Vestibular therapy addresses challenges with dizziness, vertigo and balance related to inner ear disorders and neurological conditions. The vestibular system is responsible for sensing head motion and position, and communicating to the rest of the body. As a result, this allows you to react appropriately to your environment. Problems with the vestibular system can make it difficult to perform daily activities and may increase your risk for falls.
Common symptoms associated with possible vestibular dysfunction include:
Dizziness or lightheadedness
Vertigo (sense of spinning)
Difficulty with balance or walking
Jumpy or blurry vision
Frequent falls
Neck pain and/or stiffness
Headaches
Nausea
Hearing loss
Brain fog or difficulty concentrating
Vestibular conditions can be diagnosed through assessment of inner ear activity, brain signals, eye movement and hearing. It is commonly treated with medication, physical therapy or sometimes surgery.
Physical therapy can address vestibular dysfunction through assessment of musculoskeletal range of motion and strength, eye movements, balance, gait and mobility, and positional testing. Depending on the results of the evaluation, your physical therapist will prescribe appropriate treatment which may include the following:
Range of motion exercises
Strengthening
Posture exercises
Balance retraining
Coordination exercises
Retraining of the inner ear
Repositioning maneuvers (used to address BPPV)
Common diagnoses we work with at Summit Strength Physical Therapy include:
If you experience any symptoms listed above, you could benefit from vestibular therapy. Please call Summit Strength Physical Therapy at 816-524-7040 to speak with a physical therapist today. A referral or prescription is not required to make an appointment.
A new Missouri law allows patients to see a physical therapist without first obtaining a referral or prescription from a medical provider. Prior to this law, if a patient were to have a mild injury, they would need to see a medical provider first. At that time the provider may refer them to specialist or write an order for physical therapy. This process was time consuming and costly to the patient.
Under the new law, patients can seek care directly with a physical therapist without a referral from your medical provider. Direct access allows patients to be evaluated faster which decreases healthcare costs, improves functional outcomes and satisfaction scores, and can help decrease reliance on other pain management methods such as use of opioids.
Scott Knoche, PT, Dip. MDT, CSCS, attends the signing of Senate Bill 51 at the Governor’s office.
Frequently Asked Questions:
What are your PT’s qualifications?
The physical therapists at Summit Strength PT have a doctorate degree or have 30 years-experience in the field. Many of our clinicians have also completed additional certifications to continue to further their education.
How do I know if this is right for me?
You will meet with a physical therapist and be asked specific questions ensure you are appropriate for physical therapy. The initial assessment will help determine any potential “red flags”, meaning any serious disease processes or more serious injury that could be causing your pain or dysfunction and require referral to your doctor’s office.
When should I see my medical provider first?
If you suspect a broken bone or have suffered a trauma such as a fall, seek imaging at an emergency room, urgent care office or physician’s office. We do not have imaging equipment and you may be referred out prior to being treated for your safety.
Is this covered under insurance?
It depends on your policy. Medicare and Medicare Advantage plans require a signed plan of care from a MD, DO, physician assistant or nurse practitioner within 30 days of the first visit. Some insurance companies may still require pre-authorization. Please call our office with your insurance information if you have any questions regarding insurance coverage.
Do I have to go through my insurance?
No. You may choose our cash pay option and will need to sign our self-pay good faith agreement. You will be required to pay at time of service.
How long I can get physical therapy without a referral?
Patients can be seen for 10 visits or 30 days (whichever occurs first). If no progress is made during that time, your physical therapist will consult with your healthcare provider regarding further treatment.
Alright folks, at this point I’m not the first person to tell you that you should be walking daily. For years our doctors, spouses, P.E. teachers, and anyone in between have been telling us that daily exercise is good for us. But why? Is it worth the effort? Summit Strength Physical Therapy strongly believes that it is definitely worth the effort! Here are some daily walking benefits:
Give Joints Some Love!
Most joint cartilage has very poor blood supply. Walking creates compression which squeeze your joints like a sponge – on and off. This promotes the flow of nutrients and oxygen1. Maybe those screaming joints you haven’t used just want a little movement.
2. Sharpen Your Mind!
We all could benefit from staying sharp! The University of Virginia Health System found that walking as little as a quarter mile can help decrease the presence of dementia and Alzheimer’s in men ages 71-932. It has also been found that walking 15 minutes a day can improve creativity and problem solving3.
