So How Is Everyone's PT Going...

[rocknrollgirl]

Well Walking Wounded and fellow PT enthusiasts... How is it going?

I am having mixed feelings about my PT. Nice people, but I am not sure they are doing anything for me that I could not do at home.

I just finished my second week. I have seen three different therapists in two weeks. This is one aspect of this clinic that I do not like. I would like to be assigned to one therapist to work with. But they are all nice.

My sessions start with me doing my stretches that I do at home. Exercises, that I could do at home and then maybe 10 mins of them stretching me.

I did not expect to feel any big changes this quickly, but my knee is actually more sore than before I started. I asked yesterday if that was normal, and the reply was that is should stop as I enter in to the third week. Huh?

I have learned a lot about stretching. So that is good. I think what I am missing is the link of how to transition back to exercise. I do not have a coach, so I am at a total loss of how I know when I can ride outside. How will I know when I can try to run?

The doc said right from the start to just give it a try, but that makes me very nervous.

So I am going to keep my appointments for next week, and then reassess whether it is worth the expense to continue. I will still be at a loss of how to procede, but at least it will be free!

I do now realize that whatever becomes of my training in the future that heavy stretching and leg exercises will have to be a part of it.

[bmccasland]

There may be light at the end of the tunnel - and it isn't the train about to run me over.

Wednesday when Tony stretched my shoulder there's only one position that is still tight and very painful. I was SO happy when the second one didn't hurt - I could feel the tight, but not painful. (the other stretches he does no longer hurts, there were just two I dreaded) We'll see what the prognosis is when he measures my range of motion. I get heat/stim, ultrasound, PT stretching, my exercises, and ice at the end at every session, currently 3 times per week.

My PT is with the same therapist (I believe he owns the clinic) and there are 2 aides, so there's consistency with therapy.

Rocknroll - it seems to me you should be having some one on one time with your therapist at every session - pretty much they're stretching you out, contorting your body in a way that it should but doesn't want to go. Either that or you need something specific like heat/stim just to get you able to move first. It seems my PT spends one on one time with every patient. I can feel greater range of motion with my exercises AFTER I'm stretched out (medieval torturer that he is), than before. Recovery is slow, so don't be discouraged. I think the stretching with supervision is important - I've been caught using bad posture when I start on multiple occasions, usually it's the other shoulder patient that rags on me.

[F8th637]

I was lucky in that I pretty much saw the same therapist while going to PT. There was an aide that I did work with a few times but the line of communication was very open so I never felt like I was starting over.

I hear you on the whole, "I could do this at home" thing. I think a lot of people think that about PT. It's true that once you know what you should be doing you can start doing it at home. For me, I was more apt to do it if I was actually at their office rather than at home. I hope that as time progresses they introduce more stretches and different exercises for you like they did for me. It helped keep me on my toes.

God willing, I won't have to go back to PT for a really long time since I'm now armed with the knowledge that I learned while at PT.

[SheFly]

RNRG - I think you should potentially look for a different PT. Like the others, I got to PT twice per week. My session is always with the same PT and starts with ultrasound, followed by stretching (done by the PT), followed by my exercises (she says it is good to do these while my shoulder has been stretched out, and she often will add or remove stretches based on how I am progressing), followed by stim/ice.

I have the same routine each time, and really like my PT (who also happens to be a friend and a biker).

As I mentioned in my update, my PT is going great, but I need to be a little gentler on the shoulder over the weekend ;) .

Good luck!

SheFly

[Wahine]

RnR - I would be starting to ask if some massage would help, especially trigger point and deep tissue work in your glutes, tensor fascia lata (TFL) and vastus lateralis (the lateral part of the quad). You should also ask them if there is a way to tape your knee that might help, especially before exercise. Bracing is good but does not provide as strong a directional correction for the patella. So taping can be helpful and it's a really easy tape job to do that they should be able to teach you.

As for when to get back to sport, they are probably waiting to see how the first 3 weeks of treatment goes. If you're still sore from the PT exercises, it's likely too early to talk about returning to riding etc.

[rocknrollgirl]

I will ask about the massage and taping. I am going to check in with my tri buddy later today. I think he returns to work next week. He is recovering from his own surgery.

Glad to hear the shoulder crowd is doing well.

