• For more information on how to avoid pop-up ads and still support SkiTalk click HERE.

L&AirC

PSIA Instructor and USSA Coach
Skier
Joined
Aug 29, 2017
Posts
356
Location
Southern NH
I don't have a PT recommendation with regards to selection, but I do have one with regards to expectations. Since you've stated you need help in selection and haven't had any surgeries since childhood, I'm going to make an assumption that you are a rookie with regards to going to PT. I also would bet there are probably other reading that this might help too.

So if you're a rookie at PT, I'm at least at the amatuer level or a serious hobbyist. Unfortunately I've had five different PTs across several years (4 in the last ten), for 4 surgeries and 3 injuries. Fortunately, All but the first one was exceptionally good. The first one pigeon holed my into needing what he just went to a seminar for and was wrong. It was 20 years ago and he was young and has proven to be the exception. I only bring this up so you know that like any other profession, some people suck and/or make a mistake; PTs are human too. However, when you find a good one, nurture that relationship because they can get you to do things you didn't think you would be able to do again.

The last two (only reason for the change was the previous moved away) had more letters after their names than in their names and I think the world of them. Both were also the clinics manager/director. The current one gets me pretty good and we work well together. I do see other members of the staff there now and again but it usually because of a scheduling conflict or like the past two weeks because he's on vacation.

Sometimes they will tell you to do things, or not do things, that makes NO sense to you. Don't fret, this is their profession and they have spent several years studying things that make no sense to you; embrace it.

After a surgery or injury, sometimes you have to do baby steps either though you used to be able to take giant leaps. Other times you will do things that you think have nothing to do with what you're there for. Everything in the body is connected and that odd thing might just have the biggest impact.

I had an injury when I was in my late 20s that I thought we get better by itself because I was young and stupid. 20 years later it was the root cause of the way I moved, pain, the compensating movements I did and atrophy in some muscles. When that was addressed and I relearded how to use my shoulder muscles (via baby steps) all the previous compensation went away aside from something that had become habit (i.e. opening a tight jar with my left hand even though I'm right handed because my right was useless for so long). This is a habit and not a capability. I bring this up because sometimes PT will percolate things to the surface that might not be the reason why you are there, but might be limiting your progress and need to be addresses as well.

Do the work. If you're going 2 or 3 times a week with the expectation you are doing things at home as well, make sure you do them. Also make sure you don't do more than they recommend without firs talking to them. My current issue is a tore my rotator cuff (africkingain!!!) and during early PT, it is very easy to undue what the surgeon just corrected. So when they tell you it will be 12 weeks before any strength building, it is for a very good reason, even though you "feel" like you can do it.

Ask questions and help them educate you. This will help with regards to maintain a healthy body and even though you might be done with going to PT, it isn't a bad idea to still do the exercises now and again or incorporate them into your workout routine. When you understand why something is going on or has to be done, you'll be helping your current and future self.

Expect a lot of questions from them that deserve good answers. They can't feel what you are feeling and depending on what is occurring, they have different approaches to take. I try to be as descriptive as possible and make sure I'm answering the question they are asking; like when they ask "tell me when you feel this?" I ask a clarifying question of "when I feel it stretch/pinch/tingle or when I start to feel pain?" Usually they ask for a specific but now and again they might not so it is good to clarify. For me things like this happened when I was first being seen this time and they were working on my ROM or from another issue I have with my C7 stenosis and they are using the TENS on me.

My significant other is the worst PT patient. She hates being asked questions and would give one words answers and left them guessing all the time and had a bad attitude about PT before she even went ("its stupid and a waste of time.") This limited her progress and it ended up being a self fulfilling prophecy. We are on opposite ends of the spectrum when it comes to PT. Don't be like that.

That's all for now. Have to go to work :(

Have fun and heal well,

Ken
 
Thread Starter
TS
Jenny

Jenny

Making fresh tracks
Skier
Joined
Dec 6, 2015
Posts
1,858
Location
Michigan
I don't have a PT recommendation with regards to selection, but I do have one with regards to expectations. Since you've stated you need help in selection and haven't had any surgeries since childhood, I'm going to make an assumption that you are a rookie with regards to going to PT. I also would bet there are probably other reading that this might help too.