3. Boost Your Mood!
Have you been feeling a little grumpy? Walking promotes the release of endorphins which can help improve your mood, fight depression and reduce stress3. Exercise might not make everything sunshine and rainbows, but we could all use an endorphin boost.
4. Weak Bones? GetMoving!
Do you have osteoporosis? Are you post-menopausal? Women who are post-menopausal are at an increased risk for osteoporosis. One study found that 30 minutes of walking a day for post-menopausal women can decrease their risk for hip fracture by 40%3.
5. How Many Steps Should You Take Per Day?
According to the book “A World of Hurt”, a healthy older adult should be taking between 6,000 – 8,000 steps a day. Individuals with disease or disability should be taking 3,500 – 5,5004. Go grab those pedometers or step counting watches.
6. Live Long, Walk Hard or Vice Versa!
It has been found that walking as little as two hours a week can help decrease your chances of dying from cardiovascular or respiratory disease and can even lower your chance of death by cancer.3 Moving your body is one key to longevity in life!
These are just a few of the many reasons why a daily walk is so beneficial for your life. Don’t think that walking is for you? Then look for another form of moderate exercise that you enjoy. If you have any questions, don’t be afraid to reach out to Summit Strength Physical Therapy. We’d be happy to give you tips on living a more active and physically sustainable life!
Written by Stephanie Owen, a previous Summit Strength patient.
On October 7, 2018, I woke up like I normally would to get ready for a game day. I had played the beautiful game of soccer since I was six years old and had aspirations to possibly play in college and then go on to play professionally. What would end up happening instead was not what I would have wanted before the situation occurred, but looking back now, it all happened for a reason. This particular day changed my life by giving me the ability to realize that progress will not be a straight path. It also taught me about what a family is and made me realize that sometimes things happen to prepare you for the road ahead.
Though I am not able to remember that day well, other people who saw the accident were able to fill in the gaps for me. According to the Centers for Disease Control, “Sports and recreational activities contribute to about 21 percent of all traumatic brain injuries among American children and adolescents” (Traumatic Brain Injuries). I became a part of that statistic that day in October when I was playing my primary position of goalkeeper. A striker came in at full speed and her knee connected directly with my head. The CDC also states that I am included in the “17% of traumatic brain injuries that occur from striking from or against an object, such as sports injuries” (Traumatic Brain Injuries). After getting hit, my parents took me to the emergency room where they took a CT scan, which luckily revealed no internal bleeding in my brain. However, the next few months would be a bumpy road for me in many ways.
For the first month especially, I slept many hours each day. Once in physical therapy, my physical therapist explained something called neuro-fatigue, also referred to as pathological fatigue. The Brain Injury Association in the United Kingdom defines this type of fatigue by stating “Normal fatigue is time-limited and alleviated by rest, whereas pathological fatigue, such as that experienced following a brain injury, may be present most of the time” (Fatigue after Brain). It may not improve with rest and is likely to significantly impact people and their ability to do the activities they want to do. People who have personal experience with nero-fatigue are usually able to explain it well. David Grant, a five-year TBI survivor, says “Neuro-fatigue is unlike traditional weariness…With neuro-fatigue…the tired seeps to the level of my soul — it is all-encompassing and all-consuming, sapping every bit of energy I have” (Life After Brain). Because of the neuro-fatigue, I had no real energy to spend on things that made me happy like being outdoors, playing sports, or going on long drives. There were so many days where I just wanted to stay in bed and never get up. I wondered if it would ever end. One of the many physical therapists that worked with me throughout my recovery told me something that I still remember today, especially whenever I am having a day where I am dealing with my chronic pain and fatigue. She said the words “I know that sometimes it’s hard to get up, but just getting up is a way of telling your fatigue that you won’t give up. It’s a way to have a victory over your current struggle.” For me, that meant that some days, just the act of getting up was progress. Progress will not always be a walk that goes forward. You may have to take a few steps back, and you may have to just take time to smell the roses before you continue on your journey.
