Services

Participate in a formal, customized therapy plan with a Certified Hand Therapist (CHT). Pivot can help you return to the game, work, or whatever is most important to you. Your plan of care may include weekly therapy, a personalized home exercise program, and communication with your physician or other members of your care team.

• Comprehensive upper-extremity evaluation — assessing motion, strength, sensation, coordination, pain, and function to understand what is limiting you

• Customized treatment plans — creating a plan based on your diagnosis, goals, lifestyle, and stage of recovery

• Post-operative rehabilitation — supporting recovery following hand, wrist, elbow, or upper-extremity surgery

• Fracture and injury rehabilitation — restoring mobility, strength, coordination, and function after injury

• Tendon and nerve rehabilitation — addressing conditions such as tendon injuries, tendinitis, nerve injuries, and nerve compression

• Custom splinting and orthosis fabrication — creating individualized splints to protect, support, or improve function

• Progressive strengthening and exercise — rebuilding strength and capacity in a way that supports your specific goals

• Manual therapy and movement techniques — addressing mobility restrictions, pain, and movement impairments

• Return-to-work and activity planning — helping you safely progress toward the demands of your job, hobbies, or daily life

• Return-to-sport rehabilitation — building the strength, mobility, control, and endurance needed to get back to your sport

• Home exercise programs — providing practical exercises and strategies that fit into your life and help you continue making progress between visits

• Communication with your medical team — collaborating with your physician and other providers when updates, recommendations, or additional care are needed

Dry needling is a manual technique used to address painful or sensitive areas within muscle and surrounding soft tissue that may contribute to pain, muscle tension, or restricted movement. When appropriate, dry needling can be a useful part of the therapeutic process, often used alongside exercise, manual therapy, and other treatment strategies.

Services are perfect for baseball, softball, and disc golf athletes who are recovering from injury or looking for strategies to keep themselves in the game. Schedule an appointment to learn about sport-specific recommendations to help you play as the healthiest, strongest version of yourself.

• In-depth assessment of motion, strength, and power — identifying limitations that may affect performance, throwing, or your ability to tolerate your sport

• Sport-specific exercise programming — building strength, mobility, stability, and power around the demands of your sport

• Throwing and overhead movement assessment — looking at the shoulder, elbow, wrist, and trunk as a connected system

• Injury recovery and return-to-sport planning — developing a gradual progression back to throwing, training, and competition

• Load management strategies — helping you understand how to balance practice, competition, strength training, and recovery

• Injury prevention strategies — identifying areas to address before they become a problem and building them into your existing training routine

• Mobility and stability recommendations — targeting the areas that may be limiting your movement or contributing to unwanted stress elsewhere

• Performance-focused upper-extremity training — improving strength, control, and power while keeping the demands of your sport in mind

• Sport-specific modifications — finding ways to keep you participating while working around pain, injury, or other limitations

• Individualized home and gym programs — practical recommendations that fit into the training you are already doing

• Creative problem-solving — working together to find strategies that allow you to train, compete, and keep doing the sport you love

Receive care from a therapist with lived experience of hEDS who has been vetted by the EDS New Hampshire Support Group and is listed in the Ehlers-Danlos Society provider directory.

• Gradual return to activity and exercise — creating individualized plans that consider load tolerance, POTS, dysautonomia, and your goals

• Ergonomic assessment — recommendations for work, home, and daily activities to reduce strain and improve comfort

• Trigger point dry needling — to address muscular pain and contributing movement patterns

• Pain neuroscience education — understanding pain and how the nervous system can influence symptoms

• Custom splinting and orthosis fabrication — supporting joints and improving function when additional stability is needed

• Silver ring splint measurements — helping determine appropriate support for hypermobile fingers and thumbs

• Kinesiotaping — providing additional sensory input, support, or symptom relief during activity

• Adaptive equipment recommendations — identifying tools and modifications that make daily activities easier

• Sport-specific considerations — adapting exercise, training, and movement strategies around the demands of your sport

• Creative problem-solving — finding practical strategies that help you participate in the activities that matter to you

Are you a musician with aches, muscle pain, or nerve symptoms that impact your practice sessions or performances? Pivot can help you understand what may be contributing to your symptoms and develop practical strategies to keep you playing. Body work, postural endurance training, and instrument-specific strengthening are just a few ways we can help you feel better and play your best.