[HillSlugger]

RnR, are your knees being taped? The first few times I had this done most of my body hurt (knees, legs, back, etc) and I found it somewhat hard to even walk. It gets better.

[Crankin]

My first PT went well, but I find doing the neck exercises to be a pain. I can do them when I'm home, but not at work. And she wants me to do like 2-4 sets 2-3 times a day.
My neck is stiff and my whole shoulder and back on the left side doesn't feel too great either. However, the massage she did totally took away my headaches.
SheFly, you might know my PT. Her name is Heather Stark and she used to race for Boston Road Club. I'm not sure when she stopped racing, though.

[trinena]

Hello all, I'm new here but since I just started with P.T. for knee bursitis I thought I'd share. About taping- on my second visit Fri. my knee was taped with "Kinesio Tex" and it's helped with support and from my knee cap going from side to side. (injury mostly result of our 90lb dog crashing into my right knee)

This is my second time for PT (last year for lower back) and it's helped me to become stronger, more knowledgeable about my body and proper form so that I was able to complete my first sprint triathlon (former couch potato). My P.T. did a little active release therapy on Wed. and Fri. went over a couple of exercises and then ultrasound treatment. On Fri. bridging, clamshells, two legged squats but I couldn't do the one legged squats on the reformer (lightest resistance) w/o significant pain. Next week they are putting me on either a zero gravity or water treadmill. I feel as if I'm doing "something" (can't run, can't ride, can't walk for long, going crazy) by going to P.T. and like I have a support team. I work with the same P.T. and aide/trainer. Next week I'll take a list of the events I want to do for some feedback. Happy healing everyone.

[maillotpois]

Beth - glad yours is going well.

Sorry RnR - sounds like maybe some different options might be in order - like massage - great suggestion Wahine!!!

I am still 2 weeks away from PT. :mad: I had an opportunity come up for a potential new case that I just had to take which required me to move my next orthopedist appt (the one where I hope to get referred to PT and be given some concrete info as to when I am back on the bike) back a WEEK! I hated to do it, but simply could not miss this potential opportunity. Sigh.

Just did an hour and 20 minutes of Tough Love on the trainer. It is SO hard to stand, even if I balance myself (with no weight) with the bad arm. :( I really don't want to overdo and feel certain that I am compensating for the parts I can't use by overusing other parts. I am NOT going to hurt anything else, so I am going to go relatively easy on the bike (not doing all the standing, for example, and stopping when the shoulder/back start hurting too much).

The team did 40 miles with some good but not too bad climbing (Ink Grade). I sure hope I can keep up when I get back on the bike. :rolleyes:

Good to hear some good PT feedback - nice to have some new folks commenting and sharing their thoughts as well. Welcome to the gimpy crowd. :D

[RolliePollie]

Lame ankle and foot girl here. Got my final PT billing statement today :( Does that qualify me to post here? :o

I'm happy to read about some good PT experiences. Mine was not so good, and I believe that my slow recovery from tendonitis (close to 3 months now) is actually because of my PT's over zealous use of electrical stimulus and iontopheresis. But the good news is, my ankle is doing quite well and my foot is trying really hard to be better. It's still doing bizarre tingly nerve things and it swells up out of the blue every now and then. I bought myself an ankle brace and it seems to be helping. I can tolerate long walks and downhill skiing and spinning on the trainer, AND here's the exciting news...tomorrow I'm going to try a short ride!!! Yahoo!!!! :)

Good luck to all the walking wounded out there. Hopefully by the time Spring arrives, everyone will be all better!

[rocknrollgirl]

I am glad to hear updates. Feels good to have a support group. I think part of my problem is that there is no "normal" in these situations and I want to know what is normal.

Is is normal for me to be achy after treatments?

I asked about continuing to spin and they told me as long as I am not having any sharp pain while doing an activity and no pain for 2 hours after I am ok.

Do they really mean that? So it is ok to be achy the next day?


ARGGGHHHH. I guess I just want more solid assurances. It is part my paranoia and part my doubting nature.....

[Wahine]

I'm going to post my guidelines here on the achy factor. I hope it doesn't just confuse people more.

General rule of thumb (there are always exceptions, especially if part of the treatment includes breaking up scar tissue):

Sharp pain is bad and activities that cause sharp pain during the activity should be avoided until discussed further with the PT

Muscle aching is OK and even good. I think most of you understand this.