During the recovery process, I was in physical therapy from approximately October to April at Summit Strength Physical Therapy for both the issues from my TBI as well as the spinal cord injury that I acquired from that injury as well. The Christopher and Dana Reeve Foundation has a mission to advance research regarding spinal cord injuries. The Foundation reports that since both the spinal cord and brain are included in the Central Nervous System, an injury to the spinal cord can cause issues with the brain and vice versa. This was the case for me and with this particular injury, it allowed me the chance to spend extended amounts of time working with a multitude of amazing people. Scott Knoche, who I spent most of my time with, became like a second father to me. What I didn’t fully realize until later was how lucky I was to have a support system like the one they provided me. They helped me with both the mental, emotional, and physical aspects of my injury and taught me many life lessons along the way. On the more difficult days, Scott and the rest of the group I worked with would sense my struggle without me even saying anything and went out of their way to check on me and do what they could to provide relief. I wasn’t just another patient of theirs, at least all of the staff at Summit Strength didn’t make it feel that way. I had a special connection with just about everyone there, and I still do to this day. Looking back now, I can firmly say that family isn’t just about who you share blood with. It is instead, the people that love and care for you, and would help you at a moment’s notice.
Spending so much time around physical therapists also made it clear that physical therapy was not the field I wanted to go into. Knowing that I wanted to go into the medical field was a very small part of figuring out what I wanted to do, but with a large number of jobs in this particular field, the narrowing down process is extensive. I had started shadowing under the head Athletic Trainer at my high school during the beginning of my sophomore year right before my injury occurred. Later, in a class conducted by the head Athletic Trainer during my junior year, I finally started to understand who was a part of the sports medicine team and what roles they played. It is well known, at least within the medical community, that athletic trainers and physical therapists overlap in their roles. Being able to see how physical therapists did their job while I was in physical therapy allowed me to see how they were different. I enjoyed the “first response” and thinking on your toes piece about athletic training, whereas physical therapy was slower and more clinic-based. Plus, schooling for physical therapy takes a lot longer. Without my prior injuries, including my concussion, I most likely would have had no interest in either one. Ultimately, since I couldn’t play soccer anymore, being on the sidelines and helping the athletes who played the sport that brought them joy was the alternative.
Even with the injury being more than two years ago, the situation has had a lasting impact on my life and the way I live it. Though my traumatic brain injury was not something that should have been a positive experience, it taught me a lot about life, even lessons that I did not include in this evaluation. It gave me a circumstance where I was able to learn about progress and family. It also provided me with a path towards a career that I wouldn’t have otherwise chosen.
Works Cited American Association of Neurological Surgeons. “Traumatic Brain Injury.” Aans.org, www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Traumatic-Brain-Injury Accessed 11 Apr. 2021. Christopher & Dana Reeve Foundation. “Brain Injury.” Christopherreeve.org, www.christopherreeve.org/living-with-paralysis/health/causes-of-paralysis/brain-injury. Accessed 11 Apr. 2021. Grant, David A. “Life after Brain Injury – A Five Year Lookback.” Brainline.org, 5 Apr. 2021, www.brainline.org/blog/getting-back-bike/life-after-brain-injury-five-year-lookback. Accessed 11 Apr. 2021. Headway. “Fatigue after Brain Injury.” Headway.org.uk,
Blood Flow Restriction (BFR) was a concept I became familiar with years ago while listening to people in the heavy weight-lifting and body building communities. I learned they would tie rubber tubing around the upper portion of their arm or leg while lifting. This created a more aggressive anaerobic (state of decreased oxygen) conditioning opportunity for them to gain more muscle. However, this technique was done with no regard for the amount of compression around the nerves and blood vessels which brought about safety challenges.
Evolution of Blood Flow Restriction Therapy
Historically, this concept was used for recreational weight lifting. It was further developed by a Japanese tech company called KAATSU. Six years ago, Johnny Owens, Physical Therapist, began discussions about research done by the Department of Defense. Research showed consistent results of specific chemical changes that occurred during the anaerobic stages of conditioning and fitness. They mimicked these conditions with the use of tourniquets through the lower extremity to create similar chemical changes in the blood stream. As the results were repeatedly proven, the DOD increased funding for the research to create a safe protocol that appreciated the safety of soft tissues and the nervous system.
BFRT at the Center for the Intrepid
Owens led the development of a specialized doppler to treat severely injured soldiers. Owens was in charge of the rehabilitation of all limb salvage patients at the Center for the Intrepid in San Antonio, Texas. Even though their injuries were severe, their motivation was high to regain as much function and strength as possible. With BFR, they were able to successfully reduce the number of amputations required through significant maintenance and restoration of muscle mass. Throughout this experience, Owens led the development of this protocol which eventually moved into a commercial product known as Blood Flow Restriction Therapy (BFRT) through the Owens Recovery Science Center.
