Clashing with the PT's methods & feeling stuck
 

In early September I injured my left leg going down a set of steps, landing my foot incorrectly and twisting my knee. Jump ahead 1 month - Primary care physician orders an x-ray and find arthritis in knee and calcium deposits on tendons, but nothing to explain pain and impaired mobility. Next, he orders an MRI. Insurance company will not pay for MRI until I've gone to physical therapy.

So, off I go to PT. PT is nice enough and seems to be knowledgeable, but I have no real background that would allow me to make an informed judgment. What I do know is that when he uses the Graston Technique to massage soft tissue in the region where the iliotibial band (ITB) gets close to the knee, I feel some immediate relief. However, two hours later the area becomes very painful and swells considerably. This condition can persist for two days before inflammation is reduced and pain subsides. During this time stairs are almost impossible, and even having my knee bent as far as it needs to be to drive my car is painful. He's also given me a series of stretching exercises and the ones that stretch the area around the ITB cause the same pain and swelling.

I'm maintaining that it doesn't make sense to do things that make the symptoms worse. He thinks his course of action if fine. So, yesterday he indicated that he would not write the report I'll need to get the MRI until I finish the full course of his "treatment plan." I'm telling him that I'm not doing anything that makes it worse. Now he's using the term "non-compliant with treatment plan" in his report to my primary care physician.

So, I'm feeling really stuck here. It's been almost three months of not being able to walk up stairs with any sense of comfort, an inability to drive more than 20 to 30 minutes, and many sleepless nights because of persistent pain. Today, I'm thinking of writing a detailed letter indicating my experience of this whole thing and sending a copy to him and my primary care physician. The gist of the letter, as I'm currently thinking about it, is that I want to move forward to get this resolved, but will not participate in activities that make the situation worse. So, we need to find some middle ground.

I'm pretty annoyed :notamused::notamused::notamused: by this, and not at all sure my plans are solid or just an emotional reaction. I'm open to suggestions and feedback.

PT is often about trading short term pain for long term improvement.

PT is also about communication, with therapist and patient working together toward the goal. The therapist has no way of know what the patient feels except by listening to the patient. Likewise the patient has no way of knowing what the therapist is looking for or expects except unless the therapist explains his thinking. Without good 2-way communication, decent PT is nearly impossible.

In your shoes, I'd go back to the physician with your issues, and him what he thinks, and if another therapist can be assigned to your case.

BTW- I would have gone back to the primary physician long before things came to a head.

Been there with an adversarial PT. You don't need this. No need for any drama or letters. Just ask your primary for another PT.

It is your legal and ethical right to participate in your health care. But, you also have responsibility.

I've been back to the primary care physician twice before we reached this point. I'm generally not someone who doesn't take responsibility for myself of is fearful of advocacy when needed.

Between when I first posted this and now, I've stumbled across several articles indicating that the use of massage, soft foam rollers, Graston Technique and other such treatments are not universally recognized as being helpful. In fact, there seems to be some controversy that boils down to one group thinking that to stretch something that is already over-stretched doesn't make sense and those who don't hold this view.

Your IT Band is Not the Enemy (But Maybe Your Foam Roller Is) | Breaking Muscle

DON'T Foam-Roll Your IT Band! | ASM Wellness

https://www.painscience.com/articles...me-stretch.php

I have been to many PT, and had good results with two. Go to a different one if you are not getting positive results.Pain is sometimes necessary after an injury, but it should be easily linked to positive results.

I am not a PT but am married to one....

I hear these stories every day.

Somewhere in the middle is the truth, usually.

Just because something causes you pain in your treatment, doesnt mean you should not do it. I assure you it wont get better if you always stop at any pain and swelling.

On the other hand maybe the therapist is not advising correctly.

My guess is you need to put more effort into following his advice until you can say you really have given it 100% and its not working.

Just an opinion and of course I dont see all the real facts.

My tolerance for pain is quite high. Dentistry work without an anesthetic and receiving sutures without anesthetic are routine for me. We're talking about debilitating pain that makes climbing stairs impossible, driving my car to work almost unbearable, and diminishes sleep a great deal. This is not normal "work your way through it" pain. I've followed his routine to the letter for several weeks to find myself much more functionally impaired than when I started. I've repeatedly tried to communicate with this guy; it seems, however, that he dismisses any comment that would put his plan into question. But, maybe the therapist is right and I'm just getting soft.

