Sunday, January 10, 2010

An article slams physical therapy



My cousin Lauren just alerted me to this New York Times article about treating sports injuries with physical therapy. I'm about to start some tomorrow for my knee, which has been bothering me (but isn't so bad). A sports doctor in the piece talked about "voodoo" treatments—heat, ice, ultrasound, and laser.

I have no doubt that there's a lot of quackery out there when it comes to treating sports injuries, but I was a little surprised there was no recognition of how invaluable physical therapy can be for disabled people. Max wouldn't have learned how to walk as young as he did (age three, not bad for a kid with cerebral palsy) if it weren't for Mindy, the physical therapist who worked with him for three years through Early Intervention. I felt like giving her some sort of medal!

What kind of experiences have you had with your pt?

Photo by Orthoindy

28 comments:

  1. PT for sports injuries and PT for children with diagnoses are different worlds.

    Barbara

    ReplyDelete
  2. I realize that. I still think there should have been a quick nod to PT for people (not just children) with disabilities—more clueless people might have walked away from that article thinking ALL PT is questionable.

    ReplyDelete
  3. Did two different rounds of PT for ankle. First round was longer helped to stablize the ankle. The second round was more exercises I could have done at a gym.

    Have torn MCL and had NO PT, got sever different braces for the knee. Would like PT so I don't have to use brace. Now when I turn wrong on that knee, I am not wearing the brace.

    So have fun in PT. Get a brace, and learn what to do when you hurt it again without the brace.

    smgoodie

    ReplyDelete
  4. I did PT when I threw my back out. They pretty much showed me how to do some exercises at home to help stretch and strengthen my back. They didnt do anything odd or crazy and they didnt keep me going back forever either.

    ReplyDelete
  5. I know I wouldn't have walked without the help of my fabulous-beyond-all-things-fabulous private physical therapists. It's just as with anything. Any practice that gradually works to restore your health/condition should be praised...regardless of the situation.

    ReplyDelete
  6. I, too, wish they had differentiated between PT for conditions other than sports injuries vs. orthopedic injuries. Especially if some places, like school districts may use something like this to cut PT services to students. I worked for 8 years at a school that only cut PT services for students with multiple disabilities when they were able to access the school environment functionally. I now work someplace that cuts PT services in middle school across the board with all sorts of excuses, such as "no progress being made", "no educational value", "preparing students for the real world of no services after 22", "the physical issues are neurological no physical", etc. Newly referred students receiving high levels (i.e. 2x30 minutes individual) of PT (or OT or Speech) older than age 12 or so are automatically started on a path of service reduction. It makes me sad after the gains I saw older students made through therapy at my old job.

    ReplyDelete
  7. i have done pt for shin splints and a stress fracture both times i feel it helped me, but i also think that you can do a lot of the stuff at home, icing and stretching, but i think it helps.

    ReplyDelete
  8. I had PT when I was in college sports and I think the heat/ice/ultrasound combo did it wonders. I have since got PT at a Kaiser and it was more like an evaluation than treatment, then they gave me a bunch of exercises to do. Either way, it was helpful, but I think some of it is frame of mind...if you really embrace it, it helps. If you are half-way with it, it probably won't do much!

    ReplyDelete
  9. Barbara from BostonJanuary 10, 2010 at 5:33 PM

    PT is something that would vary by state of residence, as well as by the type of insurance you have. In Massachusetts,under medicaid, federal insurance for the disabled you are now limited by the type of injury and body part injured, and they now severely limit the amount of time you are allowed to receive therapy. If you suffet
    from chronic conditions this severely curtails the services you are entitled to, as well as the period of time you can be seen. Also in Ma. you have to scrutinize the policies before you purchase car insurance. When we had an accident that totaled our car several years ago, we found that there is something called PIP. We didn't have it had saved $19.00 on the insurance bill by not getting this rider, and found that we had $%^&* ourselves by neglecting this. My husband was eligible for far less PT than he needed (less than 5 sessions) though quite injured. Check before you penalize yourself innocently.

    ReplyDelete
  10. Heat and ice are "voodoo?"

    I guess I'm a fan of voodoo, then!

    ReplyDelete
  11. In my experience?

    Foster could barely roll over unassisted at 10 months old. He couldn't sit, stand, cruise, crawl, anything. (I still resent that the pediatrician, who we dumped after we started PT just called him a "late bloomer). At 10 months, he had the gross motor skills of a 6-week-old (according to the assessments). And our AWESOME peds PT had him walking (just a little, but it SO COUNTED) by 15 months. Do I think PT works? HELL YES!

