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Physical Therapy and PAIN, PAIN, PAIN!

Posted by Pat on 2/08/05 at 17:29 (168757)

I had EPF on 11/3 (and bone spur removal)and started physical therapy last week because my heel always feels sore. The first time I went I was in pain the next day but it went away and I went back to the way I felt before the PT. Yesterday I went and there was someone else there. Basically the only thing they're doing is cream with this ultrasound thing, massaging my foot and then they put me in this contraption that goes around my stomach and foot (each foot separately) and stretches out the ligament. I stay in that for about 10 minutes. Anyway, yesterday she was doing the ultrasound thing and my foot started hurting like hell. It was almost like a nerve or something because it just burned and was sore and hurt and she said no one else ever had that reaction (I had plenty of the ultrasound at different times before the surgery and after and it never felt like this). And I started feeling like they had that huge stretching contraption on for to long. Anyway, today my foot is really, really hurting. I went back to putting my boot cast on to relieve some of the weight on my foot just to give it a rest. Behind my knee is sore, my foot is sore, my ankle is sore and I'm fed up! Is this physical therapy even worth it or could it be doing more harm. I'm starting to make myself feel like I'm nuts - my whole life resolves around my foot!

Re: Physical Therapy and PAIN, PAIN, PAIN!

BOB STOOPS on 2/08/05 at 18:01 (168760)

I hear this alot and see this alot with my team here in the sooner wrold. Sounds to me like your mouth is more sore then your knee. And if your fed up why don,t you take care of them in the first place? I,am a coach and I have seen it all. But just reading your story here it sounds like you don,t take care of them in the first place. Sounds like two nut cases in a hole!

Re: Physical Therapy and PAIN, PAIN, PAIN!

Dr. Z on 2/08/05 at 18:10 (168761)

Pat,
Some people will have this bad reaction to ultrasound treatments. Stop for a few days . Ice this for now. Boot cast for now. Call you doctor to update him. You need some pain medications. Talk to your doctor. I know this is tough

Re: Physical Therapy and PAIN, PAIN, PAIN! - Dr Z

Pat on 2/08/05 at 20:06 (168766)

Thank you for your input - it was just so strange because I've had the ultrasound treatments before and had no pain but yesterday it was a new Physical Therapist and they just kept saying 'No one ever complained of pain before' as they were doing it. I will stop the physical therapy this week and I have the boot cast on. I also have Vicodin which I take at night - it puts me out like a light so I try not to take it except for at night. I will call my doctor tomorrow. Thanks for your help.

Re: Physical Therapy and PAIN, PAIN, PAIN! - Dr Z

Dr. Z on 2/08/05 at 22:26 (168774)

Good luck. I have heard of pain from ultrasound. Sometimes just too much for you. Give it a try next week. Must keep the probe moving

Re: Physical Therapy and PAIN, PAIN, PAIN! - Dr Z

Pat on 2/09/05 at 07:38 (168781)

I guess I'm wondering what exactly the ultrasound does. I iced my foot last night and wore the boot cast and it feels alot better today. Of course I just woke up so I haven't been walking around all day but at least it doesn't hurt like the other day. Thanks for your help.

Re: Physical Therapy and PAIN, PAIN, PAIN! - Dr Z

Stanly Tanner on 2/09/05 at 15:15 (168809)

A funny thing doc. It,s too bad you suffer what many people suffer with each passing day and to know that you Docters enjoy making the money! that they have to pay. Now it,s time for you to pay a sum of money for your treatment! I,am currently eating pizza with along with a good set of foot laughing my head off at you.

Re: Physical Therapy and PAIN, PAIN, PAIN!

Buck T. on 2/11/05 at 19:05 (168915)

Hi Pat: I think sometimes one needs to talk to a physicial therapist and say what hurts. If you did that and the therapist isn't listening, then there's a problem and its not being caused by you. I'd listen to Dr Z about the ultrsound probe that should be kept moving. Maybe mention it to your PT. Also, there are fundamental reasons why standard PT stretching exercises hurt many of us with pf. I finally had this explained by a listening PT, after being treated by some other PTs. Be glas to expand if you are interested.

