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Trying to understand my flexiblity score & 1st trip to PT

Posted by Beverly on 7/17/00 at 20:16 (023466)

I had my first PT session. I was very pleased with how caring and detail oriented my physical therapist was. She is the first person who has measured my foot for my degree of flexibility. She is using that score to help interpret where we should begin... along with my pain level.

She said that normal is 10 to 15 degrees. (She used a measuring thingie to arrive at this... Sorry, you all know I'm not technical.) My right foot has a flexiblity score of 5, but my left foot was a negative score. It was -15. So, we are starting with gentle (nonweight bearing stretches). I know that is a poor score. I don't know enough about flexibility scoring to really understand it. I'm assuming the goal is to increase my flexibility along with reducing the pain.

She massaged my feet and did ultrasound. My left foot is so tender even the ultrasound was tender. My right foot held up amazingly well. (Remember, the right foot is the foot I hurt first. The left foot is a fresher injury.) We'll start the ionpheresis (spelling?) in a few days.

I'm starting out very slowing with the stretches. She is encouraging me but not pushing me. For instance, the ideal thing would be for me to do 10 towel stretches, but we've set my short term goal for five stretches. She says even if I can only hold it for 1 or 2 stretches, that is better than no stretches.

I'm sore, but the orthopedic sports med. surgeon said for me to expect that. My right foot doesn't feel too bad, but my left foot is quite tender.

Beverly

PS: Nancy, how is your PT going?


Re: Trying to understand my flexiblity score & 1st trip to PT

Nancy S. on 7/17/00 at 22:08 (023481)

Hi Beverly, it sounds as though you found a good physical therapist too! Great.
I was sore afterward also and, like you, I'm so sore to the touch that even the ultrasound and 'light' massage hurt. (They hurt worse in my non-PF foot for some reason -- maybe my achilles tendon has taken more of a beating in that foot. It's only been overused for 14 months!)
I got mixed up: my next appt. is Wednesday, was not today. And then I go Friday this week also.
I've been doing everything she told me to do and felt pretty good on the weekend, but today I've had more stiffness and swelling again. It has me wondering if even the minimal, nonweightbearing stretching I'm doing is too much. I'll be discussing this with her on Wednesday and in the meantime will do a bit less of it. I've been doing towel pulls for stretching, holding for 10-15 seconds just at the point of beginning to feel a stretch -- I do this three times on each foot each time, three times a day. Then I walk around a bit trying to do something constructive, and then I ice (three times a day) for 10-15 minutes. What is your home regimen for starters? I forget, are you icing? What did your therapist have to say about rest, did that topic come up?
I'm hoping to start the io...pheresis phenomenon on Wednesday, since I'm still swollen and inflamed. I'm now up to 2400 mg daily of ibuprofen and it isn't having much effect.
I'm beginning to think I'll be inflamed forever! Sounds kind of romantic, doesn't it?
But I'm looking forward to Wed. when I can talk all this over with the therapist. I have quite a list of questions already.
--Nancy

Re: Trying to understand my flexiblity score & 1st trip to PT

Beverly on 7/17/00 at 22:37 (023487)

Nancy,

My at home routine is this:

1. gentle foot flexing (5x) not really holding it at this point... just flex and release

2. side foot flexing 5x ... just moving foot back and forth sideways but once again not holding it

3. ankle circles (This really hurt. It remains to be seen if I am ready for this.)

4. Towel pulls (or using a belt) 5x holding briefly - one set with knee bent... one set with knee straight

5. curl towel in toes (starting out 1x but goal is to increase.)

She said I may not be up to five times for each of these and so if I can only do a few that is fine for a start. Since my feet are still so tender, the goal at this point is just to do a short stretch.

I'm suppose to do these 2x a day, but at the moment, doing this routine 1x a day may be as much as I can handle this week.
The massage hurt some but it also felt good.
She was very careful to be gentle. Throughout it, she asked if she needed to lighten up. I have decided I like PT's better than doctors.
I'm so grateful for this script, because the PT determined that I am not ready for the wall stretch or any of the weight bearing stretches.
That was my gut instinct. Yet, both the pro-stretching docs demonstrated the calf stretch and wanted me to do them. I think that each person needs a customized stretching routine. It is not a 'one size fits all kind of thing.' Since she measured my foot for my flexibility score, that made me feel like she arrived at my program scientifically as well as subjectively.

