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View Full Version : Post-op question 1: How important is Aquatic Therapy as an integral part of PT?



mdtaffet
04-08-2012, 08:33 PM
Hi all,

You may recall that I had my surgery on January 23rd, fused T9 to S1 with pelvic fixation. Tomorrow will be 11 weeks since the surgery.

I had my 2nd post-op follow-up appointment this past Thursday, 4/05. I have been cleared to drive, initially for no more than 30 to 45 minutes, and I've been cleared for outpatient physical therapy. I've also been cleared to brush my teeth while leaning over the bathroom sink (up until then, I was brushing my teeth with a portable basin while seated at the kitchen table). I've been cleared to do a small amount of twisting, and I've been cleared to lift (I think he said) 20 to 30 pounds now.

He told me that he it might be best to find a physical therapy practice that offers aquatic therapy as well. I've attempted to identify a practice in my area that both offers aquatic therapy and accepts my insurance, but so far haven't been able to find one. And thinking about it, I'm guessing that, despite the fact that aquatic therapy might be easier/helpful in some ways, in other ways it could be difficult because I am still unable to tie my own shoes, so changing to/from a bathing suit during the day could be difficult. So I'd like to get a sense of just how important the aquatic therapy aspect is. Have others been able to successfully rehabilitate without aquatic therapy?

The surgeon's goals for PT include the following:

-- Land/Aquatic Therapy
-- Conditioning
-- Paraspinal Muscle Strengthening and Endurance
-- Biomechanics Education
-- Home Exercise Program
-- Functional Restoration

-- Core Stabilization w/ abdominal strengthening
-- Pelvic Stabilization
-- LS ROM
-- LE Strengthening & ROM
-- Periscapular strengthening
-- Postural retraining
-- myofascial treatments
-- Progress to work hardening program


My own goals for PT are as follows:

-- be able to walk without the cane
-- be able to climb and descend stairs without the cane
-- be able to tie my own shoes
-- be able to put on my own footie socks on my left foot (can do it on the right, but not on the left)
-- be able to sit, stand and walk with as good a posture as I can achieve
-- be able to return to working at least part time at home (my employer will allow this)


Given the surgeon's goals, and my goals, how important do you suppose aquatic therapy is in the mix? I'm trying to decide whether or not to try harder to identify a suitable PT practice within easy driving distance that both offers aquatic therapy and accepts my insurance. I already know of 2 practices that are relatively nearby, but neither accepts my insurance. I know of 1 practice that does accept my insurance, but it is not within easy driving distance. The PT practice that had been recommended to me by the home-based physical therapist that worked with me here until March 2nd is nearby and accepts my insurance, but it does not offer aquatic therapy, at least as far as I know.

Prior to all my back issues, I had, and still have, foot issues. I pronate severely without orthotics (high arches with ankles that roll inwards). I have heel spurs, and have experienced plantar fasciitis and heel bursitis in the past. More recently, I developed Morton's neuroma, along with hammertoes on my left feet. I have metatarsalgia which makes itself known quite loudly when I'm barefoot -- such as when I'm now taking a shower standing up. But I never leave the house without a pair of good motion control shoes with my prescription orthotics in them. I've had issues using both treadmills and ellipticals in the past due to these foot problems, even wearing my good New Balance shoes. In a way, these foot issues would seem to argue for aquatic therapy in my mind. However, I've taken water aerobics in the past, and I know that my foot issues can be easily compounded when I'm in a pool barefoot. That would seem to argue against aquatic therapy in my mind.

Unless I can find a compelling reason to look harder, I'll probably call the previously recommended PT practice tomorrow and begin my rehabilitation with them, and forget about aquatic therapy.

Any comments?

-- Mary

leahdragonfly
04-08-2012, 08:56 PM
Hi Mary,

I didn't go to any PT after my fusion (which was one level more than yours), but I was active on my own with swimming. I have been a lap swimmer for years, so it was natural for me to go back to it. I have struggled with plantar fasciitis for several years also, and it really flared up around the 7-8 week post-op period due to the walking I was doing, so I had to swim instead.

This surgery (AP revision for broken rods) I have walked more, since my doc told me I couldn't swim yet due to its twisting nature. I do go to the pool the last few weeks and just kick with a kick board. I am currently 9 weeks post-op.

I am curious, what is "work hardening" that your doc mentions as a goal?