So if you're a rookie at PT, I'm at least at the amatuer level or a serious hobbyist. Unfortunately I've had five different PTs across several years (4 in the last ten), for 4 surgeries and 3 injuries. Fortunately, All but the first one was exceptionally good. The first one pigeon holed my into needing what he just went to a seminar for and was wrong. It was 20 years ago and he was young and has proven to be the exception. I only bring this up so you know that like any other profession, some people suck and/or make a mistake; PTs are human too. However, when you find a good one, nurture that relationship because they can get you to do things you didn't think you would be able to do again.

The last two (only reason for the change was the previous moved away) had more letters after their names than in their names and I think the world of them. Both were also the clinics manager/director. The current one gets me pretty good and we work well together. I do see other members of the staff there now and again but it usually because of a scheduling conflict or like the past two weeks because he's on vacation.

Sometimes they will tell you to do things, or not do things, that makes NO sense to you. Don't fret, this is their profession and they have spent several years studying things that make no sense to you; embrace it.

After a surgery or injury, sometimes you have to do baby steps either though you used to be able to take giant leaps. Other times you will do things that you think have nothing to do with what you're there for. Everything in the body is connected and that odd thing might just have the biggest impact.

I had an injury when I was in my late 20s that I thought we get better by itself because I was young and stupid. 20 years later it was the root cause of the way I moved, pain, the compensating movements I did and atrophy in some muscles. When that was addressed and I relearded how to use my shoulder muscles (via baby steps) all the previous compensation went away aside from something that had become habit (i.e. opening a tight jar with my left hand even though I'm right handed because my right was useless for so long). This is a habit and not a capability. I bring this up because sometimes PT will percolate things to the surface that might not be the reason why you are there, but might be limiting your progress and need to be addresses as well.

Do the work. If you're going 2 or 3 times a week with the expectation you are doing things at home as well, make sure you do them. Also make sure you don't do more than they recommend without firs talking to them. My current issue is a tore my rotator cuff (africkingain!!!) and during early PT, it is very easy to undue what the surgeon just corrected. So when they tell you it will be 12 weeks before any strength building, it is for a very good reason, even though you "feel" like you can do it.

Ask questions and help them educate you. This will help with regards to maintain a healthy body and even though you might be done with going to PT, it isn't a bad idea to still do the exercises now and again or incorporate them into your workout routine. When you understand why something is going on or has to be done, you'll be helping your current and future self.

Expect a lot of questions from them that deserve good answers. They can't feel what you are feeling and depending on what is occurring, they have different approaches to take. I try to be as descriptive as possible and make sure I'm answering the question they are asking; like when they ask "tell me when you feel this?" I ask a clarifying question of "when I feel it stretch/pinch/tingle or when I start to feel pain?" Usually they ask for a specific but now and again they might not so it is good to clarify. For me things like this happened when I was first being seen this time and they were working on my ROM or from another issue I have with my C7 stenosis and they are using the TENS on me.

My significant other is the worst PT patient. She hates being asked questions and would give one words answers and left them guessing all the time and had a bad attitude about PT before she even went ("its stupid and a waste of time.") This limited her progress and it ended up being a self fulfilling prophecy. We are on opposite ends of the spectrum when it comes to PT. Don't be like that.

That's all for now. Have to go to work :(

Have fun and heal well,

Ken
Thank you for this. I am indeed a rookie. On the plus side, it sounds like I am on your end of the spectrum as far as questions/answers and the value of PT. Already concerned that I won't have enough visits covered by insurance but am planning to pay OOP if necessary.

Some of the questions you mentioned are already on my list - especially the ones about doing enough but not overdoing early on.

I aim to be the world's most compliant patient.

Good luck with your rotator cuff. I sincerely hope this is the only time I ever go through this. At the moment I'm kind of in awe of anyone who has had more than one surgery. I'm going for a one and done!
 
