focus on: why PT sometimes doesn’t help, plus slides from the CU lecture

I just started PT at the Jackson Clinics in Old Town, where the difference between it and previous PT shops I’ve worked with is astonishing. With the exception of the care I got at Courage Kenny in MN (second to none, no holds barred), PT had never been noticeably helpful for me, for a few reasons:

  • my body was not physically in the correct configuration, so the exercises only made things worse, the wrong muscles actually strengthening while the ones that were supposed to be working remained under the radar
  • the sessions were business transactions. 30 minutes, in and out, with the therapist watching me do the exercises but never correcting form or being interested
  • one local guy who specializes in musicians actually scheduled 10 (TEN!!!) clients at a time, hooked us up to TENS, ice, and heat, and never laid hands on us. Talk about a rip off.
  • hampered by insurance policies and already straining because PT shops don’t make much money, many providers tried to care for me, but were discouraged by the practice from any investigation or considering that things were connected (so, they would not treat an aching neck when I was in for a hurt knee, etc).

PT will be effective for you if your injury is fairly simple and you have a clinically sound practitioner. If your injury is complex or longstanding, you need to create a confluence of self-knowledge, specialists who are thoughtful and diagnostic, and next-level therapists who combine manual therapies with targeted athletic training. PT without checking things like alignment and soft tissue function can be hazardous: they should lay hands on you each time. PT without strengthening is also hazardous: you can reinforce problems and avoid curing the underlying issues.

So now that my body has been forced into much of the right alignment, I’d been noticing that my stretches weren’t helping, but that the pain was worse…and it reminded me of the old pain: the first real symptoms I’d experienced as an adolescent.

Then it dawned on me. The last time the muscles of my back were even close to this arrangement was when I was 12 or 13. This *is* the old pain, but this time I have the opportunity, via PT, to train the right structures to do the right things!

One thing to remember is that pain can have different causes: I kept attributing all of it to tension, but I’m finding that weakness is just as much the culprit. For me, my shoulder blades (scapulae and associated friends) are incredibly weak. Massage therapists would enthusiastically go after the marble-sized knots all along the edge of the scap, but it never made me feel better— in fact, it usually made me feel worse. That’s because my pain was from another muscle (sometimes the scalenes, other times the levator scap or SCM) being asked to do the heavy lifting and provide mobility it had no business doing.

I came into the clinic in so much pain and was chagrined to see that the main emphasis would be on movements to strengthen the shoulder blades. Ugh, what a creepy feeling. Hateful. Gross. After 45 minutes of intense exercise, my pain levels were close to zero. In fact, only after I got home did my upper back begin singing the song of its people once again.

Remember the active release techniques I was talking about last post? Some strengthening exercises can act almost like one of those; firing the right fibers while (and here’s why the pain stops) giving the exhausted ones some rest. I’m not going to get into which exercises I’m doing here, because it’s not a one-size-fits-all thing. Even if your pain is just like mine, have an expert evaluate the underlying causes, otherwise you could have something even crappier in common with me: reinforcing the maladaptive stuff even more!

So the main takeaway is that a whole bunch of things have to fall in line (sometimes physically) in order for PT to be effective. Press for diagnosis, and although internet research gets a bad name, do your homework and don’t be afraid to venture guesses if your docs are stumped. The key when trawling for clues is to make sure your info sources aren’t in a place to profit from some weird syndrome they hope you have so you’ll buy their supplements or an overpriced cushion. Instagram has a treasure trove of thoughtful PTs that are a great place to start if you’re in pain and therapies thus far haven’t been successful.

Accounts I’ve found super helpful: Andreas Öhgren (@pt_andreas), Dr. Katie Clare (@drkatie_clare) and Joseph Cheung (@joerehab). I’ll be back in a week or so with more on this series!

Here are the slides from the injury prevention lecture I gave at Catholic University in April. The video is on autoplay, so if you want to read more in depth, you’ll have to pause. There is no audio!

Feel free to ask me any questions here in the comments or via email! ❤️

Last, if any of this (or previous posts, or my book, or video tutorials, or past lessons, or email exchanges) have been useful, please consider helping me pay off the considerable debt incurred over the last 4 years of disability and massive medical bills- which are,right now hovering around $13800. You can do this by scheduling lessons either in person or online (via Skype/FaceTime/Hangouts), sending a donation via PayPal(link here) or, if you’d like to pay any of the hospitals I’m currently on payment plans with (Johns Hopkins University Medical Center, Virginia Hospital Center, and George Washington Medical Faculty Associates), I’m happy to provide account details to generous souls who’d like to pay providers directly. I’m past the point of being proud. In the last 10 years, I have had to sell my instrument TWICE. I’ve had to pass up opportunities with prominent ensembles, turn down a faculty position, and scale back every expectation because the pain and dysfunction made me an unreliable performer and potential employee. While I don’t believe that everything happens for a reason, I am going to keep sharing what I’ve learned, so that perhaps other folks might be able to sidestep some of the potholes that I’ve found myself sidelined by. But to fully recover, I need help. I’m currently waiting to schedule PT because every penny is essentially going to pay off previous medical care. Without PT and continuing care, it’s going to be impossible to work my way back to solvency, so you can see how the cycle repeats itself. I’ve pushed myself too hard during recovery every time, always for the same reason: the desperate need to make money to pay off medical debt. To those who have helped me financially over the years, I am so grateful. Although this sounds like a hard-luck story, it ends up being more of a love letter. Thank you, thank you, thank you. xoxo, e.

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