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My physical therapist is extremely wonderful

Posted by Nancy S. on 7/14/00 at 10:43 (023319)

Hi all, had my first physical therapy appt. today and I am very happy and impressed.
She says every year she is seeing more and more patients with PF and achilles tendonitis -- these problems are making up the majority of her patient load (she estimates 90% of her foot-problem patients are women).
She rarely sees a PF patient who doesn't have tight achilles tendons. She usually works on both areas for this reason. If they come to her soon enough, the tightness hasn't developed into tendonitis. Then there are people like me . . .
She spent an hour with me, evaluating my conditions, doing ultrasound, doing light massage, stretching lightly, and icing with the hugest gel packs I've ever seen. She taught me the gentle stretching I should start out with at home, said to ice three times a day or more with my feet elevated when they are sore and swollen; when they just feel stiff or tight, moist heat (bath is best). The gentle stretching should also be done three times a day, starting in the morning after moist heat.
She was adamant that I must return to swimming or take up biking, at least 20 minutes at a time. I'm shuffling around not getting any cardiovascular thing going, and so the blood flow is not reaching my injured areas. She emphasized that this is crucial for healing.
She said rest is very important because my tendons are very inflamed and swollen -- but NOT to spend a whole day at total rest. Always get up and walk around and try to do at least some activities of daily living, and then rest again if my feet get aggravated. (I've been tending to do too much one day and then rest for two days or something like that.) She said rest and movement should be alternated a few or several times each day.
I have quite a bit of atrophy, so after I've stretched gently and gotten more flexible, we will work on strengthening exercises. Also she is planning to do that 'io . . .' thing because of the inflammation. (It all actually acted up more after treatment today -- she could even see my feet had swelled up a lot more, and the ultrasound and light massage were quite painful at times. But it was the 'good' pain people have posted.)
She also watched me walk and said I am not helping myself by doing this sort of protective flatfoot shuffle. I need to work on walking heel to toe again -- I was happy to find when I tried it in her office that my heels took it just fine. The push-off with toes is harder because of the AT, so I'm to work at that part gradually.
She emphasized gradual with everything since I've had this for so long (14 months) and have had no consistent treatment. (She asked about my ex-pod's 'treatment,' and she agreed with me on the quality of it -- none.)
But she believes I can get better! Even at this stage. I feel so optimistic I don't know what to do with myself!
She's a really nice person and seems to know her stuff (I asked her questions for the entire hour, through everything, and she gave me full, thought-out answers -- a new experience for me.)
She believes that checking the feet and how people walk should be a part of every regular checkup, and that corrections and treatments for walking problems should be done early in life and patients should be educated on how to take care of their feet and what shoes are good for them. (She wears Clarks at work and Birkenstocks at home, and never anything else.)
Ok, I think that's it. I see her again on Monday. It was great, folks, and I feel far more guided by her than by any doctor I've seen since this all began. She also gave me her card and told me to call her if I think of ANY question at all between appointments.
I hope you're all having a good day.
--happy Nancy



Re: My physical therapist is extremely wonderful

Bob G. on 7/14/00 at 11:12 (023321)

Good News, Nancy! Yyyyeeeeesssssss! Have a great day, and don't click your heels yet! :) BG

Re: My physical therapist is extremely wonderful

Theresa R on 7/14/00 at 11:26 (023322)

Just wanted to say thanks for sharing all of the details. I just got diagnosed w/ PF and saw my podiatrist once so far. I did not get near that level of detail (analysis or answers). In her defense, maybe I didn't do enough questioning.

Can I ask you, though - where do you Ice? On the bottom of foot (covering Plantar which is inflamed?) on the bottom of the heal (I have a heel spur) or on the back of the ankle (achilles)? I wind up putting it on achilles because that's what seems to ache after activity.


Re: My physical therapist is extremely wonderful

Nancy S. on 7/14/00 at 12:25 (023325)

Hi Theresa: Welcome to the club, and I hope for your sake that you don't need to be a member for too long!
I now ice all over. I do this by tying ice wraps/packs around both achilles tendons and ankles. Then I roll the bottoms of my feet back and forth over a plastic Coke bottle that is mostly (not completely) full of frozen water. I roll the heels and arches -- most everywhere except the toes. Since you have achilles pain, if I were you I would do something similar, but don't forget to do the bottoms of your feet too, because if you have PF you have inflammation there also. (Some people use bags of frozen peas or corn for icing -- I imagine that would work just as well, I just like to get in a little bit of massage by rolling on the bottle.)
Honestly, I don't think your not asking enough questions is a defense for a foot doctor who does not educate her patient. How do we know what questions to even ask when we come down with this thing for the first time? I didn't have a clue either. When I started to get a clue, he couldn't muster the energy to answer me in more than half a sentence. Most everything I learned up until now was from the good people on this board, not from the doctor.
Best of luck to you!
--Nancy

Re: My physical therapist is extremely wonderful

Beverly on 7/14/00 at 12:46 (023326)

Nancy,

I'm so glad to hear what a good experience you had with your first PT session! I start mine on Monday.

