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Would you keep or dump this physical therapist?

Posted by Beverly on 5/02/01 at 14:46 (046430)

Hi guys!

If you've been following my 'saga,' you know I had a very bad relaspe about a month ago after almost two glorious months of feeling like I was on the road to recovery.

I have a new physical therapist. He was reccommended by my new sports med. doc. I've had two sessions.

The good thing about this PT is that he is very hands on and his clinic is small... not crowded... alot of individual attention. We're targeting my ankle (PTT/AT) as problem number one because that is what the relapse wrought. The PF is secondary. I'm told they deal with lower extremeties more than most places.

But here is the downside. We are having a battle of the wills over stretching. I was a dedicated 2x a day stretcher before this ankle relaspe, but at the moment any stretching just plain hurts my achilles T. and causes lingering pain.

At first he wanted me to the stationary bike at my apartment and water walk in the waist high pool. I told me no way on that... too soon... needed something easier.

So, we compremised with a few simple range of motion things like flexing the foot up and down (ankle pumps) and similar things. I tried them in warm water as instructed but it still hurt. I reported this at yesterday's session. He told me to make smaller movements... find my pain-free zone. This sounded ok. BUT THEN HE ADDED THREE MORE EXERCISES! Picking up marbles with my toes, rotating my ankle on a wobbly board (seated), and rolling a tennis ball under my feet. ( I used to love the tennis ball but since tearing hamstring in October it has been more irrating at the hamstring than helpful to the foot.)

The wobbly board was new and painful. Last time I was in PT, my old PT had me work up to the marbles slowly.

Also, I told him that when I began PT last year, I started by doing three stretches of any given stretch to the point of hold and gradually increased it a little each week. This new PT didn't think that was enough even as a place to start. Once again, I compremised and did five each. He wanted me to do 10 each. I think I'm going to have an ongoing struggle with him over how much to stretch.

Finally, in his massage, and I have alot of experience with massage, when he went too deep and I said, back off, he didn't back off much.

All the PT's in this place are men as are most of the patients.

So, would you dump this guy and transfer your script elsewhere or try to break him in?
Thanks,
Beverly

Re: Would you keep or dump this physical therapist?

JudyS on 5/02/01 at 18:55 (046438)

TexBev - I feel bad for you that you're experiencing this 'communication' gap between you and your PT. It's always hard to choose the next step - but you've always done a good job with it. How about one more shot at talking with him (PT's are supposed to work WITH you), a couple more visits, then decide? While I can appreciate his theory about pushing a bit, he needs to understand that his patient has limits.

Re: Would you keep or dump this physical therapist?

Nancy N on 5/02/01 at 21:05 (046446)

Bev--

This is a really good question. My PT experience in the fall of 99 was my first, and I hadn't discovered this board yet, so I went along with everything my PT told me to do. While I was in a lot of pain, I didn't have the tendonitis problems that you do, and hadn't got to where I felt like I needed to crawl to get around or anything. It wasn't until a few months ago, when I posted about my PT regimen, that I realized I'd been pushed too hard--no wonder it didn't help! I had adopted a 'no pain, no gain' attitude in terms of what they expected of me--that they knew more than I did, and therefore I should go with what they told me, even if it hurt. If I'd known then what most PF PT is like, it would have been a different story, because I was doing things that were incredibly painful (stair stepping with hand weights, etc), and instead of feeling better when I left, I usually felt worse than I did when I went in--and that continued into the next morning.

So.... I'm not sure what to tell you, except to trust your instincts. I know you've been through PT before, but I'm not sure how you feel now compared to how you felt then. If you feel better now than you have when you've gone for PT before, then you might want to stick it out a little longer and see what happens--unless you're feeling worse as a result of the PT. But if not.... maybe call your doctor and see what they can tell you? I think they should have a much better idea of what they're expecting you to do in PT than any of us would, so that might be the way to go.

I don't know if this is helpful at all, but it's my two cents, based on my own over-zealous PT experience. Good luck, and let us know how it goes!

Re: Would you keep or dump this physical therapist?

CatherineL on 5/03/01 at 08:29 (046467)

I've been to phisio for a few things through the years. I've had 4 different phisiotherapist.

All of them felt that if there was discomfort, that was okay but if there was any pain during stretches of exercises - that was not okay and to find a way to do them to not cause pain.

As far as the massage, I have had massage on my calves and feet and although it did hurt tremendously, she explained that she was working on knots and although there was pain, it was the only was to get the knots out and it would be less painfull with each visit - she was right. The knots went away, the massage helped.

