Everyone in PT claims to do orthopedic rehab. The difference shows up in the evaluation room — in whether the clinician can actually identify the tissue at fault, interpret orthopedic special tests correctly, and build a treatment plan that matches the specific diagnosis. Generic protocols applied to back pain, knee pain, and shoulder pain regardless of what's actually wrong are not orthopedic rehabilitation. They're supervised exercise with a PT label. At Solas PT, the exam comes first — and the treatment follows the diagnosis.
"Andrew did a thorough assessment of my injury and explained my issues in a way I could understand. He recommended dry needling, talked me through the treatment, and I felt the work immediately. Within a couple of days I was back to full function with my training. Highly recommend if you are looking for one-on-one time with a physical therapist!"
"My daughter has been a patient of Dr. Cisneros for two separate injuries, and we've had an amazing experience both times. He is professional, encouraging, knowledgeable, and kind. He creates a fun and positive environment that makes recovery enjoyable and motivating. I highly recommend him — especially athletes working to get back into sports."
"Dr. Cisneros is so knowledgeable and helpful! If I could give 10 stars I would!"
Almost everyone in physical therapy claims orthopedic expertise. The difference between a skilled orthopedic PT and an average one isn't visible in the credential — it shows up in what happens during the evaluation. Can this clinician examine a joint across multiple planes of movement and tell you what's wrong? Can they perform and correctly interpret an orthopedic special test? Do they understand the biomechanical implications of a specific diagnosis well enough to prescribe the right exercises — and avoid the wrong ones?
These questions matter because the treatment plan follows directly from the diagnosis. The same chief complaint — knee pain, shoulder pain, back pain — can represent dozens of different conditions, each with distinct tissue involvement, different contraindications, and different exercise prescriptions. A clinician who doesn't know the difference treats them all the same way. That's where the cookie-cutter protocol problem begins.
At Solas PT, the evaluation is never rushed. Dr. Cisneros assesses how the body moves as a whole before focusing on the specific joint — because the source of dysfunction is often proximal to or remote from where the patient feels pain.
The treatment plan at Solas PT is built from the examination findings — not from a preset protocol for "back pain" or "shoulder pain." The specific tissue at fault, the direction of restriction, the stability of the passive structures, and the movement patterns contributing to the problem all determine what treatment is appropriate. Without that information, you're guessing.
Patients who present with knee pain and receive rotational loading exercises when they have a meniscal tear are having their injury aggravated by their PT. Patients with ACL injuries given open-chain leg extension are stressing a compromised ligament with maximum shear force. The stakes of a missed or incorrect diagnosis are not abstract — they delay recovery, increase cost, and can worsen the underlying condition.
A Grade 3 complete ACL rupture can feel subtle to an inexperienced examiner. To Dr. Cisneros, it is unambiguous. Identifying it on the first visit means the patient gets an appropriate referral to an orthopedic surgeon immediately — not after months of ineffective PT. Knowing when to refer is as important as knowing how to treat.
Dr. Cisneros doesn't start treatment on the first visit without knowing what he's treating. The evaluation is systematic, comprehensive, and — in most cases — definitive enough to build a specific treatment plan before you leave the room.
Before any movement testing, understanding how the pain behaves — what aggravates it, what relieves it, how it came on, whether it's constant or intermittent, whether it wakes you at night — tells an experienced clinician a great deal about what tissue is involved. Red flags that warrant immediate referral are screened here. Mechanism of injury narrows the differential before a hand is laid on the patient.
Orthopedic assessment doesn't start at the painful joint — it starts with how the body moves as a whole. Dr. Cisneros assesses movement through multiple planes of motion and functional patterns: how you squat, hinge, rotate, reach overhead, and load a single leg. The source of a knee problem is frequently a hip mobility deficit. The source of a shoulder problem is frequently thoracic restriction. Looking only at the painful area misses the picture.
Active and passive range of motion at the joint of interest, manual muscle testing to identify strength deficits and inhibition patterns, and precise palpation to localize the tissue at fault — tendon, muscle belly, joint line, ligament, bursae. This step narrows the differential considerably and determines the baseline from which progress will be measured.
Special tests are the clinical tools that identify specific structures. Provocation tests reproduce symptoms by stressing a specific tissue — confirming its involvement. Stability tests assess the integrity of passive stabilizers like ligaments and capsule. Laxity tests measure end-feel and joint play to determine whether structural compromise is present. Dr. Cisneros performs and interprets these tests with the experience to distinguish subtle findings — a positive Lachman that reads as equivocal to an inexperienced examiner is unambiguous in hands that have felt hundreds of them.
