Physical Therapy Woes

[Louise]

How long was it before you started seeing some results from physical therapy?

About a month ago, I started PT for some long term back pain and, most importantly to me, to see if something could be done to straighten me up as I am walking more and more bent over. I do not have osteoporosis and my doctor felt that I was so bent over because my core was weak. I’m almost 75, if that makes a difference.

I do see some results. The sciatic pain that I had has diminished, most importantly. And, I am stronger, more able to do the exercises that I am spending over an hour a day doing. But, my back still hurts quite badly and I don’t see any improvement in the way I am bent over.

I have a feeling that I have reached a plateau, and that I am too impatient for there to be some significant improvement. How long to most people stick it out? I have been pretty down today, and thinking that I will keep going to PT for the month of January and assess where I am at that time.

I feel kind of whiney even asking about this, because I know that, for my age, other than this, I am healthy and lucky to be that way. I guess I’m just looking for others who have had similar experiences, to better be able to judge my progress.

[cayuse]

I’ve been in PT many times over the years and to be honest, never found it very helpful. I had an interesting conversation just this week with a pain management doctor who, when taking my history, asked if I found PT helpful. I told him “Not really” and he response surprised me. He said he has found PT to be unhelpful in most of his patients who have chronic joint pain. Some may disagree with this but I found it to be validating. I always felt like a “PT” failure.
Your health situation is different than mine, I have progressive joint damage from psoriatic arthritis, but I wanted to let you know you are not alone in being discouraged with therapy. Maybe touch base with your doc and let him know you’ve plateaued? Maybe they could come up with a different treatment option. Hang in there.

[Critter]

I am a PT…granted my specialty is neuro stuff and my patient care was spent in a hospital setting (now I mostly teach at a university).

If you were working to rehab your horse from a training issue that had been there for a long time, do you think it would be fixed in a month?? Probably not! An acute minor injury…yes. A long standing issue that probably has lots of compensatory issues…no.

That said, PT is not a magic cure all for everything. Are there lots of things we can help people with? Absolutely. Are there other conditions where we are more focused on preventing worsening (but not focused on fixing)…yup. Are there some things we aren’t going to be able to fix. Yes to that too.

Chronic pain also requires a different approach than most typical out patient clinics are equipped to handle…it’s as much psychology as movement based. It’s a special area of practice.

I will also add that I started in ortho out-patient…I went to acute care (hospital with a trauma and neuro unit) because I felt i was more effective and able to make more of a difference with patients.

Ask your PT if they think you’ve plateaued and why or why not. If they get offended or dance around the question…find a different PT!

[BigMama1]

I have done years and years of PT for various issues, and while I’ve found it good for really bad acute injuries / pain, it hasn’t been helpful for long term pain like sciatica, chronic hip and low back pain, etc.

Honestly the thing that has made the biggest improvement in my pain and crookedness is weekly or twice weekly reformer Pilates one on one with a trainer.

That in combination with chiro when things get really painful or out of whack has been life changing.

[Quelah]

Not all PTs are created equal IME. After I broke my back nearly 20 years ago (burst compression fracture L1) I went to PT when Dr said it was appropriate. First few times were OK then I had a different PT one day. He set me back 6 months painwise. I actually had X-rays taken. Never went back, had strong aversion to PTs ever since. To the point that if I was talking to someone and they mentioned they were a PT I would be edging away from them.

About a year ago one of our clients was RAVING about her PT, suggesting I go and I was like uh uh, hard no, told her about what I’d been through etc. She said this lady is different and if you go I’ll pay for it. Sooooo OK I went.

Completely different. This lady is a healer. I love going to PT. My husband started going to her soon after I did. He has a blown rotator cuff and a partially ruptured bicep tendon. A good orthopedic surgeon that I trust recommended surgery to repair both. After a few months of PT, his shoulder is in pretty good shape and doesn’t hurt all the time anymore. He’s an electrical contractor and we own a small horse farm so he does things.

PT may not be the answer for you, or you may not be seeing the right one. Try getting recommendations from other patients and checking online reviews.

[Jarpur]

How many times a week are you going to PT? If only once, perhaps you need to consider going more frequently. One month of PT for your issues doesn’t seem that long to me. You might consider speaking with your provider about your concerns, if you haven’t already. Have you been asked for feedback?

