Concerns About Physio

Bigger Stronger Leaner Injuries and Rehab
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A while back I had posted this thread http://tnation.T-Nation.com/free_online_forum/sports_body_training_performance_bodybuilding_injuries/functional_problems_pelvic_issue in regards to functional problems I’d been having with my lumbar/pelvic region. After a consultation with my GP, I had subsequently been referred to an ortho, a physio, and am awaiting an appointment with a neurologist. Ortho immediately dismissed me, as there were no abnormalities present on X-Ray.

I am now a couple weeks into appointments with my physio, but I’m having some concerns and wanted to seek advice. One of my main concerns is that any inquires made on my behalf (i.e. non-firing glute, functional leg-length issue, hip flexor/glute imbalance) have instantly been disregarded, yet the problem area itself has barely even been addressed or examined.

Instead, what is being being focused on is ‘alignment’ of my ankles, knees and hips- yet the way in which I have been told to hold my legs (slightly knock-knee’d) is identical to the way in which I did so at the end of last year, when I had myself been attempting to adjust myself to what I had considered perfect alignment. However, all that I achieved was that I ended up with severe IT-Band syndrome and CP, in both knees (despite being an avid foam-roller); my worry is that things are going to flare up once again.

Are my concerns here at all justified? I know I am not in the LEAST bit qualified to give a self-diagnosis, and I’m here expressing concerns at the suggestions of a qualified professional, but I can’t help but feel that the focus is being shifted away from where it should be at, and is potentially putting me in a position where I could once again end up injured.

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[quote]bushidobadboy wrote:
Your concerns are 100% justified. After all, you are the patient, and the physio is supposed to be offering patient-centred healthcare.

There’s a good chance that the physio, not truly grasping or understanding the material he was taught and uni, has since been put on a course. One of those ones that brainwashes the participant into believing that whatever the specialist supject of the course covers, is the be-all-and-end-all of biomechanics, diagnostics and treatment.

Maybe he swallowed the old ‘EVERY problem begins with the feet’ approach and is too scared to think for himself for example.

Now he may actually be right in his approach. After all, a lot of problems DO start with the feet and ankles. However, only the shit therapist doesn’t bother to take the time to explain to the patients what they think is wrong, why it is wrong and how best to fix it.

That’s my opinion.

BBB[/quote]

Appreciate the reply. The essence of the feedback I’m getting is that I’m “over-thinking things” in addition to “training too much.” Over the past couple of months, my training has continually been reduced, yet my issues seem to be getting worse. I’ve been told that my movement looks normal, though it feels anything but: when I’m walking, my hips start playing havoc between being internally and externally rotated, while my pelvis feels as if it twists.

Don’t get me wrong, she has noted several issues- the most significant being the tenderness in my left SI joint (which, she has told me, is stable) but I’m frustrated that things seem to be going unaddressed. Today, I mentioned newer symptoms of tightness around my TFL and IT Band, as well as a persistant deep “clunking” with any hip flexion, but these weren’t any further looked into. When movements were being looked at, I explained that my squat stance (feet slightly out, femurs slightly externally rotated) allowed me to get a contraction of the glutes, yet following her re-alignment (toes forward, increased valgus knee) I couldn’t, and felt a greater strain on my hips. This was put down to me not being used to it. My hamstring tightness was addressed by way of issuing stretches; I’m no expert, but I at least know that hamstring tightness isn’t always merely due to the hamstrings themselves, and I would like to think that my own foam rolling and stretching would have loosened them by now.

I’m almost at a loss as to what to do, as I desperately do need some help, but want someone to at least take into consideration the symptoms I’m describing and possibly be more thorough in addressing them, even it’s to put my mind at ease by way of crossing off conditions or problems which it could be.

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[quote]bushidobadboy wrote:
But seriously, I feel your frustration. I’m on the lookout for a good therapist locally, to work on some of my tendonitis and muscular issues, but it’s hard to find one that i trust to do a good job, without me coming off like a twat, telling them what to do, etc, haha.

You are right in that muscle tenssion is often neurogenic and not likely to be improved with a simple static stretch.

Look up ‘muscle energy techniques’.

BBB[/quote]

I probably have come across as a bit of a knob, putting forward so many suggestions as to what it could possibly be. At the minute, my frustration is coming from the fact that she seems to believe that nothing is wrong which is probably why I’m making so many suggestions, as I absolutely refuse to believe that everything is normal. I’m hesitant to take any sort of action as my treatment is free, and I can’t currently afford to spend money to visit a private clinic, where I’m sure I’d be examined much more thoroughly. The other thing to consider in this whole thing is that it’s entirely neurological. I’m scheduled to have an MRI of my brain and spine, and to be honest, finding an abnormality isn’t something I’m particularly keen to be thinking about. I will check out those muscle energy techniques; are they in any way similar to neural flossing? Again, appreciate your response.