Summit Strength Implements BFRT
In 2015, Johnny Owens personally trained our clinical staff. Summit Strength was one of the first clinics in the region to proceed with full comprehensive training and certification by Owens himself. With proper measuring of pressure and cuff sizes, a substantial amount of muscle “burn” generates through the active muscle tissue that moves into an anaerobic state within just one to two minutes. While learning these protocols and safe strategies for implementation, all of our clinical staff became fully certified in BFRT.
BFRT in the Headlines
Recently, it has been fun to witness the exposure Alex Smith’s recovery from a major leg injury has given BFRT. Smith spent time rehabilitating at the Center for the Intrepid working directly with Owens. Smith used BFRT technology to build up lost muscle tissue allowing him to make one of the greatest comebacks in professional sports history. Stories like these provide further justification of the efforts that Summit Strength has made to safely and properly incorporate BFRT into our clinic practice.
How BFRT Helps Our Patients
We are confident using this technology on common post-op conditions such as a total knee replacement or upper extremity surgeries. We also use it frequently in the general musculoskeletal groups with various aches and pains. In addition, neurologically compromised individuals can see substantial maintenance of strength and function while using BFRT. We see this correlation to improvements in gait function, stair navigation function, and most importantly, minimizing falls and injuries. This particular modality provides the most aggressive technique to build tissue capacity with minimal loading of the actual structures, such as joints or muscles. It allows the therapist a way to facilitate strengthening and hypertrophy of muscle without overloading tissues with too much weight.
In March of 2020 as Covid-19 cases were on the rise, many services and programs that kept our aging population active came to an abrupt stop. To reduce the risk of spreading the virus, the elderly were advised to isolate. Gyms, malls, and senior centers closed. We limited our visits to grocery stores and ceased family gatherings to decrease risk of exposure. Nearly a year later, our elderly continue to isolate to reduce the risk of catching the virus. As a result, this has led to a sedentary lifestyle for many of our elderly population, which can negatively impact their physical and mental health.
What happens when we stop moving?
Decreased muscle mass, strength and physical endurance
Reduced coordination and balance
Reduced joint flexibility and mobility
Lower cardiovascular and respiratory function
Reduced bone strength
Increase body fat levels
Higher blood pressure
Rise in susceptibility to mood disorders, such as anxiety and depression
Risk of various diseases including cardiovascular disease and stroke
Increased risk of falls
See our previous post about lack of mobility increasing fall risk during quarantine (click here)
Our quality of life including mobility and independence can suffer drastically when we reduce our physical activity.
What can I do to stay active?
There are alternatives to staying physically active if your normal routine prior to Covid-19 included going to the gym or walking the mall. Videos for all abilities can be found on different cable networks, internet and social media, apps and YouTube. Most gyms are now offering those workout classes via zoom or other online platforms to remain active while socially distanced and isolated. For instance, try scheduling family and friend exercise time via group chat formats. Simply putting down the remote and walking laps around the house or neighborhood is beneficial. If the task of creating your own exercise program seems too daunting try the activities listed here .
Staying active during isolation to reduce risk of Covid-19 in elderly population.
Keep moving!
Above all, don’t fall victim to the negative impacts that Covid-19 isolation can have on your health. Protecting yourself doesn’t mean you have to stop your active lifestyle. Doing so will put you at risk for cardiovascular disease, compromised immune response, depression, memory issues, loss of mobility and falls. Find alternatives with at-home exercise. Reach out to your Summit Strength physical therapist or fitness facility to find out what services they are offering that can help you stay active.
Mechanical Diagnosis and Therapy is a classification system that helps guide a clinician through a series of questions and testing in order to better understand the behavior of their patient’s condition, pain, etc. Once the mechanical nature of symptoms is better understood, the clinician then classifies the problem. This simplifies the treatment approach to focus on the true root cause of the issue.
A clinician must undergo approximately 120+ hours of additional post-graduate training followed by a certification exam in order to be able to fully understand and implement the system properly. We will discuss who can become MDT certified in a future post.