I'm so happy for you that you have gotten into PT. Keep me posted how it goes. I'm not the speller you are; so I won't even attempt to spell that thing that starts with an 'i' but I an eager to try it for my inflammation. My stomach still hasn't recovered from that spell with Feldane. I tried taking Vioxx last week and my stomach was still too tender. I'll be glad when it is back to normal. I miss my Vioxx. I remain interested in Bromelain and will probably try that later, but at the moment while my stomach is calming down, I don't want to push my luck. I ice 2-3 x a day. I've been lazy about falling asleep with the gel wraps, but I was told that is a bad thing to do... could get frost bite. I certainly don't need to add that to my list!
Beverly


Re: Trying to understand my flexiblity score & 1st trip to PT

Nancy S. on 7/17/00 at 23:00 (023493)

Beverly, some of those exercises are strengthening ones, not stretching. I'm to start those later. I tried the ankle rolls several months ago, and found that they set me back. My PT didn't mention them on the first visit, and I was glad. She didn't give me any side-to-side stretching to do, though; I wonder if I should be doing that. Guess I'll add that to my list of questions.
She emphasized in the stretching right now to go only to the point of a stretch; I shouldn't really feel much of a stretch, just the smallest tincture. But I think even that might be too much, and that's what happened in the winter when I learned them on the board and was trying them. It's very frustrating, because I know I have to get these things loosened up somehow. Maybe someone should just knock me out with a baseball bat and yank on them all they want!
It's true, you shouldnn't ice for longer than 10-15 minutes. Besides the danger you mentioned, as I understand it, any longer than that brings blood flowing into the area to try to warm it up, thus killing the anti-inflammatory effects.
Good luck, let's keep each other posted. --Nancy

Re: Trying to understand my flexiblity score & 1st trip to PT

ChanaW on 7/18/00 at 09:48 (023513)

Nancy and Beverly,
I've been enjoying and learning a lot from your interchange. I'm especially interested in this stretching thing since I believe it's important to feel better but can easily make you feel worse. Thanks

Re: Trying to understand my flexiblity score & 1st trip to PT

Nancy S. on 7/18/00 at 10:10 (023515)

Chana, the stretching issue remains a real mystery to me. I've been trying to figure it out for many months. Sometimes it seemed to be helping, and then whammo, a setback. So then I'd stop stretching, and some new problem would crop up.
Both Beverly and I seem to be quite sensitive to stretching, so it will be interesting to see how each of our physical therapists guides us through this minefield. I'll keep posting, and I'm sure Beverly will too.
--Nancy

Re: Trying to understand my flexiblity score & 1st trip to PT

Nancy S. on 7/17/00 at 22:08 (023481)

Hi Beverly, it sounds as though you found a good physical therapist too! Great.
I was sore afterward also and, like you, I'm so sore to the touch that even the ultrasound and 'light' massage hurt. (They hurt worse in my non-PF foot for some reason -- maybe my achilles tendon has taken more of a beating in that foot. It's only been overused for 14 months!)
I got mixed up: my next appt. is Wednesday, was not today. And then I go Friday this week also.
I've been doing everything she told me to do and felt pretty good on the weekend, but today I've had more stiffness and swelling again. It has me wondering if even the minimal, nonweightbearing stretching I'm doing is too much. I'll be discussing this with her on Wednesday and in the meantime will do a bit less of it. I've been doing towel pulls for stretching, holding for 10-15 seconds just at the point of beginning to feel a stretch -- I do this three times on each foot each time, three times a day. Then I walk around a bit trying to do something constructive, and then I ice (three times a day) for 10-15 minutes. What is your home regimen for starters? I forget, are you icing? What did your therapist have to say about rest, did that topic come up?
I'm hoping to start the io...pheresis phenomenon on Wednesday, since I'm still swollen and inflamed. I'm now up to 2400 mg daily of ibuprofen and it isn't having much effect.
I'm beginning to think I'll be inflamed forever! Sounds kind of romantic, doesn't it?
But I'm looking forward to Wed. when I can talk all this over with the therapist. I have quite a list of questions already.
--Nancy

Re: Trying to understand my flexiblity score & 1st trip to PT

Beverly on 7/17/00 at 22:37 (023487)

Nancy,

My at home routine is this:

1. gentle foot flexing (5x) not really holding it at this point... just flex and release

2. side foot flexing 5x ... just moving foot back and forth sideways but once again not holding it

3. ankle circles (This really hurt. It remains to be seen if I am ready for this.)

