a Good Physical Therapist
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
- 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:
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.
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.
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.
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
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.)
shoe arches for my flat feet. (Yoga ended up actually correcting 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
- 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
- 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