Physical Therapy expectations

[DebBrown]

I've never had physical therapy before so I'm unclear on how much pain and discomfort I'm supposed to put up with to achieve results.

Backstory: In January I broke my wrist ice trekking in Patagonia. When I returned home, I had surgery and now have a t-shaped metal plate in my arm. The recovery has gone well and I've regained most use of my hand but not full range of motion and my thumb is causing a problem with fine motor skills, ie handwriting, using scissors, buttoning, typing. Because I regularly use my hand, I generally have been living with some degree of pain/soreness all the time.

Therapy: I went on Friday and was put through a variety of exercises. I could do it all but knew I'd be sore afterwards. By the time I got home, I was wiped out and took a nap. Even after the nap, I was in enough pain to keep me in tears and nauseous until bedtime.

So... how much is too much? Is this par for PT? Or do I need to back off?

Of course, I want a full recovery but feel like normal use and some stretching could get me there without the pain. I could be wrong.

Deb

 

[chellej]

I had shoulder surgery 18 months ago and the physical therapy was tough. You need to not push too hard. A little soreness afterwards was ok and expected. There were several times when the therapist overstreched and I had to miss the next couple of appointments. It was like one step forward then 2 steps back. I had to learn when to tell him it was enough. Are they putting heat or anything afterwards?

 

[DebBrown]

They use electrical stimulation and ice afterwards but it did little to help on Friday.

Perhaps I am too anxious to please. I want to do all the exercises but I should have known it would be too much.

Sorry to hear about your shoulder. I hope you are all healed up by now.

Deb

 

[Sandi Bo]

So sorry to hear of your injury and your frustration with rehab.

I am no expert, I'll just give you my opinion. My Dad had a stroke last fall and has been in rehab since that time. My take away from all of it, is to trust your instincts. I have seen them not push my Dad enough, and I have seen them push too much. They've pushed so far at some points that he had to take a few days off.

I am a huge fan of hydro-therapy. I just don't see how you can hurt yourself in the water. BTW, my Dad was at an amazing facility (in-patient and out-patient) in Nebraska and is now in out-patient treatment in Florida -- I have yet to convince anyone to put him in hydro-therapy. I took him myself and am still convinced it's the best therapy by far (he was grape-vining in the current pool with a huge smile on his face).

Good luck, I hope your recovery goes well.

 

[MommaBear]

Talk to your hand surgeon! There are times that there is scar tissue that needs to be stretched and there is no way around the pain, but your pain level seems to have been excessive even knowing that sometimes PT hurts. Maybe you could pre-medicate, pre-ice- there are lots of variables and your doctor and your PT are the best to know what is right in your case. I personally wouldn't go in for more therapy until I had an answer about the pain.

Sometimes increased pain is a warning.

I had a patient yesterday who was in a lot of pain after a simple frature that had been casted. She called for more pain meds, the doc was concerned so had her in for additional xrays, and she had actually extended her fracture. When she called for the pain meds she did not mention the three falls she had taken SINCE the break. In her particular case, she now needed surgery.

 

[itchyfeet]

I'm recovering from an arm fracture (should have known I'm too mature to ride a Segway!) It has been a long haul -- surgery in Orlando with plate & screws; 2nd surgery in Sacramento with new plate, rod & bone graft. X-rays show fracture is healed. My PT's philosophy is that during treatment & home exercise I should have no increase in pain. If it hurts, she changes what she is doing. She also uses ice & electric stim, which seems to help for about two hours after treatment. However, I'm also in pain day and night. I have a dr. appt. next week so will discuss this with him. Maybe we just have to learn to live with the pain?

 

[DebBrown]

itchy, how long ago was your fracture? I'm dismayed to read that you had to have a second surgery! I'm not too crazy about the idea of living with the pain. Six weeks has been enough and maybe why my threshold is getting lower.

mommabear, I agree with stretching the scar tissue. I actually don't mind stretching. (I'm a big yoga fan.) I work on my superficial scar and thumb all the time.

I go back to PT next Wedneday and I will start the visit with a chat about pain. I have decided that while PT may help, I'm not willing to torture myself.

Deb

 

[itchyfeet]

The first surgery was in February 2011. Second surgery in Sacto. was June of 2011 because the fracture (close to elbow) was not healing properly plus the screws from the first surgery had come loose. Ortho. dr. did mention at last appt. that maybe the plate needs to come out but this won't be decided until one year after surgery.

