It has been about a month now that I was discharged from aquatic physical therapy and was advised to join the “medical exercise” program. Physical therapy is one-on-one with a therapist; medical exercise is in a small group setting with an exercise coordinator. But they are both in the warm water pool, doing similar exercises as PT. I had noticed better mobility and endurance during my time in aquatic PT, so I thought continuing it in some form would be a good idea.
From what I had observed in the pool, I did not think there would be much difference overall in the two programs, and it should be a relatively smooth transition. But unfortunately, I immediately noticed a huge difference between the attitudes of my therapist and the exercise coordinator, and that too in our very first evaluation meeting!
In the past, I have felt my therapists were very good about taking it very slow and making sure that I was comfortable in the exercise routine. Our goal was to get me to start moving a little bit more smoothly and that was it. I never felt that I was pushed too hard too soon (except maybe once and we quickly backtracked from that). I knew PT wouldn’t last forever, but we took baby-steps until we felt I was ready for a bit more semi-independent program.
Now when I got to this semi-independent program, I felt pushed to immediately move on from there, despite her less-than-heartfelt verbal reassurances to the contrary. I tried to carefully describe the conditions under which I ended up in PT, my failed attempts at at-home exercises, yoga/chi gong in the past, how I felt embarrassed and intimidated at the pool in my university’s rec center around normal people my age. I explained that I liked the hot water therapy pool, that it was doing me a lot of good to just soak in it, so I preferred that to the gym. But it’s like she just couldn’t let it go that I had to move on one day into something else, even after I told her that I was intimidated by many of those things just now!
I suspect she was trying to motivate me, and make me see that I could get better and be more independent. She said she wanted to work on muscle strength and balance which should help me move on to some beginner yoga/tai chi. She talked about keeping it mild, not even moderate, and transition into a public pool under less athletic settings. But she kept trying to push independent exercise ideas before I had had a single class with her! And it left me feeling like she wasn’t very enthusiastic about having me in the program. I felt my anxiety rising, and at times I thought she noticed it too, but did not take enough of a cue to stop pushing me farther than I was ready to go right now. I felt like I had barely climbed the mole hill, and I was being pointed towards a freaking mountain!
What made it worse, I think, is that all this was happening right after I had to explain the whole history of my symptoms to her top down. It is something I never enjoy doing. I feel like I sound like a hypochondriac who needs to shut up already. Now I had the added sensation of feeling whiney as I was afraid to embrace her good suggestions.
All in all, I was glad, however, that I did not sell myself out and invalidate my emotions based off the vibes I was getting from her. I often have a tendency to say to myself that what I am feeling is false, but most often that it not the case. I am simply afraid of admitting of the consequences of the truth. I mostly refrained from doing that this time, while attempting to retain compassion for her point of view.
I have my first session with her this Friday. I am keeping my fingers crossed that our first meeting (that I described here) is not a harbinger of things to come. I know I am looking forward to being in the warm water pool. So fingers crossed that all goes well!
Love,
Fibronacci
Pain(t)h.D. 
Fingers crossed. You may learn something valuable and the rest of her advice you can ignore 🙂
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Thank you Laura! 🙂 I am looking forward to learning how to live better. I think she meant well, so I am trying to keep an open mind… one day I might get there! Until then, I am trying to stay resolved to listen to my body and not push it where it refuses to go.
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Seems to me that the goal of any physical therapy or exercise program would be to teach patients how to do it on their own. That doesn’t mean the patient will eventually get “better” — it’s more of a learning experience. Like if you take cooking classes, that doesn’t mean you’ll become a chef. And just because pain patients successfully complete treatment programs, that doesn’t mean they’ve been “cured.”
You can learn a lot of different types of stretching and exercise in these programs, but that doesn’t mean all of them will work for you. Try everything — slowly of course — then use the ones that seem to help. And be ready to be flexible, as some exercises won’t work all the time. And some exercises will make things worse.
One of the goals in creating a pain management program is to have as many choices to manage pain as possible. And also finding the ones that you enjoy doing, even though you know it will increase your pain. For instance, with my bad knees, bending down to take a picture of a beautiful flower is painful, but the resulting photo is usually worth it. 🙂
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Yes, you are right. The PT program was definitely meant to get you from an acute healing state to more of a wellness state. At that point then, they transition you into this medical exercise program, which is meant to be an intermediate between PT and independent exercise. So I realize going into it that this is not going to last forever either (and frankly, it’s just as well since it’s quite expensive!), but I wasn’t quite ready for her to usher me along so soon into uncomfortable territories before we had even started working together. I guess I was just spoiled by my physical therapists who were exceptionally mindful of my physical and emotional boundaries. And I did not feel that “safe space” with her on our first encounter. But I am still trying to keep an open mind with her because I do think she would want me to do well. Regardless, I am looking forward to that nice warm water pool again! 🙂
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I was in a very similar situation once, in a group exercise program at a pain clinic. The physical therapist who ran it was way less empathetic than someone I would have expected in her role to be.