To give you an idea, I recently finished four and a half months of twice weekly PT (hour-long sessions), although for an acute issue. Besides the initial intake paperwork, each time the therapist asked me my pain level on the ten point scale as soon as I arrived and how I’d been doing since last seen.

Every few weeks I was re-evaluated by the provider (who holds a doctorate in PT, specializes in athletes, and is associated with a hospital system), plus was occasionally given a form to fill out to grade myself on many activities. A few times, I was also surveyed by the system about my opinion of the clinic and staff.

My exercises were frequently modified as I improved, but there was a time or two where I felt I was spinning my wheels, which I shared during the brief discussions we had at the beginning of each session. My therapist told me that is the way it goes, that progress is not linear – a temporary plateau is normal. Between the evaluations and my responses on the surveys, I was given a numerical score on my progress (the PT explained it to me, and shared my score a few times).

Also, the PT prescription is yours; you can switch providers if dissatisfied. I did this, after two sessions with someone else at a different clinic – I had liked the PT there fine, but not the clinic.

Good for you for doing your exercises!

[Louise]

I think I do need to talk to my Doctor. I love her dearly, but she is very old-fashioned and tends to not suggest specialists. When I complained to her about my problems, she wanted me to go to the YMCA and do some pool walking. I had to practically insist on going to PT instead. I think, that maybe, I should have some exploration done on what exactly is causing my back problems. Is it even fixable, or is it something that I’m just going to have to live with? Is my back pain causing me to hold my body in such a way that it is causing my torso to collapse?

I have been going to PT twice a week. We are cutting down to once a week starting in the New Year, because my medical plan only gives me a limited amount of PT sessions a year and I don’t want to use them all, in case I need it more for something else later on in the year. I am very good about doing my exercises and the therapist felt that once a week would be plenty to give her evaluation opportunities.

I tend to be impatient by nature. I want change, and I want it now. Hard to accept that this might be a long-term project.

Thanks so much to all who have answered so far. It really helps me to know that I am not alone in my concerns about PT. Please keep your ideas coming.

[MsM]

I agree that the particular therapist you have can make a big difference. But do you even have a diagnosis? I would certainly want to see a specialist and get some imaging so everyone knows what you are dealing with and how to best help.

I am pushing 70 and have back problems. Small injuries, years of poor posture, arthritis, piriformas syndrome, and some bulging discs mean that it is something I am managing. I did get some excellent PT from one therapist including releasing those angry, spasming muscles. I am better, but (like most people) slacked off on my home exercises and things are not as good as they were.

[RMJacobs]

I am so sorry you are not seeing the progress you are hoping for. I’ve found PT to be helpful for some things, not so much for others.

Can you ask for an assessment appointment with the therapist? In making this request, hopefully you will be told if it’s too soon. I do think a month might be a little soon, but I know nothing about back issues.

Rebecca

[Jarpur]

@Louise

I think, that maybe, I should have some exploration done on what exactly is causing my back problems

Getting a proper diagnosis is a great idea! Perhaps some imaging – x-rays or MRI. If your insurance allows, you can refer yourself to a specialist.

[dmveventer]

Not quite the same, but when I started seeing a chiropractor I was super skeptical. I didn’t think it was working at all for the first few weeks. And then one day I looked around after about 6 weeks of treatment and realized that my lower back pain was totally gone and I had way more mobility in my hips than I had before. It was like someone had flipped a switch. No results one day, and then crazy results the next.

If you’re not sure, talk to your practitioner. Mine was super open about transitioning me to an “as needed” basis so I didn’t feel like he was stringing me along for treatment. If your PT doesn’t have a set timeline for how long you’ll be in treatment, or a good reason why they don’t know, that’s a red flag. They should have a clear understanding of what you’re working towards and how long that’ll take. If not, consider a second opinion.

[FitToBeTied]

I think it depends on what the issue is. I have herniated disks in my lower back and arthritis that extends from t12-s2. If the issue is the herniated disk then PT has been helpful. If the pain is from the arthritis PT doesn’t do anything for it. Over the years I’ve learned to differentiate the two.

One of the best things that has helped me has been an inversion table.