The examination findings produce a working clinical diagnosis. From that diagnosis, Dr. Cisneros builds a specific treatment plan: which tissues to address, which to protect, which exercises are indicated versus contraindicated, whether manual therapy or dry needling is appropriate, and whether an orthopedic referral for imaging or surgical evaluation is warranted. You leave the first session knowing what's wrong and what the plan is — not just that you have "knee pain" and here are some exercises.
Two patients present with knee pain. One has a meniscal tear. One has an ACL rupture. The treatment plan for each is not just different — the wrong exercises for one condition would actively damage the other. This is what diagnosis-specific treatment means in practice.
Generic knee pain protocols that ignore the specific diagnosis are not just ineffective — they can worsen the injury and cost the patient months of unnecessary recovery time.
The meniscus is compressed and sheared by rotational forces within the knee. Treatment must specifically avoid loading patterns that reproduce these forces while building the strength that supports the joint.
Rotational loading through the knee
Deep squats with valgus collapse
Pivot and cutting movements early in rehab
Terminal knee extension and VMO activation
Hip abductor and glute strengthening to offload
Controlled step-downs and straight-plane loading
Manual therapy for joint stiffness and effusion management
The ACL is the primary restraint to anterior tibial translation. Open-chain knee extension (leg press machine, leg extension) places maximum anterior shear force across a compromised joint — exactly where it should not be loaded. Closed kinetic chain activity distributes force through the entire lower extremity.
Open-chain leg extension exercises
High-speed cutting and pivoting before clearance
Return to sport based on calendar date alone
Closed kinetic chain: squats, step-ups, leg press
Hip and glute strengthening — reduce knee valgus load
Single-leg neuromuscular training and proprioception
Criteria-based return-to-sport testing before clearance
This is why the evaluation is non-negotiable. Without a specific diagnosis, the therapist is guessing which exercises are safe. In orthopedic rehabilitation, the wrong guess has real consequences — not just lack of progress, but potential injury to already compromised tissue. Getting the diagnosis right on session one changes the entire trajectory of recovery.
If it involves a muscle, joint, tendon, ligament, or bone — and it's limiting what you can do — orthopedic PT at Solas PT begins with figuring out exactly what's wrong.
Disc herniation vs. facet-mediated vs. SI joint vs. myofascial — these require different treatment approaches. Dr. Cisneros identifies the pain generator through clinical exam, then applies manual therapy, dry needling, and directional exercise specific to the diagnosis. Cross-link: Lower Back Pain →
Cervicogenic headaches, cervical radiculopathy, facet-mediated neck stiffness, and upper trap tension — each with different examination findings and different treatment priorities. Joint mobilization, manipulation, and soft tissue work are the primary tools.
Rotator cuff tears and impingement, shoulder labrum injuries, AC joint sprains, bicep tendinopathy, and adhesive capsulitis — each presenting differently on examination and requiring distinct treatment approaches. Cross-link: Rotator Cuff Rehab →
ACL and PCL injuries, meniscal tears, patellofemoral pain syndrome, IT band syndrome, patellar tendinopathy, and knee OA. The examination differentiates these conditions and determines which loading parameters are appropriate versus contraindicated. Cross-link: Knee Pain Guide →
Hip labrum injuries, hip flexor strains, trochanteric bursitis, IT band/TFL dysfunction, and hip OA with referred pain patterns. Hip pathology frequently presents as knee or low back pain — an orthopedic exam that includes the hip is essential for accurate diagnosis.
Ankle sprains (graded I–III), plantar fasciitis, Achilles tendinopathy, lateral epicondylalgia (tennis elbow), medial epicondylalgia (golfer's elbow), and wrist/carpal presentations. Graded correctly, treated specifically — not with the same protocol for every tendon.
Once the diagnosis is established, orthopedic rehabilitation at Solas PT draws on the full treatment toolkit — not a single modality. The specific combination depends entirely on what the examination reveals.
Joint mobilization, soft tissue work, and spinal manipulation where indicated. Restoring the arthrokinematic motion and tissue quality that allow exercise to be effective — not just pushing through stiffness with reps.
Trigger points frequently co-exist with structural pathology — and they maintain pain and guarding long after the underlying injury has begun to heal. Dry needling addresses these directly and accelerates the response to manual therapy and exercise.
