It seems important to start this post with a disclaimer. As you read, please remember that I am not a doctor and everything I write here comes from my personal experience. This post should not be taken as medical advice, and you should consult a doctor before attempting physical therapy. In addition, there are certain conditions which can be made much worse through pushing yourself to do too much activity. Please consult a doctor and research your specific condition before making any decisions.
With that being said, I have been thinking a lot about physical therapy and why I have pushed through and continued to go week after week for the past five years.
For long periods of this time, I kept going even when I was not making any noticeable progress. Isn’t that the definition of insanity? Doing the same thing over and over again and expecting a different result.
Why did I keep going?
I am glad that I did, because I am quite certain that I would not be where I am today if I had given up. I have always believed that if I can just get it right, physical therapy will be the answer for me. While I am far from completely better at present, I believe that physical therapy is a huge factor in what has improved my quality of life, decreased my levels of pain, and increased my movement ability.
My specific chronic pain condition is sacroiliac joint dysfunction. The ligaments in my sacroiliac joints are stretched out and have small tears in various places. This leads to a great deal of instability in my pelvis leading to misalignment and pain. Because my ligaments aren’t creating the needed stability, it is really important for me to develop a strong core to make up for what my ligaments can’t do and to protect the ligaments from further damage.
The problem has always been that I can’t exercise without re-injuring the ligaments. I can’t make progress because every time I start to move forward, I will push myself just a little too far, which will cause additional damage to the ligaments, more pain, and inability to exercise at all.
Over the past five years, I have gone through cycle after cycle of slowing making progress only to suddenly relapse. This is something I have written about time and time again on the blog, as I try to make sense of the agonizing slow rise followed by demoralizing crash and burn that seems to happen over and over again.
Every time I crash and burn, I show up to physical therapy once again, sheepishly let her know what happened (she is always as disappointed at me!) and start the process all over again. Like I said…the definition of insanity! I have always kept hoping that one time it would stick.
And after five years, I am somewhat hopeful that I am starting to break the cycle. It has taken years of small tweaks and changes to my process. It has taken years of highly costly trial and error. But in the end it has been worth it because I have not had a major relapse for around 16 months and the last time I had a major flare was about 6 months ago. Of course I still have small and medium flares, but nothing that lasts longer than a week or two, when before I would go through months into years of constant flaring before climbing out.
I have seen a trend with some people I talk to with chronic pain who give up on physical therapy before they can be sure if it could be helpful for them. I have also talked to many people who I can tell were going about physical therapy the wrong way, which led to regression and a fear of any form of physical therapy, even ways of doing physical therapy that might be different from their original experience.
In light of this and based on what I have learned from personal experience, I want to propose four questions for you to consider before deciding to quit physical therapy.
Question #1: Are you seeing the right physical therapist?
For my first year of physical therapy, I went to a therapist who ran what was basically a physically therapy assembly line. There would be 5-10 patients in a large room at the same time. She would tell me what exercises to do, and I would come in twice a week just to exercise. She would spend 5 minutes doing manual work on me, and I would often leave feeling worse than when I came in.
At one point I switched to a new office and I realized that my first physical therapist was not skilled enough to align me. I felt worse because I had exercised while out of alignment. Once I found the right physical therapist, things began to change.
This physical therapist would spend a whole hour working with me one on one. She would spend most of the time aligning my pelvis, releasing tight muscles, and helping me stretch out fascial restrictions. She clearly knew what she was doing. She would give me exercises to do at home instead of taking up my whole time with her to do them in the office.
This physical therapist who I currently see has what is called CFMT certification. FMT stands for Functional Manual Therapy, which is “an integrated and seamless treatment system which couples mechanical treatment of the joints, soft tissues, visceral and neurovascular systems with manual neuromuscular facilitation to enhance optimum motor control and human function” (See their website).
While there are likely other certifications or types of physical therapists without this certification who do excellent work, my experience with my physical therapist and all of her colleagues at her office who I occasionally see and have this same certification, has been wonderful.
You can check their website to see if there is a CFMT certified physical therapist close to you.
In general, ask yourself if you trust your physical therapist and if he or she trusts you. Does your physical therapist listen to you? Does your physical therapist let you stop when you say you need to stop? Does your physical therapist believe how much pain you are in? If not, it might be that you need a different physical therapist, not that you need to stop physical therapy altogether.
Question #2: Are you increasing your exercises slowly enough to avoid relapse and regression?
Closely related to whether your physical therapist listens to you is if you are increasing your exercises slowly enough to avoid relapse and regression.
I think this is probably the number one reason people stop physical therapy too soon. I believe that some physical therapists are just not aware of how slowly some individuals with chronic pain need to start and how slowly they need to progress. It is hard to understand how sensitive our bodies can become in the midst of chronic pain.
With most of my exercises, I only increase by one time when I make an increase. Meaning, if I have been doing that exercises 5xs, when I increase it, I do it 6xs. It feels quite ridiculous, but over time, this is how I have made progress.
When I have had to start from the ground up after a relapse, I have found over time, that I need the gentlest of exercises to get me started. Sometimes I can only start with one exercises for the first while, and that is all my body is able to handle.
You have to start with your baseline, and the truth for many of us is that our baselines are barely above moving. Our baseline may be one raise of the leg or 5 seconds holding a pelvic tilt. And this is OK! Next week raise your leg twice. The week after that hold your pelvic tilt 6 seconds. My experience has been that I need to start with my baseline or I won’t make progress. I have learned that I need to accept my baseline, even when it is way lower than seems even possible.
Question #3: Are you utilizing pacing on the days you do your physical therapy exercises?
You can read more about the pacing system that I use in these two posts: This post describes how to set up a quantified tracking system. And this post describes the benefits of using this tracking system to pace. One of the things I have learned from this pacing system is the importance of keeping track of everything you do over the course of the day and the combined sum of all of your activities.
To pace on the days that you do your PT exercises means that you can’t do your PT exercises and everything else you normally do. You have to cut something out. It is the combined sum of all the activities that you do that is important ensuring that you don’t overdo it.
This pacing system is the reason I haven’t relapsed in almost a year and a half and the reason my flares have been manageable over the last six months. When I stay within my pacing system, especially when it comes to my exercises, my body is able to make progress without major setbacks.
Question #4: If your physical therapy is not leading to less pain, is it possible that it is preventing regression or increasing your mobility and activity levels?
When I switched from my first to second physical therapists I stopped doing my exercises for a two-month period. My exercises had not been helping my pain, but what I didn’t’ realize is that they had been preventing regression.
When I finally got the appointment I needed two months later and tried to start exercising again, I realized that I had experienced a severe regression. I look back on that mistake with regret, because I wonder if things would have turned out differently if I hadn’t stopped.
Instead of giving up completely on your physical therapy exercises, if they are feeling too much for you, consider dropping back on how many you do. It may be that you haven’t started from your baseline as I talked about before. Keep doing something no matter how small it is. Movement and exercise are so important to avoid deconditioning. Rest and not pushing past your limits are important too. It’s hard to find a good balance of both, but my personal experience is that any time I have stopped completely it has been a bad decision.
Why have you not given up on physical therapy? Or why have you chosen to stop?
This post is not meant to be a judgement on those who have decided to not keep going with it. You have to make what you think is the best decision for you in your specific case. Sometimes breaks are necessary. For some conditions, physical exercise is detrimental to recovery and leads to a worsening of the condition. Please, please consider if your condition may be one of these before moving forward.
In the end, my hope is that these questions will cause you to more carefully consider if you gave physical therapy the best chance possible to work for your body.
What other questions would you suggest people ask before giving up on physical therapy?
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