The PT made me cry today~~~~

Discussion in 'Fibromyalgia Main Forum' started by kadywill, Feb 20, 2003.

  1. kadywill

    kadywill New Member

    I usually love going to Physical Therapy for my back pain/buttock pain and the stretches and piriformis isolation stretches feel so good, but, today the therapist was "working" out the ???band along my outer thigh and rubbing out the fascia, the fibrous membrane which covers and supports the separating muscles. This fascia pain is one of my major complaints, but I had NEVER mentioned it to anyone because I thought it was "just" a tender point r/t my Fibro and it never occurred to me that a PT would be interested in it. He rubbed deeply along my left outer thigh, first, and I broke out in a sweat, started crying and nearly jumped off the table. He was shocked at my reaction because he says that I have a really high tolerance to pain, usually. He acknowledged that this was really "tender" and that he suffered with the same thing. He explained that it was caused by my not stretching enough and allowing the muscles in that area to shorten. He said it was quite common. This type of pain is exactly the reason I have never tried massage; I tried one of those roller-type things once to massage my legs and gave that up after rolling it over this are once! Anyway, when he said the word "tender", I laughed and said that it was much more than tender and that it was as bad a pain as I have ever experienced. He said, "Oh, come ON, it can NOT really hurt THAT bad!." It did~~I cannot describe how badly it hurt, but I WILL say that I have never, even during labor, a liver biopsy, a dislocated shoulder and knee, fractures, post-op, migraines, TMJ.....never has pain been any worse than this. Now, it didn't last and it doesn't hurt now...it was ONLY when he was rubbing it, but he continued and told me to "breathe through it." This pissed me off and he said that this deep massage was the ONLY way to loosen the fascia that was painful; he could feel through my pants the areas that are fibrous and ropey and those were the places that are unbearably painful when massaged.
    Is this a Physical Therapy issue? Does anyone else have this fascia pain? I want it "fixed" if it can be, but, my goodness, is it this painful for anyone else? I know it pushed me to my limit of endurance when he was doing this. I was embarrassed to admit that it hurt this badly, but my skin and tissue are always this painful and I am even on Prednisone right now, which normally takes most of the inflammation away.
    Please advise!!
    Kady
  2. RedB

    RedB New Member

    If you are talking about the same area that my PT started messing with on my outer thigh last week, I have a vague idea what you went through. I about jumped when she started on a spot that I did not even know was sore. Two of them actually. I managed to suck in my breath and let her finish, but I told her that if she started attacking the actual hip joint area, I would probably get up off the table and walk out!

    I have less pain in my legs than most people, but my hip joints are always extremely tender. I just didn't know that there were some spots just beneath them that were tender, also.

    I will say, that when I let her know it was painful, she worked on it a bit more gently, I believe. If you're like me, and you don't have all that much trouble with your legs, then maybe you'll have to just tell your PT that you will deal with the pain down there. Just leave it alone.

    I've only been going for physical therapy for a few weeks now, and I'm still not sure if it is worth the hassle of the trigger point release. My PT always says that that is the "relaxing" part of the hour, but you can't prove it by me! It kind of makes me dread going in to her, even though she is very good.

    Kathy
    [This Message was Edited on 02/20/2003]
  3. kadywill

    kadywill New Member

    this pain I am trying to describe is not muscular or joint pain, it is actually the thin fibrous membrane under the skin that has (for lack of better words) become twisted, hardened, ropy and painful. If I press the thigh area right above and toward the outside of my knee, not the front, and I press with four fingers as I travel up my leg, *this* is where I feel the pain. It isn't my hip or anything at all to do with the muscle or joint. This is why I was surprised that PT would even work on this area. All I know is, IT HURT! I want to know if this is Fibro pain or just because I am not "lean and mean" anymore!
  4. bamboo

    bamboo New Member

    don't know if this will be helpful, but here's my experience. i checked the area you described on my own leg and there is plenty of pain there and has been for a long period of time. my own rule of thumb is that i'm not being helped if someone is causing me more pain than i already have, even if i don't get a flareup from it afterward. i use a pt for injuries and exercises, but not for trigger point work. for years, i have used massage therapy instead. it has taken as much effort to find the right massage therapists as it has the right doctors, but the most useful ones have been able to help me with release without causing pain in doing so - i come away from the massage feeling relaxed and more flexible. and. . .my body is different every time i get a massage - one time it may be very sensitive and another time not so much. so, i can't advise, but perhaps my experience will give you another perspective on what is helpful to you.
  5. Frogdogger