 

[TSchmidt]

Deb,

I broke my wrist in July 2007 when I was 62. Mine was a right distal radial fracture. I have lots of pins, but do not have the metal "t" that you have. Perhaps yours was a different type of fracture. I also did not have the pain you are experiencing after therapy. I remember that some of the stretches that the pt did were very painful, but didn't experience the pain you are having after the sessions.

Are you taking and advil prior to your sessions? I was advised to do that. I probably took some afterwards as well. I did not ice my wrist, but I did have the electric stim which I did not like. Sometimes I left early to avoid that. I couldn't see how that would help.

Is your wrist hurting before you had pt? I don't remember having any pain after the first few weeks after surgery.

I have regained all of my strength and range of motion - perhaps very slight less range of motion. I am not hampered in anything that I do. I do have a spot on the palm of my hand that is what I call hypersensitive when I run my finger across it. That will probably never change. But I am able to type, button things, cut things etc. without any problem.

I remember that I used my left hand a lot in the beginning to open jars, milk cartons, cans, etc because my strength to do those things with my right hand was not as strong. But my right hand has strengthened since then and I have no problems whatsoever.

I hope your recovery will be as successful as mine has been. The stretching is very important. I would sit while watching television and stretch, stretch, stretch.

Good luck with your recovery!

Tamara

 

[pittle]

Sorry to hear about your accident and broken wrist. Back in 2000, I slipped on ice and broke my elbow. After surgery with several screws and pins, I also had PT. I always told the gal that it was short for Physical Torture. I saved my pain pills for when I got home. When they ran out, I would take 4 Advil an hour before I went to therapy (my doctor said that was OK). After several months, my elbow was as good as new. So the old "No pain, no gain" saying worked for me. Hang in there, but talk to the therapist and your doctor.

 

[Pat H]

How do you feel today? Are the aches and pains significantly less? If yes, then most of the pain is probably from lack of use and strecthing. If it's the same, then you definitely need to speak with the therapist.

 

[BevL]

This is quite interesting. I've only had physio once, same person both times. Both times I came away that it was a total waste of time becuase they would basically do a TENS thing with a machine, one short set of exercises and that will be $50 please. I really felt that there should have been a series of exercises.

After about three and a half weeks I stopped going.

This is for a chronic rotator cuff problem. It's not something that is going to really heal, it's more management. So I googled some exercises that seem to be at least keeping it managable. Maybe I should give a different physio a try, it might get better.

 

[DebBrown]

How do you feel today? Are the aches and pains significantly less? If yes, then most of the pain is probably from lack of use and strecthing. If it's the same, then you definitely need to speak with the therapist.

It's better today. I'm sure you are right. The stretching and repetitive motion of the exercise is the cause of the pain. I used to not be able to type or write without pain but now can work for much longer periods. I don't doubt that the exercises are helpful. I do doubt that they need be so extreme.

I appreciate everyone sharing. It seems people's experiences are all over the board.

Deb

 

[bogey21]

I am a huge fan of hydro-therapy. I just don't see how you can hurt yourself in the water.

I am also a big fan of hydro-therapy. If I ever need physical therapy again, I will insist on hydro-therapy if at all practical.

George

 

[Kaelyn]

scarring

Fair disclosure, This post is less about this specific case and more about PT in general. I'm a medical and orthopedic massage therapist, and have been for 27 years. Spent my first 5 years with an orthopedic surgeon in Atlanta doing hip, knee & ankle injury & surgical work. Hold licenses in NC & CA, and sat for the Nat. Cert. for Medical Massage while it was still available.

Lets start with a couple of facts about healing. Your body will put down new tissue in a big hurry, and not always in a particularly organized fashion, which often results in adhesions and scarring. This has to be corrected. It's not always comfortable. That being said, there are ways to reduce the discomfort, and there are levels of pain you should not go beyond. Doing so risks further injury.

As for PT. Well, PT is designed to work with gross motor movement, OT (occupational therapy) is designed to re-hab for fine motor control, which if your hands are involved, you probably need. Another fun fact, PT & OT don't work well when everything is stuck together, it hurts, and you don't make much progress. This is why they use things like ultrasound to break all that up. But if they're not doing tissue remodeling or neuro-muscular re-education, it's less effective. Things need to move properly for you to gain strength & control.

