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Is it normal to start PT before receiving a diagnosis?

Hello all,

In the past four weeks my life has changed dramatically for the worse. I have been experiencing painful muscle spasms in the back of my neck which has led to headaches, muscle stiffness, and limited range of motion. It has caused me to miss almost two weeks of work and has severely limited my activities. I have received a CT scan, X-rays, and an MRI which I was told were all normal. I've been prescribed muscle relaxants and pain medications which have barely taken the edge off the pain. I had an appointment with a pain management specialist today who informed me that the MRI I had was done only for my head and not my neck (despite my having told the doctor that my neck was the primary issue.). So I have yet another MRI scheduled in two days. In the meantime I will be starting physical therapy tomorrow, and somehow trying to make it through the day at work (I'm a teacher) because I can't use up any more sick days.

I am all for doing the therapy if it will help me get my life back to normal (went from being an exercise nut to spending all my time lying in bed because that's the only thing that makes the pain go away.). I have suffered no major injury and all of this seems to have come out of nowhere. However, if the doctors aren't even certain what the underlying cause of my pain is, then I find it strange that they're recommending PT.

Is this normal? Is there a chance that physical therapy could make it worse (whatever "it" ends up being)?

Thanks for your replies. Just looking to commiserate with those who had experience with debilitating pain.


  • LizLiz Posts: 7,832
    edited 12/11/2013 - 3:50 AM
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  • RangerRRanger on da rangePosts: 805
    edited 12/10/2013 - 10:08 PM
    The protocol your doctor(s) are taking are indeed normal. Most go with the conservative route trying to be least invasive.
    If you have any doubts and even if you have no doubts it is good to get more than one professional opinion.
    Hope all goes well for you and keep us posted here.
  • It would be wise not to undergo PT until after your Cervical MRI and a consultation with a spine specialist discussing the pros and cons. Depending on the nature your problems, PT, Chiropractic, etc may aggravate them. I speak from experience.
    Grayslake, IL USA
  • yes, that happened to me before too. i'd keep pressuring to do more testing even during p/t unless p/t is helping a lot. generally p/t is not going to make anything worse and sometimes the p/t people can tell right quick if this is for you or not.
    Surgery c4-5, many epidurals, many different drugs.
  • My doctor did the same thing, I had a feeling that I had a pinched nerve in my neck because my neck was killing me, my shoulder blade, and my tricep and my forearm and my fingers started tingling. I could turn my head to the right but if I turned it to the left then it would irritate the symptoms even worse. All my pain is on my left side. I went to a doctor that specializes in sports injuries so I thought he would be the best one to diagnose the problem and get me better. He spent 5 minutes with me and said he suspected a herniated disc in my neck and take some prednesone and I will be just fine. I took the prednesone and it didn't help so he sent me to pt.

    Physical therapy asked me all of my symptoms, did a real good evaluation of my pain, then tried traction. I couldn't lay down on the traction table without being severely uncomfortable and they immediately stopped it. They put these giant suction cups on my back to try and relieve some of the tension from my back muscles, left great big round bruises all over my back,and I got a very small amount of relief for 1 day out of it and then everything went back to the way it was, they ended up saying they couldn't help me. I found another doctor that ordered an mri and that confirmed that I have a herniated disc in my neck, but his office was to far away for me to travel, so I found a pain management doctor and she has done some cervical epidural injections and just yesterday did a facet block.

    There is a great chance that physical therapy will give you some relief, Just don't let them do anything to you that causes more pain than what you can handle. You know your body and you know if what you are doing is causing more harm than good, Just listen to what your body is telling you. If it hurts to do it then don't do it.

    I hope you have good luck and can return to a normal life, keep all of us informed of your prognosis. This support forum has helped me tremendously...there is a lot of experience between all the members here and we all try to give you all the information that we can about what to expect and help out in any way we can.
  • I don't know why a doctor would order physical therapy without a current MRI of your actual symptoms. what is going to happen if the therapy makes it worse or even damages something? mistakes happen with diagnosis, but the therapy can wait IMO
    Cervical 360 ACDF C6/7-C7T1 Posterior fusion with hardware C3-T1 11/11/13
  • I asked my doctor the same thing and he said that pt is much cheaper than an mri and it is standard protocol to take on some pt before you get an mri because sometimes pt can solve the problem. My case I couldn't do any therapy because it hurt to bad, I told them every time it hurt and they would stop. The last session I had with them they just did a muscle stimulator which is supposed to relax your muscles and some heat at the same time, it didn't help me either so they told me that there wasn't anything they could do without me getting my pain under control first. I had to go to 3 doctors before I found a doctor that would even try to fix my problem. I have not had 2 epidurals in my neck (didn't help) and 3 days ago I had a giant freaking facet block. They give me shots in every joint of my cervial spine from C1 to T3. I am 2 days post procedure and I am feeling better so far. Hopefully this keeps up.