    Frogdogger New Member

    My rule of thumb has become, don't take any type of abuse off anyone. And if I'm telling someone it's hurting too much, they need to listen to me and my body. I know there's things I've tried and continue to try that may initially hurt, but I'm think it's abuse for someone to in essence ridicule you when you're telling them how severe it was hurting. It just always seems to get back to trial and error with this damn disease (whatever). Everybody's different and what may be this p.t.'s exerience with other patients doesn't matter. My massage therapist always says that his job is to help me feel better, if he's not then he's not helping me.
  6. kadywill

    kadywill New Member

    I thank you for your reply. I'd consider massage, but I cannot afford it right now. All my $$ is being spent on necessities since I've been on LOA from work and my meds cost a lot even with the co-pay! I have had expensive procedures done this year and I just wouldn't dare incur additional bills. I really couldn't stand it if it would be anything like I experienced today. I didn't expect a physical therapy assistant to be rubbing my thighs this way~~it shocked me. I know he was trying to do something or another with the ____band that runs up my thigh in that area. I can't remember what the name of the band was, but he told me that the fascia was ropy and fibrous and he could feel it and knew that it was tender. He said this is very common. I always thought it was part of my Fibro. Is it?????? He said it wasn't, but he really doesn't act as if Fibro is a real syndrome and he believes that everything can be fixed by stretches and strengthening exercises. Now, I KNOW I am out of shape....I take full responsibility for the cellulite on my legs and buttocks and for all the food I pack in, but why should I have to endure that kind of pain when I am there for a back problem???? Today is the last day I'll work with this particular PT assistant because he is moving next week, but he said the replacement PTA's will work on this next week.
    I'd really like to know who all has this type of pain, what is really is and if it is part of Fibro.
    Please advise!!!!
    Love,
    Kady
    [This Message was Edited on 02/20/2003]
    [This Message was Edited on 02/20/2003]
  7. bamboo

    bamboo New Member

    i sure empathize with the financial burden of trying to get the different forms of help we need. well, i'm saying i have the same pain, from your description, that you have and i am sure mine is fibro. i spent many years, before i became too ill, in ballet and i didn't have the pain then. if i were you, and i had the flexibility to do so, i would get a second opinion from another pt and i'd absolutely refuse to work with any practitioner of any sort who did not support fibro, who caused me pain, and who didn't listen to me. i've tried several pt's - there's still a lot of "old school" thinking out there - mind over matter, just keep working at it and it will improve, etc. even though it can be stressful, it is worth finding the right people to work with and i hope you are in a position to do so.
  8. shell

    shell New Member

    Hi Kadywill,

    I thought I don't have a soar spot there cuz my legs are not my problem area (sore but not painful) but I pushed with all 4 fingers the area you said and OUCH! I think there is something definitely there it is a hard band that travels up right after the soft tissue. I just started PT this week and we havn't gotten to the massage yet. I definitely know I would have to threaten a knock out (not really) if the pain was worst then those other things you described though!! Definitely don't let them do that one again!! Are you at a place where they can just switch you out to a different PT? That way they will still have all of your notes and you won't have to start over at a new place.

    TAKE CARE!
    Shell
  9. Seagull

    Seagull New Member

    You have described what sounds a lot like chronic myofascial pain (frmly known as myofascial pain syndrome) and it is as painful as you describe. I have it all over my body and it does present with ropey and knotted muscles. They have trigger points, not tender points, and must be treated in a different manner. I do not know that stretching in the past would have prevented it -- mine set in after injuries received in a car crash, although I was physically in great shape and stretched all muscles on a daily basis before getting this.

    You need a therapist who understands how to massage these trigger points and the fascia, because if it is not done correctly, the treatment can cause you further injury and pain. Check out Devin Starlanyl's website for further information on this and take printouts of it with you to show this guy before he touches you again. I hope you get the right help soon.
  10. ruby7

    ruby7 New Member

    I totally understand! I have been going to pt 3x's a week for a month now & have asked him what he thinks about FMS and he doesn't believe it's a disease. His assistant however now does, she has 2 sisters & a daughter with FMS. She said most PT's feel the same. I am supposed to start water therapy soon.
  11. kadywill