As I was reading your post something crossed my mind. If it had not be for your achilles tendonitis, you probably would not have met the doctor at the clinic who gave you the referral to physical therapy. So, perhaps something good came out of the bout with tendonitis.

One thing I have discovered is that doctors are more generous in their PT scripts than one would think, but if you want some of the 'extra's' like pool therapy, you have to ask for it. I got some extra 'goodies' just because I asked for them. The orthopedic surgeon added them to my PT script like it was no big deal.
Good luck with PT. I'll keep you posted on mine.

Keep us posted,
Beverly


Re: My physical therapist is extremely wonderful

JudyS on 7/14/00 at 12:52 (023328)

Nancy, you're post here reminds me of several others over these last few months - the most recent from Beverly. It seems that what these posts have in common are a strong sense of positiveness and hope - finally, for each poster. You know, we move from Doc to Doc to therapist and, over time, it just all begins to seem so hopeless.....until, that is, you see someone like you saw today. Someone who is willing to communicate, educate and, above all, say yes, this CAN be improved! Someone who produces definitive guidelines for self-treatment. So hurray for you! I feel better already!

Re: My physical therapist is extremely wonderful

sam on 7/14/00 at 12:58 (023331)

i'm glad to hear about your positive visit. I felt the same way my first day at PT. The person I went to was very knowledgeable, a runner, and formerly had PF. It was good to see somebody who understood what I was going through. She was very intensive with the massage and I think that helped loosen up a lot of the knots and relieve some of the pain.

Good luck with your treatment.


Re: My physical therapist is extremely wonderful

Nancy S. on 7/14/00 at 13:24 (023334)

Thanks, guys. Beverly, that's an excellent point, and it's true -- if it hadn't been for the AT, I don't think I'd have found my way to physical therapy. So today, for the first time, I'm actually glad I got AT. Life can be strange.
The dr. I saw at the clinic didn't even write a script -- just said to go for PT. So it's up to the therapist what to do with me, and I have every confidence in her so far. But I will ask if something occurs to me. I'd rather go back to my own 'pool therapy' at the pool where I had a membership in the winter. I swim therapeutically, not intensely athletically.
I do hope you have a good experience on Monday -- I'll be thinking of you and watching for your post.
--Nancy

Re: My physical therapist is extremely wonderful

Steve P on 7/14/00 at 13:46 (023336)

Nancy --- I am so happy for you! A good physical therapist is key to recovering from so many injuries, and it sounds as though you have a great one. Teriffic!
I try to go swimming almost every day & I find it to be mentally as well as physically therapeutic. It gives me a sense of wellbeing that lasts the rest of the day. So I'm glad you're considering swimming too.
Did you discuss a Night Splint with your therapist?

Re: My physical therapist is extremely wonderful - Swim !

Rock on 7/14/00 at 14:41 (023341)

Guys,

Get serious about swimming !

Swim long and hard, kick but never push off the walls with your feet.

I swim about 4 days a week and EVERY time, my feet and legs feel better for the rest of the day. I suspect that may be because of the increased blood flow during 40-80 minute sessions.

Rock.


Re: My physical therapist is extremely wonderful

Nancy S. on 7/15/00 at 08:11 (023363)

Steve, it's great that you swim nearly every day. I was going three times a week during the winter, and I think it helped just about everything, like you say. I wish I hadn't stopped. But I'm signing up again on Monday.
I forgot to ask the therapist about the night splint! I will next time (which turns out to be Wednesday, when I checked my calendar, not Monday. Monday it's one of the cats going to the vet -- these things all start to run in together after a while you know.) --Nancy

Re: My physical therapist is extremely wonderful

Bob G. on 7/14/00 at 11:12 (023321)

Good News, Nancy! Yyyyeeeeesssssss! Have a great day, and don't click your heels yet! :) BG

Re: My physical therapist is extremely wonderful

Theresa R on 7/14/00 at 11:26 (023322)

Just wanted to say thanks for sharing all of the details. I just got diagnosed w/ PF and saw my podiatrist once so far. I did not get near that level of detail (analysis or answers). In her defense, maybe I didn't do enough questioning.

Can I ask you, though - where do you Ice? On the bottom of foot (covering Plantar which is inflamed?) on the bottom of the heal (I have a heel spur) or on the back of the ankle (achilles)? I wind up putting it on achilles because that's what seems to ache after activity.