Thread Starter
TS
Jenny

Jenny

Making fresh tracks
Skier
Joined
Dec 6, 2015
Posts
1,858
Location
Michigan
So, I met the PT coordinator at the Sports Medicine place last night and got the tour. She answered lots of questions about how it all works, how they coordinate with the doctor, who determines the rehab plan, etc. etc. Stuff that those of you who've gone through this before know, but it's all new to me. She did say that the therapists that work there have additional sport-oriented certifications, but didn't say specifically which ones. One of them is a triathlete - I think I saw him behind the desk - man, is he in shape!

I did not realize that I/they/the doctor could appeal to extend the number of visits allowed if they felt I still needed more at the end. Wonder how often that actually works? I need to find out how many I have left - think I have 26 for the year, but then used some up before knowing that I'd need surgery, so it's probably close to 20 that are left. But I did learn that after therapy is over that they extend a free 30 day membership to the Y (where the office is located) so I can continue to come in and strengthen everything.

Because they are located in the Y, they have access to all of the machines and the pool, so not just what they have in the therapy office. She again confirmed that they are 1:1 sessions, and they do a lot of hands on manual therapy. They also have private rooms so if I turn out to be a screamer I won't scare the other patients! Sounds like they have some nice things - they have a gait analysis room, and they're set up to be able to (somehow) do that even if someone isn't totally weight-bearing, which I don't understand at all, but it involves some sort of hoist. Hope I get to see that in action on someone while I'm there.
 

VickieH

Contrarian
Skier
Joined
Nov 13, 2015
Posts
1,934
Location
Denver area
Sounds like you are on a good path.

I have had PT only once -- after my proximal tibia fracture. Having no experience whatsoever, I just went where and did what I was told ... well, as far as PT sessions and exercises were concerned. I don't recommend that path. I was hyperfocused on what I was feeling, what my right leg did vs my left, etc. And that's what led to a good outcome. When I became FWB without crutches, i noticed my gait was wrong. Then the PT actually looked at it. She gave me some suggestions. I devised my own 'exercise'. I emerged with a normal gait ... ok, normal for me ... and no discernable difference between legs.

The therapist I was assigned was green. She had a lot of knowledge and skills and, when pressed, would apply them. Your process seems like a good one. You're setting the tone up front. Stay focused on what you want out of this and don't accept less. Your well-being, your ability to lead the life you want depend on it. Your work with the therapist should feel like a partnership -- focused energy of both of you toward a common goal. Good luck! Looking forward to some good reports!
 

mdf

entering the Big Couloir
Skier
Team Gathermeister
SkiTalk Supporter
Joined
Nov 12, 2015
Posts
7,299
Location
Boston Suburbs
I think we are atypical PT customers. Just based on what I saw around me during my visits, I think half or more of their job is getting their patients to do their prescribed exercises. And if they won't do them at home, they have to be walked through them on every PT visit. That can lead to a very human relief and backing off when someone like us comes in.

I was generally very happy with my PT, but there was a little bit of this happening. My PT did a lot of very valuable hands-on range of motion extension in the first few weeks, but after awhile I was just going through the routine, adding a new exercise periodically. I had to ask her to watch me walk and especially climb stairs because I felt something was a little off. But once I reminded her and we did that, she figured out what was happening and helped me fix it.
 

Monique

bounceswoosh
Skier
Joined
Nov 12, 2015
Posts
10,561
Location
Colorado
Just based on what I saw around me during my visits, I think half or more of their job is getting their patients to do their prescribed exercises.

Yes.

My husband had some "clean up" done on his knee. I'd been to the same PT office for my ACL surgery. So when he saw "our" PT, he immediately said to her, "Don't expect me to do all the homework that Monique did!"

.....

I'll admit that I was MUCH more consistent with ACL PT than with any other PT I've ever done. Of course, it was MUCH more critical to get it right, on time, than any other PT I've ever done.
 
Thread Starter
TS
Jenny

Jenny

Making fresh tracks
Skier
Joined
Dec 6, 2015
Posts
1,858
Location
Michigan
My husband had some "clean up" done on his knee. I'd been to the same PT office for my ACL surgery. So when he saw "our" PT, he immediately said to her, "Don't expect me to do all the homework that Monique did!"
LOL - I like it!

I will, however, be doing the homework.
 

MarkP

Saturday, and Saturday, and Saturday...
Skier
Joined
Jul 15, 2017
Posts
1,187
Location
Maryland
Yes.