    kadywill New Member

    and Seagull, I really appreciate the info. about the myofascial pain....this is exactly what I thought I had. I got out the HoMedic "E. T. the extraterrestrial-looking" massager this p.m. and TRIED to use it on this area of my thigh and it hurt so badly! (nothing like when he rubbed so deeply, though) I just can't imagine that this should hurt so badly if this is so common a problem, like the PT asst. said. Why do I not know about it, as a nurse, if this is something MOST people have? It doesn't ring true to me that it's something that he poo-pooed as my fault for not stretching enough. My legs have always been my strongest asset and I walk daily. In my profession, I use my legs a lot and it's hard for me to accept that they are THAT out of shape.
    Nink, I am SO sorry about your father. I, too, saw my father treated badly when he was in the hospital. No dignity was given to a man who previously was huge and strong, an ex-highway patrolman who was the personal aide to 3 NC governors and who received many, many honors and hero awards during his lifetime. He knew presidents and he was my greatest pride! This man, like your father, deserved better and it angered me that he was reduced to tears at times, too, unnecessarily. We all deserve to be believed. I know that pain is now considered the fifth vital sign and a patient's temp., pulse, respirations, BP and PAIN level must be assessed in diagnosing and treating them. What the patient says is to be believed. If he says he has a pain level of 9, then he does. That's it. The old, outdated (thankfully) way that pain was treated was judgmental and humiliating for the patient and they were made to feel like drug-seekers when they required analgesics to treat their discomfort. Sadly, I still see nurses say things behind a patient's back about their doubts that the patient REALLY was in pain. This needs to change. If this DD has taught me anything at all, it is that pain is real and it is imperitive that the patient be believed when he tells us that he hurts.
    Love,
    Kady
  12. darlamk

    darlamk New Member

    I know you have had a lot of responses and ideas but I wanted to add what my PT did when I saw him for the arm/hand tendonitis. He also noted how tender I was just below my elbow and above my wrist and he did "friction massage" which is short quick back and forth rubbing the opposite direction the tendon is (rubbed across it). It always felt really good and he did not press hard while doing it. This therapist was experienced in "the McKensie approach" which is a little different than regular PT people. I do not think your PT should have hurt you like he did. How can he help you if he does not understand fibromyalgia? Also a nurse friend of mine who now does massage and has had extensive training says she would not do massage on me -just healing touch since the massage would cause too much pain by releasing too much lactic acid into the tissues. Best Wishes Kady and take care.
    Darla
  13. kadywill

    kadywill New Member

    you would not believe the bruises, swelling and heat all along the area he rubbed yesterday! It is all very hard and hot and red~~like cellulitis and had small purple bruises on each of the knotted areas! It takes so much for me to bruise~~I rarely EVER do and this just really bothers me. I woke up with hives all up and down the leg, too. (I have chronic hives and pressure is one cause; this is why I am taking Prednisone right now)
    No one will do this again to me.
    Love,
    Kady
  14. Fibromiester

    Fibromiester New Member

    I hope you are feeling a little better now...
    I've been reading these posts, and I have to agree with Mel and Seagull. You have FM- and he said "this pain is not from FM"-- he was not discounting you, he was telling you that you had another kind of pain, too, Myofascial Pain- the Fascia- in hard, ropy, fibrous bands & knots that he could feel, and he was trying to "release" them. Just doing a Bad Job!! FM has Tender Points. MFP has Trigger Points. When my Trigger Points, like in my shoulders & neck, get real hard- ropy & fibrous, I ask my Hubby to come Do My Neck. He will feel around until he can feel the Trigger "Points" and I'll say YES THATS IT!!!!(because it hurts so much)--then he will slowly press,and Press,and PRESS!!! and I just relax,& give into the pain because-all of a sudden he'll stop!...the lump is gone, the pain is relieved! That is Myofasial Release. And that is my 2cents!
    I am so sorry he hurt you like that. I know that You are in a lot of pain, anyway, and you don't need more insult! He should have told you what to expect if he knew it was going to hurt you! Do look up Devin Starlanyl's site, she has FM herself, and has written about it extensively for years.
    God Bless you love,
    Fibromiester
  15. missvickielynn

    missvickielynn New Member

    Kady,

    You have responded to some of my posts in such a kind and supportive way, that I felt I had to respond to this post.