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sorry to hijack, BBB, are there any physios you would recommend in the london area? where exactly are you located in wales, if i have no joy in london, i study in exeter, and the 2.5 hour car wouldn’t bother me much

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where are you in midlands? mind putting your details up or pm’ing me. i’m not so much after a therapist who lifts, just one who is trusted by someone who lifts. last one i went to told me that squatting has nothing to do with hamstring strength, and that when i squat i should wear running shoes with very soft soles… i haven’t been back in a while. so if you could also forward me the details of your friend in bristol, i could drop in on my way to Exeter.

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One of the biggest mistakes people make when receiving therapy of any kind is not giving it enough time. The second is thinking they know more than the practitioner. Manual therapy creates an environment for the body to heal itself, and that can take months. Though BBB raises some valid possibilities, do not think yourself into a problem before it occurs. Give it 10-12 sessions before you make any judgments, and talk to the therapist about your concerns. Giving good feedback is essential, and tell them about everything you are doing at home. Take a humble and inquisitive approach, rather than a why the hell are you not doing xyz. Some people find instant relief, some gradual and in some cases more problems can arise before they are resolved. It is not uncommon to uncover latent issues that have been there for years.

Good luck.

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…With all that being said, if you do not feel comfortable with the quality or depth of care you are receiving then you need to move on. Having faith and trust in your therapist in important.

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Nottingham, i know someone who lives up there, so sounds pretty sweet.

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[quote]bushidobadboy wrote:

[quote]chriscarani wrote:
Having faith and trust in your therapist in important. [/quote]

Well said.

BBB[/quote]

Thanks! Don’t know if you remember me or not it has been a long while (we had the disagreement on lumbar rounding during squats) but good call on the posterior capsule adhesion in the shoulder. I did some deep cross fiber on that SOB and it healed up nicely. Still have to work the RCM every now and then, but much better.

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[quote]chriscarani wrote:
One of the biggest mistakes people make when receiving therapy of any kind is not giving it enough time. The second is thinking they know more than the practitioner. Manual therapy creates an environment for the body to heal itself, and that can take months. Though BBB raises some valid possibilities, do not think yourself into a problem before it occurs. Give it 10-12 sessions before you make any judgments, and talk to the therapist about your concerns. Giving good feedback is essential, and tell them about everything you are doing at home. Take a humble and inquisitive approach, rather than a why the hell are you not doing xyz. Some people find instant relief, some gradual and in some cases more problems can arise before they are resolved. It is not uncommon to uncover latent issues that have been there for years.

Good luck. [/quote]

I probably haven’t given her the respect she deserves, and admit that I’ve jumped the gun too soon with thinking she’s not properly addrsssing the issue. However, I do still hold some concern that I was urged to continue to practice a new form of alignment which has caused me great pain and discomfort, particularly in the past. I have my next session on Thursday, and would like to come away from it feeling more positive; you’re right when you say I should at least have some faith.

And BBB, I’ve checked out those muscle energy techniques you mentioned and will give them a try. Are they not quite similar to an active isolated stretch, in that you take a joint to the end of its ROM, but you then focus on contracting the problem muscle itself, instead of contracting the atagonist (like in AIS)?

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So, latest development… I have to give up weight-training. Apparantly there are niggling injuries in my body and I have to find an alternative form of exercise, as it’ll never get better if I keep lifting weights. She’s even talking about getting me referred to see a psychiatrist to make it ‘easier to deal with’. Not sure exactly how to take this, or what to do next. Do I really give up weight-training? Do I look at seeing another physio, to get a second opinion? I’ve expressed concerns about possibilities of things such as functional scoliosis or leg-length discrepancy, but these have immediately been dismissed, without (what I would consider) a more thorough examination. I’m certain that there are visible physical assymetries which would point towards them being possibilities, but I don’t feel as if I’m being listened to; even humouring me to perform tests to prove that such things are a non-issue would have been appreciated. Drastically scaling down my training over the past few weeks has made no difference, and a greater focus on foam-rolling and stretching of the muscles she suggested actually seems to have made muscles tighter. There are things I’m experiencing that have remained despite prolonged breaks, making me wonder if there really is a congenital issue. Should I consider visiting a Chiropractor, to get a spinal issue ruled out?