I figured out a unique way to put on my socks, since my legs don't cross easily across my lap. I face my bed and put my knee on the bed, then I dangle the sock over my toes, then pull it on. My shoulders are flexible so I am not twisting. I don't know if it would work for you.

Best of luck,

mdtaffet
04-08-2012, 09:26 PM
I am curious, what is "work hardening" that your doc mentions as a goal?

I figured out a unique way to put on my socks, since my legs don't cross easily across my lap. I face my bed and put my knee on the bed, then I dangle the sock over my toes, then pull it on. My shoulders are flexible so I am not twisting. I don't know if it would work for you.




I don't really know what "work hardening program" means, but I'm guessing it must be related to allowing me to return to work.

You must be more flexible than I am. If I face my bed and put my left knee on my bed, then reach down with my left hand, I can't even reach my heel, not to mention my toes....I just tried, and it didn't work.

The only time I have ever managed to get that footie sock on over my long sock on my left foot (I wear two sets of socks to sleep during colder weather) was when I was sitting in the rocking chair, had my left foot propped up on the ottoman in front of me, somehow managed to use the grabber to get the top of the footie sock over my toes, then tried my best to reach it with my right hand to pull it the rest of the way on, then tried again, and again, and again, and again, and again, etc. until I was finally able to do it. The only reason I even attempted to do it at all (it was very uncomfortable) was because my husband had injured his own back at that point, and I didn't want him to have to be in pain just to help me. But it wasn't comfortable for me to do it, and I haven't really even tried since then, because my husband got better.

If I find out what is meant by "work hardening program", I'll be sure to let you know.

-- Thanks,
Mary

mdtaffet
04-08-2012, 10:57 PM
I have struggled with plantar fasciitis for several years also, and it really flared up around the 7-8 week post-op period due to the walking I was doing, so I had to swim instead.

,

Gayle, I should have mentioned earlier that one of my methods for keeping ahead of the plantar fasciitis lest it return with a vengence is to replace my shoes every six months. I tend to wear the same pair of New Balance shoes every day under normal circumstances, and I've found in the past that if I didn't replace them after six months of continuous wear, the extreme discomfort of the heel spurs/heel bursitis, and sometimes even the plantar fasciitis itself, can return.

An additional complicating factor right now is that I started taking an NSAID daily in 1989, originally for the plantar fasciitis. In 1993 I had a really bad fall on the ice which led to over two months on disability due to shoulder problems, so at that point, the NSAID was also treating the shoulder as well as the feet. Then when my back problems started in 2003, the NSAID was treating my back, shoulders, and feet. I had to stop the NSAID 2 weeks before surgery, and have not yet been allowed to resume taking it because it is believed to interfere with the fusion process. I was warned that my foot and shoulder problems could return due to the absence of the NSAID medication and the resulting unchecked inflammation, and that they might get even more inflamed than usual. Fortunately that hasn't yet happened. If I'm really lucky, the only real use I'll have for NSAIDs after this fusion is complete is the occasional headache (I have been cleared to take Aleve sparingly on an intermittent basis if needed).

LindaRacine
04-08-2012, 11:05 PM
Hi...

I personally do not think aquatic therapy is a necessary part of postop PT. If you can do what you need to without the pool, it really makes no difference.

If you don't have a sock puller, you should get one.

Sock Puller (http://www.amazon.com/Ableware-F738520000-Deluxe-Sock-Aid/dp/B000PGRKXE/ref=sr_1_1?ie=UTF8&qid=1333944238&sr=8-1)

Trying to put socks on without an aid could be harmful.

Regards,
Linda

mdtaffet
04-08-2012, 11:22 PM
Hi...

If you don't have a sock puller, you should get one.

Sock Puller (http://www.amazon.com/Ableware-F738520000-Deluxe-Sock-Aid/dp/B000PGRKXE/ref=sr_1_1?ie=UTF8&qid=1333944238&sr=8-1)

Trying to put socks on without an aid could be harmful.