A little aching in an injured joint, tendon, ligament is OK as long as it subsides within 2 hours of the activity and does not cause a change in function eg limping. If it lasts longer that 2 hours or causes a change in function, it may still be a good activity but requires some tweaking (time, intensity, positioning...)

Intense aching that last longer than a day is an indicator of an activity that you're not ready for and needs to be adjusted.

No aching in the injured tissue at all during an activity followed by aching later that day or the next day, typically means that the achig is coming from increased stress on the area from muscle imblances that are working against you either during the activity or as they tighten up afterward. That means closer attention to stretching, self myofascial release, yoga.

Phew. Hope that helps and doesn't confuse.

[rocknrollgirl]

Yoda, that actually makes a lot of sense. Thanks.

I have not had any pain in the joint while doing any exercise or spinning. Just achy afterwards. Usually a few hours later. Always gone the next day.

I was really achy yesterday afternoon, but I did a good stretch this morning and felt good all day today. So that probably falls into the third category. I am going to print your reponse and put it on the fridge!

I am going to call my PCP tomorrow and see about a test for Lyme's. My husband and I think it is very strange that I am aching in so many places at once.

Thanks for the input!

[Wahine]

I am going to call my PCP tomorrow and see about a test for Lyme's. My husband and I think it is very strange that I am aching in so many places at once.

Thanks for the input!

You're welcome and the Lyme test is a very good idea.

[rocknrollgirl]

PT was better today. My tri buddy PT returned to work. I was so happy to see him. I only see him at the pool, so I blurt out..." hey, I hardly recognize you with your clothes on"

Big laughs all the way around.

He zoomed right in and evaluted and chatted with the girl I have been working with on and off. He answered many of my questions, they both helped me get info on a good massage therapist, he taped me before I left to help stretch the IT band.

He said the fact that I can make it through my treatment sessions without any pain in my knee is a very good sign.

He also looked at my bad elbow and gave me some tips for that.

So I am 3 hours post treatment without any serious aches setting in. I was able to spin on my bike and do a few mins on the eliptical today.

I went for blood work today to get tested for Lyme's and they threw in an RA test just to be safe.

It could all go to hell tomorrow, but right now, I am OK.

[Wahine]

That sounds really positive RnR. I'm glad to hear it.

[rocknrollgirl]

Well, the overnight report is good. I did get sore at the tape site, as they told me I would, but no soreness post session in my knee, none last night and none this morning.

I just did my more spin, 20 mins and stretch and so far ok. Aside from tired muscles, not ache.

It may change after being on my feet all day, but for now I will take it.

[maillotpois]

Now that I am officially a member of the club I thought I'd post. I had my first PT session today. The therapist had seen my Xrays, and seemed very knowledgeable about what happened. She asked a lot of questions about what hurts, when, etc. Honestly, the WORST thing is taking a sports bra on and off, and I told her that. Sure it hurts other times, but this is one thing I still have a VERY hard time doing alone.

She was very nice, and gave me some basic stabilizing and strengthening exercises to do at least once a day, more if possible. These should generally help my posture as well.

I think my ROM is basically ok, but then she had me raise both arms straight in front of me and the made me look at myself, and the left elbow was totally out of alignment, trying to compensate for the loss of strength. It was just all off balance, which was funny. I think she said something about "winging". She also said it's very swollen back there and i should ice. I hate ice. :rolleyes: It's cold!

Anyway, I will go once a week for the next month. I have a short ride set up for Saturday. I will see how it feels.

[trinena]

(Maillotpois)Ice is your friend! it's helped me to cut down on the ibuprofen. Maybe put on a warm layer, throw a blanket and sip on something hot on when you ice.

Update on my pt: I missed a couple of sessions because of illness but I have gone to a few more sessions in the past two weeks. One session this week was on a water treadmill where I learned exercises to do in the pool for less impact on my knee. I will go to the pool tomorrow and I have to get over my embarrassment of being seen as a waterwalker. I know my issues.

I also pushed it too far this week when I walked for almost an hour with some hills - hard to avoid where I live and when I want to go play at the creek/dog run. I had very sharp throbbing pain in my knee - I'm thinking besides the bursitis there could be torn cartilage-will see doc again next week.