Looking back– especially now that I have shadowed a bunch of physical therapists in different settings– I think that sometimes people who hold positions such as these are under pressure to demonstrate that their patients have made “x” amount of progress, in a certain amount of time. I can’t speak for your PT, but it is possible she is just trying to move all of her patients along based on the same template, ensuring they try a certain number of new techniques and exercises in a certain amount of time. I don’t want to be a complete downer, and I agree with other commenters who say you should try to get out of it whatever can be helpful to you. But don’t lose hope, or faith in yourself. Ultimately you do know what’s best for you, and if someone can’t trust in your judgement, they might not be the right fit.
If you’re interested, here is a link to the post I wrote about my own experience.
https://sunlightinwinter.com/2012/12/23/pain-clinic/
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Thank you so much for the link to your article. I am very sorry you had to go through that experience but was glad to see that I am not completely alone here. I could also really relate to your feelings about yoga – I have had similar experiences with it before.
It makes a lot of sense what you said about the expectations that the therapists have to meet driving their attitudes. Fortunately, I have had a very good relationship so far with all my PTs. And I am hoping we can continue that with this one despite the rocky start. I am hoping that once we actually get into the pool and start doing stuff, things might fall into place more – she will get a better idea for what works or doesn’t work for me, and I will get to try out her suggestions and see how they work out. Despite her immediate demeanor, I am hoping that she is willing to be more patient with me and with what feels right for my body. And despite my initial desire to hide in the shell, I hope that I can bring myself to at least give her suggestions the ole college try! 🙂 Thank you so much for your support!
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Like Sunlightinwinter said, some therapists really just take the x progress in x amount of time thing too seriously! Sometimes if you can arrange to work with a different therapist with a different personality/approach to therapy, that gets rid of the problem. It’s kind of hit or miss trying to figure out if they want to push you too hard until you’ve had a few sessions with them.
A good therapist should eventually help you learn to do exercises that are reasonable for your abilities on your own. They should also realize that for some of us, doing all of the exercises for balance at once, or all of the exercises for a particular muscle group at once is too much, but if we mix it around we actually give the muscle groups a break so we can do more exercises total with each muscle group. And sometimes I can extend my exercise capacity by taking a break to just walk around slowly in the pool.
I have to say that I have sworn off all group exercise as I really can’t stand being the worst at the exercises, and the pressure to “keep up” is so high I think that it would take superhuman self-control to not overwork myself. But I do like going to the YMCA to do exercises on my own – near us they keep the shallower “leisure pool” (about 3.5 feet deep) decently warm so I can do my exercises by myself at my own pace.
Also, sometimes if the therapist is giving me suggestions to try on my own I’ve gotten in the habit of just asking one or two things about the biggest concerns for how to get my body to handle it, and then very carefully and slowly try them on my own. I think it’s easier for them to swallow when I say I can’t do something after I’ve tried it, and it makes it easier for me to try to explain what I got stuck on.
Finally, I generally find that therapists who have taken classes from the Postural Restoration Institute tend to be much more understanding of unexplained pain/exercise problems and have much more insight about them. If you feel like your therapists are helping, I would stick with them, but if you get stuck in a spot where no one wants to help you do exercises that are reasonable for your abilities/current struggles, then I would check out the list of Postural Restoration therapists on their site to see if there is one in your area: http://www.posturalrestoration.com/find-provider . I know the name Postural Restoration makes it sound like they are just about helping people stand up straight, but really they are about helping people who struggle with chronic pain and have trouble coordinating their body/just getting through normal, everyday physical movements. It’s not guaranteed that therapists with this training will be more understanding, but in general they know more about unexplained pain/movement problems. Though it can be hard to find Postural Restoration therapists who do water exercises, I think most of them have been trained to do “land therapy” as my therapists say.
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Thank you so much for your thoughtful response! 🙂 Unfortunately, it doesn’t seem like they have any postural restoration therapist in my state. I think I am just going to have to be very clear regarding my boundaries with the current exercise physiologist, since she’s the only one in the area doing a program like that. I had my first session with her yesterday and it was OK. She definitely wants to help, just maybe too much too fast. We tried to target some of my problem muscle groups in the back, and it nearly brought tears to my eyes after a while and I had to stop it. I explained that I also had work afterwards so we need to take this easy, though I am trying my best. So then she let me just hang in the warm water with a neck-float, and that helped a lot! She seemed happy that I felt more relaxed. After that we decided that we will take problem muscles much more slowly than we did yesterday.
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