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Advice On Physical Therapy

me again.

I was hoping to get some advice on what I am doing.

Through the last year I have been going to PT consitantly with mixed results. The first Chiropractor I ever saw was a quack and I believe aggravated my symptoms and injury.

The irony of it all is that everyone has given different explanation.  One says stretch another says don't stretch. One says acupuncture the other says sublaxation etc etc.

Today I went to see a chiropractor/Physical Pt cause I figured if a chiro aggrevated it, maybe another one can help solve it.... I Know I know, crazysauce thinking.

I explained to the Dr today EVERYTHING i had been through and all what the other docs said, pt etc.
He didn't touch me, and I told him I didn't want that, just too see if he could garner anything new from my situation.

Anyways, He gave me a thorough exam (not one like any one else has done.) He checked the whole spine etc,  muscles. He was also going to look at my xrays and mri's before he does anything.

but from the exam he said that I was SUPER tight muscles, and that is what was causing the joints and everything else to have no mobility. This might be in line with the advice I got from LazyMoose about Trigger Points and general muscles locking up.
He did the electro stimulation as well as the Utlra sound to help break up scar tissue and get the muscles to relax. After he studies the xrays mri's etc he will formulate a plan and see what the best treatment is. He said not Heat, but Ice. Heat brings in more blood etc, while it feels good while you are doing it, it creates inflammation and something to do with joints etc.

The other therapist  does stretching on the neck and shoulders, basic manipulation then I finish with workouts and basic heat and electro. This has helped me and I really like this therapist as well.

Is this six a half of one and half a doze of the other?

Or does one approach make more sense then the other?
16 Responses
798555 tn?1292791151
I dont realy understand your question........?

Not a whole lot of PT info on the thyroid forum. Not much anywhere else either. I researched that a lot before thyroid stuff, since I've been thru that numerous times before I discovered taking something with  T3 in it.

So it sounds like you have muscle knotting all over your back creating sublexations in your spinal column. Sounds familiar. Chiros love this, as they can crack you 2x per week for the rest of your life. That will only offer partial relief. You see its the muscles are doing this to your vertebrae. But chiros cant fix muscles, only snap joints back in place with the muscles still tight and ready to pull everything out of place later on. Best when used occasionally with PT - and keep doing the trigger point release at the same time.

The best PT , even for people with herniated discs, is strengthening the back muscles. The best back gym type strengthening machine is made by Med-X, only the best PT places offer this. And ask the PT the best technic for lumbar extensions on what is called the 'Roman Chair' bench. Its tricky to do correctly, most people don't and compensate using their glutes - totally wrong way with zero results.

The back muscles on either side of the spine IS what keeps the spine aligned, that is why these need to be stronger than the opposing muscles in the shoulders and glutes - the strongest muscles win over the others.

Yes Ice is best. Try this in the morning, warm shower on back to loosen up followed by cold (if you can stand it on your back for 10-20 seconds). Good way to start the day.

So did I answer your question.......?

Keep an eye on and post your free T3, if its lower than 50% of range, muscles hurt and cannot rebuild properly as the ATP process is slowed resulting in Lactic acid build up and muscle knotting / aches / pains.

Avatar universal
Thanks LazyMoose!!!!!!

I was posting on the two different approaches that the different people I am seeing are taking and which "Tool" is the best. One PT says stretch the other says NOT to. One says heat and another says ICE...

  I had held off working out since I was afraid to do more harm but I think it is helping to be a little more active.... I will defo be adding the yoga at least once a week.

I keep trying and keep learning the Trigger point down. I helps a ton on the scalenes and traps.. the back is alittle more tricky.

My idea was to report what the PT/Chiro are saying and hoping to get feedback from those that have been through it to tell me what makes most sense..:)

Avatar universal
Also as far as ICE, I thought that was only between the first 24 hours of an injury.. to reduce swelling. Then after is heat. So I have been heating everyday 2-3 times a day thinking it will help with the spasms etc. But this dude said that while it feels good while you are doing it, it really doesn't help with anything.. so he wants me to ICE not heat..

798555 tn?1292791151
Stretching is good if you can. See, stretching has become a popular phrase, its the 'thing' to do. But how many people understand that you can not stretch and injured muscle with knotting in it? How many understand that you must first force the lactic acid out of a knotted muscle before you can truly, physically stretch it? Not many. This knowledge could cut chiros business in half - they don't want you to know this. Any good recently educated PT should know this importance of Myofascial muscle release (trigger point).

PT's do all different things. Many different approaches. Not all work. They should have you doing some sort of muscle specific exercises to build strength once the spasms settle down.  Muscle specifc (muscle isolation) exersises is not the same as 'working out ' at the gym.  They need to be giving you exercises that isiolate specific back muscles- the ones that have atrophied. When you just 'workout' , other muscles compensate for the injured ones and you dont get them stronger  that way - plus injury may likely repeat itself as the problem was not delt with in the first place.