My husband had some "clean up" done on his knee. I'd been to the same PT office for my ACL surgery. So when he saw "our" PT, he immediately said to her, "Don't expect me to do all the homework that Monique did!"

.....

I'll admit that I was MUCH more consistent with ACL PT than with any other PT I've ever done. Of course, it was MUCH more critical to get it right, on time, than any other PT I've ever done.

I fall into that hating and not always doing the "homework" group. Slowly, over 40 years of dealing with neck, knee, shoulder, lower back, lower-er back, groin and groin again, I have gotten better at the doing, but have the same or more level of hating. Suppressing that "I should be able to get over/through it naturally and without any extra effort" is an ongoing challenge.
 

Brian Finch

Privateer Skier @ www.SkiWithaGrimRipper.com
Industry Insider
Joined
Nov 17, 2015
Posts
3,392
Location
Vermont
6457326D-D0DA-4DEA-B753-4744A44ACB23.jpeg
I actually go to PT tomorrow for first time*

:armsling:

*pending good checkup & surgeon clearing cast removal.

:crossfingers:
 
Thread Starter
TS
Jenny

Jenny

Making fresh tracks
Skier
Joined
Dec 6, 2015
Posts
1,858
Location
Michigan
Cast off today - weight bearing in the boot with crutches, weaning back to shoes by the end of August. Rx for PT In hand, ready to start in about a week, after I spend the next few days getting some range of motion started (point/flex, invert/evert, tiny circles).
 
Thread Starter
TS
Jenny

Jenny

Making fresh tracks
Skier
Joined
Dec 6, 2015
Posts
1,858
Location
Michigan
Look what I can do! This doesn't quite capture just how slowly I’m walking, so as not to limp, but I’m mobile!

Five PT visits so far.

9BDA9082-05C2-4ADE-8E15-E13C8177854A.gif
 

Magi

Instructor
Instructor
Joined
Apr 8, 2017
Posts
404
Location
Winter Park, Colorado
@Brian Finch would you give your take on the following statement? "PTs get your range of motion and basic function back.
CSCCs get your athletic function and performance back."

Personal experience, a great PT and the 2-4 months that insurance covers will get you "working". I, like @Monique - also needed to retain a (fantastic) Strength Coach to go from "my shoulder has 100% range of motion and works fine" to "My shoulder is strong, works as well/better than it did before the injury, and the muscular imbalances I developed during healing are better". Phase one (PT) took about 2-3 months, phase two (Strength and conditioning) took a about another year.

Both the PT and the CSCC were recommended to me by my Doctor (who is a surgeon, but did not need to cut me).

So I'd suggest the idea that "I do PT for 3 months and my body is back to 'normal'" isn't the path to optimal health.
 
Thread Starter
TS
Jenny

Jenny

Making fresh tracks
Skier
Joined
Dec 6, 2015
Posts
1,858
Location
Michigan
@Brian Finch would you give your take on the following statement? "PTs get your range of motion and basic function back.
CSCCs get your athletic function and performance back."

Personal experience, a great PT and the 2-4 months that insurance covers will get you "working". I, like @Monique - also needed to retain a (fantastic) Strength Coach to go from "my shoulder has 100% range of motion and works fine" to "My shoulder is strong, works as well/better than it did before the injury, and the muscular imbalances I developed during healing are better". Phase one (PT) took about 2-3 months, phase two (Strength and conditioning) took a about another year.

Both the PT and the CSCC were recommended to me by my Doctor (who is a surgeon, but did not need to cut me).

So I'd suggest the idea that "I do PT for 3 months and my body is back to 'normal'" isn't the path to optimal health.
Oh I know I won't be all better with just the PT - I’ll need to work a lot harder than I have before to make sure I get strong again. But the PT will put me on the right track, making sure I do things properly so that when I am released I won’t be damaging myself. And since we can self-refer here, I can always check in with them if I feel something isn’t right. I'm very happy with the PT that I’m seeing.

In some ways, I feel lucky - I didn't really do enough exercise before this injury (except for yoga), certainly not on a regular basis, but rehabbing from the surgery is important to me, so I should develop some good habits by the time this is behind me.
 