    As far as recovery for adults goes? This summer, I finally started PT for my chronic shoulder pain. What did I have to lose? The only things that calm the pain are narcotics - nothing OTC. I was not willing to live that way. After four weeks of PT, my shoulder pain was minimal. But you know what? My insurance refused to pay it, and I can't afford it! ARG!

    I think you'll find the PT helpful in some way, especially if you follow through on your homework exercises.

    Since you asked...

    ReplyDelete
  12. Our PT became a very good friend. She taught me so much about how to care for my child with disabilities. She taught my daughter how to sit up and how to crawl, and taught me what I needed to do at home to help her.

    She was a huge source of support and information, and that made a huge impact on our lives. I really don't know what we would have done without her.

    ReplyDelete
  13. Physical Therapy was torture for Graham (who was born critically ill and had two brain bleeds, low tonw, and a slight right sided weakness) From 5 months old til he was three, I dragged him twice a week... he screamed his head off and barely participated.

    What PT taught us was something very important about Graham; he would do things IN HIS OWN TIME and ON HIS OWN TERMS.

    I honestly think he would have reached all of his milestones, just as late with or without the PT.

    Fast forward to school age Graham. He has PT at school and LOVES it! He comes home and shows me exercises he has learned and I can see his strength and balance getting better and better all the time.

    ReplyDelete
  14. I agree with you, Ellen - there should have been some mention about how important PT is for people with disabilities.
    Daniel's PT is our savior. Even when he tried every trick in the book to get out of doing therapy, she persisted and instilled in him that he COULD do the things she was trying to teach him. She has helped not only Daniel, but our entire family so much. While Daniel has "mild" CP/hemiparesis, I have wondered what he would have been like if he hadn't gotten PT. Would he be the active little ball of energy who tears up the house? Would he be able to walk at all? I don't think he would. Without therapy, he very well could have ended up in a walker or crutches. At best, I know he would have reached his physical milestones - especially walking - much later than he did with therapy.

    ReplyDelete
  15. I haven't had need for PT yet. knock on wood. So glad that Max had Mindy. Wish you luck with your PT, too.

    ReplyDelete
  16. Our PT (yes, she's OURS, not just Addison's) is amazing. She's a Warrior Mama, too, so sessions can be therapeutic for me. To hear that I'm not crazy and get the inside scoop on things we haven't been thru yet.
    Addison still does things on her own time frame, and NOT in the way the PT tries to teach her, but I know it has helped her. And she doesn't scream through it anymore, so that's a bonus too!

    ReplyDelete
  17. You can read the response of the American Physical Therapy Association at www.apta.org

    All the testimonials here are nice to read. Does an old PT's heart good.

    Somehow the slant of one news article does not work me up. I will agree that if you get most of your information from news media - isn't that the business you work-in, Ellen? - I better stop, eh?

    Nice of you to call 'em out. Did you leave a comment on the article? Barbara

    ReplyDelete
  18. Wow, very encouraging words about adult PT, and so wonderful to hear that all of your kids have found good ones to work with. Thanks for that link to the APTA, Barbara and, yep, I'm "in the media"—I'm a magazine editor/writer. By the time I got to the article, "Comments" were closed—there were a whole lot of them.

    ReplyDelete
  19. Voice of dissent here. . . hope I don't make anyone too crazy.

    PT can be VERY good for children with mild to moderate disabilities, but I think it's important to recognize that even in that area there does not exist a huge body of substantive data to support the things that they do. I pulled this info from an article over at Canchild, the Canadian research center for chilhood disabilities. Here's the article:

    http://www.canchild.ca/en/canchildresources/alternativetreatmenttrenches.asp

    This is not to say that it doesn't work, but rather to say that the research is not yet there.

    I also think that PT has yet to find ways to significantly improve the lives of children who have moderate to severe CP. They try, but the current techniques just aren't there. I love our PT and think she's great, but I think of her more as a cheerleader than as the person who will help Charlie to sit/walk/etc.

    Now, I only hope that all the nice people here don't kill me.

    ReplyDelete
  20. At least the NYT article was published this week, not last century.

    Science is a slow-moving massive behemoth. It can be tough to keep up with which direction it is headed, but people keep trying to make it 'news'.