Linda,

I was sent home from the hospital with that exact same sock puller, but (1) it is no match for my Nike Dri-Fit socks, which are like compression socks, and (2) it won't do anything for little footie socks; it's never even come out of its plastic bag since I got home. What I bought to help me with the Nike Dri-Fit socks is the Heel Guide Compression Stocking Aid, also sold by Amazon: http://www.amazon.com/Heel-Guide-Compression-Stocking-Aid/dp/B0052ZX7F8. My son finally put it together for me one day last week and I successfully used it on Thursday after my shower for those Nike Dri-Fit socks. But the other footie socks that I can't get onto my right foot without assistance are much smaller, and really don't have a "neck" (for lack of a better term) for a "sock puller" to grab/connect onto.

leahdragonfly
04-09-2012, 10:26 AM
I don't really know what "work hardening program" means, but I'm guessing it must be related to allowing me to return to work.

You must be more flexible than I am. If I face my bed and put my left knee on my bed, then reach down with my left hand, I can't even reach my heel, not to mention my toes....I just tried, and it didn't work.

If I find out what is meant by "work hardening program", I'll be sure to let you know.-- Thanks, Mary

Hi Mary,

I wanted to clarify my sock application method because I don't think it requires extra flexibility nor does it risk any harm to the back. I stand at the end of my bed, and I bend my knee up to lay my entire shin flat on the mattress, with my foot just off the end of the bed. I am standing straight, except on one leg like a bird. My foot is right below my seat, and with my arm hanging at my side, my hand easily reaches my foot. From there it is easy to slip my toes into the sock. It works for me anyway!!

mdtaffet
04-09-2012, 11:11 AM
I wanted to clarify my sock application method because I don't think it requires extra flexibility nor does it risk any harm to the back. I stand at the end of my bed, and I bend my knee up to lay my entire shin flat on the mattress, with my foot just off the end of the bed. I am standing straight, except on one leg like a bird. My foot is right below my seat, and with my arm hanging at my side, my hand easily reaches my foot. From there it is easy to slip my toes into the sock. It works for me anyway!!



OK, following this revised set of instructions, I would be able to reach my heel, but still wouldn't be able to reach my toe area (my arm is just not that long), so I'd have to use my existing method to get the sock part-way on (over the toes only) downstairs in the living room, then I'd have to walk up the stairs with only socks on, holding that foot in such a way as to not knock off the sock from the toe area, then come to my bedroom upstairs to put it the rest of the way on. That might or might not work, but is a lot of work for just one sock. I get the right one on by sitting down and placing my right leg over my left knee such that my right foot is just past my left knee. It's a bit uncomfortable, but I can hold that position long enough to get the right sock on. But that doesn't work (yet) for the left sock, because I am not yet able to lift my left leg up high enough to put it over my right knee.

I could try experimenting with my grabber to see if I would be able to get the sock over the toes while in that position that you described, but I wouldn't expect that to work very well up front.

-- Thanks again,
Mary

Confusedmom
04-09-2012, 10:03 PM
I have been using the sock puller that I think Linda recommended for footies, and it works fine for me. I sit in a chair while putting the footies on. I don't have to get them on all the way, just enough so there is a mouth for my foot to go through.

On the aqua therapy, if you decide you really want to do it, you might get your insurance company to make an exception for you, since you are medically restricted from driving too far. Maybe they would conver the closer one as "in network" as an exception for you. Also, aquatics teacher said definitely wear shoes during pool therapy if you have foot issues. You can get aqua shoes at dick's.

Good luck!

mdtaffet
04-09-2012, 11:10 PM
I have been using the sock puller that I think Linda recommended for footies, and it works fine for me. I sit in a chair while putting the footies on. I don't have to get them on all the way, just enough so there is a mouth for my foot to go through.

On the aqua therapy, if you decide you really want to do it, you might get your insurance company to make an exception for you, since you are medically restricted from driving too far. Maybe they would conver the closer one as "in network" as an exception for you. Also, aquatics teacher said definitely wear shoes during pool therapy if you have foot issues. You can get aqua shoes at dick's.



I guess I could try that device they sent me home with for the footie socks, but I'd have to experiment with it quite a bit first.

Dick's, or any other place that sells them would most likely not carry any aqua shoes wide enough to fit my feet -- my shoe size is a men's 8 EEEE. I have in fact never seen any aqua shoes made in that width range; if I had, I would have bought them decades ago.