    As I remember, you acknowledged me positively about a month ago when I was attempting to correct someone's misunderstanding about the difference between FMS Tender Points, and Myofascial Pain Syndrome TRIGGER points. I am very glad to see that several others have brough this up in reply to you here, and that they also have advised you to check out Devyn Starlanyl's site. Not only would I echo that, but I would go a step further and say that you should get a copy of her books, "FMS and CMP - A Survival Manual, 2nd addition" and "The FM Advocate, etc." If you have to buy them, and can only afford one, then get the first one, "Survival Manual"

    I have checked out both books from my library, 3 different times. I have them checked out right now, because I want to take them with me when I interview a "potential" new Doc, who is a Physiatrist, who "supposedly" knows all about this concept. My brother-in-law has offered to send me to someone for a really accurate and "sympathetic" evaluation for SSDI, and this doc supposedly specializes in doing disability evaluations for the patient....not the SSA or Insurance Companies. But I have become so jaded by docs who really are not "current", especially if they are not familiar with Starlanyl's work, that I am going to interview her before I actually agree to see her for evaluation.

    It is very frustrating to me that this is still a common misunderstanding, even among Docs who say they "believe" in FMS/MPS, and say that they know how to do both a Tender Point Exam, and a Trigger Point Exam. It becomes clear that most still do not understand the difference between the two when, for one thing, most docs (at least where I am from), don't even DO a Tender Point exam, much less a Trigger Point exam.

    A good example is that the Doc that SSA sent me to did what she called a tender point exam, but she not only did not use the right amount of pressure, she didn't even test all 18 sites, and she didn't "hit" most of the ones she did test. Then, in her report, she said: "Patient claims exquisite tenderness almost everywhere she is touched, but there is no apparent pattern to the tenderness."

    What a joke that was! But, don't get me started!

    I know how painful the area on the outer side of your thigh is, and how badly it hurts with improper (deep-tissue) work. This is one of the very issues Starlanyl addresses in her book.

    I used to see a massage therapist back when I was still working. I went to her when I was having pain flares in my hips and lower back and legs that nearly crippled me. She was wonderful, because not only did she take the time to have her own books on FMS, but she bought Starlanyl's book when I asked her to, and she was so wonderful about working with me to find the right technique, and the right amount of pressure to work on these trigger points and taut bands of fibrous tissue. I wish I could still afford her.

    I also have learned to work on some of my own spots using her "tennis balls" method of self-help. And I have learned that, while it is true, that the more tender the area, the more it needs working out. However, there is a fine line between enough and too much, and only the PATIENT can say when too much is too much. On the other hand, when I am really hurting, using the balls even GENTLY will take my breath away, and bring me to tears. BUT.....I have learned that if I use just enough pressure, sometimes even enough to make me nearly cry, then stop, and go back to it a few minutes later, and repeat that process, the spots can tolerate more pressure each time. And it really does help ease the generalized aching, as well as the spot tenderness, and also the associated symptoms depending on the area being worked on. It helps, also, to do this work when the muscles are warm, either after a hot bath, or after using direct heat, preferably moist heat.

    I think you will agree, if you do some reading on her site, and particularly if you get her book, where you can see the illustrations of the pain patterns associated with various MPS Trigger Points, you will think she had been reading your mind when she wrote the book.

    One more thing I will suggest that helps me with the trigger point tenderness, and associated problems (for example, sciatica from nerve entrapment from trigger points)
    is Electrical Muscle Stimulation. I am not talking about TENS, which is different. I have never tried TENS. But the EMS actually causes the muscles to contract gently, and it really feels good, and eases the tenderness, tension and pain in the muscles so much. See if your PT has an EMS machine (most of them do.....I used the one at my Chiro's office), and ask if you can try it. My Chiro only charges $15 for a 15 minute session.

    I hope you get some relief, and a lot more sensitivity, from the new PT. I am so sorry you had to have the experience of one who not only used too much pressure and poor technique, but even worse, practically called you a liar when you expressed your level of pain! When will they ever learn?

