Off-Topic Physical Therapy

[oukeith1]

Hi all. I am going to go see a physical therapist. I am having pain doing most things overhead. It’s not bad pain, but I can’t run a pressing program or do a lot of yoga moves without gradually increasing discomfort each day I perform those moves.

Thankfully I can still perform a getup without issue.

Any advice on how to go about choosing a PT? I figured the folks here might have some insight on my specific situation and what to look for in a good therapist.

I’m in the States, by the way…

Thanks!
Keith

 

[Halfakneecap]

Hi all. I am going to go see a physical therapist. I am having pain doing most things overhead. It’s not bad pain, but I can’t run a pressing program or do a lot of yoga moves without gradually increasing discomfort each day I perform those moves.

Thankfully I can still perform a getup without issue.

Any advice on how to go about choosing a PT? I figured the folks here might have some insight on my specific situation and what to look for in a good therapist.

I’m in the States, by the way…

Thanks!
Keith

Hey mate, when I snapped my kneecap I looked around for a good PT. Luckily, a local PT works with national level sports teams and I was able to book in with them. I went twice a week for months, and while they weren’t cheap, they were worth every cent. 7 years later, any physical injury for me, or anyone in my family, I don’t bother with the dr. I go straight to them. A good PT is worth it

 

[Eyetic]

You didn't specify where is the pain....guess are in your shoulders if its overhead.

I've got many PTs during the last..14 years or so, the good PT will examine you, your postural behaviour, your examns (or ask you for examns like MRI or X-Rays), then will check you physically and not just the part where the pain is, a full check, then will try to isolate the reason or the source of pain, either if its a movement/pattern etc... anyway its difficult to find the best one for any specific person.

My best one was a Sport specialist PT, he was an ex soccer player who got into PT after many years of playing soccer professionaly, and you could feel his determination to find the problem in each visit and find how to address it from many different sides with various treatments and teamwork.

 

[offwidth]

1. I would see a good sports medicine doctor prior to going to a physiotherapist. This way you stand a chance of the physiotherapist knowing exactly what they are treating.
2. Try to find a physiotherapist that is use to treating athletes. The higher caliber of athlete the better.

 

[Antti]

Success among the demographic you're in would be great. I also like if the PT has real experience with strength training.

I wouldn't look for a cheap trainer and a good trainer. I can only afford one so I prefer to just pick the good one. Be picky. That doesn't mean that cost is indicative of value but I wouldn't pick the PT based in price if I wasn't forced to.

 

[oukeith1]

You didn't specify where is the pain....guess are in your shoulders if its overhead.

I've got many PTs during the last..14 years or so, the good PT will examine you, your postural behaviour, your examns (or ask you for examns like MRI or X-Rays), then will check you physically and not just the part where the pain is, a full check, then will try to isolate the reason or the source of pain, either if its a movement/pattern etc... anyway its difficult to find the best one for any specific person.

My best one was a Sport specialist PT, he was an ex soccer player who got into PT after many years of playing soccer professionaly, and you could feel his determination to find the problem in each visit and find how to address it from many different sides with various treatments and teamwork.

Yep, shoulder. Doesn’t bother me on the day-to-day as long as I don’t do all the things I would like to be doing. If I start doing pull-ups, C&P, downward dog, etc, my shoulder will get sore fast and start feeling like it’s hanging from my torso incorrectly.

 

[oukeith1]

1. I would see a good sports medicine doctor prior to going to a physiotherapist. This way you stand a chance of the physiotherapist knowing exactly what they are treating.

That is interesting. I don’t know if a doc is going to find much in an x-ray or anything, because I’ve done a good job of protecting myself from making it worse. I will research sports medicine and see if that makes sense.

 

[oukeith1]

Success among the demographic you're in would be great. I also like if the PT has real experience with strength training.

I wouldn't look for a cheap trainer and a good trainer. I can only afford one so I prefer to just pick the good one. Be picky. That doesn't mean that cost is indicative of value but I wouldn't pick the PT based in price if I wasn't forced to.

Cost isn’t necessarily an issue, thankfully. I will try to find someone focused on sports and strength training for sure.

 

[oukeith1]

@Halfakneecap - thanks for the advice. I will try to focus on a sports based doc.

 

[Anna C]

My perspective, if it helps...

I have a similar thing going on and started physical therapy a few weeks ago. on 11/24. Like you, I didn't have a specific injury or any event or surgery to recover from. Just pain and discomfort in certain positions and with certain movements, and intermittent pain in the shoulder area, especially at night.

As much as I'd like to choose a specialist in strength training, insurance doesn't work that way. I go where my referral sends me. Fortunately they're pretty good, as I went to this practice last year for a similar situation with my hip, and they helped me solve it.