Sincerely, Buck T.

Re: Physical Therapy and PAIN, PAIN, PAIN! - Dr Z

Ed Davis, DPM on 2/12/05 at 13:48 (168936)

Pat:
Hopefully you have read Scott's Heel Pain Book and only had the surgery after you had tried all the reasonable conservative means without success. Considering the fact that the surgery was done, ultrasound will hurt the most during the first three applications and then get progressively better. Consider a few things:
1)apply ice massage immediately after each ultrasound treatment
2)consider massage therapy, possibly with a topical anti-inflammatory after each ultrasoud application.
3) has any form of immobilization been used, even taping after treatment? I realize that you have a boot but the boot can be very flat inside. Ask the doc to modify the boot utilizing a scaphoid pad (arch elevation).
4)Since ultrasound stirs things up before making things better, consider adding another modality, one that is more soothing to the regimin, such as iontophoresis.
Ed

Re: moderator--please look at this post

Ed Davis, DPM on 2/12/05 at 13:49 (168937)

What exactly are you talking about?
Ed

Re: Physical Therapy and PAIN, PAIN, PAIN! - Dr Z

Pat on 2/13/05 at 19:07 (169011)

I called my doctor after the last physical therapy treatment because I think the stretching thing that they were using was also causing me alot of pain. He said he would call the PT place because he felt they were being to aggressive in their treatment. I cancelled the appointments for this week. They were doing some massage therapy but were not applying a topical anti-inflammatory nor were they tapking or anything like that. Basically I'm not even wearing the boot (I did it a few times after physical therapy because it hurt so much). And I'll mention iontophoresis. I had that before the surgery. I'm waiting for the PT place to call me but I never had that kind of pain before from PT and I didn't know what to do. Then when I called the doctor he never called me back and I had to call the next day and I told him I was in excruiating pain.

Re: Physical Therapy and PAIN, PAIN, PAIN! Buck

Pat on 2/13/05 at 19:10 (169012)

I would like like to hear your explanation about the stretching and why they hurt - my email is (email removed) - i told the therapist about it hurting (believe me, I'm from New York City originally and don't have a problem explaining anything! LOL) but they kind of have the same reaction as the doctor - that it shouldn't hurt and I'm making to much out of it. I had this surgery ten years ago on my other foot and a nerve was cut during the surgery and I had a really long healing process so maybe I'm being extra careful (plus i have some neurological things going on now) but it's like they look at you like you shouldn't be telling them that you're in pain.

Re: Physical Therapy and PAIN, PAIN, PAIN! Buck

Elliot V on 2/28/05 at 16:09 (170161)

Just to clear up a few things for you.
Ultra sound therapy is a considered a deep heating modality. Deep because it can heat up tissues 3 to 5 centemeters deep into your body.
In basic terms Ultrasound works by passing elecrity through a quarts crystal (the thing that goes on your body)
This produces a sound energy known as the Piezo electric effect.
PT's use this treatment because it can increase the permiability of tissue, a mico massage to the area, and deep heating.
However, the deep heating effect is only present when the machine is set on a continuous or 100% level. The level is determined by the PT and depends on whether your inlamation is acute or cronic. Some PT's recomend a 20% level for Acute injuries. (an acute injury is usually something recent or recently bothering to the patient) Sounds like maybe you are in an acute stage. Sugggest lowering the level of the ultrasound. Then it shouldn't be uncomfortable.
All iontophoresis is, is using a low volt elecreotherapy treatment to administer medication like painkillers or anti-inflamatories. Ponophoresis is the same thing except using Ultrasound to do it. If you are getting a massage you don't need a 'topical' cream because your injury is deep and the only way to get something to the injury would be by injection or one of the other ways I mentioned. By the way the Gel they us for ultrasound is not medicated. it is just a cunducive agent that helps the sound energy to get where its going.
Finally, if you have the Ustrasound on continuous and you don't move it around you can get a Periosteal Burn. Which is a burn on the 'Skin' (periosteum) of the bone, and can be painful after a while. But rest assured, most PT's should'nt let that happen. Good Luck, and please be careful with the pain killers, they are not Tylenol.