Increased Pain with PT

[briarrose]

Hi everyone,

I just finished my 3rd week of physical therapy and I've found that my pain has increased greatly since I started. I'm definitely stronger now though. My increased pain is in my shoulder blade and this sends shooting pain down my right arm. I had this problem before my surgery but not this bad. Now my leg has the same type of pain. My arm will also get very tingly. I've told all of this to the physical therapist but I'm still doing the same exercises. I've had an MRI of my neck done to check for herniated discs but they appeared fine. I'm going to see a neurologist next month for the arm pain/numbness and possibly an EMG of both arms. Does anyone else have these sort of problems? This pain has me really depressed lately. It's slightly worse than it was pre-op. I was not expecting this.

Thanks,

Shell

[LindaRacine]

Hi Shell...

It seems to me that you might want to find a new PT. If you've talked about the pain, and your exercises didn't change, you're working with someone who is incompetent. Be sure that you're working with someone specialized in spine.

Regards,
Linda

[titaniumed]

Hi Shell

Wow, its been a year! You might want to slow down on the PT. Maybe skip a week and see if you recover.

I did all of my recovery at a snails pace and listened to my body. My PT was a huge success, and hopefully you can get this shoulder, arm pain under control.

Linda is right, if your physical therapist isn't responding in any way to your cries of pain, something's wrong. If they have never worked with a scoliotic, they should say so, and at least put on the brakes.
Ed

[briarrose]

Thanks Linda and Ed! I have PT again tomorrow and I'm planning on telling the guy flat out (again) what is wrong. If he doesn't change my exercises I'm going to call my surgeon and ask him to recommend someone. A week off may do me some good too. When I'm not at work, I'm at home lying on the couch recovering from the day. This is not fun.

Thanks again!

Shell

[debbei]

Thanks Linda and Ed! I have PT again tomorrow and I'm planning on telling the guy flat out (again) what is wrong. If he doesn't change my exercises I'm going to call my surgeon and ask him to recommend someone. A week off may do me some good too. When I'm not at work, I'm at home lying on the couch recovering from the day. This is not fun.

Thanks again!

Shell

Shell,

some muscle soreness after PT is ok, but not what you describe. Sounds like you have a good plan. When I overdo it with my arms, I also get pain around the shoulder blades (and sometimes it takes up to 10 days to get completely better); however, I don't have any shooting pains like you describe down your arm.

I hope you can figure this out and maybe get a gentler PT.

[LynnMarie74]

I had a similar experiance working w/an exersice ball. My PT had it on a bed & had me lay forward on it while my feet stay on the ground. Then I was to roll it back and forth using my hips. Yea...I just didnt move like that, but I tried. I then, after 4 rolls in both directions, said " Um, I dont think I should be doing this one" She asked why....I told her, its very uncomfortable and it feels like Im over extending my spine/back. I was VERY sore the next few days and I told her I refused to do that one again. Taken care it.....that one bit the dust. I did take a week off too....and felt bad about it...not doing any of the "hard core" thigh/leg moves, but I promised myself I would start fresh tomorrow!

[debbei]

I had a similar experiance working w/an exersice ball. My PT had it on a bed & had me lay forward on it while my feet stay on the ground. Then I was to roll it back and forth using my hips. Yea...I just didnt move like that, but I tried. I then, after 4 rolls in both directions, said " Um, I dont think I should be doing this one" She asked why....I told her, its very uncomfortable and it feels like Im over extending my spine/back. I was VERY sore the next few days and I told her I refused to do that one again. Taken care it.....that one bit the dust. I did take a week off too....and felt bad about it...not doing any of the "hard core" thigh/leg moves, but I promised myself I would start fresh tomorrow!

Lynn & Shell,

I didn't like the exercise ball either. The PT put it on the ground and had me lean across it (like on my hands and knees with this ball supporting me underneath. Then either with no weight or just 1 lb weights in my hands, she'd have me raise one arm at a time and then one leg at a time, and then one arm and the opposite leg BOTH at the same time. This just seemed to put too much stress on my back and I was ALWAYS sore afterwards. We both jointly decided that it just wasn't right for me.

[briarrose]

Lynn and Debbe,

I'm not a fan of the exercise ball either. I can't believe they had you lay across a ball with a fused spine! I do that same move but without a ball underneath me.

I just got back from PT and told the guy that I thought the exercises were aggravating my shoulder and arm. He had me do only leg stuff today. My shoulder is still hurting really bad so maybe the exercises aren't related to the pain. This is so frustrating.