Using MDT builds consistency from one clinician to another so that there can be a common “language” spoken as well as predictable progressions based on initial classification. The goal of the system is to increase a patient’s ability to treat themselves for long-term success rather than short-term, passive symptom relief. No matter the condition or problem, MDT’s foundation is in patient education rather than a specific technique needing to be performed “on them” in order to get better. This increases self-efficacy and ultimately reduces reliance on someone else for musculoskeletal management.
During clinical rotations at the University of Kansas Medical Center, I observed many different styles and settings of physical therapy (PT). I quickly discovered that not all PT is the same, much like not all primary care, athletic training, orthopedic care, etc. is the same. Variation is a good thing. I was challenged by trying to understand many different schools of thought at the same time.
Physical therapy is recommended or prescribed for a large range of conditions, pains, injuries, and more. It can be quite overwhelming and challenging as a physical therapist begins their career. How can I possibly know how to treat or be an expert on treating such a wide variety of conditions?? I knew quickly that I needed additional training to provide me with an actual system to approach patient care.
My introduction to MDT
Once introduced to MDT, I applied the system with my own patients. Being able to witness someone’s pain rapidly reverse and remain better was a game changer for me. Not everyone will be able to have such a quick result, but seeing that it was possible allowed me to feel like I was better prepared to help my patients. I believed this approach utilizes the body’s natural ability to repair itself and process pain. Additionally, I found that the MDT philosophy of teaching patients how to control their own symptoms for long-term management and prevention was the best version of clinical care.
Finally, I appreciate that MDT focuses less on specific anatomical deviations that may be found via imaging and more on learning how symptoms behave in relation to position and movement. Humans are not created nor built equal and symmetrical. Pain is very complex. At times, imaging is crucial to help diagnose serious pathology and injury to the body such as when a bone is fractured. However, modern imaging is less successful at telling us why we hurt and what to do about it. We see this most often when patients have aches and pains without any mechanism of injury. The MDT system has a “built-in” screen for serious problems. This allows me to rule in or out mechanical issues without reliance on imaging. MDT allows me to work WITH a patient instead of ON a patient.
Summit Strength is a Certified McKenzie Clinic, one of the few in the KC area. Check out this blog post to learn more.
As a new physical therapist who graduated from the University of Missouri in 1987, I was allowed the opportunity to work side-by-side with physical therapist trained in mechanical therapy (MDT). My experience started in an outpatient clinical setting in St. Louis. I was introduced to my mentor. He practiced with a focus on performing guided active treatment, in which the patients fully participate. The mechanical therapy approach aims to provoke change in signs and symptoms with various body positions and repeated movements. The process required substantial questioning and dialogue with the patient resulting in hours of communication back and forth over multiple visits.
Change in Approach
This signified a major shift in practice away from passive modalities and inactive treatments that had been the “norm” for many years. Historically, passive modalities including heat, ice, diathermy, electrical stimulation, and ultrasound were performed frequently with patients two to three times per week. This approach would provide short-term pain relief at best and this was a common practice in physical therapy. We hypothesized that patient’s body positioning likely contributed to some of their relief at this time.
Better Outcomes
Over the years, therapists were motivated to update their skill set to provide better long-term outcomes. Educating patients where strength deficits existed, physical therapists were able to form relationships with patients. It was great to see patients experience long-lasting change and progress in their function. Patients saw an increase the amount of time able to perform a favorite activity or being able to perform physical activities with more vigor. The mechanical therapy approach to patient care has been very rewarding to practice over my 34 year career. This gradual but steady change in physical therapy has become the standard. Therapists now look more carefully during evaluations with assessment of changing function. The mechanical therapy method has been shown to be most successful to me.
Summit Strength is a Certified McKenzie Clinic, one of the few in the KC area. Check out this blog post to learn more.
With the change in current world events, the immobility rate has been increasing over the recent months as people have been quarantining in their homes. This is causing people to lose strength and balance and is ultimately increasing fall risk. We are providing you with fall risk and prevention education to help you combat this difficult time.
Fall Statistics
Each year, more than 1 in 4 older adults aged 65 and older will fall
Approximately 300,000 elder Americans (>65 years old) are hospitalized annually due a hip fracture, >95% of those caused by falls
Half of these will have another fall in the subsequent year if no prevention measures are taken
Falls are the leading cause of fatal and non-fatal injuries
Hip is the most common location of fracture from a fall due to the specific anatomical location of the hip and surrounding structures
Missouri’s rate of injury by falling is 31% higher than the national average
Who is at risk for falls?