Not a generic exercise sheet — a progression designed around the specific tissue at fault, the biomechanical deficits found on examination, and the functional demands of the patient's life and sport. The wrong exercise for the right structure is still the wrong exercise. Inadequate or incorrect exercise prescription is one of the most common failures in cookie-cutter insurance PT.
Patients who've spent months in insurance PT receiving the same exercises each visit — regardless of how they responded — often see more progress in their first two sessions at Solas PT than in their previous two months. The difference isn't the equipment or the facility. It's the quality of the evaluation, the specificity of the diagnosis, and the precision of the treatment that follows. That's what orthopedic rehabilitation is supposed to be.
Orthopedic physical therapy is the evaluation and treatment of musculoskeletal conditions — injuries and disorders of the muscles, bones, joints, ligaments, and tendons. It begins with a thorough clinical examination that identifies the specific tissue at fault, assesses movement through multiple planes, and uses orthopedic special tests to determine the nature of the injury. The treatment plan is then built entirely around that diagnosis — not a generic protocol applied to everyone with the same chief complaint.
Orthopedic special tests are clinical assessment tools designed to provoke or reproduce specific symptoms, assess joint stability, or identify tissue laxity. The Lachman test and anterior drawer for ACL integrity, McMurray and Thessaly for meniscal pathology, Hawkins-Kennedy and Neer for shoulder impingement, and dozens of others — each is designed to isolate a specific structure and reveal how it's functioning. Interpreting these tests correctly requires clinical training and hands-on experience. A grade 3 ACL rupture can feel subtle to an inexperienced examiner — to Dr. Cisneros it is unambiguous. Missing it means missing the appropriate referral, which costs the patient time, money, and potentially their joint.
Because the wrong diagnosis produces the wrong treatment — and the wrong treatment can actively worsen the injury. A patient with a meniscal tear given rotational loading exercises is having their injury aggravated by their own PT. A patient with an ACL rupture given open-chain leg extension exercises is placing maximum shear stress on an already compromised ligament. The diagnosis determines which tissues to protect, which exercises to prioritize, which manual techniques to apply, and when to refer to a surgeon. Getting the diagnosis right at the first session changes the entire trajectory of recovery.
Lower back pain (disc, facet, SI joint, myofascial), neck pain and cervicogenic headaches, shoulder pain (rotator cuff, labrum, impingement, AC joint), knee pain (ACL, meniscus, patellofemoral, ITB), hip pain (labrum, hip flexor, trochanteric bursitis), ankle sprains and instability, elbow and wrist injuries (lateral epicondylalgia, carpal tunnel presentation), and general musculoskeletal pain without a clear imaging diagnosis. If you have a musculoskeletal problem, the first step is a proper clinical examination.
No — and in many cases, imaging before a clinical examination is premature. A skilled orthopedic PT can identify the tissue at fault through clinical examination alone and determine whether imaging is actually necessary. Many patients arrive with imaging reports showing findings that have nothing to do with their current symptoms — or the imaging misses what a clinical exam would reveal immediately. Dr. Cisneros performs a thorough assessment first, then determines whether imaging or specialist referral is indicated based on examination findings.
No. Texas is a direct access state. You can book directly with Dr. Cisneros without a physician's referral and begin orthopedic evaluation and treatment the same week. If your examination reveals a condition requiring specialist referral — an orthopedic surgeon for surgical evaluation, for example — Dr. Cisneros will make that referral. Most orthopedic conditions can be evaluated and treated immediately without waiting on a physician's order.
Two reasons. First, insurance-based clinics often don't dedicate adequate evaluation time — a 15-minute initial assessment shared between multiple patients doesn't allow for the thorough examination that orthopedic diagnosis requires. Second, generic protocols get applied regardless of the specific finding: "knee pain" gets the knee pain protocol, regardless of whether the problem is the meniscus, ACL, patellofemoral joint, or IT band. At Solas PT, the evaluation is comprehensive, the time is dedicated entirely to your case, and the treatment plan is built specifically around what the examination reveals.
If you've been through PT that didn't work, there's a good chance you never received a real orthopedic examination. Book an evaluation at Solas PT in west El Paso — same-week appointments, no referral needed, no cookie-cutter protocol.
Lower Back Pain Guide → | Knee Pain Guide → | Rotator Cuff Rehab →