Wednesday, October 2, 2013

Back in physical therapy

My foot, my dumbbell
Photo description: brown carpet in the background, a pale short and wide foot with green nailpolish stepping on a grey dumbbell marked with "15" for its weight.

Because my new pain management doctor doesn't believe me that I'm taking three or more dance classes a week (and therefore meeting the current recommendations for physical activity according to the US government), I consented to going back to physical therapy, with the caveat that it had to be aquatic PT (I miss lap swimming, and my last pool adventure over the summer was a minor disaster pain-wise as the water pressure alone hurt).  Despite knowing he's being a fatphobic jerk, he's the first doctor that has taken me seriously about my desire to be on something other than opioids but realizing that opioids are the meds that are getting me through life right now.

A couple weeks ago, I had my PT evaluation with the new clinic (my old one doesn't have pool access).  I decided to wear my department t-shirt with the university logo and "KINESIOLOGY" in large letters, along with comfy drawstring shorts and my trusty sneakers.  PT evaluations almost always involve being touched in various ways to see how joints move (or don't move), to see what hurts with what kind of pressure, to test strengths, weaknesses, or imbalances, and sometimes end with heat, ice, or some other soothing modality (because if you're in need of PT, these evaluations almost always cause pain or other problems).

Since I've been through physical therapy quite a few times in my life (three times just for my spine fracture & vertebra slip), I have certain requirements that need to be met to deal with a PT.  First of all, my weight (if mentioned at all) needs to be addressed in a weight-neutral manner.  I have a history of disordered eating.  Yes, fatness is correlated with various biomechanical issues, but so is being tall, so is bone structure, so is age.  For the vast majority of people, weight is not modifiable.  The only thing dieting has ever done to me is make me unhealthy and bigger than had I just left my body alone.  Besides, people of all sizes get injured and just treat me like a person with an injury or disability!

My second requirement is an acknowledgement of my desire to be active.  This is why I tend to go to appointments in my department's tshirt, a shirt from a triathlon or 5k, or a dance related shirt (like one of my Bellydance Superstars show shirts).  I want to be clear....physical activity isn't something that magically makes me a good fattie or some sort of supercrip.  I just have found that if I don't show proof of my prior activity status, I don't get treated seriously (I had a PT not believe that I was active at one point, despite my involvement in a dance troupe and dancing from 15-20 hours a week on top of my full time job).

Lastly, compassion.  The combination of my love of being in motion and being a people-pleasing introvert means I will push to far at least once...and I will struggle to the point of tears and panic to tell the PT or PTA that I've gone too far.  There are a lot of things that my body can do that I shouldn't do (like impinging my sciatic nerve), but I still do them in the attempt at getting praise and being treated as a "treatment compliant patient."  This is awful, both for me and the PT.  I'm slowly getting better at saying stop, but if I don't have therapist-client rapport yet....well, it's going to take a lot to actually be able to say it.  This is something that comes from trust (and works best when I have only a one or two person "team"....I only roleplay an extrovert!).

The therapy pool at the PT clinic
Photo description: shown at an angle, a small indoor pool, approximately ten feet by 10 feet with stairs and handrail leading in to the approximately four foot deep green-tinged water.  There is a mirror on the upper right side of the picture and wooden doors on the upper left side.  The tile around the pool is grey, the pool itself has beige, blue, and coral tiles in a geometric pattern.  A wooden bench is barely shown in the lower right side of the photo.

I agreed to biweekly aquatic physical therapy at the new clinic.  I gave it a good solid couple of weeks.  I really tried....but just being in the water hurt.  Walking hurt worse as the 98 degree Fahrenheit water loosened up my already hypermobile ligaments and tendons and ended up pinching nerves.  I wasn't even getting any benefit from the water exercise because I was either too strong, too flexible, or in too much pain.

Thankfully, this physical therapist is being awesome (not only does she meet my PT requirements that I put at the beginning of this post, but she's friendly and funny).  We're doing "land-based" PT including E-stim (like industrial TENS) and dry needling (like a cousin to acupuncture, but different in that it tries to derail nerve issues in trigger points).  We'll see what happens.  I really don't have the money to be doing the human guinea pig thing ($20 biweekly copays add up, especially with my other medical bills), but I would really like to be more functional in my life.  I'm still dubious as the increased pain is draining my energy, making school and work extremely difficult.  I guess what matters is that I'm trying, right?


  1. Thank goodness you have a good PT!
    I wasn't even getting any benefit from the water exercise because I was either too strong, too flexible, or in too much pain.
    Argh, that's awful. That's pretty much why I haven't pursued swimming further, although eeeeveryone thinks it would be awesome - it made things in my elbows, knees and ankles click in and out really painfully (didn't know I was hypermobile at the time, but it makes perfect sense now). Thankfully hydrotherapy doesn't actually increase my pain levels, it's just not doable for me for other reasons right now.

  2. Just hang in there. Some things sometimes get worse before it gets better, so let’s hope all these pain will yield a somewhat wonderful result to your health and wellness. And even if it didn’t, like you said, what matters is you’ve tried. Anyway, I hope the therapy has given you a superb outcome. How are you going now?

    Darryl Hier @ U.S. HealthWorks