I'm trying to focus on what I can do:
I can go on my trainer every other day for 10 minutes with no resistance.
I can start to swim again and I can do my home exercises.

Today my pt session was a pilates one. Okay pilates is hard to get right!! There is so much to remember but this PT (& a plus is that she's a triathlete) was very good about correcting me.

The bad news: I found out today that my PT place will stop treating folks with my insurance. I have until the end of this month with them. I am very bummed about this as I wanted to be able see them through a few sprint tri's. Speaking of...

I had already signed up for a sprint in the first week of June - the PTs talk as if I can do it but I'm feeling down cuz I can't even walk for long even in the house w/o needing to ice. How will I be able to run? Maybe my PT's want me to stay positive. Wow I went on and on here...:eek:

[rocknrollgirl]

Hi Trinena,
I am not sure what your knee diagnosis is, but I can tell you that I recently rounded a corner in my recovery and rounded it quickly. I did 4 weeks on the couch, 4 weeks of PT which finished on the 4th of March. At that point I did not really feel all that much better. In the two weeks since then I have started running again.

I know everyone is different, but don't give up hope. Keep pushing through it. You have plenty of time until June.

I would say that if it is hurting you while you are out on your walks, you should cut back. I think the rule of thumb posted here has been no pain during the activity.

Keep us posted.

[bmccasland]

Yesterday was my final session (3 days per week x 2 months). My shoulder still isn't 100%, but I can take off a sports bra. My PT laughed when I told him that was one of my goals. I'm to continue my exercises, to continue stretching the tight muscles. It still is uncomfortable to lay on my side with my "bad" arm outstretched, head on arm. I can feel the tightness. But doing so is not extremely painful like it was 2-3 months ago.

What was fun yesterday was HOLLYWOOD was filming in the mini park out front of the clinic, and since the clinic has large streetside windows, we had full view. They're filming some teeny bopper slasher film, episode #4.
Dude on riding mower, cutting the grass, roll foward about 30 ft, stop, CUT, return to places, do it again, and again, and again. I missed the part where the mower was supposed to "throw a rock" - apparently they fired a starting pistol. Guess the rock is supposed to hit someone.
Next scene, lots of extras in the little park, window shopping in the stores adjacent. Everyone has their place, ROLL, they walk, ride bikes, go foward about 50 ft, CUT! back to the beginning, repeat.

Unfortunately for them, the scenes were supposed to take place on a warm spring day, and it was 50. Saw one college kid showing off the various layers of T-shirts wardrobe gave him, just to keep warm. We could tell when they were filming, as Wardrobe lady would come and take away everyone's coats.

PT with entertainment.

[maillotpois]

Trinena - thanks for the ice reinforcement. ;) I wore an ice wrap for most of the night last night (after my first ride in 2 months) and it doesn't hurt today! Yay!

[trinena]

Thanks Rocknrollgirl for the encouragement and sharing your recovery experience. It gives me hope! I am limiting the walking and no more hills. I was diagnosed with Pes Anserine Bursitis & PFPS (i'm embarassed to admit I forgot what that stands for but I think it's about wear and tear of the knee) a month ago. I am returning this Thurs. for a re-check. When I first saw the sports dr. it was mainly the bursitis pain (she attributed it to overpronation - I have superfeet but now I'll be getting ortho inserts) but soon I began having very sharp kneecap pain (miniscus tear?). Can you believe I did not remember that our big dog had run into my right knee cap when we went snowshoeing in mid Jan.?! :eek:A couple weeks before that I had strained my back from carrying something heavy (I already have lower back disc L4 L5 S1 protrusion so that's a no-no ) and I had a mild calf strain in the right leg. So it's probably an accumulation/cascade of issues. I think its time for an mri but I can't blame the doc for not ordering one yet since I had not told her about the 90 lb dog running through me! I would think that if the main injury was in mid-Jan I'd be better by now.

Maillotpois I'm glad the ice helped and you got to go for your first ride in months! I haven't tried an ice wrap overnight. I think I'll try it since I'm waking up with some pain. I guess it's still inflamed from earlier this week. Happy healing everyone. Sigh - my hubbie just left for a long ride and the day is gorgeous.

