Physical Therapy and a few random Q's

[MarkH]

My first physical therapy session/evaluation appointment post ADR surgery was this morning and I wanted to post my experience, get some opinions, and ask some questions. Surgery was on 3/29, PT on 4/14.

My evaluation consisted of:

10 minute talk with PT, he inquired what the surgery was, and where pain was located.

5 minutes of physical evaluation and manipulation by PT.

15 minutes wired up to a tens unit and heating pad, wired up by assistant.

10 minutes getting ultrasound on back only at S1-L5, performed by assistant.

10 minutes of physical manipulation by PT, including discussion of exercises to perform, and performing exercises.

10 minutes on treadmill.

My questions:
Is this standard? Is there anything additional that I should be expecting or asking for?

Despite stressing pain in right leg and foot, no attention was given to it.

No ultrasound at incision. Perhaps it's too fresh?

No charts, labs, mris, x-rays, were present, I don't think he had a clue of my medical history, or had bothered to read paperwork PT office had me fill out.
This is the PT facility recommended by my doctor, and is located within the same building, I was honestly shocked that they didn't appear to have access to my images, and hadn't asked me to bring them.

The physical manipulation was pretty intense, including yanking quite hard on my left leg when an assistant held my right in place, is this safe this soon after the surgery?

While I have had other physical therapy for the back, this is the first post-surgical. I'm not sure if my expectations were too high.

Thanks,
MarkH

[annapurna]

Sorry to say, this is standard for PT here. After a number of surgeries and recoveries, I finally found a PT that would agree that I could do all my own exercises and my own ice and stim (we owned a TENS unit) and would focus on the stuff only the PT could do for me. Most PTs insisted on having me go the same useless route on every visit. That's why we now own our own NEMS (next thing up from the TENS) and ultrasonic unit, look up the appropriate exercises on the web and try to communicate directly with the surgeons if something odd happens. Visits to PTs only happen if we need guidance over some detail thaty we can't glean on our own. I'm not saying that this works for everyone am I'm also sure that there are good PTs, just not as many as there are bad PTs.

[MarkH]

Thanks very much for the information. I'm hopeful that my first non-evaluation appointment goes better. If not I'll shop around. I know of two other PT's in the area with good reputations, but assumed that the one the surgeon recommended would have some useful insight.

[Hooch]

This is garbage PT, you need to be working on core activation, body awareness and proprioception as a long term goal.

This TENS, heat pad stuff is just a money turner as they can walk into the next patient while your on the machine. It achieves nothing, you can use heat at home if you find it helpful. Unless the physio was monitoring your gait as you were on the treadmill, I suspect you would be better off not paying someone an hourly rate so you can walk...

What are you 2 weeks out from surgery? And you're letting yourself get chiro style manipulations? My advice is to walk away and educate yourself, at the very least you wont hurt yourself walking.

Have a read of this

http://www.physiomax.com.au/downloads/InTouch3_06.pdf

[Cirobi]

Edit: I think you may have beaten me to it on the signature. Oops! Disregard that part below. Hope the rest of the feedback helps though.

MarkH,

You need a signature that tells us a little about your overall situation. It's not fair to you to get advice that may not pertain to your situation (levels worked on, degeneration? other issues at other levels? etc). I would imagine whether or not your PT session was good or not will be highly dependent on your overall situation.

For me, post-op, my evaluation session was nearly zero actual physical therapy work and mostly filling out papers, being examined by the therapist, answering a lot of questions (actually went through my whole spinal story for the umpteenth time, haha) and only a couple of very basic movement things. It was designed this way so the therapist could get a clear understanding of my situation instead of dumping me into a pre-planned routine.

The question I'd have for you, did you select a therapist who was well versed in spine issues?

I was fortunate enough to speak to a couple therapists before deciding where to do my post-op therapy and one of the first questions I asked any therapy office was whether or not they had a therapist who had extensive experience with spinal patients. You'd be surprised how many don't. I actually had one therapy place flat out tell me that they had someone with a little experience but if I was looking for someone well versed, their location was not for me.

My real PT sessions consisted of quite a bit of exercises. I started off getting warmed up on the treadmill. Everything else was mixed up from appointment to appointment so as to not risk muscle memory issues hindering progress. I did numerous core stabilization drills standing on one or two feet, sat on a large ball and did some light weights (a couple lbs max), did some weight machines (low weight - leg presses mostly), some resistance band work, a lot of light weight/body weight drills laying on a table, light stretching with some ice afterward.

