers, and getting them back to what they love as quick as possible. We treat anyone from Professional athletes to competitive Hula dances to weekend warriors. We also treat anything from headaches, low back pain to ankle sprains and everything in between.


How much does a visit cost?

We pride ourselves in trying to keep our prices as reasonable as possible and well below industry standard for a cash based practice.

Our fee for a one-hour treatment is $150. A thirty-minute treatment session is $80. The full session is spent with a highly qualified Doctor of Physical Therapy.

Ask about our multi-session packages that are available to reduce the per visit cost of each session.

You may be able to get a percentage of this payment reimbursed through your insurance company. Please see our “Can I submit for reimbursement from my insurance company for my out of pocket expenses?” above.

For more information on why you should choose an out of pocket payment option please look at these links. Click here for more info.


Can I use my Flex Spending Account/Health Savings Account at Surf and Shore PT?

Yes, you are able to use your FSA account at Surf and Shore PT, ask about our special FSA package rates. Please let us know if any written documentation is needed to help with FSA use.


Recovery is the name of the game

The CrossFit open is almost here. Most people will be one and done, but for some this means 2 maybe even 3 goes at the open WODs. What does this mean for you? Recovery is more important than ever. Along with the open, CrossFit competitions are becoming an almost monthly routine in the state of Hawai’i which makes recovery for competitors much more important than ever. This process can be the difference between over training and rapid strength loss and huge gains. If you follow these tips and tricks you will be on the road to recovery and the best possible set up for success. Recovery can be broken down into 2 main categories, muscle and central nervous system (CNS).


Muscle recovery is the easiest to manage, assuming proper nutrition. If the nutrition is lacking then the muscle will not have the available building blocks to recover. Another way to help is to create a better environment for the muscles to recover. As you work out muscle is broken down, with this break down there is a small, hopefully controlled inflammatory reaction. As the muscle heals itself byproducts are released into the air that change the pH balance in the muscles creating soreness. If we can flush these out it will create a better environment for healing. The ways to do this are by light flushing exercise, rolling, or use of compression like the VooDoo Band or NormaTec systems. Any time you are trying to create a system flush you should try to push everything to the heart.


Body weight exercises

These are a great way to get blood flow and push out any negative byproducts out. These movements should be slow and controlled. For all these we will go through lower body muscle recovery.


The goal with this is to improve blood flow and flush out the muscle.

VooDoo band

The VooDoo band had 2 goals one is a flush which means wrap towards the body, the other is to get an active release of the muscles,

The other half and often the biggest mistake that I see with recovery after comps is continuing the same volume the week after a competition, even though the body is sore and most likely the CNS has been heavily taxed. This typically either leads to musculoskeletal injury or over training. I recommend a de-load week for the body to recover the week after. The day following a comp should be a relative rest day depending on soreness and typical training volume, light cardio is recommended to flush the body and start to reset the CNS. I like the rower due to the low impact and full body nature of it, but hiking, biking, light running, or low intensity WODs are ok as well. The movements of the competition should also play a part in what the de-load week looks like. If the competition was heavy leg oriented, put less stress on the legs and vice versa for if it was a shoulder intensive competition.

The CNS is the most over looked are of recovery and with consistent high intensity training and competitions.



Sleep has been consistently shown to be a must for a healthy life style, impacting everything from mental clarity and energy levels to chemical responses in the body. Recovery happens while we sleep in both the musculoskeletal and nervous systems. If we are short on sleep we will not get the recovery needed to regenerate properly.



This is simple, if we do not take in the necessary building blocks to regenerate our tissues or chemical signal pathways we do not recover properly. Quality also plays a factor.


Breath Exercises

Breathing can be a great part of any routine to reset the body and mind. There are many different forms of this category. From meditation which is very calming focused to Wim Hof breathing that is varied in depth and type. There are many other types of breathing exercises just as there are many forms of exercise. Find one that works for you and stay consistent.


Decrease Stress

Sleeping, eating, and performing some breath exercises are an easy way to decrease stress. Prolonged stress has many different negative effects on the body. Increased cortisol levels is one, some of the many symptoms of this are increased fatigue, weight gain with associated increased fatty tissue deposits, muscle weakness and cognitive difficulties. Taking some small steps to decrease stress can lead a long way to help with overall health and body recovery.

My Hamstrings Are Always Tight

“My hamstrings are always tight.” This is a constant for most of us whether you are deadlifting, running or doing almost any other activity we tend to overuse our hamstrings then sit for hours. This tightens them up with minimal to no stretching. We used to be forced to stretch before gym class and before any sport practice. What happened and why didn’t we keep up with that stretching? Work, life, family, stretching is dull, whatever the reason we all need to get back into stretching to get our hamstrings back to supple, flexible muscles.

There is no better time to get back into it than right now. Really you should do a quick hamstring stretch right now… Then read on and we will get into tips and tricks to keep up with a program that will keep you interested and show changes fast. The focus of this is stretching but getting into the muscle and rolling it out is always a good idea as well. As with anything you do you need a test/retest to make sure you are getting the changes that you want, as well as to find out what exercise is the most effective way for you to get those changes. Here is an easy “straight back toe touch” that is a great way to get a start. Make sure the back is flat and reach as far forward as you can while maintaining the flat back. Then make a note of where your fingertips got to.