ETA: I will say that every day I do the stretching and PT exercises I’ve learned over the years. I hate doing them but I think it is better to do them religiously rather than wait until I have a problem. The other thing I’ll add is that overall strength and core strength are particularly important. If you are strong then there is less chance of an injury by overextending.

[HorseLover65]

I have used PT/OT on three separate occasions. Twice for broken bones in hand and it was phenomenal. Most recently for low back, right hip pain. Progress was slower and less linear than with the hand. I will second the inversion table - I was amazed at the relief I felt from it. I also came away with a plethora of exercises which help when I do them. Finally, I have an amazing chiropractor (who also rides) and she keeps me going. The back pain (for me) requires a multi-faceted approach.
Good luck!

[Kyrabee]

I am currently doing PT after a PRP treatment to my torn gluteus minimus tendon. Oh, I am 67.
It took nearly a year to get it diagnosed and I did do 2 rounds of PT prior to said diagnosis.
1st session did nothing and I quit after a month. Went to an orthopedic that diagnosed bursitis and I tried again about 6 months later with a different PT, again before tear was diagnosed and although it didn’t seem to hurt anything, nothing got better.

Current round is helping but damned it seems to be near a glacial pace. However, I really hadn’t done anything since the last round of PT in May save walk and ride my horse (amazingly it didn’t hurt to ride?). I think by this age, it is really hard to build muscle and yes, it seems to take forever.

Are you doing exercises everyday? I had that problem with the 2nd session. Things actually felt better once I stopped. With this session, I specifically asked the PT how to let muscles that are being newly stressed recover? She said do it every-other-day. I have strength exercises and proprioception exercises and so I do the strength exercises one day and the proprioception ones the next day. Still doing something everyday but allowing muscles to have a bit of recovery. I have my 6 week follow-up with the DR that did the PRP next week. I will see what she says. I was sure hoping for more improvement in pain but then it has been painful for over a year so I don’t suppose it will go away in 6 weeks .

Did you get a referral? Maybe a physiatrist MD could be helpful? I don’t know. I am right there with you (getting impatient).

Susan

[4horses]

I had an x ray and MRI for upper mid back pain. It didn’t show anything so I was referred to PT. So far I haven’t seen much difference but then again I don’t have a diagnosis as to what is wrong. I’m thinking of asking for a referral to a back specialist to see if they can do any additional diagnostics.

My tentative diagnosis is rhomboid pain, but it is focused around one particular part of the spine. I am very active and probably do way too much physical work. Currently replacing some fencing on the property. I’m sure that isn’t helping but I do limit my heavy lifting.

[Louise]

Yes, it’s rough as we get older and things heal/strengthen slower. My situation was a bit different, as I was pretty sure my problem was with my core, and was a strength problem, not an injury problem. It was my idea to go right to PT, without seeing any kind of orthopedic specialist. I wanted to see if that would solve the problem, before taking any other steps.

I do my exercises every day. It takes about an hour and a half to get through them all and I do them in different segments through the day, not all at once (one good thing about being retired). There are a couple that I do every other day because they are hard on other parts of my body, but they are in the minority.

It’s been about six weeks since I started, and I am FINALLY seeing some results. My big triumph yesterday was walking all the way out to the mailbox without being bent over. Not surprisingly, I am better early in the day. By night, I still cannot hold myself upright. But, I am beginning to have more confidence that will come. And, I think that, as I gain strength, part of the challenge is going to be mental, not physical. I am so used now to walking bent over that it has become normal. I am going to have to remember to purposely hold myself upright, so that become normal again.

So, I am mentally in a much better place now than I was when I started this thread. I just have to keep on going, and I’m not a quitter, so that will happen. It has been so helpful reading this thread. Helps me remember that I’m not alone.

[NaturallyHappy]

Could you share exercises you do to stand upright? Thank you.

[Louise]

I would be glad to, but there are at least 15 different ones that I do, and some have multiple parts. It’s hard to explain them without the instruction sheets containing diagrams that I have and those sheets are created and distributed by the PT company that my therapist works for. I don’t think I would feel right passing them around as they are the creative property of that company.

[NaturallyHappy]

I understand. Can you share the company name (or pm me)? Perhaps if I called I could do a teleconference w them. I do see a PT (have seen many, actually) and they are not all created equal. Thank you!

[Louise]

It’s Latimore Physical Therapy, in Rochester, NY