Brian Finch

Privateer Skier @ www.SkiWithaGrimRipper.com
Industry Insider
Joined
Nov 17, 2015
Posts
3,392
Location
Vermont
@Brian Finch would you give your take on the following statement? "PTs get your range of motion and basic function back.
CSCCs get your athletic function and performance back."

Personal experience, a great PT and the 2-4 months that insurance covers will get you "working". I, like @Monique - also needed to retain a (fantastic) Strength Coach to go from "my shoulder has 100% range of motion and works fine" to "My shoulder is strong, works as well/better than it did before the injury, and the muscular imbalances I developed during healing are better". Phase one (PT) took about 2-3 months, phase two (Strength and conditioning) took a about another year.

Both the PT and the CSCC were recommended to me by my Doctor (who is a surgeon, but did not need to cut me).

So I'd suggest the idea that "I do PT for 3 months and my body is back to 'normal'" isn't the path to optimal health.

OK I will bite, this will also likely start some fire flaming.

Physical therapists are first and foremost superb diagnosticians when it comes to musculoskeletal conditions. However, PT is like many of the health profession are absolutely horrible when it comes to progressing strength or assessing real world demands.

The classic example is of the woman with the 9 pound purse lifting 2 pounds in therapy.

I recognized that there was a void in my knowledge base and prior to being licensed and completing my degree went for my certified strength conditioning specialist credentials through the national strength conditioning Association

This was by far the best thing I’ve ever done for my career because I feel that I can accurately assess a persons functional demand and then create a program around it.

The other cliché about physical therapy is people doing reps of 20 to 30 and then talking about gaining strength. If you’re really going to progress strength, the most efficient way to do it is with lower reps that will actually stimulate neural muscular development.

Physical therapy or strength conditioning, my perspective is that people give up on the training when they’re doing activities that aren’t dialed in to advancing the goals they have and therefore they don’t see results but are putting out effort.

One of my more memorable patients in the recent years was a spinal cord injury client who was wheelchair-bound and happened to meet me ; I just knew there was more for this patient based on my PT background. We started swinging 60 to 70 pound kettlebells and he’s now back to driving and hasn’t use the wheelchair since.
 
Last edited:

Corgski

Getting off the lift
Skier
Joined
Dec 5, 2017
Posts
375
Location
Southern NH
OK I will bite, this will also likely start some fire flaming.

Physical therapists are first and foremost superb diagnosticians when it comes to musculoskeletal conditions. However, PT is like many of the health profession are absolutely horrible when it comes to progressing strength or assessing real world demands.

The classic example is of the woman with the 9 pound purse lifting 2 pounds in therapy.

I recognized that there was a void in my knowledge base and prior to being licensed and completing my degree went for my certified strength conditioning specialist credentials through the national strength conditioning Association

This was by far the best thing I’ve ever done for my career because I feel that I can accurately assess a persons functional demand and then create a program around it.

The other cliché about physical therapy is people doing eps of 20 to 30 and then talking about gaining strength. If you’re really going to progress strength, the most efficient way to do it is with lower reps that will actually stimulate neural muscular development.

Physical therapy or strength conditioning, my perspective is that people give up on the training when they’re doing activities that aren’t dialed in to advancing the goals they have and therefore they don’t see results but are putting out effort.

One of my more memorable patients in the recent years was a spinal cord injury client who was wheelchair-bound and happened to meet me ; I just knew there was more for this patient based on my PT background. We started swinging 60 to 70 pound kettlebells and he’s now back to driving and hasn’t use the wheelchair since.

I would not have thought that this is controversial. My impression has always been that PT is more for when you are in a very bad state, the problem comes when one has maxed out the benefits of a rehab protocol but does not know where to go from there. The more popular exercise routines are often not going to do it for one either and strength coaches without a medical background have limits in their ability to deal with preexisting conditions.
 
Last edited:

Monique

bounceswoosh
Skier
Joined
Nov 12, 2015
Posts
10,561
Location
Colorado
The classic example is of the woman with the 9 pound purse lifting 2 pounds in therapy.

Well, it very much depends on what you're doing with those two pounds. there are some where two pounds is plenty; others where it's ridiculous.
 

Sponsor

Staff online

Top