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Pain after ART

Posted by Pat W on 6/17/05 at 21:18 (177038)

I had two ART treatments last week. For the second one, the provider really dug in on both feet. I had a lot of pain following that second treatment, culminating in a really terrible day 5 days later, with ongoing pain since then. It's been 10 days since the second treatment, and I'm still having a lot of trouble walking. Is that normal? I have spent much time goggling ART, but only see that ART has helped almost everyone, and I have not been able to find any descriptions of different kinds of outcomes, especially for people with severe conditions. I wish I knew more about what to expect. Should I go back? My feeling is that this wasn't good for my feet, but I'm not sure...

HilaryG, when you say ART made you worse for awhile, can you be more specific? Was it worse for 2 days, then better, or much worse but you went back anyway?

I was hopeful that this would help me. sigh....

Re: Pain after ART

Daria on 6/17/05 at 21:33 (177039)

ART didn't work for me. I had about 10 treatments. It hurt while it was happening, and I felt no relief after. I have stopped the treatments. It is not for everyone.

Re: Question for Dr.Rob Sanfilippo about Pain after ART

HilaryG on 6/18/05 at 01:35 (177043)

I'm hoping Dr.Rob can offer you some advice. As for me- the pain I felt when I first started ART was different than the PF pain itself- it was worse but different. The fact that it was different made me hang in there. I figured any change was good. And I was right. Eventually it got better. it took about a month. Have you talked to your chiro about it? But everyone is different. I don't know if your pain is the same as mine. I can only tell you my experience. I changed the subject of this message hoping Dr.Rob who is a chiro who does ART will chime in and offer you some advice. I hope that is ok with you. Hilary

Re: Pain after ART

MariannePT on 6/18/05 at 14:34 (177062)

I have found as a physical therapist when treating plantar fasciitis there are 2 basic phases: the first phase is the acute stage that could last for a very long time, and deep tissue techniques should not be used at this stage. The next, 2nd, stage is when things calm down a bit after taping for a while and getting the right orthotics is when deep tissue techniques can be used.

Re: Pain after ART

Robert J. Sanfilippo, DC, CCSP, ART on 6/18/05 at 22:01 (177063)

Hello there Pat, I see that you didn't have a favorable outcome with your ART treatment. As Hilary has said, many people respond differently to the same treatment. That is what makes us so unique I guess. With ART alot depends on the practitioner who is administering the technique. I have no idea how skilled this ART practitioner was and if they are certified to administer the technique. You should feel relief immediately or within a day after the treatment. Worst case scenario with my PF patients is that they don't feel any change. Knock on wood, they have never gotten worse. And for ART to be successful it should be administered no more than 2 times a week. That allows for proper healing to take place. Is the doctor treating other areas as well as your PF? The doctor should be evaluating your low back, gluts, hamstrings, gastrocnemius, etc... Before you decide to discontinue care have those questions answered first by the doctor.

Re: Pain after ART

Robert J. Sanfilippo, DC, CCSP, ART on 6/18/05 at 22:14 (177064)

Marianne, how long are we talking about in this 'acute' phase that you are describing?? Generally when we speak of the acute phase it lasts no longer than 24-72 hours. Then that can be followed by the sub-acute phase that lasts from 7-14 days. After than we are into remodelling of tissue and fibroblastic proliferation. So I am very curious to what exactly you are speaking of. In order to treat a PF you must get control of the inflammation, if there even is one, because that will control what type of fibrous tissue will be laid down. You have to stress the tissue (Wolff's Law) in order to control the fibroblasts. We must achieve a successful remodelling in order for the plantar fascia to maintain its flexibility.

I routinely treat people with 'acute' PF with soft tissue mobilization (ART and Graston) and they do just fine. It is the skill of the practitioner to know the boundaries to push or back off. It is also vital for the practitioner to assess the entire kinetic chain which commonly causes or contributes to PF. McConnel taping works great with PF as well.

Re: Pain after ART

Pat W on 6/20/05 at 09:32 (177080)

Thanks for your response. I went to the ART doctor only for my PF; he is not treating other areas. He did watch me walk briefly, but he decided that only my feet needed treating. He seems young, but he verified that he is certified in lower extremity for ART, and he told me that he has done workshops with Leahy in Colorado. I will call him and tell him what happened after the last treatment, even though I don't think I could bring myself to go back. I'm just starting to get over it, after almost 2 weeks of staying home and completely off my feet. I can't understand what is going on with my feet. I can only stretch very little, even Julie's yoga stretches caused tearing after a week of doing them. Icing sets my feet off. I tried increasing my thyroid, but I completely stopped sleeping, so I went back to what it was. I feel that there is something amiss with the tissue itself, in that it won't heal and I can't do things like stretching, icing, or deep massage. Again, thanks for your response.