    With love,

    Vickie
  16. kadywill

    kadywill New Member

    Thank you all for this wonderful info.
    When I was diagnosed with Fibro., it was by my PCP and he suggested I visit a Rheumatologist. I made the appt. and my hubby and I went. He asked why I was there and I told him that I thought I had FMS. He asked if I'd read up on it on the internet and I said I had. So, he did a general exam and asked questions~~all what I expected. If he did a tender point exam for this or a trigger point exam for MPS, it was vague and I wasn't aware that it was what he was doing. He never really mentioned any diagnosis, per se, but he asked which bothered me more, the fatigue or the pain. I told him that the fatigue was something I could manage right then, but the pain wasn't, so he prescribed pain med. for me. He was very, very gentle and supportive and called me to talk to me when I called the office with a question or concern. In the meantime, I had an MRI for the increasingly severe buttock pain, but the Rheumatologist was unaware of this; my PCP ordered the MRI @ my request. The results showed spinal stenosis, bulging discs and joint arthropathy and my PCP took me out of work and ordered stronger pain medications. I saw a Neurologist for this and he did nerve conduction tests and determined that I had no permanent nerve damage and that he didn't think my pain was not only a result of the MRI findings, but from the FMS ; he ordered Neurontin and Physical Therapy and said that he and my Rheumy were going to work closely together to alleviate my pain. I am scheduled to see both of them on March 7th. The PT determined that I had good strength, but that I had a lot of muscle shortening and I required much stretching to fix this. I do my homework stretches as ordered and I love the way the stretches make me feel.
    Now, I am sure this Physical Therapy ***ASSISTANT*** has had no formal training in the release techniques....he is leaving to work in a different field altogether this week, so PT is not really his *love* and I don't think he was really qualified to do what he was doing. You should see the cellulitis in my leg!!!!! It cannot be right~~now, pain I expect if this is done correctly and I understand the concept of releasing the adhesions, etc., but I didn't expect this and he has caused much damage to my leg. With my chronic angioedema and urticaria flaring, too, I cannot have pressure applied to any part of my body. Not even restrictive clothing can be worn with severe reactions, so the timing couldn't have been worse for me. I will look up this info you guys suggested and I will read Devin Starlanyl's books~~thank you all so much!!!
    Love,
    Kady
  17. IntuneJune

    IntuneJune New Member

    Having had FMS/MPS twenty plus years now, I have tried many approches to deal with pain/fatigue/associated symptoms of this syndrome. I was particularly excited to see in Dr. Devin Starlanyl's second edition of Fibromyalgia and Chronic Myofascial Pain, (published in 2001) on pages 235-236 she addressed myofascial release, John Barnes style as I had been receiving myofascial release (MFR) treatments since Jan 2000. I was barely able to walk into the facility that first visit, the PT and PTA helped tremendously. Fascia is EVERYWERE in our body, not just in particular spots, however, we may hurt MORE in particular spots. (But don't we hurt all over?)

    During my visits, a PT and PTA work on me. The PTA has had the formal training in John Barnes MFR. The work is wonderful. Parts of the treatment are difficult, but not in the same way you experienced.

    When I started I could barely walk into the PT facility, the transformation has been remarkable. I am able to work 24 hours a week, take water aerobics three times, work out on an eliptical bike, presently have my 14 month old grandson and his parents living with me, AND take NO medications. This had not been the case in the past. (Yes I am tired!) I am not pain free. But it is NOTHING like it was. Don't discount the PTA on the sole critera he is an assistant. Look further behind those credentials and find other training a therapist has. If a PT, PTA, OT wants training in MFR, often it is out of pocket expenses pain on his/her part or if they are lucky, their employer will pay for the additional training. Historically, this has not been taught in formal degree programs.

    Good luck, Kady
    PS have not been around for sometime with my son/daughter in law and grandson living with us now. I do miss this board but have little time.

  18. kadywill

    kadywill New Member

    I am feeling much better now and the bruises are fading; the area is very tender to touch, but I plan to talk to the PT I'll be seeing tomorrow a.m. about their training in Myofascial Release Techniques. I nned to know that they are trained in this so that I know the pain is for a purpose, not because of a mistake!
    Love,
    Kady
  19. Ness

    Ness New Member

    Kady my dear this is exactly what happened to me before christmas when my massage therapist went deep into the area I have around my shoulder blade and upper back..this is the area that gives me so much pain even with out being touched...well I screamed during and it sent me Flaring for over 2 months and I do not believe I am still the same since that day.....and she told me she only got through maybe 25% of the actual problem the knots and ropes.

    Well, I have not been back since because I am in enough pain already with out being sent into a Major Pain Flair up..not to mention the burning pain that came along with it....you are lucky that it did not last very long...

    I am sorry that it hurt you so much..I know that there are people who are trained in myofacial release.....the person I go to is trained but she told me she knows someone that only does that kind of work...I have beeen afraid to see this person,,cause I do not want to go through another few months of bringing out pain that was not there...and I too have a very high pain threshold.......besides my husband told me that he just didn't see the point of paying someone alot of money to make me worse..

    Love Ya
    Ness
  20. kadywill

    kadywill New Member

    PT today @ 3, so pray for me!
    Love,
    Kady