Injured reserves ... does physical therapy actually work?

[Whitestripe]

I went over the handlebars at a mountain bike camp in mid-July.  I broke my collarbone and tore my labrum (anterior inferior, AKA Bankart tear). The radiologist at the ER in Vermont (where we were riding) originally said no break, but I saw an orthopedist at home in NY a week later and sure enough, I had joined the Clavicle Club.  The torn labrum wasn't discovered until late September, after I continued to have more pain than expected for a nicely healing bone.   The orthopedist is taking a conservative approach and does not recommend surgery. I'm finally getting physical therapy 10 weeks after my fall.  Thing is, I'm not sure that the PT is doing anything. I've been told that soft tissue takes forever to heal, but dang!  It hurts, I'm hella annoyed that I can barely even ride a stationary bike these days, and I'd like to be able to pick up the cat without having to use both hands.  What's been your experience with PT? 

 

[Maithanet]

I did my first round of PT on my knees in 2019, and am doing a second round right now.  My knees are messed up from so much running even though I'm not really that old, and I've been to a bunch of different orthopedists, but none has ever really been able to do anything to improve things.  My latest orthopedist recommended another round of PT, and since I'm basically out of other options I'm giving it another try.  I've been doing it for a month now and have not felt like my knees are getting better at all.  Which is frustrating, because this is America, so PT is costing me thousands of dollars, and I have to take off work to do this, and PT itself isn't fun, so overall this is just a very shitty experience.

I'm in a very bad mood right now because I feel like I can't get any exercise that I actually enjoy (swimming laps doesn't do anything for me) without hurting my knees, and when I don't get any exercise I'm grumpy a lot.  I'm really frustrated that it is looking more and more likely that I'll just never be able to play pickup with my friends or even teach my son to play soccer. 

[Whitestripe]

I'm grumpy too. I've missed the entire second half of biking season. 

[Which Tyler]

Yes PT works, but it takes time and effort, and is often unpleasant. But generally the better option than surgery if possible (if only because PT doesn't limit the surgeon's option at all, whilst the vice versa is not the case).

There's also a lot of mythology around things like PT, based on instinct and gut feeling rather than actual evidence (for example, that dunning is bad for the knees, the importance of good posture, discs that slip or spines tha are out of alignment) Which often get in the way of PT being effective without a lot of patient education to undo those instincts, and correct harmful thought processes that come from them.

[Kalbear]

I'll give you my super frustrated answer: 'it depends, and not always'. 

PT is one of the things that doctors - largely because of insurance companies, the fuckers - recommend first. For some injuries it can work though it can take a lot of time. For soft tissue it can work and can be better because surgeries do not have a great success rate in that.

The problem in the US is that it's recommended to do no matter what and if it doesn't end up helping they'll blame you instead of questioning if it's working or not. And in a lot of cases, the surgery that WOULD fix things is denied because apparently you can just fucking will your abdominal wall together if you just think real hard about it while hurting yourself repeatedly. 

[Madame deVenoge]

As has been stated, PT caaaannnn help, and won’t hurt anything, and it’s a hoop you will have to jump through regardless.

I just hope to get a hot therapist, which at least provides me with visual stimulation whilst I am balancing on a board or doing leg lifts.

[Raja]

Emergency Medicine doc here, and I don't practice in the US so when I recommend PT, it has nothing to do with insurance.

Physiotherapy absolutely works, in a lot of cases it works wonders and people see a big difference within that time frame. This is particularly true of shoulder injuries.

However, it will not work for some people. In addition, there are some injuries where operative management is better than treating with physiotherapy first. It's up to the Orthopod that sees you to obviously guide you towards which mode of action is better *for you* - and hopefully the orthopod has done that here! If you're seeing them it would be reasonable to ask them why they've gone for one option over the other, if you haven't already.

I'm bolding 'for you' there because management will also depend on the context. Sometimes you're not going to do a surgery because the patient in question is frail, old, has no mobilty and cancer everywhere and you know just by looking at them that they are not going to survive an operation - I'm not saying this applies here, but trying to give an idea of where you would opt for one over the other.