Re: My physical therapist is extremely wonderful

Nancy S. on 7/14/00 at 12:25 (023325)

Hi Theresa: Welcome to the club, and I hope for your sake that you don't need to be a member for too long!
I now ice all over. I do this by tying ice wraps/packs around both achilles tendons and ankles. Then I roll the bottoms of my feet back and forth over a plastic Coke bottle that is mostly (not completely) full of frozen water. I roll the heels and arches -- most everywhere except the toes. Since you have achilles pain, if I were you I would do something similar, but don't forget to do the bottoms of your feet too, because if you have PF you have inflammation there also. (Some people use bags of frozen peas or corn for icing -- I imagine that would work just as well, I just like to get in a little bit of massage by rolling on the bottle.)
Honestly, I don't think your not asking enough questions is a defense for a foot doctor who does not educate her patient. How do we know what questions to even ask when we come down with this thing for the first time? I didn't have a clue either. When I started to get a clue, he couldn't muster the energy to answer me in more than half a sentence. Most everything I learned up until now was from the good people on this board, not from the doctor.
Best of luck to you!
--Nancy

Re: My physical therapist is extremely wonderful

Beverly on 7/14/00 at 12:46 (023326)

Nancy,

I'm so glad to hear what a good experience you had with your first PT session! I start mine on Monday.

As I was reading your post something crossed my mind. If it had not be for your achilles tendonitis, you probably would not have met the doctor at the clinic who gave you the referral to physical therapy. So, perhaps something good came out of the bout with tendonitis.

One thing I have discovered is that doctors are more generous in their PT scripts than one would think, but if you want some of the 'extra's' like pool therapy, you have to ask for it. I got some extra 'goodies' just because I asked for them. The orthopedic surgeon added them to my PT script like it was no big deal.
Good luck with PT. I'll keep you posted on mine.

Keep us posted,
Beverly


Re: My physical therapist is extremely wonderful

JudyS on 7/14/00 at 12:52 (023328)

Nancy, you're post here reminds me of several others over these last few months - the most recent from Beverly. It seems that what these posts have in common are a strong sense of positiveness and hope - finally, for each poster. You know, we move from Doc to Doc to therapist and, over time, it just all begins to seem so hopeless.....until, that is, you see someone like you saw today. Someone who is willing to communicate, educate and, above all, say yes, this CAN be improved! Someone who produces definitive guidelines for self-treatment. So hurray for you! I feel better already!

Re: My physical therapist is extremely wonderful

sam on 7/14/00 at 12:58 (023331)

i'm glad to hear about your positive visit. I felt the same way my first day at PT. The person I went to was very knowledgeable, a runner, and formerly had PF. It was good to see somebody who understood what I was going through. She was very intensive with the massage and I think that helped loosen up a lot of the knots and relieve some of the pain.

Good luck with your treatment.


Re: My physical therapist is extremely wonderful

Nancy S. on 7/14/00 at 13:24 (023334)

Thanks, guys. Beverly, that's an excellent point, and it's true -- if it hadn't been for the AT, I don't think I'd have found my way to physical therapy. So today, for the first time, I'm actually glad I got AT. Life can be strange.
The dr. I saw at the clinic didn't even write a script -- just said to go for PT. So it's up to the therapist what to do with me, and I have every confidence in her so far. But I will ask if something occurs to me. I'd rather go back to my own 'pool therapy' at the pool where I had a membership in the winter. I swim therapeutically, not intensely athletically.
I do hope you have a good experience on Monday -- I'll be thinking of you and watching for your post.
--Nancy

Re: My physical therapist is extremely wonderful

Steve P on 7/14/00 at 13:46 (023336)

Nancy --- I am so happy for you! A good physical therapist is key to recovering from so many injuries, and it sounds as though you have a great one. Teriffic!
I try to go swimming almost every day & I find it to be mentally as well as physically therapeutic. It gives me a sense of wellbeing that lasts the rest of the day. So I'm glad you're considering swimming too.
Did you discuss a Night Splint with your therapist?

Re: My physical therapist is extremely wonderful - Swim !

Rock on 7/14/00 at 14:41 (023341)

Guys,

Get serious about swimming !

Swim long and hard, kick but never push off the walls with your feet.

I swim about 4 days a week and EVERY time, my feet and legs feel better for the rest of the day. I suspect that may be because of the increased blood flow during 40-80 minute sessions.

Rock.


Re: My physical therapist is extremely wonderful

Nancy S. on 7/15/00 at 08:11 (023363)

Steve, it's great that you swim nearly every day. I was going three times a week during the winter, and I think it helped just about everything, like you say. I wish I hadn't stopped. But I'm signing up again on Monday.
I forgot to ask the therapist about the night splint! I will next time (which turns out to be Wednesday, when I checked my calendar, not Monday. Monday it's one of the cats going to the vet -- these things all start to run in together after a while you know.) --Nancy