Re: Pain after ART

Robert J. Sanfilippo, DC, CCSP, ART on 6/20/05 at 10:07 (177081)

I agree, I probably wouldn't go back myself. He may be certified in lower extremities, but in order to be an 'ART Doc', like myself, you have to be certified in lower extremities, upper extremities, spine, and biomechanics. This allows you to assess the entire person, instead of just one area. I hope you feel better soon and if you have any further questions feel free to ask.

Re: Pain after ART

Ron on 6/20/05 at 14:06 (177100)

If icing doesn't work, then an option would be to use heat, possibly even infrared heat.

Re: Pain after ART

HilaryG on 6/20/05 at 14:12 (177101)

Dr.Rob, with all due respect, I do not agree. My pain got much worse when I first began ART treatments. It was worse for the first few wks. Like I said previously.. the pain was different but worse. However I preservered and eventually the ART kicked in and I felt much much better. I do not know why it worked that way. But that is wwhat happened with me. I do realize that everyone is different. As an aside, perhaps that is why my chiro only saw me once a wk when as you have said the protocol is to see a patient with PF twice a wk. Maybee he simply didn't want to cause me any further pain. Anyway ART has been the only thing that helped and I am very glad I hung in there. I am now going to someone who is treating me twice a week for about 5 wks now and my pain is almost all gone.

Re: Pain after ART

Robert J. Sanfilippo, DC, CCSP, ART on 6/20/05 at 17:52 (177120)

Hilary, thank you for your comments. With regards to ART, many times the pain will get worse but it only should get worse by a fraction. I am glad that your ART practitioner is helping you and he/she should be commended. My experience is that people come to me for relief. Yes, there is soreness associated with treatment but rarely such a drastic increase in pain. We both agree that every person reacts differently to treatment. I was trying to tell her that she should contact her doctor and express her concerns and pain. I believe that treatment should feel good and even hurt. I am a firm believe in 'good hurt' versus a 'bad hurt.' Many times the addage 'no pain, no gain' can be followed but within reason.

Re: Pain after ART

Pat W on 6/23/05 at 09:27 (177248)

Dr. Rob, thanks for your comments. I did finally call the ART chiro, but all he really said was that everyone responds differently. There is one other ART chiro here in Raleigh who is certified for lower extremity, and I think that in a few weeks, I will go and talk with him. Can you suggest any questions I might want to ask him, or suggest how to tell him that I may need light treatments to start with? Also, it sounds like they should be working on my leg muscles as well as my feet, is that right? In spite of my experience, I think the theory of ART sounds like it should help.

Re: Pain after ART

R on 6/24/05 at 10:23 (177276)

Pat, are you in Raleigh, NC? I have been going to a chiro in Cary that is certified in ART. My visits are very short and intense, however I am concerned that my visits are too short (5 mins) and not enough leg work is being done. If you decide to go for visits I am very curious how long they last and if leg work is done....I might need to switch doctors! I have seen some benefit with ART and am holding out hope that it will help even more as time goes along.

Re: Pain after ART

R on 6/24/05 at 10:30 (177277)

Pat, I am sorry about my above post. I just realized you are the original poster and are having troubles. Perhaps you could try another chiro? The one I am going to in Cary seems good, with the exception of short visits, but maybe that's what you need, less intense short visits. I would hate to see you give up on ART if you possibly just had a bad chiro or bad technique.

Re: Pain after ART

Pat W on 7/04/05 at 17:08 (177804)

R - I saw Dr. Schmeul (spelling?) in Cary. He works in Dr. Staker's office. The first session was very short at my request, but the second session was a full 30 minutes on both feet. It was way too much for me. Maybe we should switch practitioners :-) Short, less intense visits sounds about right for me.

Re: Pain after ART

Pat W on 7/04/05 at 17:13 (177805)

R - I just responded to your other post, but now I want to respond to this one as well. The doctor I saw didn't do any leg work at all, only the feet. He is certified in lower extremity ART, but I didn't know to ask about leg work. There is another ART doctor in Raleigh, off Glenwood, and I may eventually try him, but if I do that, I will prepare myself with questions about leg work and whatever else I can find out to ask about. I'm glad you have seen some benefit with ART.

Re: Pain after ART

R on 7/19/05 at 07:56 (178620)

Funny - I am seeing the same doctor in Cary, small world!