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Phyiscal Therapy- just given strengthing, but no stretching???

AnonymousUserAAnonymousUser Posts: 49,671
For anyone who has had physical therapy -
I have been doing some reading and it appears that there should be stretches for the hamstrings and the hip flexors.
I asked about these stretches and was told that my hamstrings seemed fine, that I didn't need to stretch them?

My PT has been only lying on the floor on my stomach and now building up the core muscles. I have a lot of pain in my hips, can not lift my legs very high, or sit for more than 15 minutes with out a lot of pain in my hips and my butt. My hips and upper thighs just hurt to be touched. I am wondering if there shouldn't have been stretching excerises before building up the core? It seems like the pain in my hips is getting worse as I do the core exercises ( basically leg lifts to the side, back, bending my knee behind me and standing on my toes). At this point, it now hurts for me to lie on my stomach, which was never the case before, and I can not lie on my hips, or back for long without pain. I also can not sit or stand in one place for more than 15 minutes without muscles locking up on me. Walking is becoming painful as well, and the pain is starting to go into my calves again. Before it was going down to my toes, so I guess that is some improvement.... Prior to PT, I had been walking at least a mile a day for probably 25 years with no pain.
I have been having pain in my legs, hips, and butt since September 2008.

I am concerned that doing the strengthing excercises without getting the pain out of my hips first is setting myself up for more problems.


  • Having gone through 3 courses of PT at three different places at different points in my back journey, I can assure you that there is a great deal of variety in what the client is offered. I really didn't realize what a big difference this can make until I found my third physical therapist who works in a clinic that only deals with scoliosis and other spinal issues. It made all the difference in the world.

    Have you seen a spinal specialist for your condition? Have you had imaging done, such as MRI?

    PT is often prescribed at the beginning of back pain or injury and stretching and strengthening are usually done, if the client is beyond the point of being in bad pain. Otherwise, passive therapy is done -- ultrasound, maybe a tens unit, gentle stretching done by the therapist, etc.

    Are you doing stretches at home? There's quite a bit of good information on the internet. However, I don't think I would proceed without having had an MRI and some direction from a spinal specialist. There are some conditions that could be made worse by certain activities.
  • gwennie17,

    I am doing hamstring stretches at home - those seem to help.
    There has been no ultrasound, no tens, no stretching etc. Frankly, I have been rather disappointed by the phyisical therapy. I told the person doing it that I am having pain in my hips, and rear, that I can not cross my legs, that I need something to help stretch my hip flexors. I also asked about hamstring stretches, was told that I don't need to do them! She basically ignored that and assumed that I have a bad disk in my back. I also asked about pirformis stretches. I was told "what difference does it make?" It looks like it could make a big difference as the treatment seems to be different.
    Fortunately, a lot of the traveling pain is gone, but I still can't sit for very long, driving is torture and sleeping is hard at times. It feels like the muscles are very tight. She even suggested I get a desk I can stand at for work. I am an accountant and that is not a feasible solution- neither is being only able to sit for 15 minutes. I am going to be calling my doctor this week, and hopefully he can point me in the right direction. Thankfully my husband, who has piriformis, has been able to help me with some of this. Without the hamstring stretches, I think I would be in even more pain.
  • dilaurodilauro ConnecticutPosts: 9,859
    The work that your Physical Therapist is doing is first based on what the doctor's prescription was written for.
    Many times, the script is detailed enough to determine what you will be doing in PT.
    Personally, strengthening before stretching does sound a bit out of order. In the 100's of PT sessions that I have been through over the years, this has been the sequence:
    1- Heat/Ice Treatments
    2- Ultrasound
    3- Stretching while on the table
    4- Adding one of the exercise bands while on the table
    5- Moving on to some gym equipment (light work)
    From there on the treatment may vary. I stick with 1 through
    5. After that, my experiences have been that the additional use of gym equipment created my problems for me.
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • Hi Ron,

