Physical therapist Amy D. Sanchez practices from the 4060 Fourth Avenue Medical Arts Building, the Hillcrest tower whose upper floors concentrate one of the densest clusters of orthopedic surgery and spine practices in central San Diego. Post-surgical orthopedic rehabilitation referred down-building from San Diego Orthopaedic Associates Medical Group, Inc. on the seventh floor makes up a sizable share of the caseload here. Treatment sessions are built around hands-on manual therapy, progressive loading, and neuromuscular re-education rather than open-gym group circuits. Spinal rehabilitation cases here focus on muscle re-education and lumbar stabilization work, leaving the high-velocity joint manipulation side of recovery to chiropractic operators such as Acru Health: Precision Chiropractic on Fifth Avenue. Total knee and total hip arthroplasty rehabilitation '' twelve- to sixteen-week progressive protocols starting within days of surgery '' represents the most demanding work on the caseload.