So far, it's going well with the shoulder rehab. They diagnosed weak rotator cuff muscles. As I understand it, when certain muscles are weak and not doing what they're supposed to, and I am doing hard things with other muscles in the area (i.e. I'm doing a lot of things with a heavy barbell), the small weak muscles get overworked, tight, and inflamed. Inflammation in the muscles in the shoulder area leads to things getting even more cramped because there's not a lot of room in the shoulder joint. This leads to a sort of secondary impingement when I move my arm up overhead. This leads to more inflammation. Etc.

So the solution is to do a series of 4 stretches (because weak inflamed muscles get tight and cranky, and restoring full ROM is helpful to properly working the muscles), about 10 seconds of 10 reps in each stretch, one for each of the 4 rotator cuff muscles, then do a rotator cuff strengthening series using bands and about 4 sets of 10 reps of 4 different exercises. They do a bit of manual stretching and manipulation to loosen up the shoulder, too. This clinic also does dry needling, TENS, and other things... but they don't feel that it's needed for this issue right now (I agree).

I was pretty sure before I went to PT that I needed this type of work, and had a lot of good suggestions from people when I expressed my problem with painful push-ups in this thread. However, I was really hesitant to add stuff to what I was doing when my muscles felt overworked already. So it helps a lot to have a PT that tells you exactly what to do.

Not sure if this helps with your situation, but part of the lesson for me is that it's probably not a super complicated situation. A PT clinic that deals with common problems is probably going to help you just fine. Chances are good that if you get on the right track to improving things, your body will be able to heal.

Good luck and let us know how it goes...

 

[Manuel Fortin]

I was pretty sure before I went to PT that I needed this type of work, and had a lot of good suggestions from people when I expressed my problem with painful push-ups in this thread. However, I was really hesitant to add stuff to what I was doing when my muscles felt overworked already. So it helps a lot to have a PT that tells you exactly what to do.

I saw the push-up thread and almost responded "TGUs", but since I'm not a doctor, I refrained from doing so. Since it seems that weak stabilizers are the issue, I now feel free to say that TGUs have worked miracles on my shoulders after years of water polo, which really creates imbalance in your shoulders. It took some time, but after a year or so, my shoulder stopped nagging me. So, maybe some getups would help you too. As usual, start with a weight lower than you think you should use and build volume slowly.

 

[Anna C]

I saw the push-up thread and almost responded "TGUs", but since I'm not a doctor, I refrained from doing so. Since it seems that weak stabilizers are the issue, I now feel free to say that TGUs have worked miracles on my shoulders after years of water polo, which really creates imbalance in your shoulders. It took some time, but after a year or so, my shoulder stopped nagging me. So, maybe some getups would help you too. As usual, start with a weight lower than you think you should use and build volume slowly.

I agree! I do them sporadically but I agree, need more, and would benefit the shoulders.

 

[Manuel Fortin]

I agree! I do them sporadically but I agree, need more, and would benefit the shoulders.

I find that any time I drop them out of my training, I regret it. There seems to be some magic to them. Doesn't have to be a lot of volume once you get back to a certain level. For me, once I achieved the Simple getups standard, then maintaining with 1-2 each side with 32 during my warmups is good enough.

 

[Halfakneecap]

I agree with getups and shoulder health. In fact if I had to choose one exercise for the rest of my days it would be TGU’s. So good !

 

[barrak]

I agree with getups and shoulder health. In fact if I had to choose one exercise for the rest of my days it would be TGU’s. So good !

Getups with a press at every stage. I cheat and call them one exercise. I do them twice a week as a strength complement to my current running Base cycle.

 

[barrak]

My perspective, if it helps...

I have a similar thing going on and started physical therapy a few weeks ago. on 11/24. Like you, I didn't have a specific injury or any event or surgery to recover from. Just pain and discomfort in certain positions and with certain movements, and intermittent pain in the shoulder area, especially at night.

As much as I'd like to choose a specialist in strength training, insurance doesn't work that way. I go where my referral sends me. Fortunately they're pretty good, as I went to this practice last year for a similar situation with my hip, and they helped me solve it.

So far, it's going well with the shoulder rehab. They diagnosed weak rotator cuff muscles. As I understand it, when certain muscles are weak and not doing what they're supposed to, and I am doing hard things with other muscles in the area (i.e. I'm doing a lot of things with a heavy barbell), the small weak muscles get overworked, tight, and inflamed. Inflammation in the muscles in the shoulder area leads to things getting even more cramped because there's not a lot of room in the shoulder joint. This leads to a sort of secondary impingement when I move my arm up overhead. This leads to more inflammation. Etc.

