"Kneecap Training"

Wahine and Knot,

Thanks for all of your insight and encouragement. I will definitely go to today's session as a better informed patient!

So far, the cure is worse than the condition. I've had two PT sessions, on Wednesday and Friday and I'm physically uncomfortable. Since the first, my back is hurting and it's making me very unhappy and grumpy. I don't know if the back pain is due to the knee taping itself, the exercises I'm doing, or that maybe I'm not doing the exercises correctly. On Friday, before they made me do anything they asked how I was doing and I told them that my back was hurting. They didn't really respond to this. I've had two sessions and two different therapists so I don't know if I can expect any real continuity of treatment. I guess for my next session on Tuesday I have to force them to listen to me.

I assume I shouldn't be hurting this way! Do I need to find a different approach?

Thanks, Nicole

Knee tape shouldn't make your back hurt.

Did they say anything about your back at all?

Is your back still hurting? (and how are the knees?)

Does the PT stay with you while you exercise, correcting your form and talking about the exercise and what you should be feeling and how to check your form at home?

You should have fatigue-y muscle-y soreness after PT, but you should not be suffering. And, ummm, I don't think new body parts really should be getting miserable... Did they change any of your exercises to make it better for your back?

Can you describe the "quad extensions?" Are you sitting on a machine with your feet dangling with a padded bar across your shins and then straightening your legs?

Did your back start to hurt on that exercise?

Did they give you any stretches yet? (these could be sort of active stretches, like 'walk with your lower belly flat and hold yourself tall with long strides and feel a brief stretch in your groin with each stride' kind of thing. Or they could be the sort where you hold yourself in one position feeling the stretch for 30-60 seconds)

+1 what Knott said. All of the above.

But I really want to bring up that if you're not doing stretches by now you should be. You can strengthen til the cows come home but if there are tight structures preventing the proper movement patterns you may not be doing yourself any favors.

(This is just a little interjection...as a non-medical type...I sure am grateful that all the PTs and docs and nurses and others on TE are so generous with their knowledge & experience...Thank you so much Wahine & Knot!!) :)

I'm no PT and I have no idea if this applies to your situation (or if my self-diagnosis is even correct), Nicole, but I used to have low back soreness from doing yoga. What I think was happening was that I was flattening the lumbar region of the spine during certain postures and it seemed to be straining the muscles around the sacrum. After I learned how to maintain a more natural curve to my spine in those postures, the strain went away. A similar thing also happened when I used to lean forward from the hips when cycling, instead of curving forward from the stomach. Knot & Wahine, is it possible that something similar could be happening if Nicole's flattening her lumbar spine during leg presses and quad extensions?

Yup, could be that too. That's why it's sooooo important that PT's stay with their patients and correct their form on everything.

There are a couple other things that could be causing back pain, too. Darn, wish there was a way we could do a quick TE PT session in person!

The PTs leave the exercise supervision to the assistants. They don't necessarily stay with you either as they may be ushering around a few people.

Something about the taping, or the exercises, is restricting the mobility of my knees, making it hard to bend them. Is this normal?

Taping will restrict the ability to bend the knees. That's pretty normal. But I don't like the back pain and achy joint bits. The next time you go in I would make it very clear that your back has gotten sore since starting the exercises and it's not getting better (or maybe worse?) and that you want to make sure that the exercises you are doing are not irritating your back. It doesn't sound to me like you're getting enough one on one input.

I know I can't expect overnight improvement but I'd like to have confidence that I'm being treated correctly and that the therapists are properly looking out for me. I guess right now I have neither.

MD - I am not a physical therapist, and have sought much PT advice on this same forum. But, that said, Mr. Sheesh was having knee issues related to cycling and went to PT. While that helped stretch some muscles that were tight in the knee area, he found the most help when he went to a club-sponsored biomechanics study. The doctor team (mostly chiropractors, but trained in sports medicine and one specifically does custom orthotics) video-taped the participants as they cycled. Then they reviewed the footage and found that Mr. Sheesh had an abnormal pedal stroke which was leading to his knee pain (tibial torsion, he says). A few wedges in his cycling shoes later, and his pedal stroke was drastically improved and knee pain went away!

I was also going to PT for tight calves which were leading to other issues (including plantar facitis and lower back pain). Anytime I mentioned a pain or something like my feet going numb after 30 miles on the bike, my PT just said "Hmm, that's strange." That was her entire response. She has now "released" me from PT and says my issues are solved, but I'm still not convinced that the underlying cause of my pain has been addressed. If the pain returns, I plan to ask for a different PT because I'm not convinced that my original PT did much more than look at the symptoms and treat that.

Good luck! I hope you're able to find relief!

Wahine and I need to open a clinic. TE PT.

MDHillSlug - If the PTAssts are covering more than one patient at a time, you should NOT be charged for that time. (check your bill) In fact, it is illegal to charge you for non-one-on-one time, as "group" charges only count if the entire group is doing the exact same thing. (check your bill, really. go in and ask for a complete charge sheet for your last two visits)

Sheesh - I'm sorry your PT was a dork. The foot numbness/plantar fasciitis/ tight calves are probably very related, and I'm surprised she didn't address it or look at how your posture (maybe due to the leg stuff) was effecting your back.

Sign me up for TE PT! :D

Yes, Knot, after reading your advice on my previous post, I became pretty convinced that my PT was only interested in relieving the symptoms. During one of my visits when she was out of town and I had to schedule with another PT, the new PT gave me some other stretches to release the nerves in my ankles, and that really helped the numb foot issue. I was amazed at what a difference that small change in stretching made!