I have a love-hate relationship with PT. Many years ago, I went through two series of sessions for frozen shoulder—once in each shoulder. Those resolved completely, and I was sold on the benefits of PT. A couple of years later, I did several weeks of PT exercises for Temporomandibular Joint (TMJ) pain. Let me just say, jaw exercises are weird. Once an MRI was ordered and the results were in, it became clear why the exercises hadn’t worked.
It turns out my jaw pain was the result of a displaced articular disc in the joint. Articular discs provide a cushion where the temporal bone and the mandible bone meet so one bone isn’t grinding against the other, which is what was happening. No amount of jaw clenches, chin tucks, and dry needling could move the disc back where it belonged At least my jaw and chin were well toned. Who knew there were so many muscles involved in chewing?
Photo by Bas Peperzak on Unsplash
In late 2023, another pain appeared in my right leg. Consequently, I’m now on my third round of PT for ischial bursitis-herniated disc-sciatica-piriformis syndrome-proximal hamstring tendinopathy-hip bursitis. The diagnosis depends on who you ask. No matter what you call it, it’s a real pain in the ass—literally. Maybe if either the diagnosis or the assigned therapy was on target, I wouldn’t still be dealing with this pain, but here we are.
Here’s how PT has gone this time around:
- Get a referral order for 6 sessions of PT from an orthopedic surgeon, who listens to my symptoms and diagnoses sciatica without putting a hand on me. He recommends a series of McKenzie PT exercises.
- The receptionist at the Physical Therapy clinic reads the referral and shakes her head. “This will probably take more than 6 sessions.” When I express concern, she says, “Don’t worry. Medicare will pay for it.” It makes me a little nervous that she thinks this will make me feel better.
- I meet the Physical Therapist assigned to me. She scans the referral form, shakes her head slightly and says, “I don’t use McKenzie exercises in my practice. Instead, I’ll do a thorough assessment on your right leg to see where we need to work.” I like the sound of “thorough.”
- The PT proceeds to push, pull, rotate, and pinch my leg all the way from my right cheek to my right foot. (Okay, I made the pinch part up, but from the pain points in my leg afterward, it feels like it was pinched.) At each move, she says, “How does that feel?” When I shrug, she says, “Hmm. How about now?” And so on, until I scream “OUCH!” She nods and says, “This is where we need to work.” I won’t swear to it, but I think there’s a sadistic smile tugging at her lips.
- When I ask what she does recommend for sciatica since she doesn’t assign McKenzie exercises, she says, “I don’t think that’s what you have. You have right proximal hamstring tendinopathy. We’ll work on your right hamstrings. They’re weak.” I’m insulted. I’ve walked two or three miles several times a week for years. I think my hamstrings are fine.
- I bring home the printed list of exercises and secretly research the McKenzie series. I add three of them to the routine the PT gave me. For good measure. I do all the exercises daily. I’m a little OCD, plus I’ve never experienced this kind of sustained pain. I want it gone.
- After a couple of months of therapy, the pain subsides and my therapist proclaims—a little smugly, I suspect, “Your right hamstrings are really strong now, stronger than your left.” I’m still a little hedgy about her diagnosis, but I can’t argue with success. High fives all around.
- Six months later, the symptoms and pain return. I consult a new orthopedic surgeon, who finally orders an MRI, which finds a “slight protrusion” of a lumbar disc that might be putting pressure on the sciatic nerve. Finally! Empirical evidence. I choose the same PT, who scans the MRI results and seems skeptical. Rerun the previous script, with a few changes. After a couple of months of exercises, the pain resolves again. Maybe she was right all along?
- Four months later, the pain comes back. At that point, I switch PTs and keep the orthopedic surgeon. He orders a second MRI showing an increase in disc herniation. I ask for a referral to a PT who’s a lumbar spine specialist. I’m optimistic until the first words out of his mouth after hearing my story and reading my referral are, “I don’t think an MRI is the whole story, and I don’t do McKenzie exercises in my practice.” When he detects my doubt, he says, “Your glutes are weak. Your hamstrings are compensating.”
- I want to yell, “That’s because I’ve been working on strengthening my hamstrings for almost a year!” But I don’t. The lumbar and spine specialist assigns glute exercises and says, “Give me two weeks.”
- When I tell him after two weeks I haven’t noticed any improvement with the glute exercises and scheduled no more appointments, he seems alarmed. I guess he didn’t think I’d take him seriously when he said to give him two weeks.
- “We need a new strategy,” he says. Damn right! Something about his focused attention on this second assessment reassures me. I take the three new exercises he assigns (roughly 100 repetitions each, or so it seems), determined to do what I’m told.
You can’t say I haven’t given Physical Therapy a chance. My husband says therapists aren’t used to patients doing the exercises they assign, and I’ve thrown him off guard. However, in my experience, resolution has usually come when I’m diligent in working toward healing. So I comply.
I’m not sure I have much choice. My doctor’s nurse practitioner cautioned if the recent epidural steroid injection and PT don’t resolve my pain, the next step is a surgery consult. PT is the less invasive option and therefore preferred. Nevertheless, I’m skeptical of all the diagnoses and theories about what’s causing my pain.
To be fair, the muscle attachments and potential for constriction at the juncture of the femur and the pelvis are very complicated. Odd that mine are more complicated on one side than the other, but what do I know? I’m trying to give the therapist the benefit of the doubt. He’s a professional, and this is his area of expertise.
I’ve obediently done the prescribed exercises—twice a day, every day. Despite everything, I’m still hopeful. I made two more appointments for a third week of therapy.
Here we go again.
Janice Airhart 