    Don't be afraid to keep trying different doctors until you get the results you want, I have heard of some people on here going to 6 or more doctors until they found one that was willing to help them out.
  • Thanks for all the replies. I did end up attending the PT session. Fortunately the therapist was very gentle. He asked a lot about my symptoms and is actually the first person to attempt to give me a diagnosis. He thinks I have an "irritated disc" ( not sure if that's the same thing as a herniated disc or what).

    He showed me a few very gentle exercises to build the stabilizer muscles in my neck and also did some light traction. What impressed me most was that he was feeling around on the back of my head and was able to identify the spots where I've been having the most pain just by feel. He attempted some trigger point release which felt good at the time though my neck stiffened up again as soon as I stood up.

    Had the MRI yesterday but have to wait until my doctors appointment Monday to find anything out. (Why call with the results when they can just charge me for another office visit?).

    The weird thing is my neck feels a little better but I've been having really bad burning pain on the top of my scalp for the past couple of days, I'm assuming these are from inflamed nerves, but the Vicodin doesn't even touch it. The doctor (nurse practioner actually) also gave me a trial of Cymbalta but after reading about the potential side effects (ED, high BP) I don't want to try it!
  • My pt tried traction on my but I couldn't handle the pain of laying down, by doctor says they can do it in a door way too but they never offered, maybe they weren't capable of doing that at my pt office. When I went in for the results of my mri, they gave me the sheet that the radiologist typed out for the doctor, his findings and when I had the actual mri they gave me a disc for me to look at and sent another copy of the pics to the doctor. My doctor just wanted to sit down with me and talk about the results. He started off by not even looking at the radiologist notes, he looked at it for the first time with me and told me what he thought and then he read the radiologist report and agreed with some of what they said and disagreed with some too. I was glad I went in to talk with him though, they also set up my appt for my epi shots after that reading. There are a lot of reasons why they call you into the office instead of just calling you. It may seem like a waste of money but it was worth it to me.
  • Brandon77BBrandon77 Posts: 4
    edited 12/14/2013 - 3:56 AM
    Yeah I hope I will actually learn something (and that it won't be too serious obviously). With every other exam I've had (CT scan, X-rays, head MRI) the doctors have just said they were "clear" and sent me on my way. As if I've just been imagining all this pain for the past month!
  • Finally received a diagnosis. Turns out I have three different bulging cervical disks. All are considered "mild" (I'd hate to know what a moderate or severe feels like!). I'm continuing the PT and have a cervical epidural scheduled in two weeks, though if the PT alone is helping enough then I can cancel it.

    I was also given a prescription for neurontin instead of the Cymbalta. My wife actually took the same medicine after her wrist surgery and said it made her feel hungover, if it will help get rid of my constant headaches and face pain then a Ill take feeling hungover.

    The cervical epidural sounds a little scary. Anybody have experience with one?
  • I had to go PT before I could get an MRI once. It wasn't my doctor's order. My insurance would not pay for the MRI until I had PT. It was the most painful part of herniated disc adventure. Read my signature I have had quite the experience. Haven't had any PT since.
    Discectomies 05/08 and 04/11, fusions L4-5 Feb 9,2012 and L3-L4 June 28,2012, Staph infection washout 3/2/2012, Bulged L5-S1. SCS trial on January 17th, 2014, which was a success! Permanent SCS on February 20th.
  • I was diagnosed with multiple bulges too, and I would hate to see what severe felt like. I think atleast in my case it was the position they put me in for the mri, my neck was cradled and wasn't hurting to bad, if I lay flat without any neck support it is unbearable. I haven't been put on neurotin yet, I have thought about requesting that. If therapy is helping you then that is great, if you don't feel like it is helping enough then I would get the epi. I have had 2 and they are scary at first but it isn't a big deal. I don't do needles so it kinda freaked me out. I didn't get much relief from the epi's but I have heard a lot of people do get relief, my doctor said she expected at least 6 weeks of relief. My wife had lumbar herniated discs and she got a lot of relief from them, she avoided surgery for 4 years but hers was inevitable. Good luck
  • Also had epidural it did help temporarily, but have never heard of if ever fixing anything. Just a bandaid
    Cervical 360 ACDF C6/7-C7T1 Posterior fusion with hardware C3-T1 11/11/13
  • Yes, it is a bandaid, it will help calm the nerve down and give you some comfort to do some pt either from a professional or at home by yourself. Your body is supposed to absorb the bulge and heal itself, the epi is also supposed to help you cope with the symptoms while your body is trying to heal itself. I have heard of people not having any symptoms after the epi, and only needing one and never having any symptoms again, but I think that is if it is only very minor.
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