LindaRacine
04-10-2012, 11:01 AM
Linda,

I was sent home from the hospital with that exact same sock puller, but (1) it is no match for my Nike Dri-Fit socks, which are like compression socks, and (2) it won't do anything for little footie socks; it's never even come out of its plastic bag since I got home. What I bought to help me with the Nike Dri-Fit socks is the Heel Guide Compression Stocking Aid, also sold by Amazon: http://www.amazon.com/Heel-Guide-Compression-Stocking-Aid/dp/B0052ZX7F8. My son finally put it together for me one day last week and I successfully used it on Thursday after my shower for those Nike Dri-Fit socks. But the other footie socks that I can't get onto my right foot without assistance are much smaller, and really don't have a "neck" (for lack of a better term) for a "sock puller" to grab/connect onto.

I actually use the sock puller I referred to for both my compression socks and footies. I agree, however, that it's not as easy as regular socks. I have a similar device as the one you refer to, for compression stockings as well. The big problem with that one is that it is definitely not portable. Interestingly, I've recently had more of an issue removing compression stockings than putting them on. You can actually buy a tool to remove them, but I found that using my long-handled shoe horn works. I just need to be careful not to let it poke through and ruin the stockings.

mdtaffet
04-11-2012, 07:18 PM
I am curious, what is "work hardening" that your doc mentions as a goal?



I had my first outpatient physical therapy visit today. I learned that (a) those weren't actually goals of the surgeon, but rather the things that the therapist was allowed to do in terms of treatment, and (b) "work hardening" is really mostly for people who perform some sort of manual labor, such as people at the Department of Public Works who might be required to lift heavy trash cans and then empty them for 8 hours a day. Those patients would start off their therapy by first working up to the types of manual labor that their job called for (e.g. an amount of weight to be lifted), and then they would work up from a smaller period of time in therapy doing a similar motion with the same weight to a longer period of time so that they would be able to go back to their jobs once therapy was completed. I can't imagine someone doing therapy for 8 hours straight, but that's sort of what it sounded like when the therapist was explaining it to me. So basically "work hardening" doesn't really apply to me since I have a desk job.

leahdragonfly
04-12-2012, 10:11 AM
Thanks for explaining that, Mary. Makes sense!

I am starting PT next week, I think it will mostly be lower extremity and core strengthening, not sure what else. I am fused similar to you, but my recent surgery was a revision for pseudoarthrosis/broken rods. I am currently about 9-10 weeks post-op.

BTW, thanks for the advice about shoes. What type of Brooks do you like?

Take care,

mdtaffet
04-12-2012, 11:07 AM
BTW, thanks for the advice about shoes. What type of Brooks do you like?



Gayle,

I don't wear Brooks. I wear New Balance, primarily MR1012MC. I also have some MR1123MC (replaced by M1540WB1 which I also have but haven't tried yet). And when I need to wear nicer shoes, such as at work sometimes or for more formal occasions, I also have MW925WT and a newer pair of MW927BK. I just bought, but haven't really worn yet, other than to try them on, MW577VB and MW927VK.

I no longer wear them, but I did previously wear Brooks Beast. The only time I use the Brooks Beast now would be for a spinning class because they are stiffer so handle the pedals better; but I haven't been to a spinning class in at least 6 months if not longer.

What I'm currently wearing around the house in lieu of flimsy slippers is a pair of Orthofeet shoes from FootSmart called Thomas (http://www.footsmart.com/P-Orthofeet-Mens-525-Thomas-Shoes-71374.aspx); they are slip-ons for me and can accommodate my orthotics which I found to be much better for getting around in my house. I started off wearing just my flimsy old slippers, but I didn't like the way they were making my feet feel, and also didn't like the way the slippers were making me walk. In the slippers, my extreme overpronation was constant, along with my ankles rolling in.

As a reminder, I have to wear men's shoes because women's shoes are just too narrow for my feet. I wear a men's 8 EEEE.

-- Mary

mdtaffet
04-12-2012, 09:55 PM
After my shower this evening I was able to put on my own left footie sock. I first tried Linda's suggestion to use the sock puller that the hospital had given to me. It took me two tries to get the footie sock far enough onto the device so that it would come down over my toes successfully. Then I was going to try the other suggestion from I think it was Gayle to face my bed, place my shin on the bed and then I was going to grab the footie sock and pull it up over my heel. To my surprise, it was already up over my heel. That didn't initially seem to be the case when I first pulled the sock puller device away that 2nd time; I thought I both saw it and felt it bunched up under my arch, but I guess that must have been my imagination.