Hope this helps

CL

Re: Would you keep or dump this physical therapist?

Sherrie M. on 5/03/01 at 08:40 (046468)

Hi Beverly, When you stretch your achilles tendonitis hurts worse doesn't it? I know mine does. I think I will stop stretching for a few days, I will ask my pt tomorrow about taking it easy for a few days than start gently stretching after my hot soaks. I just had my 3rd ESWT treatment with Dr.Z on Monday and I am sore from that also-I'm really miserable right now but it is like this for a few days or around a week after treatment ( atleast I know what to expect ) prior to this 3rd treatment I was experiencing some really good days and I am hoping for those again real soon.If I were you I would give this guy a chance, tell him it's just to much all at once, make sure he understands that these exercises or causing you discomfort. I will let you know what my pt says about stopping the stretching and taking it easy for a few days.After reading some old posts from March I discovered that you are in Texas- I still wish you could be seen by Dr.Z. See ya, Sherrie

Re: Would you keep or dump this physical therapist?

Beverly on 5/03/01 at 11:06 (046484)

Thanks Judy, Katherine, Nancy, and Sherrie,

It is always good to have someone farther away from the situation than myself give their two cents worth.

Yes, I will give the guy another couple of sessions. When I began stretching back in July 2000 for the PF, it was uncomfortable but I don't remember it causing lingering pain. Back then, it was uncomfortable at the arch.
And after the PTT developed last Fall, I remember the same thing. Over time, it stopped bothering me and I was able to stretch better.
The difference now is that I have lingering pain that goes into the next day. My right ankle is worse than it was when I began.

I'm going to see if I can negoiate with this PT to wait a week before I stretch again... get some soft tissue treatment/massage over the next week without the stretching and try it again. My doctor specifically told me he does not believe in stretching if it causes pain and if that happens to back off for awhile and try again later.

I think I'll know alot about what to do next by how my PT reacts to my request.
Thanks,
Beverly

Re: Would you keep or dump this physical therapist?

Nancy N on 5/03/01 at 11:07 (046485)

Bev--

I would quote your doc about the stretching if your PT gives you trouble about it. Your doc's opinion should override the PT, IMHO.

Re: Would you keep or dump this physical therapist?

ellen w on 5/03/01 at 17:17 (046527)

Bev--my experience was pretty much the same as Catherine's. I just wanted to add that my PT wouldn't add new exercises until she felt I could handle them, using how I was doing with the existing set plus how stiff my leg was to judge.

ellen

Re: Negoiated a one week break from stretching

Beverly on 5/03/01 at 19:08 (046537)

My PT was much more agreeable today. I told him that I faithfully attempted stretching 2x a day for several days but that it is making me feel worse.
I said I felt like I needed to have a week off from stretching before we try it again. In the meantime, I'll have PT 3x a week... getting e-stem with heat, massage, and ionphresis with ice. The ionprehresis didn't do much last time around for my feet, but I'll give it a whirl on the ankles.
No one wants to get back to stretching more than I do. My feet feel so much worse since I've had to step back from it.

Looking around the place, I've noticed that the vast majority of the patients are jocks. Naturally, their rehab is going to be more intense. I was never a jock.
Thanks,
Beverly

Re: Would you keep or dump this physical therapist?

JudyS on 5/02/01 at 18:55 (046438)

TexBev - I feel bad for you that you're experiencing this 'communication' gap between you and your PT. It's always hard to choose the next step - but you've always done a good job with it. How about one more shot at talking with him (PT's are supposed to work WITH you), a couple more visits, then decide? While I can appreciate his theory about pushing a bit, he needs to understand that his patient has limits.

Re: Would you keep or dump this physical therapist?

Nancy N on 5/02/01 at 21:05 (046446)

Bev--

This is a really good question. My PT experience in the fall of 99 was my first, and I hadn't discovered this board yet, so I went along with everything my PT told me to do. While I was in a lot of pain, I didn't have the tendonitis problems that you do, and hadn't got to where I felt like I needed to crawl to get around or anything. It wasn't until a few months ago, when I posted about my PT regimen, that I realized I'd been pushed too hard--no wonder it didn't help! I had adopted a 'no pain, no gain' attitude in terms of what they expected of me--that they knew more than I did, and therefore I should go with what they told me, even if it hurt. If I'd known then what most PF PT is like, it would have been a different story, because I was doing things that were incredibly painful (stair stepping with hand weights, etc), and instead of feeling better when I left, I usually felt worse than I did when I went in--and that continued into the next morning.