Older than 65 years old
Previous history of falls
Hearing or visual impairments
Other comorbidities such as diabetes, neuropathy or Parkinson’s Disease
Limitations with mobility
Recent/sudden decrease in activity
Falls are NOT a normal part of aging. You are at higher risk if you fall into any of these categories above.
Fall Prevention
The good newsis…
FALLS CAN BE PREVENTED
Balance and strength training routines determined by a Physical Therapist
Monitoring specific comorbidities, by yourself and with your Primary Care Doctor, such as blood sugar and blood pressure levels are likewise crucial to decrease risk of any metabolic changes leading to a fall.
Appropriate vitamin and mineral levels
It is also important to talk with your Primary Care Doctor to consider proper vitamin and mineral intake. Vitamin D and Calcium intake are noted to increase bone density and overall bone health.
Safe and clutter free living environments
Properly lit rooms and walkways
Decreased clutter in walking paths
Secured non-skid rugs
Install grab rails as necessary
Wear shoes or non-skid socks
Physical Therapy & Fall Risk Reduction
It is proven that specific balance training and controlled exercise can help decrease your fall risk and in turn help keep you staying upright and active. Through Physical Therapy services, in person or virtual, specific balance and strengthening plans can be generated for each patient to keep them off of the floor and fracture-free.
Also, it is important that these are individualized to your specific needs and deficits, as well as ensuring your safety and proper technique to maximize your benefits and reduce your risk of falls. There are numerous and seemingly endless balance related exercises than can be prescribed in therapy. However, based on your presentation, clinicians can deem some exercises more appropriate/safe than others.
Examples of therapy exercises for balance (as deemed safe):
Single leg balance with eyes open (static balance activity as pictured to the left)
Double leg balance with eyes closed
Side stepping over small hurdles
Walking heel-to-toe
As most of you who read this may agree, you have gotten out of your normal “workout” or daily movement routines as you have been quarantining in your home due to COVID-19. Immobility can be detrimental to your balance and increases your risk of falls. Now more than ever, it is crucial to be sticking to a routine as to create normalcy in our lives but ultimately keeping us out of urgent cares, ERs and hospitals.
How can we help?
Summit Strength Physical Therapy offers 1-on-1 therapy and virtual visits, over the length of 45 min-1 hour sessions. Our facility is 20,000 square feet that allows us to social distance. We have a variety of equipment for all levels of balance and strength training to help you reach your goals and minimize your risk of falling.
Staying active and healthy during the pandemic is important. The CDC is urging people to stay active as means to help cope with stress and maintain overall health. If you are concerned for your safety and mobility reach out to your physical therapist to help prevent falls and get you back on track.
Summit Strength PT is now home to one of the only REPEX tables in the KC Metro Area. The REPEX is a therapy treatment table created specifically for the management of mechanical disorders of the lumbar spine. Often those suffering from easily irritable low back pain and/or radiating symptoms can experience pain with even the smallest of active movements of the spine or surrounding joints/tissues. This is due to increased sensitivity of both the local and central nervous system to “protect” against perceived threat. In most cases, this does not equate to structural or tissue damage. However, this sensitivity can make it difficult for a patient to initiate and tolerate movement-based approaches to treating back pain. Insert REPEX. Once directional preference is appropriately established, the REPEX can allow the patient to achieve numerous reps of a desired movement in a relaxed and non-threatening way to the patient’s nervous system. Directional preference is defined as “the clinical phenomenon where a specific direction of repeated movement and/or sustained position results in clinically relevant improvement in either symptoms and/or mechanics.” (MDT definition via the Mckenzie Institute)
Treating with the REPEX™ is based on the patient’s directional movement preference (established via sound and thorough mechanical assessment) and provides measurable and positive outcomes particularly in the management of acute/chronic low back and leg pain patients. The REPEX™ takes the patient through repetitive and adjustable passive-range-of-motion movements of flexion and/or extension.
**Approved by Robin Mckenzie for applying the Mckenzie Method**
800 NW Main St, Lee’s Summit, MO 64086
info@summitstrength.com
816-524-7040