So, how much pain should you be expected to "take"? You do need to push a few boundaries, but there should be no need to take advil BEFORE the session. In fact, your pain processing can be dulled, and you could push too far and do damage. I don't advise this. If you rate pain on a 1-10 scale, with 1=faint headache you wouldn't take tylenol for, and 10 being tears, a 5 is about where you would start to involuntarily hold your breath. Your therapist may ask you to breathe through this, but you shouldn't really be going over it for more than a few seconds. Every patient is a little different, but your therapist needs to respect your pain tolerances. You need to do the homework they assign. Most PTs do very little massage, but quality massage performed by a well trained therapist can really speed up your re-hab, and significantly reduce your pain. Most of all you need to listen to your body, if you need to slow down, slow down. I've watched PTs try to re-hab a shoulder surgery on a mid-40s sedentary woman the same way they would do it for a 25 year old semi-pro ball player. Failing to adjust the therapy to the age & condition of the patient is a recipe for disaster. If your PT is not listening to you, or seems to disregard your concerns, do not be afraid to ask for someone different. YOU are the one who has to live in your body, if they damage you, it doesn't really affect them, it affects you.

Lest you think I'm too hard on PTs, I'll tell you this, in every licensed profession, you have the Good, the Bad, and the Ugly. Sadly, I've found that about 30% (in all licensed professions, including my own) have no business practicing, and they give the rest of us a terrible name. It's your body, and you have the ultimate right to determine who you will or will not work with.

Good luck

 

[Kaelyn]

Has the pain stopped, and where is it? If it's in the front of the shoulder, about level with the lowest part of your collarbone, you should know that the shoulder is the second least stable joint in your entire body, and it's not uncommon at all for it to be very slightly dislocated in the forward direction. We're talking 1/16 of an inch, which will not show up on an X-ray or MRI. You doc will call it "normal human variance". 1/16" doesn't sound like much, but it can make your life a misery. A really good quality chiropractor or honest-to-god ADJUSTING osteopath can fix it. Takes a few seconds and is rarely painful. The doc can palpate directly for it at the medical head of the bicipital groove. If the "bad" side feels "pointier" than the other side, there is a good chance it's out of whack. Thanks to a little lip on the back of the cup of the scapula, it cannot be adjusted too far back, so if you still have pain in the front of your shoulder, get it checked out.

 

[Kaelyn]

scarring

Fair disclosure, This post is less about this specific case and more about PT in general. I'm a medical and orthopedic massage therapist, and have been for 27 years. Spent my first 5 years with an orthopedic surgeon in Atlanta doing hip, knee & ankle injury & surgical work. Hold licenses in NC & CA, and sat for the Nat. Cert. for Medical Massage while it was still available.

Lets start with a couple of facts about healing. Your body will put down new tissue in a big hurry, and not always in a particularly organized fashion, which often results in adhesions and scarring. This has to be corrected. It's not always comfortable. That being said, there are ways to reduce the discomfort, and there are levels of pain you should not go beyond. Doing so risks further injury.

As for PT. Well, PT is designed to work with gross motor movement, OT (occupational therapy) is designed to re-hab for fine motor control, which if your hands are involved, you probably need. Another fun fact, PT & OT don't work well when everything is stuck together, it hurts, and you don't make much progress. This is why they use things like ultrasound to break all that up. But if they're not doing tissue remodeling or neuro-muscular re-education, it's less effective. Things need to move properly for you to gain strength & control.

So, how much pain should you be expected to "take"? You do need to push a few boundaries, but there should be no need to take advil BEFORE the session. In fact, your pain processing can be dulled, and you could push too far and do damage. I don't advise this. If you rate pain on a 1-10 scale, with 1=faint headache you wouldn't take tylenol for, and 10 being tears, a 5 is about where you would start to involuntarily hold your breath. Your therapist may ask you to breathe through this, but you shouldn't really be going over it for more than a few seconds. Every patient is a little different, but your therapist needs to respect your pain tolerances. You need to do the homework they assign. Most PTs do very little massage, but quality massage performed by a well trained therapist can really speed up your re-hab, and significantly reduce your pain. Most of all you need to listen to your body, if you need to slow down, slow down. I've watched PTs try to re-hab a shoulder surgery on a mid-40s sedentary woman the same way they would do it for a 25 year old semi-pro ball player. Failing to adjust the therapy to the age & condition of the patient is a recipe for disaster. If your PT is not listening to you, or seems to disregard your concerns, do not be afraid to ask for someone different. YOU are the one who has to live in your body, if they damage you, it doesn't really affect them, it affects you.

Lest you think I'm too hard on PTs, I'll tell you this, in every licensed profession, you have the Good, the Bad, and the Ugly. Sadly, I've found that about 30% (in all licensed professions, including my own) have no business practicing, and they give the rest of us a terrible name. It's your body, and you have the ultimate right to determine who you will or will not work with.

Good luck