So.... I'm not sure what to tell you, except to trust your instincts. I know you've been through PT before, but I'm not sure how you feel now compared to how you felt then. If you feel better now than you have when you've gone for PT before, then you might want to stick it out a little longer and see what happens--unless you're feeling worse as a result of the PT. But if not.... maybe call your doctor and see what they can tell you? I think they should have a much better idea of what they're expecting you to do in PT than any of us would, so that might be the way to go.

I don't know if this is helpful at all, but it's my two cents, based on my own over-zealous PT experience. Good luck, and let us know how it goes!

Re: Would you keep or dump this physical therapist?

CatherineL on 5/03/01 at 08:29 (046467)

I've been to phisio for a few things through the years. I've had 4 different phisiotherapist.

All of them felt that if there was discomfort, that was okay but if there was any pain during stretches of exercises - that was not okay and to find a way to do them to not cause pain.

As far as the massage, I have had massage on my calves and feet and although it did hurt tremendously, she explained that she was working on knots and although there was pain, it was the only was to get the knots out and it would be less painfull with each visit - she was right. The knots went away, the massage helped.

Hope this helps

CL

Re: Would you keep or dump this physical therapist?

Sherrie M. on 5/03/01 at 08:40 (046468)

Hi Beverly, When you stretch your achilles tendonitis hurts worse doesn't it? I know mine does. I think I will stop stretching for a few days, I will ask my pt tomorrow about taking it easy for a few days than start gently stretching after my hot soaks. I just had my 3rd ESWT treatment with Dr.Z on Monday and I am sore from that also-I'm really miserable right now but it is like this for a few days or around a week after treatment ( atleast I know what to expect ) prior to this 3rd treatment I was experiencing some really good days and I am hoping for those again real soon.If I were you I would give this guy a chance, tell him it's just to much all at once, make sure he understands that these exercises or causing you discomfort. I will let you know what my pt says about stopping the stretching and taking it easy for a few days.After reading some old posts from March I discovered that you are in Texas- I still wish you could be seen by Dr.Z. See ya, Sherrie

Re: Would you keep or dump this physical therapist?

Beverly on 5/03/01 at 11:06 (046484)

Thanks Judy, Katherine, Nancy, and Sherrie,

It is always good to have someone farther away from the situation than myself give their two cents worth.

Yes, I will give the guy another couple of sessions. When I began stretching back in July 2000 for the PF, it was uncomfortable but I don't remember it causing lingering pain. Back then, it was uncomfortable at the arch.
And after the PTT developed last Fall, I remember the same thing. Over time, it stopped bothering me and I was able to stretch better.
The difference now is that I have lingering pain that goes into the next day. My right ankle is worse than it was when I began.

I'm going to see if I can negoiate with this PT to wait a week before I stretch again... get some soft tissue treatment/massage over the next week without the stretching and try it again. My doctor specifically told me he does not believe in stretching if it causes pain and if that happens to back off for awhile and try again later.

I think I'll know alot about what to do next by how my PT reacts to my request.
Thanks,
Beverly

Re: Would you keep or dump this physical therapist?

Nancy N on 5/03/01 at 11:07 (046485)

Bev--

I would quote your doc about the stretching if your PT gives you trouble about it. Your doc's opinion should override the PT, IMHO.

Re: Would you keep or dump this physical therapist?

ellen w on 5/03/01 at 17:17 (046527)

Bev--my experience was pretty much the same as Catherine's. I just wanted to add that my PT wouldn't add new exercises until she felt I could handle them, using how I was doing with the existing set plus how stiff my leg was to judge.

ellen

Re: Negoiated a one week break from stretching

Beverly on 5/03/01 at 19:08 (046537)

My PT was much more agreeable today. I told him that I faithfully attempted stretching 2x a day for several days but that it is making me feel worse.
I said I felt like I needed to have a week off from stretching before we try it again. In the meantime, I'll have PT 3x a week... getting e-stem with heat, massage, and ionphresis with ice. The ionprehresis didn't do much last time around for my feet, but I'll give it a whirl on the ankles.
No one wants to get back to stretching more than I do. My feet feel so much worse since I've had to step back from it.

Looking around the place, I've noticed that the vast majority of the patients are jocks. Naturally, their rehab is going to be more intense. I was never a jock.
Thanks,
Beverly