OK, enough of my venting. I've decided to send a letter to him and copy my primary care physician. It occurs to me, as I've thought about the responses, that I don't want someone else to have to go through the same experience with this guy. I don't think he's a nasty or bad person. I think he just needs to do a better job of listening and trusting that some people do know their own bodies fairly well.

Does that rank above or below playing one on TV? (answer neither required or desired)

I'd be all for finding a new PT that will listen to your concerns. I could not stick with a guy that won't take my feedback about something causing more pain than it is relieving. I have had numerous PT cycles over the years and found most to be helpful. This therapist seems to not want your input from what you say in your posts. Your planned course sounds best to me, I'd also copy the insurance carrier so your side doesn't buried in the pile.

Good luck with getting some resolution, and some relief for the knee.

Bill

Wow, is this ever the runaround! All you want is a diagnosis and those who are supposed to be treating you are making it impossible for you to get one. There can be no successful treatment without diagnosis! So without a diagnosis, what the heck is the PT treating you for? They should be doing exploratory therapy, looking at pain and range of motion, range of non-painful exertion, all the sort of stuff that might enable a tentative diagnosis and create a temporary treatment plan.
From the wiki:
Sounds to me like an unscrupulous practitioner has got hold of you and wants your money or that of your insurance company. Doesn't sound at all like the treatment you probably require. You've probably torn something loose and this guy's fooling with it is making it much worse.

If you can't get anywhere with your doctor, there are boards of medical supervisors . . .

This whole situation is totally unacceptable and unconscionable. This injury occurred in early September and you're now in severe pain and barely able to walk down a staircase and you still don't have a diagnosis?

Forget the PT issue ... your primary care physician needs to help you resolve the MRI issue with the insurance company immediately. Depending on what you've done to your knee, you could be making the situation worse just by walking on it. You need to get a diagnosis ... now!

+1

Let's see ... lets try to solve the problem before we know what it is. Yea ... that makes sense. :notamused:

At a minimum, your relationship with your PT is compromised. You need a second opinion about the course of treatment/therapy.

I'll just add my voice to the crowd. If you didn't like your doctor, we'd tell you to find another; well switching PTs is much simpler than switching doctors. Ask your doc for another recommendation.

I would say just pay for the MRI out of pocket. The added cost is small compared to getting your health and biking back.

Charlie

No way to get a different PT?

I've had to go the PT route 3 times--2 of which got the MRI authorized. First time in 2000 where I herniated the L4/L5 disc and went through 6 months of hell before the MRI approval--results, a lumbar laminectomy. 2nd time around 2012 or so but PT did the trick this time. 3rd time, around mid 2013, I went through the PT and then got the MRI authorized. The MRI was hell--something about the position and being there for so long was just a nightmare, but I ended up with an injection which has worked ever since.

I have fired doctors and therapists before -------------- get ones you like, and do their job!

Sounds like a bad PT person. I am going through some PT right now for some back pain and my PT person was very clear that some discomfort while doing the exercises or stretches is OK and normal, but increased pain is not.

Hope you are able to get this resolved and get on with getting better.

I don't think my PT has a high opinion of these techniques. He told me it amounted to taking a traumatized area and traumatizing it even more. ITB issues also tend to defy therapy.

Insurance companies shouldnt dictate diagnostics, but we all know that.

When something doesn't seem to make logical sense to you, follow the money.

Of course the PT guy wants you to follow the full course of his treatment plan. He gets paid by the procedure. I'd go back to the physician to either work out an alternate plan or to obtain an explanation of how the current plan is supposed to work.

Update.

I did send a letter to PT indicating what I thought was taking place & how the current treatment was causing more damage. He called yesterday & apologized say he understood my perspective and that it could be spot on, but until we have the MRI ther is no way to know. So, he'll recommend the MRI as the next step in his report to my primary car physician. This, hopefully, will be what the insurance company needs to authorize it. I must say this situation has really forced me to learn much more about my own body. Sixteen hours of research & reading has helped me realize I do not have to be ignorant about the most important thing in my cycling - my own body.

How come you are not going to an orthopedic doc?Hope things work out.