So the solution is to do a series of 4 stretches (because weak inflamed muscles get tight and cranky, and restoring full ROM is helpful to properly working the muscles), about 10 seconds of 10 reps in each stretch, one for each of the 4 rotator cuff muscles, then do a rotator cuff strengthening series using bands and about 4 sets of 10 reps of 4 different exercises. They do a bit of manual stretching and manipulation to loosen up the shoulder, too. This clinic also does dry needling, TENS, and other things... but they don't feel that it's needed for this issue right now (I agree).

I was pretty sure before I went to PT that I needed this type of work, and had a lot of good suggestions from people when I expressed my problem with painful push-ups in this thread. However, I was really hesitant to add stuff to what I was doing when my muscles felt overworked already. So it helps a lot to have a PT that tells you exactly what to do.

Not sure if this helps with your situation, but part of the lesson for me is that it's probably not a super complicated situation. A PT clinic that deals with common problems is probably going to help you just fine. Chances are good that if you get on the right track to improving things, your body will be able to heal.

Good luck and let us know how it goes...

A very informative description. Mimics very closely my teenage boy's journey to fix is plantar fasciitis.

He was extra lucky to find a PT who has tons of experience with high school runners... terrible body mechanics, stiff foot-locking shoes, out of whack body chemistry, emotional stressors...etc. My boy had them all!

 

[Steve Freides]

Hi all. I am going to go see a physical therapist. I am having pain doing most things overhead. It’s not bad pain, but I can’t run a pressing program or do a lot of yoga moves without gradually increasing discomfort each day I perform those moves.

Thankfully I can still perform a getup without issue.

Any advice on how to go about choosing a PT? I figured the folks here might have some insight on my specific situation and what to look for in a good therapist.

I’m in the States, by the way…

Thanks!
Keith

Your posts reminds me of the old joke:

What do you call someone who graduated last in their class from medical school? (I'll let someone else supply the punch line.)

In your position, I'd ask around for recommendations for someone who works with athletes.

Without knowing anything further about you or your overhead pressing issues, I will offer some personal observations. I had been told, by shoulder specialists, that I have severe arthritis in both my shoulders, but I still press without pain. It's funny when they ask me, during an examination, if I can put my arm over my head - I raise my hand like a kid who's try to get the teacher's attention so they can get to the bathroom in a hurry.

1. I have found, for myself at least, that the sweet spot for overhead work is to do low volume, daily or nearly daily pressing, with a moderate weight. (Think PTTP or DDD.) And find the cues you need to focus on that work best for you.

2. Certainly StrongFirst has a lot of great pressing cues - my favorite is "long collarbone" - this seems to set me up for successful, pain-free pressing better than anything else. Find the important cues for you and don't ever press without them.

3. Watch Fabio's "Victorious" course - it's made a difference for me by giving me more cues and technical details (e.g., where to grab the kettlebell handle, which he discusses in detail) and my pressing is going even better.

4. Find the kinds of presses that works best for you. Kettlebell or barbell, strict, side or bent press, etc. E.g., I came to bench pressing late in life, but it agrees with me; it really opens up my shoulders and t-spine. Go figure! For kettlebells, I stay away from doubles and I stay away from bent presses, doing only your basic one-bell military press, and these are my nearly-daily presses. The bench press I hit at least 3 times a week, one of them a heavy-for-me 5 reps x 5 sets as I train for a PL meet, then I put the BP away for a few months post-meet.

IOW, you need to, in addition to finding good medical advice, take the time to figure out your own limitations and how you can best work around them. A few years ago, I had trouble closing the rear door on our SUV but I've gotten better through through my mid-60's primarily by paying a lot of attention to what my body likes and doesn't like and focusing on what I can do.

JMO, not medical advice, of course. YMMV.

-S-

 

[brocule]

Hi all. I am going to go see a physical therapist. I am having pain doing most things overhead. It’s not bad pain, but I can’t run a pressing program or do a lot of yoga moves without gradually increasing discomfort each day I perform those moves.

Thankfully I can still perform a getup without issue.

Any advice on how to go about choosing a PT? I figured the folks here might have some insight on my specific situation and what to look for in a good therapist.

I’m in the States, by the way…

Thanks!
Keith

the choice with a good PT will be the best way. Sometimes amateur practising will worsen your pain.

 

[bluejeff]

. I had been told, by shoulder specialists, that I have severe arthritis in both my shoulders, but I still press without pain. It's funny when they ask me, during an examination, if I can put my arm over my head - I raise my hand like a kid who's try to get the teacher's attention so they can get to the bathroom in a hurry

I’d have to go searching for them…. But I have seen studies discussing the rates of people who have structural “problems” on MRI, X-ray, etc who are also asymptomatic . Meaning, they show arthritis, herniated disks, partially torn rotator cuffs and so on but they have no pain and can move just fine. I don’t quite understand why but it’s a thing!

 

[Steve Freides]

@bluejeff, I am not asymptomatic, just unwilling to give in. Where there's a will, there's a way.

-S-