    Barbara

    ReplyDelete
  21. Barbara from BostonJanuary 10, 2010 at 9:40 PM

    Good, true point, Katy.
    I totally forgot that in my previous life (before Industrial Accident/disability) I was jack of all trades in Department of Mental Retardation/Mental Health. Did everything from direct care to directing an off site Vocational Workshop in a leather goods factory. Many times have I sought PT evals, many times have I carried out prescribed exercises. Everybody I have worked with benefited from the one to one or small group setting. Didn't always see much in the way of huge breakthrough. Often gains could be seen in small increments - an easier time using sign language, someone blossoming emotionally through positive attention. For some goals you can make it fun - I have always seen clients enjoy working in the kitchen even if its non cooking items like peanut butter balls. And while being productive it gave a chance to work on side skills like sign language, hand washing cooperation, manual dexterity, eye/hand coordination, measurements... There were gains but a primary goal is making the person feel positively about themselves, their skill, etc.

    ReplyDelete
  22. As a mother of a child with severe CP, I can very much identify with Katy. (My Emma is more physically disabled than intellectually disabled.) As a matter of fact, Katy took the words right out of my mouth. We have had some super nice PT's over the years, but I would definitely say their contribution to Emma's development has been more "cheerleader" like than anything else. I love our PT, but it seems like she gave up on Emma quite some time ago. She has not been the only PT in Emma's life to throw in the towel. I think she tries, but she has little hope that Emma will overcome the odds. Ironically though, I often find myself envious of all the fabulous work that PT's have done with children that I read about through blogs, etc. I do know that they can absolutely work miracles with children who have milder insults, and I have seen that first-hand in other children at our PT clinics. We live in a rural area, and hurt children like my Emma don't come along every day. She is the only one that requires a wheelchair for transport. Thus, the experience is not there either. To be frank, I wrestle with the notion that we are just wasting our time most days--which consist primarily of stretching and maintenance routines. Thank God that we have found other resources for Emma and are able to travel with her. I have found the more alternative forms of therapy to be most helpful to MY severe child. Certainly, this is just a personal perspective.

    ReplyDelete
  23. Amy, I am glad you have found alternates to PT. I agree with you and with Katy‚ I think PT can be less effective with kids who are more involved. Max is all-around involved, but he is considered "mild" in terms of his legs—his arms are more screwed up, to use the correct medical terminology. It's just luck of the draw where the brain damage strikes.

    I think it's good to still get kids the PT, since you just never know. I come from the "more is better" school of therapy, as I'm sure a lot of moms here do. It couldn't hurt, it just might help.

    ReplyDelete
  24. I'd like to ditto Therextras comment that science is a slow-moving behemoth. As a teacher we often felt trapped by the neccessity to only use "proven" methods and I'm sure that's true in many fields. Sometimes you can't wait around for a double-blind study and what that article calls "voodoo" might just be things that haven't yet undergone the rigorous testing process. Doesn't mean that dont' work.

    ReplyDelete
  25. I love our main PT for my baby, and the other, who we have because we go to a Shriner's Hospital for orthotics and they have a "team" approach, is also helpful but not as significant to us. And the main method my PT used is not favored by the OTs we work with or other PTs but I tell you all that as soon as he splinted my baby's elbow she stopped clutching her arm up which kept her off balance, and within days she was working on sitting up. Now I get compliments on how well her shoulder and trunk move, even from those who don't believe in this non standard method. I absolutely believe we are way further along than we would be without that PT.

    ReplyDelete
  26. Honestly, when we were told to get our 2 month old (CP from birth injury) started with physical therapy, I thought it was craziness. Now, six months later, I can't believe how much it has helped him, in really visible and measurable ways. Right now the PT and the speech therapist (severe hearing loss too) are the most important people in our lives. Seriously.

    ReplyDelete
  27. When we got stationed near Seattle in 2008, we happened upon The Best PT for Isaiah. He didn't use a cookie-cutter approach with Isaiah and was willing to mix some old school with the new school---low tech with the high to bring out the best in Isaiah.

    He saw Isaiah's tremendous potential and worked with our family to that end.

    Last summer, his PT suggested we try Aquatics Therapy. Three weeks after he started working with the PTA in the pool, Isaiah was walking by himself.

    I can definitely appreciate how in tune our PT was with our family and Isaiah.

    For me, the results speak volumes.

    ReplyDelete
  28. luckily i have never had to have PT but I wish you luck with it

    ReplyDelete

Thanks for sharing!