Like Which Tyler states, I find that a lot of times opinions of PT are based on gut feeling as opposed to evidence and this notion that surgery is a panacea.

One should never have the experience that @Maithanet is having though, PT can be so useful for people and should be easily accessible.

Edit: Just want to add a caveat that some injuries need surgery asap, and physio is for the recovery process. If you have a neck of femur fracture ( ie a hip fracture), you're going to get surgery almost every single time no matter your age. Now compare that to a pubic rami fracture ( fracture of the lower part of your pelvis), where you almost never do surgery and it just heals by itself & physio.

[Whitestripe]

1 hour ago, Raja said:

Physiotherapy absolutely works, in a lot of cases it works wonders and people see a big difference within that time frame. This is particularly true of shoulder injuries.

However, it will not work for some people. In addition, there are some injuries where operative management is better than treating with physiotherapy first. It's up to the Orthopod that sees you to obviously guide you towards which mode of action is better *for you* - and hopefully the orthopod has done that here! If you're seeing them it would be reasonable to ask them why they've gone for one option over the other, if you haven't already.

 

I’m perfectly happy to try the PT, and I’m doing my home exercises and going 2x a week. Ortho said the tear was small, so hopefully it can heal with time and PT. I know it’s not an immediate fix, but I am impatient. This particular PT clinic works with sports injuries (they have worked with my local AHL team) so I’m confident they know what they are doing.  I’ve had broken bones, sprains and strains aplenty, and this just feels different. 

[Starkess]

My experience with PT has only been a "go once to get an opinion and then never again because my insurance didn't cover it". I'm actually going on over a year now of battling some mysterious glute injury that I picked up while training for a marathon. I visited two PTs (once each) and got some suggestions that helped a bit, but I 1) am not going to do a series of stretches for 20 minutes 2x a day for the rest of my life and 2) didn't really solve the root issue. I just changed to a new insurance plan and I think PT is a lot more reasonable now, so I'm considering going back. Getting old sucks.

[mcbigski]

As a US question, it depends on your coverage, deductibles, financial situation, et al.  

Leaving the financials aside, I'd think it's best to give a few months to 2 or 3 physical therapists before opting for surgery.  Depends on the exact injury, but for the every day wear and tear stuff surgery should be a last resort.  There are a host of stretching, strengthening, massage therapy, resistance training, and just in general mindful working out methods that can have a way better risk reward profile than surgery.

 

[Impmk2]

So my experience with PTs have generally been good. Have had a couple knee issues (largely coming from a massively tight ITB) which was pretty easily resolved with a few weeks easing off the running, stretching, massage, and a few strengthening exercises. Took seeing a couple of them though before I found one which I was comfortable with.

The other injury I've had was climbing related minor tear in my rotator cuff. Again the PT was good with guidance for rehab and how far I could still push the climbing / exercise to maintain fitness without doing myself any more damage. It did take a lot longer to heal though. Was about 6 months before the shoulder was back to full strength, and a full year until I stopped having the occasional twinges in it at all. Now though that's the stronger of my 2 shoulders.

[ljkeane]

I’ve done a fair amount of physio over the years. It definitely works but the nature of physio is that it’s pretty tedious and often uncomfortable/painful until it’s worked. I think a lot of the skill of being a good physio is being entertaining to be around while you’re doing the shit you don’t really want to do.

To be fair all the physio I’ve had has either been through the NHS or through my rugby club so I’ve never had to pay for it. I’d probably feel a bit less positive about it if it’s cost me thousands.

[Raja]

12 hours ago, Whitestripe said:

 I know it’s not an immediate fix, but I am impatient. This particular PT clinic works with sports injuries (they have worked with my local AHL team) so I’m confident they know what they are doing.  I’ve had broken bones, sprains and strains aplenty, and this just feels different. 

How long have you been at the PT so far? From my experience it can take a couple of months to see progress, but ymmv. It also sounds like there was a delay in diagnosis of the tear of the labrum, which might be why they went for conservative management, but I'm not an orthopod, and I hate to speculate.

I'm hoping it helps and you feel back to your normal self! I certainly would say though that you should advocate for yourself if things aren't improving in a couple of months, or you think you're getting nowhere.

