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Posts Tagged ‘PT’

Previously in this blog I have chronicled my experiences with physical therapy and physical therapists.  I recently had a radial tear of the anterior horn of the lateral meniscus in my knee, along with a leaking popliteal cyst.  I started physiotherapy about 10 days post-injury, and I managed to stick with it for 6 sessions not counting my initial evaluation.  Each visit resulted in  a $40 co-pay, which is the same co-pay as a visit to my orthopedist or a surgeon or some other specialist, which means if I had continued on for six weeks at two visits per week, as prescribed, it would have cost $480.  That’s a lot for someone to watch you exercise, but more to the point, the system is broken.  Insurance companies treat PT as a specialist consultation, but therapists treat it as a long-term relationship  of weeks or months,  and that disconnect isn’t helpful to patients.  If a patient isn’t motivated or able to do their rehabilitation exercises at home, then an appropriate treatment plan may legitimately require biweekly therapist visits for 6 or eight weeks.  Insurance should treat it as one visit. With one co-pay.   For me, 6 weeks of therapy is never going to happen.  I show up for an eval, with the goal of getting back to my activity as soon as possible.  I want to minimize my visits and get the most benefit in the shortest period of time, and if my injury is chronic, I want to know why I’m injured and how I can prevent it.  But typically, I’m given a treatment that is gradual and incremental in nature, and predicated on the idea that I’m going to keep coming back until I am “discharged”,  giving the therapist constant feedback on how I feel after each treatment.  That’s unrealistic, and taxes my patience.

I believe that exercise is very beneficial in most injuries, and I welcome an expert prescribing a rehabilitation plan for me.  But, give it to me up front, let me do it at home, chart my progress on-line, and come back in a few weeks for a re-eval.  In fact, depending on the injury, it seems to me that four visits spread over 8 weeks could be more valuable than the same 4 visits crammed into the first two weeks, especially if the patient never comes back after the two weeks are over.   I wonder if anyone has done a study about that?

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It’s week three post-procedure .  At week two,  I had my follow-up visit with the doctor.  She  seemed mildly surprised but happy that I had not had any significant pain, and wrote me an order for physical therapy, accompanied by stern reminder to do everything gently, gently, gently.   I did not tell her that I had been walking 4 miles a day; no reason to spoil her happy mood.   Both my old PTs were booked up for weeks, so I made an appointment with a new therapist who works out of the gym where I do my work outs.  She listened to my long rambling account of my long rambling injury odyssey, and decided not to put me through another evaluation, but to jump right into therapy.  She had me stand on one foot for her, stand on tiptoes, and twirl my feet around to demonstrate my range of motion, and pronounced me in pretty good shape.  She seemed optimistic, though she might jsut have been an optimistic type of person; it’s hard to say on the first meeting.  But anyway, I liked her better than the infamous “Rick”.  She gave me stretches and exercises with the stretchy-band to do at home.   So now, I have a colorful array of red, blue and green Thera-bands draped on my bedpost.  She told me to do 2 sets of stretches and one set of the resistance exercises daily and not to overdo it.  So of course, I overdid it.  Because that’s who I am.  And today I’m sore.  Lesson learned.

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“Rick” has triple-booked today, so he is working with three clients at the same time.  This means he gives me an exercise to do, and I do it, and then I have a 10 minute interval while waiting for him to come back to me, during which I  read my email on my phone and start thinking about other things.  Eventually he comes back and asks me about the exercise I’d just done and by this time I can’t remember how many reps I did or how it felt.  He has me run on the treadmill.  Yay, I get to run!  He tells me that my right knee is collapsing in and I need to strengthen my right hip.  I’m on it!

OK,  this is now my current nightly exercise routine:

back extensions

plank

side-lying quad stretch

pigeon pose

some sort of back stretch thing that I can’t even describe (I’m not so sure this is good for my back anyway)

lateral leg raises against the wall

bridges

clamshells

squats

single leg stand

rear-elevated lunges

monster walks with theraband

hip hikes

figure 4 stretch

bendy foot exercises with the theraband (no idea what these are called)

concentric heel lifts

eccentric heel drops

calf stretches, gastroc

calf stretches, soleus

Sigh…this is a lot of stuff to do…

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