So thanks for your suggestions; that's one more task I can do for myself that my husband will no longer have to do for me.

That leaves tying my shoes, applying the Nivea lotion to my legs below my knees after my shower (i.e. shin, calf, ankle, foot -- I found that my skin got very dried out after the surgery because I was no longer applying Nivea regularly), washing my back and legs during my shower (I can sort of get my back, but not very well), and doing my laundry as the major chores my husband now does for me that he had never done before. Oh, and pulling my long hair from the shower drain as well.

Anybody got any good solutions for either applying lotion to your lower legs or for picking up long hairs from the shower drain, or even better, keeping them from going there in the first place?

-- Thanks,
Mary

LindaRacine
04-12-2012, 10:20 PM
Hi Mary...

Little victories... right?

I purchased THIS (http://www.amazon.com/As-Seen-Roll---Lotion-Applicator/dp/B000MBNLF8/ref=sr_1_7?ie=UTF8&qid=1334286773&sr=8-7) gadget, but would definitely not recommend it. I ended up just living with horribly dry and itchy legs.

As for picking up the hair, there are some grabbers that would probably work OK. I have 2 different grabbers. Some work better for different tasks.

--Linda

mabeckoff
04-12-2012, 10:25 PM
I am totally fused from C2 to my pelvis. I am about 9 months from my big surgery and I am finally able to put cream on my lower legs. Before that I was using a clean bath sponge , on a stick to apply cream.

Congratulations on your latest victory

Confusedmom
04-13-2012, 09:55 PM
I am 4 weeks post-op, T4-sacrum. I can put my right ankle on my left knee and thereby put on lotion, socks, shave, or whatever. However, I haven't been doing this because I am afraid it is a big "no-no," like no BLTS. Thoughts? It would make life easier if I could just do it.

Confusedmom
04-13-2012, 09:59 PM
Also, the two remaining mysteries to me are the laundry and the bottom drawer of the dishwasher. I think I can coerce my children into helping with the dishwasher, or else just wash that stuff by hand. But the laundry? I can't really even wrap my head around that yet.

LindaRacine
04-13-2012, 10:13 PM
I am 4 weeks post-op, T4-sacrum. I can put my right ankle on my left knee and thereby put on lotion, socks, shave, or whatever. However, I haven't been doing this because I am afraid it is a big "no-no," like no BLTS. Thoughts? It would make life easier if I could just do it.
I would definitely not do that, as I think it puts a LOT of strain on the L5-S1 joint (depending on how loose your hips are). If you don't feel any pulling, it might be OK, but I personally wouldn't do it until 3-6 months postop.


Also, the two remaining mysteries to me are the laundry and the bottom drawer of the dishwasher. I think I can coerce my children into helping with the dishwasher, or else just wash that stuff by hand. But the laundry? I can't really even wrap my head around that yet.
I did laundry within maybe 3 weeks of surgery. I just used my grabber for everything. I also used my grabber to load and unload the top rack of my dishwasher. I discovered that grabbers don't do a great job on knives, but I got around that by grabbing the entire flatware basket, loading it from my countertop.

I think it takes some time to get creative in terms of solving all the problems of every day living, but I definitely came away with the belief that necessity is definitely the mother of invention.

--Linda

mdtaffet
04-13-2012, 11:17 PM
I would definitely not do that, as I think it puts a LOT of strain on the L5-S1 joint (depending on how loose your hips are). If you don't feel any pulling, it might be OK, but I personally wouldn't do it until 3-6 months postop.


That's what I had been doing to get my right footie sock on (though not in the beginning), but I do feel some discomfort doing that. I didn't realize that what I was feeling could be stress on L5-S1 (definitely one of my problem spots before surgery). Now that I've learned from you guys that I can use the hospital-supplied sock puller to put on my footie socks, I should just switch to using it for both of those footie socks.

Confusedmom
04-14-2012, 09:37 PM
Okay, thanks Linda. I will try to behave myself. Sometimes it's easy to forget, surprisingly.

One more question, is it bad to just squat say 3-4 inches with your hips/knees to get something that's just a little out of reach?

Roxjanine
04-16-2012, 09:22 AM
I started aqua therapy at 2 weeks post op. It really helped not waiting so long to get moving again. A lot of people on the forum thought it was too soon, including me. But now I see the results and I am glad I began aqua therapy early on.