Shell

[debbei]

Lynn and Debbe,

I'm not a fan of the exercise ball either. I can't believe they had you lay across a ball with a fused spine! I do that same move but without a ball underneath me.

I just got back from PT and told the guy that I thought the exercises were aggravating my shoulder and arm. He had me do only leg stuff today. My shoulder is still hurting really bad so maybe the exercises aren't related to the pain. This is so frustrating.

Shell

Shell,

I would think it's more stress on the spine without the ball underneath. It was there for support. I think for me it was more a matter of doing the one arm opposite leg at the same time that put me over the edge. Anyway, if something bothers you, the thing to do is stop until you're feeling better then try again slowly, or just cut out that thing all together. AFter a few times of that really getting to me, we mutually decided it was enough!

How is your shoulder hurting? Around the back, where your shoulder blade is, or at the very top of your arm?

[briarrose]

Shell,

I would think it's more stress on the spine without the ball underneath. It was there for support. I think for me it was more a matter of doing the one arm opposite leg at the same time that put me over the edge. Anyway, if something bothers you, the thing to do is stop until you're feeling better then try again slowly, or just cut out that thing all together. AFter a few times of that really getting to me, we mutually decided it was enough!

How is your shoulder hurting? Around the back, where your shoulder blade is, or at the very top of your arm?

I'll have to try that exercise with the ball. I have one at home. That one doesn't bother me though.

My shoulder blade area hurts the most- sometimes at the base of my shoulder blade. The worst pain is about 1.5 inches to the right of T2 and T3. It hurts just to touch that area and it also burns most of the time. Massaging it shoots pain down my right arm. I also have a lot of pain in between my collar bones on the right side. Are you still having shoulder pain? Is yours anything like this?

[aterry]

How did you find your PT? Was the place recommended by your doctor? Is there a listing of PTs who specialize in spine exercises? Like SRS for doctors?

[MissEmmyF]

How did you find your PT? Was the place recommended by your doctor? Is there a listing of PTs who specialize in spine exercises? Like SRS for doctors?

I've wondered about that too. Are there PTs that are specifically trained in therapy for after fusion? If not, I'd be extremely leery to work with a PT even if they were well trained in the spine...

[LindaRacine]

How did you find your PT? Was the place recommended by your doctor? Is there a listing of PTs who specialize in spine exercises? Like SRS for doctors?

aterry, The UCSF spinal deformity clinic has a list of local physiotherapists who specialize in spine, so you might want to start your search at your specialist's office.

MissEmmy, I doubt there is any specific training for treating patients with spine fusions. My physiotherapist worked on the spine floor at the hospital prior to going into private practice. So, she had a lot of experience from that perspective.

--Linda

[debbei]

I'll have to try that exercise with the ball. I have one at home. That one doesn't bother me though.

My shoulder blade area hurts the most- sometimes at the base of my shoulder blade. The worst pain is about 1.5 inches to the right of T2 and T3. It hurts just to touch that area and it also burns most of the time. Massaging it shoots pain down my right arm. I also have a lot of pain in between my collar bones on the right side. Are you still having shoulder pain? Is yours anything like this?

Shell,

my pain is the same, about 1.5 inches but to the left of T2 & T3. Massage by my husband helps, but only for a few minutes. Any more than that drives me crazy and starts to hurt. I don't have any of the collar bone problems though. My shoulder issue is a frozen shoulder, and I'm back in PT for it which is really helping.

[briarrose]

Shell,

my pain is the same, about 1.5 inches but to the left of T2 & T3. Massage by my husband helps, but only for a few minutes. Any more than that drives me crazy and starts to hurt. I don't have any of the collar bone problems though. My shoulder issue is a frozen shoulder, and I'm back in PT for it which is really helping.

So how do you know if you have frozen shoulder? I've been wondering if I had this since I saw one of your past posts about it. I'm able to rotate my shoulder. I have some limited movement but I assumed this was from being fused up so high. Did you have this pain pre-op?

[debbei]

I went to the orthopedic Dr. when I was around 6 months post op. He took Xrays to make sure nothing was broken or torn, and then told me that it was this frozen shoulder thing. Ever since my fusion, both shoulders were kind of sore, and the right one seemed to get more and more limited in my range of motion as time went on. The PT is helping tremendously. I can't believe how quickly it's helped. I have about another month to go. I go back to the shoulder Dr. on Thursday for a checkup.