4. Towel pulls (or using a belt) 5x holding briefly - one set with knee bent... one set with knee straight

5. curl towel in toes (starting out 1x but goal is to increase.)

She said I may not be up to five times for each of these and so if I can only do a few that is fine for a start. Since my feet are still so tender, the goal at this point is just to do a short stretch.

I'm suppose to do these 2x a day, but at the moment, doing this routine 1x a day may be as much as I can handle this week.
The massage hurt some but it also felt good.
She was very careful to be gentle. Throughout it, she asked if she needed to lighten up. I have decided I like PT's better than doctors.
I'm so grateful for this script, because the PT determined that I am not ready for the wall stretch or any of the weight bearing stretches.
That was my gut instinct. Yet, both the pro-stretching docs demonstrated the calf stretch and wanted me to do them. I think that each person needs a customized stretching routine. It is not a 'one size fits all kind of thing.' Since she measured my foot for my flexibility score, that made me feel like she arrived at my program scientifically as well as subjectively.

I'm so happy for you that you have gotten into PT. Keep me posted how it goes. I'm not the speller you are; so I won't even attempt to spell that thing that starts with an 'i' but I an eager to try it for my inflammation. My stomach still hasn't recovered from that spell with Feldane. I tried taking Vioxx last week and my stomach was still too tender. I'll be glad when it is back to normal. I miss my Vioxx. I remain interested in Bromelain and will probably try that later, but at the moment while my stomach is calming down, I don't want to push my luck. I ice 2-3 x a day. I've been lazy about falling asleep with the gel wraps, but I was told that is a bad thing to do... could get frost bite. I certainly don't need to add that to my list!
Beverly


Re: Trying to understand my flexiblity score & 1st trip to PT

Nancy S. on 7/17/00 at 23:00 (023493)

Beverly, some of those exercises are strengthening ones, not stretching. I'm to start those later. I tried the ankle rolls several months ago, and found that they set me back. My PT didn't mention them on the first visit, and I was glad. She didn't give me any side-to-side stretching to do, though; I wonder if I should be doing that. Guess I'll add that to my list of questions.
She emphasized in the stretching right now to go only to the point of a stretch; I shouldn't really feel much of a stretch, just the smallest tincture. But I think even that might be too much, and that's what happened in the winter when I learned them on the board and was trying them. It's very frustrating, because I know I have to get these things loosened up somehow. Maybe someone should just knock me out with a baseball bat and yank on them all they want!
It's true, you shouldnn't ice for longer than 10-15 minutes. Besides the danger you mentioned, as I understand it, any longer than that brings blood flowing into the area to try to warm it up, thus killing the anti-inflammatory effects.
Good luck, let's keep each other posted. --Nancy

Re: Trying to understand my flexiblity score & 1st trip to PT

ChanaW on 7/18/00 at 09:48 (023513)

Nancy and Beverly,
I've been enjoying and learning a lot from your interchange. I'm especially interested in this stretching thing since I believe it's important to feel better but can easily make you feel worse. Thanks

Re: Trying to understand my flexiblity score & 1st trip to PT

Nancy S. on 7/18/00 at 10:10 (023515)

Chana, the stretching issue remains a real mystery to me. I've been trying to figure it out for many months. Sometimes it seemed to be helping, and then whammo, a setback. So then I'd stop stretching, and some new problem would crop up.
Both Beverly and I seem to be quite sensitive to stretching, so it will be interesting to see how each of our physical therapists guides us through this minefield. I'll keep posting, and I'm sure Beverly will too.
--Nancy