[Whitestripe]

9 minutes ago, Raja said:

How long have you been at the PT so far? From my experience it can take a couple of months to see progress, but ymmv. It also sounds like there was a delay in diagnosis of the tear of the labrum, which might be why they went for conservative management, but I'm not an orthopod, and I hate to speculate.

I'm hoping it helps and you feel back to your normal self! I certainly would say though that you should advocate for yourself if things aren't improving in a couple of months, or you think you're getting nowhere.

This is week three. I’ll keep it up through the first of November (when I have my next ortho appointment) and reassess.

 

6 hours ago, mcbigski said:

As a US question, it depends on your coverage, deductibles, financial situation, et al.  

 

I’m fortunate to have pretty comprehensive insurance, which covers quite a bit of PT. I was coaching at the mtb camp when I crashed. I’d expected to volunteer my time, but it turns out I got a small stipend. In my mind, the unexpected stipend is paying for co-pays. (Even though I’d be able to pay anyway.) 

[Whitestripe]

Update: I’m headed into week 5.  The orthopod recommended 4 weeks on my chart while the PT recommended 8. My insurance covers 25 weeks max, so why not keep going?   However, I don’t see a whole lot of improvement.  I still have enough pain to need rx strength relief daily and I still have the exact same triggers. Plus, I still can’t manage even a 5 pound weight with proper form on that side. I was supposed to have a follow up with the orthopod 11/4 (where I planned to discuss all this) but it’s been pushed back to 11/16.  Needless to say, I am beyond annoyed. 

[Take on Me]

On 10/7/2022 at 5:15 PM, Kalnestk Oblast said:

I'll give you my super frustrated answer: 'it depends, and not always'. 

PT is one of the things that doctors - largely because of insurance companies, the fuckers - recommend first. For some injuries it can work though it can take a lot of time. For soft tissue it can work and can be better because surgeries do not have a great success rate in that.

The problem in the US is that it's recommended to do no matter what and if it doesn't end up helping they'll blame you instead of questioning if it's working or not. And in a lot of cases, the surgery that WOULD fix things is denied because apparently you can just fucking will your abdominal wall together if you just think real hard about it while hurting yourself repeatedly. 

I've had a somewhat similar experience.  I injured both shoulders a few years back.  I couldn't raise my arms over my head for more than a few seconds, couldn't touch my hands behind my back, put on a jacket unassisted, etc.  I saw my doctor.  Expected to get an MRI, X-ray, something.  He straight up told me that insurance wouldn't cover an MRI unless PT was done first.  The PT was somewhat successful.  I regained full range of motion again, albeit not without pain.  I still can't workout like I used to, and certain movements cause painful impingement.  I had to see a different doc for the follow-up.  He basically had the impression that I was now fixed.  Still no confirmation if anything is damaged.  So, I'm good now?  Frustrating... 

[kairparavel]

As a child/teenager I had PT 3 times after some serious knee injuries and it did its job. I did not do mine (maintain a regimen of leg strengthening and *oh how I wish I had...)

Since 2012 I've gone to PT 4 times:

2012, hip bursitis, exercises and shots

2019, right hand CMC joint arthritis, exercises and a shot in my thumb that is still working. I couldn't open ziplock bags before I went and had no hand strength at all.

2021 spring, right shoulder, required by insurance before granting an MRI, exercises relieved my pain, so no MRI. I couldn't lift my arm most days without pain before going. 

2021 late fall, right knee, exercises and a shot - this was a particularly distressing time as the ortho advised that I was going to need knee replacements (*yes, plural), and a hip replacement in my too near for my age of 50 future. 

Anyways, in all cases ~6-8 weeks of PT 2-3 times a week plus daily exercises at home did what it needed to do. I've gotten pretty slack in the past few months and my right knee has started to hurt again so I'm starting up my exercises again because I don't have the time or interest for formal PT again. 

All that to say that PT can and does work but it won't fix everything. 