[JenniferG]

Glad to hear the PT is helping so much, Debbei.

I wonder if my surgeon will suggest PT for me at my August appt. I've never had much faith in physiotherapists (from past experience) but it seems a lot of patients on this forum have benefited quite a lot from it. I guess it's a matter of fluking the right practitioner?

[asccbodypro]

I would agree with Linda. If you have told them about your pain increasing and they still have you on the same program I would be a little worried about their knowledge of the scoliotic spine. Your body is trying to tell you something.....slow down or back off on the exercises because something isn't working for you! Good luck. I hope you can figure out what is going on. You need to move forward not backwards!!

[briarrose]

Thanks ascc. I called my surgeon's office last week and told them my pain had increased with PT. I was told I could have pain killers if I wanted. I declined because I'm not ready (mentally) to start taking pain killers on a regular basis. I was also told to ease up on the PT and if the pain increased to call back and come in to see the doctor. Well I did ease up a good bit but I still have a lot of pain. I don't know what to do. This is all so depressing. I've spent my Sunday mainly lying on the couch because doing anything is painful. I know when I go in, the doctor will order x-rays and everything will come back normal. Are narcotics really the next step? I guess hardware removal would be a possibility too. I'm not sure what to do.

Shell

[JenniferG]

Oh dear, Shell. This is not what we want to hear. I fully understand you not wanting to go back on the meds. I can only suggest you rest up, avoid all PT for a while, and hopefully, things will settle down.

I see you are a year post-op. Have you tried anti-inflammatories? I would imagine you are fully fused by now? I know we are all different, but I used to swear by Nurofen. It not only took away the pain, but once the inflammation was gone, often the problem would be fixed.

Fusion or no fusion, we all get pain from overdoing things at times, and hopefully this pain is no different. Sometimes these things take a long while to heal.

Check with your surgeon first, but my advice would be Nurofen and good, solid rest. And try not to think about rod removal or permanent medication.

[LindaRacine]

Thanks ascc. I called my surgeon's office last week and told them my pain had increased with PT. I was told I could have pain killers if I wanted. I declined because I'm not ready (mentally) to start taking pain killers on a regular basis. I was also told to ease up on the PT and if the pain increased to call back and come in to see the doctor. Well I did ease up a good bit but I still have a lot of pain. I don't know what to do. This is all so depressing. I've spent my Sunday mainly lying on the couch because doing anything is painful. I know when I go in, the doctor will order x-rays and everything will come back normal. Are narcotics really the next step? I guess hardware removal would be a possibility too. I'm not sure what to do.

Shell

Hi Shell...

I agree that you should lay off of PT for awhile. If your pain hasn't improved significantly in a month, I think you should consider getting a second opinion. There's a reason for your pain.

Regards,
Linda

[briarrose]

Thanks Jen and Linda,

I called my surgeon's office again yesterday and said the pain was still pretty bad. I was told to stop the PT and see my surgeon soon. I'm going in on Monday morning. My hardware has started to bother me too. I get shooting pain going up and down my spine. Maybe it's still the nerves regrowing. I also have this buzzing type feeling at the base of my neck. It feels like I have a TENS unit on a low setting there permanently. I'm really scared that something has gone wrong.

I've started taking Advil on a regular basis but it doesn't seem to be doing much. Thanks ladies!

Shell

[txmarinemom]

Shell,

my pain is the same, about 1.5 inches but to the left of T2 & T3. Massage by my husband helps, but only for a few minutes. Any more than that drives me crazy and starts to hurt. I don't have any of the collar bone problems though. My shoulder issue is a frozen shoulder, and I'm back in PT for it which is really helping.

Shell and Debbe ...

Debbe, I still think you're describing the rhomboid (http://wpcontent.answers.com/wikipedia/commons/thumb/a/aa/Rhomboidei.PNG/250px-Rhomboidei.PNG), and I'm serious ... that Theracane (http://www.theracane.com)thing I ordered ROCKS for that spot.

There's a really good book on frozen shoulder (http://www.amazon.com/OPTP-The-Frozen-Shoulder-Workbook/dp/B002C9ORNS/ref=sr_1_4?ie=UTF8&s=sporting-goods&qid=1246502342&sr=8-4)...

The more you understand the mechanics of it will help with either active therapy (PT) or passive modalities (which can also be active) like massage therapy.

Y'all hang in there.

Regards,
Pam

[briarrose]

I may have to try that Theracane thing, Pam. Thanks for suggesting it.