Those fancy electrical do- dads may calm current spasms but do nothing to prevent future ones.

There should always be more ice time than heat. If you must use heat to loosen up a muscle, ice should then follow.
Avatar universal
Yea, none of the PT's I have seen have really done any Myofascial pain anything. I usually finish the sessions with doing Bands as the routine, Flys, pulls etc. They all have me doing some sort of basic routine after they "work" on my neck/back.

It seems I have had the spasms since day one. While they have reduce pretty significantly, the are still there. The Chiro/PT said today that my whole back was extremely tight. Not sure if that was a bone thing or a muscle thing.... I will post his assessment when I go back on tuesday. Hopefully you can tell me what you think.

I guess I will have to do the Trigger point on my own, or keep trying different people out till I find gold. The guy  I am seeing now is supposed to be the best in town. I have heard them mention it but they have never used it. I wonder too if they ever consider if a patient is hypo that should change their approach. It was interesting that the book you recommend talked about Hypo.

UGH- I have been heating religiously, now I need to ice. HA.

The new guy I tried to day mentioned ICE as being primary and this seems to go with what you are saying... so that is a good start. Will see what he says, if he wants to focus primarly on adjustments or if he has other plans. I know that he has a doctor, a message therapist as well as a Pt in his office.. so maybe he will see fit to throw different tools at the problem...

This is helping me alot LazyMoose and as always I really appreciate it!!!
798555 tn?1292791151
"Not sure if that was a bone thing or a muscle thing.... I will post his assessment when I go back on tuesday. " -

A bone thing? I highly doubt it.  

The simplified vicious cycle that is usually the case -
1)Hypo causes slowed muscle recovery and ATP process, high lactic acid.
2)That in turn makes an injury worse
3) Muscles knotting from lactic acid stops nutrients from entering the damages tissue so healing is stalled.
4)Then stretching will not work as you can NOT stretch a knotted muscle - its like pulling on a garden hose with a knot in it - it gets tighter and restricts flow.
5) Inflammation spreads
6) Other muscles compensate the ones that have atrophied.
7) Muscle memory is changed, muscle imbalance sets in, spreads to other muscles.
8) Other smaller muscles are overworked, from doing their job + much more.
8) All this imbalance in strength and flexibility issues cause subluxations (limited dislocation) in the spinal column soft tissue and even herniated discs as very weak muscles are no match for strong opposing ones that were once even in strength.
9)It turns into a tug of war, side to side on each vertebra pulling the nerves and spinal cord side to side with it..

You might run all this across the people that are treating you. Only some 'get' the whole picture.

Treatment usually is:
-Correcting Thyroid free levels FREE T3 is most important in correcting muscle chemistry. Which will in turn lower lactic acid, speed up ATP, and allow Myfascial release (trigger point) to speed things up faster. Stretching will then improve. Simple PT muscle specific exersises are started, low weights, bands ect, floor exercises.. Chiro can then be fit in here if needed to put vertebra and shoulders / hips back in place as needed. Sooner or later the simple PT exercises will reach there limitations and it will be time to step up the weight to make the back muscles along the spine strong. Based on your specific injury this may or may not apply to you: This is where an adjustable weighted lumbar machine that 'isolates' the back muscles works well, ask a PT about this and the proper way to do lumbar extensions on a 45 degree bench "Roman Chair" , most gyms have one.  

Any good PT had body chemistry classes If they have a degree in PT but are never told about what hypo does to body chemistry. I even met a PT that was hypo - I explained to her what was going on, and why did she not know this is beyond my imagination. Just like many endos, the more some specialize they stop looking at the body as a whole.

Avatar universal
Bone thing meaning the "Mild to moderate Cervical Disc degeneration."

I think I have to find a way or someone to do the Free t3 and t4 then... Cause none of these docs are doing it because they say that the TSH is more accurate because it is more "Sensitive."
798555 tn?1292791151
"Mild to moderate Cervical Disc degeneration"

- seriously, chiros use this term to scare people into a 'plan'  to see them for eternity.  Everybody over 30 has mild disc degeneration  with some areas that are moderate.  Its normal wear and tare as we age. This itself does not cause pain. Subluxation can / does cause pain.

TSH changes per hour, its not accurate. TSH is not a cell consumable hormone. Cells dont use TSH. TSH is just a signal from the pituitary to the thyroid. It is impossible to measure each thyroid hormone by looking only at TSH. They are assuming that you convert T4 to T3 efficiently. Guess why they have T3 meds........because some people dont convert well and need them. How do they figure this out?.......from free T3 testing.

Your thyroid docs are not a good ones at all. They are totally wrong. Find a different doctor. Forget endos, find a family doctor that will test the frees. Call and ask their nurse if so and so tests frees. Dont waste money on appointments to just ask a simple question.

If you dont get free testing you may never feel 100% again. You know what to do, go find a good doc...... You could go to your local pharmacy and ask for docs that prescribe Cytomel , a T3 med, these docs have to test Free T3 if they are prescribing it! This approach works!