• Instrument-specific assessment — evaluating posture, movement, strength, endurance, and technique as they relate to the demands of your instrument

• Postural endurance training — building the strength and endurance needed to maintain comfortable playing positions for longer periods

• Instrument-specific strengthening — developing targeted strength and control for the muscles and movements your instrument demands

• Practice and performance strategies — modifying practice habits, positioning, and workload to help manage symptoms and improve tolerance

• Ergonomic assessment and recommendations — optimizing your instrument setup, workspace, and positioning for greater comfort

• Injury prevention strategies — identifying contributing factors and building sustainable movement and recovery strategies into your routine

• Pain and nerve symptom management — addressing symptoms that may interfere with playing, including muscle pain, tendon irritation, or nerve-related symptoms

• Manual therapy and body work — addressing areas of muscle tension, mobility restriction, or discomfort that may affect playing

• Gradual return to playing — creating a step-by-step plan to return to practice and performance after an injury or period away from your instrument

• Creative problem-solving — finding practical ways to keep making music while working around pain, injury, or physical limitations

Are you experiencing jaw pain, tension, clicking, or other symptoms that make it harder to talk, eat, sleep, or go about your day? Pivot provides individualized treatment to help you understand your symptoms and find strategies to make daily life more comfortable.

• Jaw and upper-extremity assessment — evaluating jaw movement, posture, muscle tension, and contributing factors

• Education and self-management strategies — helping you understand your symptoms and what you can do between appointments

• Manual therapy — addressing muscle tension, mobility restrictions, and areas of discomfort that may contribute to jaw symptoms

• Trigger point dry needling — an option for addressing muscular tension and pain when clinically appropriate

• Functional adaptations — finding practical ways to modify eating, talking, sleeping, and other daily activities while symptoms are present

• Postural and movement strategies — addressing the relationship between the jaw, neck, shoulders, and upper extremities

• Exercise and home programs — individualized strategies to support mobility, strength, and symptom management

• Coordination with your care team — communicating with your dentist, physician, or other providers when additional evaluation or care is appropriate

• Creative problem-solving — finding realistic strategies to help you keep doing the things that matter to you while managing jaw symptoms

At Pivot, we fabricate custom thermoplastic orthoses for a variety of hand and upper-extremity conditions, including fractures, thumb arthritis, carpal tunnel syndrome, tendon injuries, and more. A custom orthosis can provide a more individualized fit than a pre-fabricated splint and can be adjusted as your needs change throughout the healing process.

• Custom-fit fabrication — creating an orthosis specifically for your anatomy, condition, and functional needs

• Protection during healing — supporting injured or healing structures while allowing you to safely participate in appropriate daily activities

• Pain and symptom management — positioning painful or irritated structures in a way that can help reduce stress during daily activities

• Post-operative support — fabricating orthoses when prescribed or recommended as part of your rehabilitation

• Adjustable and remoldable — modifying your orthosis as swelling decreases, your range of motion changes, or your needs evolve

• Functional design — balancing protection and support with your ability to work, exercise, play sports, or complete daily activities

• Education and fitting — teaching you how to properly use, care for, and monitor your orthosis

• Ongoing modifications — making adjustments as needed to improve comfort, fit, and function

Graston Technique is a form of instrument-assisted soft tissue mobilization that uses specialized stainless-steel instruments to assess and treat areas of muscle and soft tissue that may be contributing to pain, tension, or restricted movement. The instruments provide tactile feedback that can help your therapist identify areas of tissue restriction and guide treatment.

• Targeted soft tissue treatment — addressing areas of muscle and soft tissue that may be contributing to pain or restricted movement

• Assessment through touch and instrument feedback — using the instruments to help identify areas of tension or altered tissue mobility

• Improved movement — incorporating soft tissue techniques to help restore comfortable movement when restrictions are present

• Pain management — using instrument-assisted techniques as one component of an individualized approach to managing musculoskeletal pain

• Support for tendon and muscle conditions — incorporating treatment when appropriate for conditions involving irritated or overloaded muscles and tendons

• Combined with active rehabilitation — pairing soft tissue work with strengthening, mobility, and movement exercises to address both symptoms and function

• Individualized treatment — adjusting the technique based on your symptoms, tissue response, and overall goals

Not sure if occupational therapy is right for you? A free screen with an occupational therapist is a great place to start. We’ll learn more about what you’re experiencing, your goals, and how your symptoms are affecting your daily life. From there, we can help determine whether you may benefit from therapy, whether a referral to your physician or another provider would be appropriate, or whether you should seek more immediate medical attention.

It’s also an opportunity to learn more about the unique services Pivot provides and decide whether we’re a good fit for your needs.

Contact us to schedule your free screen.