I would hope that everyone's PT routine would turn out a little different with maybe some basic similarities mostly because each of us is so different even if our maladies are similar. I would not get spooked by a single session, especially one labeled as an evaluation. A good therapist will either be personally or through their assistants keeping an eye on and evaluating your progress. An initial evaluation session just gives them a framework from which to build your actual therapy sessions. I'm not sure what to use as a description for a bad therapist as I was blessed to find a phenomenal one the first time around. I still have the exercise sheets from those sessions and refer to them regularly even though I'm pretty far beyond that point. They're still useful for those sort of off days.

~Sara

[MarkH]

Thanks for the replies Hooch and Sara.

I attended Fridays actual appointment and wasn't anymore impressed than I was with the eval. Again it consisted of 10 minutes with NEMS and heating pad. 10 minutes with ultrasound and assistant. A 10 minute period of discussion with the PT during which we talked about pain levels and he checked my alignment of legs, hips, etc. An assistant then told me to do my exercises for 10 minutes and left the room... most of my exercises used the partial exercise ball seat which wasn't in the room. 10 minutes with the PT out on the floor where the actual equipment for the exercise was located but he honestly seemed bored, he'd correct my posture or technique a few times, but mostly looked out the window. I again brought up the distraction pain in the right leg and he was again resistant to do anything for it. He then wanted to place me for 10 minutes on the treadmill unsupervised to end the appointment. I went ahead and canceled Monday's session at the conclusion of the meeting.

I probably should have made this decision after the evaluation, but I was hesitant for a few reasons. I thought that as my surgeons recommend PT location they would be amazing. They had a 7am time slot which is rare and would let me get sessions in during my normal work day. I assumed that the evaluation would wouldn't be a fair way to judge and that I should attend an actual session.

I took my information to two other Physical Therapists on Friday:

Option 1. Excellent physical therapist who I've used in the past. No gimmicks, exercise, strength symmetry, and conditioning are pretty much all he relies on. My only real worry is he's pretty hardcore, I left his sessions feeling wiped out when I went two years ago for back pain. His conditioning and workouts are what allowed me to make it two more years though before choosing surgery. I think he's worked with ADR recipients before, he did see my full medical history, and seemed confident. I hope he can chose a starting pace that it safe for recovery. He is also part of a large spine center, and easy guess I'll have 1 to 2 other people in my block. He generally has 1 assistant per patient, and everything is done in one large open room.

Option 2. Physical therapist that I've only heard recommendations for, never actually worked with. She has an excellent reputation, and I talk to her on occasion when swimming laps. Her approach is the closest to 1 on 1 that I've heard of and she seems very knowledgeable. Unfortunately she will be out for two weeks on vacation. On the bright-side, her absence made my decision easy.

I have an evaluation booked with Option 1 this Monday and will let you know how it goes. I'll print out that article Hooch and bring it with me.

Thanks again for the advice and responses,
MarkH

[Hooch]

Sounds like a plan

If you want to do it proper you need a physio who understands this and will take you through it

Resources - Exercise Practice - Lumbopelvic Core Muscle Training - Diane Lee & Associates - Consultants in Physiotherapy

Good luck

[Harrison]

Sara, your comments are eloquent and insightful as usual. I love this nugget:

"...I would hope that everyone's PT routine would turn out a little different with maybe some basic similarities mostly because each of us is so different even if our maladies are similar. I would not get spooked by a single session, especially one labeled as an evaluation. A good therapist will either be personally or through their assistants keeping an eye on and evaluating your progress. An initial evaluation session just gives them a framework from which to build your actual therapy sessions..."

Hooch, cool reference -- I'll check out the PDF(s) from Dianne tomorrow, it looks well done. Mark, good luck with your visit on Monday and thx for thinking of sharing...it helps more people than you know!

[Cirobi]

MarkH,

Sounds like you're on your way to getting the right PT care. Even if that guy is hardcore, it's better than just floundering with someone who's not going to help you take care of that repaired spine of yours. Besides, it sounds like he has a better grasp of your particular situation and can better tailor your sessions accordingly.

I recall being tired after my PT sessions as well post-op, but then again, after staying home for so many weeks on medical leave, anything short of driving to the grocery store wore me out! Haha.

~Sara

[MarkH]

My evaluation with the Option 1 Physical Therapist was great. I feel incredibly relieved after talking with him. Spent about an hour and a half one on one. I'll post in more detail tomorrow, but this change has made me feel like I have significantly more direction in my recovery.