    Interesting. The PT person only had that I had sciatica and she didn't even know that there had been x-rays. I told her that there were and that they came back "normal". The first thing she had me do, was lie on the floor for every two hours, then at the next appointment, extension exercises ( like a modified push up). By the third, strengthening the glutus. I was still having quite a bit of pain down my legs at that point and then last week, leg lift exercises. She seemed surprised that I still had pain in my legs, hips etc. There has been no stretching on the table, no heat/ice, exercise bands, etc. She has had me stand up and try to touch my toes and then seem surprised when I had no pain touching my toes. Usually I can reach down past my toes, when I am tight I can get to about my ankles. She told me to walk everyday, which I have been doing anyway for years and she didn't like the idea of using an eliptical at the gym as she felt that could hurt my back. She was also concerned about my using a gazelle edge. Something about making sure I stand straight. I will have to call my doctor to find out what is going on, but something doesn't seem right to me. She said she checked for periformis, but all she did was raise my legs and note that the left had less strength than the right. I guess we will see what happens today....
  • As Dilauro said the PT script has alot to do with what you actually get at PT. If the doctor writes core strengthening or lower back pain, then PT really cant offer modalities such as tens, biofeedback, massage, ultrasound etc... Alot of it has to do with billing too. I have gotten scripts that are so vague its not funny.

    Talk ot your PT to see if other treatements are warranted, if they think so they can always get an updated (more specific) script.

    Take Care,
  • Well, I am scheduled for one more PT session to see if that helps. I was given a stretch for my hips to see if that helps. If not, then after the next PT session, I will have to go to my doctor to proceed. I am also going to try some more of my husband's stretches, see if that helps.
    I was told that this could come back, so that important thing is to make lifestyle changes and that basically, I will be limited to about one hour of sitting and then needing to get up and take a walk. So, if that is the worst of it, but I can get back to some sort of normal, I will be happy. I guess on the plus side, that should be the end of jury duty. It's an hour to the courthouse, and from what I understand, they then have you watch an hour presentation, then lots of sitting and if you are selected, you could be stuck sitting in a courtroom for hours- obviously, I can no longer do that. I guess the same goes for long meetings - I will have to excuse myself every hour. Now, fortunately, I don't have many meetings, but my company does have one required all day Saturday meeting and a dinner that runs for 5 hours the day before. I'm only part-time and 99% of what is in the meeting does not apply to me, but attendance is required, so I guess we will see what happens when that come around.... maybe by then things will be more normal!!!
  • There are ways around all the sitting. You could stand at the back of the room, for example, or sit off to the side or back where you could alternate sitting and standing. I am a docent at an art museum, and that's what I do at our weekly lectures.

    When my husband herniated a disc many years ago, he elected to wait it out rather than have surgery. He did a lot of his work standing up, rather than sitting at his desk. It made others uncomfortable, but it worked for him!

    Can you go to a different PT? It is really important to go to one who specializes in orthopedic cases. It concerns me that she has you doing extensions without knowing your specific issues. You mentioned you had an x-ray and it was normal. Was it an x-ray with flexion and extension? Have you had a MRI? I gather your problem is sciatic pain? This could be caused by a number of issues, and depending on the diagnosis, you should be doing different exercises.

    If you do not get better soon, I hope you will go to a spinal specialist and get a thorough evaluation.

    xx Gwennie B)
  • I told a co-worker about being told by my physical therapsit that basically for the rest of my life, I need to get up every hour and stretch and I think he feels I am making this up! I am finding that as long as I get up every hour and walk around, and do things such as hamstring stretches every hour, sometimes two, I am keeping the pain down. If I don't, I end up with a ton of pain in my back and hips. So, I guess now the hard part is going to be convincing my employer and co-workers that this is really what I need to do. I never thought that people wouldn't believe this and that I might be making it up or exaggerating!
  • It shouldnt be hard to get your employer to do this, it is called reasonible accomodations! They are required to adapt your work area/situation so that you can continue to work as you are. It may mean scheduling your day so that you can officially alternate sitting and standing, you can stand to file for 10 minutes, make copies, type at a laptop stand. OK, your day might not be as efficient but you can break things up.

    Good Luck!
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