[Oneily]

On 10/7/2022 at 10:42 PM, Whitestripe said:

I went over the handlebars at a mountain bike camp in mid-July.  I broke my collarbone and tore my labrum (anterior inferior, AKA Bankart tear). The radiologist at the ER in Vermont (where we were riding) originally said no break, but I saw an orthopedist at home in NY a week later and sure enough, I had joined the Clavicle Club.  The torn labrum wasn't discovered until late September, after I continued to have more pain than expected for a nicely healing bone.   The orthopedist is taking a conservative approach and does not recommend surgery. I'm finally getting physical therapy 10 weeks after my fall.  Thing is, I'm not sure that the PT is doing anything. I've been told that soft tissue takes forever to heal, but dang!  It hurts, I'm hella annoyed that I can barely even ride a stationary bike these days, and I'd like to be able to pick up the cat without having to use both hands.  What's been your experience with PT? 

Update: I’m headed into week 5.  The orthopod recommended 4 weeks on my chart while the PT recommended 8. My insurance covers 25 weeks max, so why not keep going?   However, I don’t see a whole lot of improvement.  I still have enough pain to need rx strength relief daily and I still have the exact same triggers. Plus, I still can’t manage even a 5 pound weight with proper form on that side. I was supposed to have a follow up with the orthopod 11/4 (where I planned to discuss all this) but it’s been pushed back to 11/16.  Needless to say, I am beyond annoyed. 

 

So my experience with PTs have generally been good. Have had a couple knee issues (largely coming from a massively tight ITB) which was pretty easily resolved with a few weeks easing off the running, stretching, massage, and a few strengthening exercises. Took seeing a couple of them though before I found one which I was comfortable with.

The other injury I've had was climbing related minor tear in my rotator cuff. Again the PT was good with guidance for rehab and how far I could still push the climbing / exercise to maintain fitness without doing myself any more damage. It did take a lot longer to heal though. Was about 6 months before the shoulder was back to full strength(able to climb, carry my own survival gear https://gritroutdoors.com/outdoor-survival/ with close to pain over long periods of time, etc), and a full year until I stopped having the occasional twinges in it at all. Now though that's the stronger of my 2 shoulders.

As many people mentioned, PT is case to case. Some people get much greater results from it and for some it's a slow process. Don't get me wrong, it DEFINITELY works, just pace for different people is different. By the sound of it you sustained some pretty severe injuries, so no wonder it take a quite a bit of time to heal up. My personal experience with PT is a mixed bag: I've had rotator cuff problems and even though I got most of my mobility and like 70% of the strength back in 10 weeks, it still feels stiff and hurts time to time even now(it's been 2 years at this point). So I got decently fast results, but didn't recover fully(and probably never going to at this point). 

[Ser Scot A Ellison]

On 10/7/2022 at 3:42 PM, Whitestripe said:

I went over the handlebars at a mountain bike camp in mid-July.  I broke my collarbone and tore my labrum (anterior inferior, AKA Bankart tear). The radiologist at the ER in Vermont (where we were riding) originally said no break, but I saw an orthopedist at home in NY a week later and sure enough, I had joined the Clavicle Club.  The torn labrum wasn't discovered until late September, after I continued to have more pain than expected for a nicely healing bone.   The orthopedist is taking a conservative approach and does not recommend surgery. I'm finally getting physical therapy 10 weeks after my fall.  Thing is, I'm not sure that the PT is doing anything. I've been told that soft tissue takes forever to heal, but dang!  It hurts, I'm hella annoyed that I can barely even ride a stationary bike these days, and I'd like to be able to pick up the cat without having to use both hands.  What's been your experience with PT? 

 

When I suffered a hirneated disk at L5/S1 22 years ago physically therapy was what finally relieved my pain.  Take that for what it’s worth.

[Whitestripe]

So I have had sort of a break though. I've got a lot of range of motion and function back. I can get a shirt on without having to lean at the waist and dangle my arm down and I can put on a sports bra without having to step through and pull it up over my waist. BUT I'm still experiencing a lot of pain, and my shoulder crunches when I do the scapular strengthening exercises.   I had a long chat with the PT today, and I'm transitioning to strengthening exercises. He did say that I might be as good as I'm going to get without a surgical fix.