Test/retest- back flat stretch

Now that we have a baseline we can get into the fun stuff. Stretches can be varied in type and style. Static holds are the classic style. Personally these are not my favorite purely due to getting bored with a 2-min hold. I prefer a more ballistic style with 10-15 second holds with the total time around 2 min of stretching. I stay interested since it keeps me. You can also vary the type of stretch. Having multiple types of stretches that you can do is a huge help especially when the environment changes. For me it is easy to stretch while lying on the floor. If you are out getting ready for a run and the ground is wet, you might want to go with a standing stretch. Here are some of my favorite variations of hamstring stretches.

Hamstring stretches

High Hamstring stretch

If stretching is a tough routine, rolling out may be more your style. This is a great way to break up muscle adhesions and get blood flow into the muscle which can create some length in the muscles. Here are 2 of my favorite examples.

Hamstring smash

With these exercises, it is always a great idea to follow them up with a functional activity to help keep the changes that you just created. Hopefully the exercise will be similar to the activity that you will be doing. If you are going to deadlift, perform some ballistic stretching then get out a band and do some RDL’s. Inch worms are a great way to get a dynamic hamstring warm up as well as a stretch.

Inch worms

Band RDL’s

Remember that you should do the test/retest to make sure that you are getting the changes that you want. With any stretching/mobility program consistency is the most important factor. Stretching should be done daily with a minimum of 5x per week. Remember to try and keep it interesting and fun this will help you stick to your stretching. Getting friends, family and gym buddies involved is another great way to stay

Anterior Shoulder Pain Fix

You’ve been on FIRE, hitting the gym regularly getting stronger, healthier and improving your skills. Then out of nowhere you start having shoulder pain. Thinking it will get better, you keep training. Then you start getting weaker, losing skills because your shoulder gets in a cycle of hurting then getting better, then hurting again.

This is a common occurrence with training, we can fatigue our small muscles, especially the small muscles of the rotator cuff that stabilize our shoulder. These muscles work to keep it in the best possible position for high level functioning. When they fatigue, or have a small injury, they shut down. This is our body’s natural protective mechanism but unfortunately, we can override and push through it if we want. By doing this, we start to over use other muscles, and put stress on other tendon and ligament structures that are not meant to take on these types of forces. The most common structure at the anterior shoulder that is over used and cause pain is the biceps long head tendon. It runs over the front of the shoulder and can be used as a shoulder stabilizer. It crosses the shoulder gleno-humeral joint.  Often rolling out the tendon or the area in the front of the shoulder will cause an increased inflammatory response, prolonging pain and decreased functioning.


Mobility and stability exercises are important for full recovery of anterior shoulder pain. Mobilization normalizes movement, stability and re activate the rotator cuff muscles to take pressure off the biceps tendon. These are some of my favorite exercises to help.




Biceps stretch

The long head of the biceps muscle crosses the shoulder joint and can be used as a stabilizer muscles when the small rotator cuff muscles begin to deactivate with over use, pain or injury to the surrounding tissue. Stretching the muscle out will help take the passive tension off of the muscle, allowing the tendon to heal.

This exercise is typically performed by my athletes for 5-10 seconds, for 10 reps, 1-2 times a day, 4-5 days a week.

Watch an example of biceps stretch here:


STM to posterior cuff

The muscles at the back of the shoulder are important shoulder stabilizers and often deactivate with pain from the shoulder. These are 2 of your 4 rotator cuff muscles. The exercise is designed to decrease tension in the muscle allowing the muscle to become more active and increase blood flow to the area.

This exercise is typically performed by my athletes for 1-2 minutes, 1-2 times a day 4-5 days a week.

Watch an example of smashing posterior cuff here:


Row and rotation

This exercise is focused on following up on what we did with the first exercise after loosening up the posterior cuff. We then need to remind the muscles how to work. It is used for the transition of moving the arm overhead.

This exercise is typically performed by my athletes for 8-12 reps, 2-3 sets, 1 time a day 4-5 days a week. Form is more important than weight.

Watch an example of standing row with external rotation here:


STM to pecs

The pecs can be a huge limiting factor in the ability to move. Most of us live in a world of poor posture working on a computer, sitting at a desk or watching TV. These and similar daily positions cause the pecs to tighten and limit motion especially with activities that require good posture and shoulder retraction.

This exercise is typically performed by my athletes for 1-2 minutes, 1-2 times a day, 4-5 days a week.

Watch an example of smashing pecs here:


Sub Scap release

This muscle is located on the front side of the shoulder blade. It is the largest rotator cuff muscle and an important shoulder stabilizer. It is used when the arm pulls or stabilizes overhead. This exercise is designed to decrease tension in the muscle, allowing the muscle to become more active and increase blood flow to the area.

Watch an example of how to release the sub scapularis here:

This exercise is typically uncomfortable and can be performed for 20-60 sec and 1-2 times a day, 4-5 days a week.

Thanks for reading.


Dr. Scott Layne PT, DPT, CSCS, CF-L1