I saw my surgeon this morning. He had me go for x-rays of my shoulder but everything looked normal. It's probably all muscular and nerve related. I mentioned my spine pain (especially at the base of my fusion) and he said if it did not go away in 6-8 weeks, I should have a cat scan done to check the fusion. He didn't think it was likely, but thought that fusion failure could be the problem if the pain persists. Can fusion failure occur in a small area or the entire part that was meant to be fused?

I really wish I would have asked for a steroid injection for my shoulder. I completely forgot about it until I got to my car.

I think I'm going to give acupuncture a try. At this point I'll try anything except narcotics.

I go to see the neurologist next week for my arm pain/numbness. My surgeon is anxious to hear what is going on with my arm. I'm afraid of having an EMG done though. They sound so painful!

Thanks for listening everyone! I appreciate the support.

Shell

[LindaRacine]

Can fusion failure occur in a small area or the entire part that was meant to be fused?

Hi Shell...

I think it's much more common to have one area of non-fusion vs. multiple areas of non-fusion.

Regards,
Linda

[briarrose]

Hi Shell...

I think it's much more common to have one area of non-fusion vs. multiple areas of non-fusion.

Regards,
Linda

Good to know. Thanks! Does this have to be fixed or can it just be ignored (I know it's really difficult to determine if the fusion has failed) if the pain isn't too bad?

Shell

[titaniumed]

Shell

EMGs are nothing to worry about. They tape electrodes to your body and measure electrical signals in millivolts. The removal of the tape is the worst of it.

I always keep Celebrex around the house just in case. Its an NSAID, and they are effective sometimes in certain cases. They don't slam your head, and it wouldn't hurt to get some. Your GP could give you some samples. Read about them, its worth a try.

I always have had great success with hot water for pain. I always hop in the bath tub when I'm in trouble. You could also try some Tiger balm that Pam has mentioned in the past.

I don't blame you with the meds. I actually have my own pharmacy here at the house, with one hell of a selection of goodies acquired with all my surgeries, but I'm extremely hesitant to take any of it. With my rotator cuff surgery and shoulder repair, I took 2 Celebrex pills and after my gall bladder removal, I didn't take anything. They wanted to give me 100 percs for that one. LOL That's like a 2 month nonstop party.

Its the equivalent of getting a bottle of liquid morphine for stubbing your toe...............Ye ha.

Having a non-union fixed is a good question.There are people that go years and don't even know it, till some hardware breaks after a million cycles. You are in pain, so that changes decision making timeframe. Unfortunately, do to the process, this could take some time. If that were the case, I would ask about BMP.

I don't know if you have ever tried massage. With hot water immersion before, and a good massage, they are fantastic. You will need an experienced masseuse, one who goes easy. I also had a Chinese girl who did acupressure on me who was fantastic. She could literally shut down certain muscles, which was amazing.
I didn't have luck with acupuncture. I think that was because the Dr wasn't Chinese.LOL I think that helps quite a bit, you know. I still wouldn't discount it, acupuncture is absolutely amazing science.

I hope you can manage this till the smoke blows over. Sometimes its difficult.
Ed

[briarrose]

Thanks for the reply, Ed.

I'm pretty sure this EMG involves needles though I could be wrong. The script says EMG-NCS.

I will look into Celebrex. Thanks!

The narcotics didn't really affect me mentally. They completely screwed up my GI system. That's one of the reason I don't want to go back on them. I don't want to turn into an addict either. I work with a lot of narcotics at my job and if word got out that I was taking them on a regular basis, I could run into some problems. Percocet worked so much better for my pain than Vicodin. I have a bunch here too in case I have a really bad day. Do muscle relaxants work for you?

Is a BMP a basic metabolite panel? What would that show if I had a failed fusion?

A massage sounds great but I'm afraid to get one. I had a few done pre-op and always found them very painful but I usually felt great the next day. There are certain spots on my back that make me jump when my husband massages them so I'm a little leery of going.

I actually work with about 20 Chinese. I've been wanting to ask them if they know a good acupuncturist but I'm worried about offending them like Jerry did on Seinfeld. "You think just because I'm Chinese I know where all the Chinese restaurants are!"

This pain is scaring me. It shoots up and down my spine or will sometimes radiate it certain areas. I really hope it passes.

Thanks again for the reply.

Shell

[titaniumed]

Shell
Here is a BMP link.
https://www.infusebonegraft.com/how_infuse_works.html
Ed