Physical Therapist Problems WWSDs Do?

[Babette]

I have a male PT working on my knee (post knee replacement). He's very interested in physically pushing my knee to increase range of motion. (I like on my back and pull my heel as close to my rear as possible.) I am 6 degrees short of where he wants me to be. At first he said, "You get there yourself and I won't push you." He upped the ante recently and when I told him I was very aware of my pain limits and how much *I* was able to push beyond them, he suggested I "ask my husband to push my knee." Dh said "No way. I won't hurt you."

Went back yesterday and told him that while I think he's a good PT and that I like working with him, I have decided that he will not be pushing my knee." He was sort of OK with it, but couldn't resist saying "Well, if you don't get to full range of motion, it's on you. And I'll tell your doctor."

What would you do?

 

[geargrrl]

I would get a second opinion. I don't know about your town, but we have 100s of PTs in our area. Having a PHD-PT program in town does that. So, lots to choose from.

That being said, I worked really hard on my ACL rehab, which was really a drag at times: painful and tedious. I was released to ski without a brace, and I know it is because I pushed through the hard parts, and did everything even when I didn't want to. Sometimes the only way to break up scar tissue IS to push through the pain and ice afterwards. Not having a full range of motion can cause all sorts of future problems with gait, alignment, muscle balance. I have one good friend whose knee would not respond to ROM beyond a certain point. The surgeon had to "force" as in manually apply pressure, until the adhesions ripped apart. She said it was horrible --- but she finally got her full ROM back.

Maybe some different ROM exercises? There is not one way to regain full flexion. I did a lot of heel slides with a strap, socks and a hard wood floor. There is kneeling on a foam pad and making sure you (finally)get both butt cheeks on your heels, balanced. There are ways to gain degrees of extension using a crutch to push against. Pain is just pain, it won't hurt you. Ice and Ibuprofen afterwards.

6 degrees is quite a bit so I would definitley do some research.

It is very common for PT to communicate with the surgeon. My PT did a report every 6 weeks or so.

 

[Little Lightning]

When I tore my ACL and had ROM issues my PT had me foam roll my quad muscle. That helped to loosen the muscles. If not foam rolling maybe a massage therapist could help.

I too worked very hard on recovery. Started easy spinning on my bike a week after surgery. Was outdoors riding by early May, was released by the Dr. in early June. Did 3 week long bike tours that summer and was back on skis in Nov. Surgery was early March. Never used a brace.

My Dr. gave me his protocol of where he expected his patients to be by a given time. It helped a lot with understanding my progress. BTW, at the time I was age 57.

 

[geargrrl]

My post in no way is intended to imply that Babette is not working hard on recovery. Expectations and results can vary for sure.

 

[Babette]

I work very hard in PT and sweat bullets . I have a history and the mindset of an athlete: figure skater when young, advanced skier, swimmer in adulthood but I draw the line at someone else manipulating my knee when I know I'm going past my pain threshold myself. My gut tells me that pain beyond THAT pain could lead to damage ... more inflammation, etc. I could be wrong.

 

[geargrrl]

Definitely seek a second opinion then!! Absolutely nothing wrong with that. what does your surgeon say?

 

[Babette]

I have an appointment with my surgeon in mid-October but he's a prima donna. He has his PAs and NPs return all calls, manage Rxs, referrals, and offer advice. I'll need to call the office and tell them I need a call from HIM.

 

[marzNC]

I have an appointment with my surgeon in mid-October but he's a prima donna. He has his PAs and NPs return all calls, manage Rxs, referrals, and offer advice. I'll need to call the office and tell them I need a call from HIM.

A good PA can be helpful to talk with. My followup appts with my thyroid specialist are with his PA. He talks a lot slower than the doctor. Also follows up on labs and any online questions very promptly. I like the doctor but don't feel the need to see him more than once a year.

For my knee injury, my first appt at the ortho office was with a PA. Found out everything I needed to know. After the MRI, I had an appt with the surgeon but that was three weeks later. In the mean time, the PA and PT were taking care of what I needed to know or do.

 

[Babette]

That's a really good point, marzNC. I've often found that both NPs and PAs are treasure troves; they spend more time in the trenches.

 

[2ski2moro]

Go with your gut feelings on this one. After I fractured my fibula at age 50-ish, my ankle was stiff from being in the cast for 8 weeks. The PT was a little too aggressive with the pushing to get range of motion. I wound up back on crutches for two weeks from the pain. The doctor said that the PT was known for working with high school and college athletes, but maybe was too aggressive for me. I went to another PT and it worked out well for me.

You know your body better than anyone. Go with your feelings, but get ready for skiing. I want to ski with you this year!

 

[Babette]

I want to ski with you, too! I remain as determined as ever, but I need a PT who's really positive and not threatening. Fortunately, I don't need a referral from my surgeon. I can go anywhere. So while I've kept my appointments with my current therapist through mid-October, I'm going to visit a couple of other practices on my off-days.

Thanks for the validation!