[Wahine]

I was diagnosed with Pes Anserine Bursitis & PFPS (i'm embarassed to admit I forgot what that stands for but I think it's about wear and tear of the knee) a month ago. I am returning this Thurs. for a re-check. When I first saw the sports dr. it was mainly the bursitis pain (she attributed it to overpronation - I have superfeet but now I'll be getting ortho inserts) but soon I began having very sharp kneecap pain (miniscus tear?). Can you believe I did not remember that our big dog had run into my right knee cap when we went snowshoeing in mid Jan.?! :eek:A couple weeks before that I had strained my back from carrying something heavy (I already have lower back disc L4 L5 S1 protrusion so that's a no-no ) and I had a mild calf strain in the right leg. So it's probably an accumulation/cascade of issues. I think its time for an mri but I can't blame the doc for not ordering one yet since I had not told her about the 90 lb dog running through me! I would think that if the main injury was in mid-Jan I'd be better by now.


PFPS = Patellofemoral pain syndrome, it's a nice catch all phrase for pain around the knee cap that sounds impressive but doesn't really tell you what the root cause of the problem is.

Based a lot on what I learned in my running biomechanics course this weekend, I would suggest a few things. First off are you using a motion control shoe with your orthotics? If so you could have an over correction and may need a more neutral shoe now that you have the orthotic correction. Second, your orthotics are not going to do your knee a lot of good if part of the problem is coming from poor movement control at the hip. A good screening test is to see if you can do a side plank. Go up and down into the position repeatedly for 1 min with smooth control. If you can't do this, you likely have some hip weakness and you may need help from a PT to sort it all out and give you the right exercises.

Now more from my background with a lot of extra training in spinal mechanics, pathology etc... L4, 5 and S1 problems lead to muscle balance issues in the hip and lower leg that go with your pattern of problems and probable (because I haven't actually assessed you) movement dysfunctions. I would strongly recommend that you should also be doing rehab that involves your low back and hip if you want this to be corrected to the best of your ability.

Hope that helps.

[trinena]

Thanks Wahine for such an informative reply. I've printed it out and I'm taking it with me to the P.T. tomorrow morning. Thurs. I am seeing the ortho doctor right before I see the sports medicine doctor so I will be able to ask him about my motion control shoes (new pair of brooks adrenaline) and the orthotics.

I was told that I do have hip weakness (planks are hard for me), my right side is particularly weak. I was also told that I have to get my glutes to fire more (esp. for running). Through the pilates portion of the PT I also learned that I wasn't really engaging core muscles.

My P.T. told me she thought my knee issue had to be connected to my back (my doc didn't think so) but I need all of this clarified with more detail. I have a vague notion of what's going on in my body so I know I need to learn more and ask more questions. It helps to know what questions to ask!

[rocknrollgirl]

Trinena,
PFS is what I was diagnosed with also. Mine is being caused by muscle imbalance and a very tight ITB. I too had very sharp pain under the knee. I was convinced that the meniscus was torn. How could it not be with that much pain? I had the MRI and it was totally intact. All of that pain was from the poor tracking and the rubbing of the kneecap.

So getting to the root of the problem is KEY. Once they find out where the source of the problem is, they can give you the exercises and stretches to deal with it.

In my case, I just have to realize that I have to do the homework for the rest of my life, smallprice topay for getting going again.

Keep us posted.

[Wahine]

Thanks Wahine for such an informative reply. I've printed it out and I'm taking it with me to the P.T. tomorrow morning. Thurs. I am seeing the ortho doctor right before I see the sports medicine doctor so I will be able to ask him about my motion control shoes (new pair of brooks adrenaline) and the orthotics.

I was told that I do have hip weakness (planks are hard for me), my right side is particularly weak. I was also told that I have to get my glutes to fire more (esp. for running). Through the pilates portion of the PT I also learned that I wasn't really engaging core muscles.

My P.T. told me she thought my knee issue had to be connected to my back (my doc didn't think so) but I need all of this clarified with more detail. I have a vague notion of what's going on in my body so I know I need to learn more and ask more questions. It helps to know what questions to ask!

This to me sounds like your PT has a good handle on what's going on. She may not have articulated things in the same way but she's got you working on the right stuff. What's really important is that as you get better control at your hip doing slower exercises in easier positions, like lying down, you eventually progress to faster movements that mimic rate of muscle contraction with running speeds and in weight bearing positions. But you can't do those until you have good control with slower movements.