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Finding a Good Physical Therapist

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I've been to a number of physical therapists (PTs) for my fibromyalgia, repetitive stress injuries, scoliosis, creaky knees, kyphosis, TMJ, sciatica and various other orthopedic problems. Most of the therapists made me worse, yet one group of PTs that my children and I went to played a major role in helping us end our pain problems and live normal lives.

I think finding a good PT is like finding a good artist. Not everyone who goes to art school becomes a great artist, and based on my experience, not everyone with a degree in physical therapy is really good at what they do. The trick is finding the good ones. So all you can do is ask around for references and try different therapists until you find one that is able to help you.

If a PT is not helping you after the initial session, in my experience it is time to cut your losses and move on to someone else right away. If they don't give you some constructive advice from day one, I doubt it will ever happen. They either know how to treat people with your type of condition or they don't. If they don't, it is best not to be their guinea pig.

The physical therapists who ended up helping my family:

  • Spent a lot of time evaluating our posture and body alignment.

  • Watched us walk and gave us exercises to correct our gait.

  • Evaluated our movements to see if the right muscles were being activated at the right times. For example, my shoulders were overly tight, so more muscles were being engaged when I lifted my arms than should have been. That was because the areas around my shoulder joints were very tight, compressed and moving as a solid unit instead exhibiting the normal range of shoulder joint motion.

  • Gave us foam back rollers, therapy balls and massage tools to use at home.

  • Spent most of our PT sessions evaluating our alignment and then giving us specific, individualized exercises we could do at home.

  • Gave us exercises and stretches that did not hurt.

  • Never asked us to "work through the pain".

  • Focused on body alignment and gentle stretching more than strengthening exercises.

  • Spent time asking us about our PC and school work stations and helped us to set them up for improved ergonomics.

  • Gave us lumbar cushions and instructions on how to use them to improve our posture for school work, PC work and driving.

  • Understood trigger pints and how to deactivate them.

The physical therapists that made me worse:

  • Gave me exercises that hurt and then told me to "work through the pain". I have absolutely never, ever had anyone with this type of advice help me in any way. PTs who told me this always made me worse. Pain is your body's way of getting you to stop doing things that are bad for you. They just told me to work through the pain because they were at a loss to suggest anything better.

    The worst physical therapists I went to were the ones that gave me standard back strengthening exercises when my back hurt. I did the exercises faithfully even though they hurt, thinking that over time I would eventually see improvement. But over time I actually had trouble even getting out of bed. I only started to recover when I realized their exercises were what was making me so sore and I stopped doing them completely.

  • Insisted I do strength training exercises when I was in so much pain it hurt just to move, let alone lift weights and work with resistance bands. A good physical therapist will work on getting tight muscles relaxed first, and will not ask you to do anything painful.

  • Spent a lot of time on muscle massages, often stretching and massaging the areas that hurt that when those were the areas that were already weak and stretched out, and ignored the overly tight areas of my body that didn't hurt but were actually the sources of my pain.

  • Focused on only one part of my body instead of looking at my posture and muscle alignment as a whole. At one point I went to a hand clinic for repetitive strain injuries. My hands did get better from all of their stretching exercises, but then I developed all sorts of odd knee and ankle injuries.

    Instead of solving my pain issues, the PTs at the hand clinic had just transferred the tension points from my upper body to my lower body. I know now that the concept that a therapist can help your hands, arms and neck without checking your feet is like an engineer trying to fix a sagging two story building without looking at the foundation. In most cases, it simply isn't going to work. The engineer knows to always look at the foundation, because even though that may not be where the sag is most apparent, that is most likely where the actual cause of the structural defects first begin to occur.

  • Taped my knees. Taping just wasted my time and irritated my skin. (Yoga postures are what actually brought my knees back into the right position. My knees were out of alignment because my muscles were pulling them off center. Taping them into place did nothing to correct the underlying cause, took a lot of time each day and gave me red, irritated skin.)

  • Gave me shoe arches for my flat feet. (Yoga ended up actually correcting my flat feet.)

  • Iced my knees. (For me, ice only helped to calm down irritated nerves in when my arm with the TOS (thoracic outlet syndrome) would go numb. Otherwise, icing always made me worse since the coldness causes muscles to tighten.)

  • Ignored my numerous posture problems.

  • Thought it was perfectly normal for my body to start making creaky and crunching sounds because of their exercises. One of my therapists said that was common "among all of his patients". Well, those creaking and crunching sounds are not normal. With me they were caused by ligaments, bones, joints and other body parts being overly tight, compressing and rubbing together where they should not be rubbing.

    When a bike starts to make weird noises it usually means something is rubbing on one of the wheels or gears, and I think the same thing happens with the human body. If your car starts making weird sounds, you know that there is something wrong and need to have it checked out by a mechanic. It is unfortunate that there are not more people who understand what it means when a human body starts to make weird creaking and cracking noises.

  • Used a lot of generic or "canned" routines they learned in college, instead of developing individualized exercises based on my specific body alignment problems.

  • Used up the clock by spending a lot of my session time on filler type activities like heat packs, massages from low paid PT assistants, etc. - basically anything that didn't require their personal time. That way they could bill insurance companies for two or three patients at a time, instead of spending a lot of one on one time with each individual patient.

    Some heat pack time is okay because heat does loosen up your muscles and makes it easier to do exercises. However, you (or your insurance company) shouldn't be paying to have you sit under heat packs for 50 minutes followed by a 10 minute session with the PT. The majority of your therapy session should be one on one time with your therapist evaluating your issues and teaching you exercises and home therapies you can learn to do for yourself.

If you live in California, the addresses of the physical therapists at Optimal Performance, the ones who helped my family, are in my contact page. I found them from a referral from a neighbor and also they were recommended by members a local chapter of a repetitive stress injury group that I found on the Internet.

It is interesting to note that some of the PTs and other health professionals that I went to that were supposed to be experts in their field, at least according to their peers and resumes, were actually the ones that harmed me the most. It just shows that people can often build themselves up with a certain reputation through marketing skill rather than actual expertise at what they do. So beware, just because someone develops a reputation as a TMJ or neck pain specialist may not really mean anything other than they understand how to market themselves well.

 
 

 

Related Pages

How do I find a holistic doctor?

How effective is physical therapy for scoliosis?

Related sections of interest:

Natural Treatments for Fibromyalgia

My Personal Causes of Neck Pain

Thoracic Outlet Syndrome Defined

What Causes TMJ?

Finding a Good Physical Therapist

 

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