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Physical Therapy first day...Not sure if their going the right route for me.

JakotsuJJakotsu Posts: 212
edited 06/11/2012 - 8:28 AM in Back Surgery and Neck Surgery
I had therapy at this place before for me knee (to prevent surgery) and was very successfull for patella femoral knee pain, went away.

So today for my back, was the first real day of therapy (eval was two days ago).

The therapist concentrated on my legs/hamstrings way to much in my opinion. I am a very big guy, 6ft 360lbs, so just lifting out of any chair takes a lot of leg strength.

By the time it was over, and I got home and sat down, I could barely get out of my chair because my legs were so sore.

Did anyone elses therapy start out like this? I really don't want to complain and overstep my bounds, but I will be going to therapy 3 days a week and I can't afford my leg strength to be depleted for "stretches".

He tried several exercises to get my lower back muscles but as I explained to him they werent hitting my back muscle, guess I'm not flexiable enough and never have been lol.

Any advice appreciated. Naturally I will not complain to the therapist as thats what hes educated for, but I also like being able to walk and get out of my chair where I sleep and live 18 hours of the day/night lol.


  • Hi,

    I absolutely recommend you tell the therapist. They need the feedback from you as to what is going on. Often they will back off a bit and then build up. They do definitely need the feedback on how you feel in order to make the most success of the PT.
  • They really NEED to know what kind of pain you are having after a treatment so that they can change their course of action for your next treatment. Perhaps they were a little more aggressive at first because they thought with your condition your body could handle it. If it can't they will cut back or perhaps even completely change their course of action. They definitely need feedback from the patient.
  • My physio therapy certainly included my legs (tight hamstrings and calf muscles have a big negative effect on the lumbar spine) but it by no means focussed on the legs, and certainly not in the beginning.

    I would suggest that you ask the therapist to outline for you the entire rehab programme that he is envisaging for you and get him to explain the rationale behind each major part. For example, to explain his rationale behind working so much on the legs in the first place.

    But perhaps before even going into that detail you may want to explore his specific experience relating to rehabilitation therapy following spinal surgery. If his experience is light in this regard you might want to consider seeking out a clinic with therapists that specialise in rehabilitation therapy after spinal surgery.

    I am totally convinced that proper therapy is critical for a long term successful recovery after spine surgery, and for building the core muscle strength required to take you into the future with minimising the risk of further spine problems - but its got to be the right therapy.
    Keep positive!


    ...an old timer here and ex-moderator

  • I am surprised you have been asked to go to PT three times per week so extremely early in your recovery. Unless your therapist is absolutely on the same page as your surgeon, there is a good chance you can so as much harm as good.

    What Bruce said is so important. Depending on how is doing your therapy, it can be extremely helpful or a big waste of time and money. I didn't realize how different individual therapists are until I found my most recent PT. Now I realize the two other times I went through months of therapy were worthless.

    If I were you, I would ask lots of questions before doing much more. Find out the clinic's strengths and what they have planned for you. There is a fine line between working to stretch and strengthen and doing something that is going to ultimately harm you...and the PT will not always know the difference.

    Please proceed with caution. I know you feel great now and are eager to get going...but you had a big surgery and are very far from being healed.
  • What Bruce said. Also I agree tell you therapist where you now hurt. It is important to differentiate between nerve pain and muscle pain, too, as therapy should not cause nerve pain.

    Therapy does hurt me some and tire me out, but I find that ice packs work better than any meds for that.

    A good PT can be essential to recovery and helps communicate with your doctor, so you need a good relationship. I firmly believe in PT, especially in working on core muscle strength.
  • I go back Friday and will talk with them. I do ask a lot of questions to begin with.

    The physical therapy department is associated/same building as my spine surgeon. Its a big joint institute here (Spine surgeon and an orthopedic surgeon with a PT department).

    My spine surgeon ordered the therapy eval and treat there as he can keep an eye on progress and any issues which is nice.

    Today I feel much better the tightness in my legs is gone as well as the pain (was muscle related not nerve).

    Thanks for the info def going to be careful even at therapy, don't want anything happening.
  • You didn't mention whether you are wearing a back brace or not. I started PT immediately on being released from the Rehab hospital, 3 times a week for 25 visits. I am a big guy too, 6'2", 290, or at least I was until I lost 70 pounds. I wore a big hard shell brace during all my visits. My biggest issue was tight muscles, especially my hip flexors. However, They also worked on upper body strength using weight machines, treadmill walking, and stairs.

    Emergency surgery in March of 2006 for spinal infection of L 2 and L 3. During surgery, discovered I had Cauda Equina Syndrome. Spine became unstable after surgery and had 360 fusion with 10 pedicle screws, plates and rods in April of 2007.
  • Never wore a brace. My surgeon told me my titanium rods were my brace ;D

    Yesterday they started me on a exercise bike where you push down and up, then they did the stretching exercises, the big ball that you sit on and had my dry hump as I called it, and partial squats.
  • I started PT yesterday (8 weeks ALIF)and the only thing they had me to was pelvic tilts..3 sets of 10 daily.

    I was thinking "Are you kidding me??" I can do these in my sleep. Well, by the afternoon I was soooo sore. I am going to pull back a little & do 1/2. I go back tomorrow & I will tell him what I experienced.

    I have had PT for my back since jr high (25+ years) and I always find that they need your feedback to design your plan. It is really the only measurement they have early to gauge how much & when. If it is too much it can set you back, please speak up.
  • Hi Jak,
    I had a PLIF on Dec 2nd of L4 to S1 and started physical therapy at week three. When I first started out, I started with strethes, the ball thing as you mentioned, scar tissue massage, ice down and went home. I have been going three times a week since then and each week it seems as though they add a new excersise for me to do. I got sore after the BLT was lifted and we started doing bending and lifting (very minor bending and lifting) and my poor legs were so sore, as well as my abs.
    I ask my physcial therapist everything, I want to know why I am doing this and how it is helping me and what my body is doing properly (the correct way to move and what not). My NS recieves weekly updates on my progress as they are in the same building and he helps guide them with what he see's in my appt's with him. Each one of them has seen his surgeries, and he will only let them touch his patients after they have watched him perform a back procedure. I guess in this way I am lucky that there is alot of communication between the two. But then I also know after my ACL reconstruction I also asked them "why why why" like a toddler so I would know exactly why I was doing what. I would say talk to you therapist as Bruce suggested to see what Plan of Action they have and why. All the best of luck
  • Thanks for all the advice, going to definately have a more detailed talk tomorrow.

    And luckily my spine surgeon also gets updates since their in the same building/business so to speak, one counters the surgeons the others therapies :D

    But I also want to get better and don't want to go to slow at it.

    I will request less leg exercises maybe do less of them as I am still somewhat sore tonight.
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