Avatar universal
Ok I am on it!
548668 tn?1394190822
I just want to say thank for the time and effort you put into your reply to dreeftwppd.  I was diagnosed spondylitis which I believe was incorrect.   I do have a bone spur on the C3 but it's 'encroaching' the nerves.   My shoulder/arm went after being hyperactive and having severe inflammation bursitis (which has since rectified, except for my shoulder arm).   The only person who seemed to help worked on the trigger points, and that, along with 'tai chi' posture (and now using a tennis ball on the shoulder joints), is helping.     It makes sense now that the stretching excercises didn't seem to bring relief, and I will do the ice as well.  THANKS!!!
(I'd been deciding which therapist to try next, and if my own self-exercising doesn't, I'll see if I can track down the neuro-muscular man who was massaging us at our desks at work - he seems to work on the trigger points.
Avatar universal
yeah, LazyMoose is great!!!
798555 tn?1292791151
Myofascial muscle release, or Trigger point release / therapy is slowly gaining credibility, and for good reason, its not just theory, it really  works. And its something that many people can study and learn on their own to relieve and correct muscle, tendinitis, bursitis, carple tunnel pain - but some creative thinking is involved. It is very useful for people with Hypothyroid and Fibromyalgia, and even getting more popular with pro athlete / Olympic trainers and athletes in general.

Janet Travell, MD, (White House physician for the Kennedy and Johnson administration), first started using this on patients in the 1940's. She and David Simons, an MD for the US space programs and Air Force in the 1960's published several versions of "The Trigger Point Manual" starting some time in the ehghties. Its been revised many times since Dr Travells 'departure' by David Simons and now Clair and Amber Davies "The Trigger Point Therapy Workbook", in book stores today.

The later book was first suggested to me four years ago by a recent and young PT school graduate whom new I had Hashimotos disease and was in a lot of physical pain, I also had stomach ulcers from high doses of prescription Ibuprofen which didn't help much with the pain anyway. This young graduate was the first person that understood and explained to me the underlying cause of Hashimoto body pain - the body soft tissue 'chemistry' and rebuilding process (ATP) is unbalanced. Its factual, not a theory. My insurance only covered minimal PT visits which was not enough time. The solution she (PT) said was to learn it on my own after some 'lessons' during what little PT insurance coverage I had. Since then, I'll admit, I've become a pain elimination geek.

'Couching' is not an option for many that like and enjoy physical activity, outdoors, sports ect., but the pain later on can deter us from doing what we like to do. Hashimoto made me stop doing all the things that I love to do about six years ago, until I learned about Myofascial Trigger Point release and later, the importance of T3 levels from people here two years ago. At one point like a few here time to time,I was labeled with Fibro, it didn't seem right to me since I had Hashimoto. Still not 100% better, might have some permanent tissue scaring, but I can do things again.

In the past I was tested for many things to figure out my body pain, while knowing I had Hashimoto. That young PT was correct about thyroid and body pain, doctors I seen were clueless on the subject.

798555 tn?1292791151
There is a gene they test for that 80% of individuals with  Ankylosing Spondylitis have.

I'am assuming you had this blood test.?

This with hypothyroid would be a challenging combination, hopefully you tested neg for that gene.
798555 tn?1292791151
The best thing for you to do is to continue to learn as much about Hashimoto and treating its symptoms that you have, research it to death, life is to short to put up with it. Doctors knowledge as you are figuring out, is limited.
Avatar universal
I have to say that the trigger point is helping me immensely... I think.

I am still learning the techniques etc but I find that it really helps!!!!

I kept describing the pain in my back like being stung by bees.. not sure if that is how trigger points feel or are supposed to feel. But I am starting to think (as I read the book) and see that a big majority of my issue might be trigger point related. I might discuss this with both PT's  and see if they can provide any solution.
548668 tn?1394190822
Thanks so much - I'm going to the doc's tomorrow;  I'll question him about the gene... I know it's not spondylitis (he hadn't mentioned it to me, but put it on a specialist referral form).   He had tried carpal tunnel (no), and someone else suggested 'polymyalgia'..  Bursitis seemed to be the closest fit from what I researched;  the inflammation has died down, except in my shoulder - I really think it's left over scar tissue and trigger points from my compromised posture when I was in so much pain.

I'm not hypo (yet) but had a low dose of RAI in October for a toxic nodule, so am on the watch for hypo.  I was hyper when I had the inflammation, but I believe it was due to another medication I'd been on.  Med free now; just mopping up!!

I had bought one of the books you spoke about;  I've started Tai Chi exercises again, and adding the tennis ball scrunch has now become part of my daily exercise.  You're so right; the 'couching' is simply not acceptable, and, statistically, I have got hypo to go through sometime in the future, so am trying to get on top of this while I can.

Once again, thanks so much - my GP will be working for his money tomorrow.  The therapist at work said he did 'neuomuscular work';  is that the same as trigger point therapy??
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