Physiotherapy frustration

Is my physio an idiot or am I being unrealistic?

1 to 20 of 35 messages
25/02/2009 at 15:27

I've entered the Paris marathon on 5 April. I've had ongoing knee niggles, which about three weeks ago got a lot worse, too bad to run through. When it didn't get better after a couple of weeks I made an appt with a physio.

According to him, the problem is that my knee ligaments are loose and my leg and glute muscles weak, which means the joint isn't moving propeerly, which is causing pain. Fair enough. He gave me a load of exercises to do to help strengthen things, and made another appt for today.

 FF to today. I've been doing the exercises and have noticed a big improvement in how able I am to do them. Great - but there's been no improvement in the knee pain, in fact yesterday it flared up and became a lot worse than it had been for the past few days. 

At today's appointment, he basically gave me more exercises to do. He says there is no damage to the joint, but then why is it so sore and not getting better, even though I haven't run for over two weeks? And even if I do the exercises and strengthen the muscles, if I can't run there's no point, is there?

I feel like today I was charged £50 to be told to do lunges. I've made another appointment on Monday, but I can't afford to go on with this if this is all he is going to do, and at this rate I feel I am no closer to being fit for 5 April than I was two weeks ago.


25/02/2009 at 15:56
What's the injury?
25/02/2009 at 16:10
Um... hurtyknee-itis? He hasn't given me a diagnosis as such, he just says that the loose ligaments and lack of muscular control have led as I've increased my mileage to the joint not tracking properly, hence pain. This is part of my concern - that he's addressing the cause but not the problem, iyswim?
25/02/2009 at 16:45

You have my sympathy Sophie, I went through similar knee issues a few years ago, but mine was after a hill walking accident. I self-referred to an NHS physio, I assume you have done the same but with a private one and have not seen a doctor first?

I had about 8 sessions, including exercise sheets (at least mine were free), the pain location was pointing to a torn cartilidge but again he wouldnt be drawn on the precise injury. But I also have hyper-flexibility so the 'loose joint' thing a bit like yourself. I finally drew the line when for the last 2 appointments he had me cycle on the stationary bike for 10mins, asked how I felt then sent me home! ( I was cycling c.150 miles every weekend outdoors at this point, but not running at all, so I was well cheesed off. Would have been even more p*ssed if I'd paid him for that 'treatment'!!!).

After that farce I went to see my local doctor, luckily a locum was on and she was clued up on sports stuff, she put me through for x ray (showed nothing) and MRI scan (nothing again). Then finally sent me to see a new physio, who said Aha!, hip trouble, knee trouble, get thee to a Podiatrist! and forget about physiotherapy, cos that aint the issue, you're fit and motivated, you dont need to come here and have me watch you do the exercises!

So, podiatrist solved my problem completely. Physio for me was a waste of time, like you say it was exercising / easing the pain, but not solving or even addressing the underlying problem. My advice to you Sophie is get a second / third opinion, maybe see your doctor (you may get a sympathetic one like I did), but i sure wouldnt be paying for it.

Sorry long winded ...Good Luck!

25/02/2009 at 16:47
If in doubt maybe seek a 2nd opinion with a different physio?

Over Christmas I tore the cartliage in my right knee ...I was pretty sure I knew what I had done as I had the same injury in my left knee the year before ...unfortunately my usual physio had gone to South Africa for 3 weeks over Xmas so I had to see one of his colleagues ...he said that I hadn't torn my cartliage not to worry about it let it settle, rest and come back next week and I'd be up and running within a couple of weeks appointment I saw the locum for a 2nd opinion and she said the same thing ..not all knee injuries need surgery blah blah give it a couple of weeks and you'll be up and running ...gave up with those 2 as costs were mounting and waited for my trusted physio to return and sure enough straight away diagnosed that he suspected torn cartliage and that I knew my body and was surprised with the opinions of his colleagues the wheels in motion 3 weeks late to see the surgeon and get an MRI.
25/02/2009 at 16:59

Yeah, it strikes me that the medical profession (like many others I'm sure) is a total lottery as to who you get to see. Of course, the advantage of paying for it is it all gets done really quickly. I had to wait nearly two years to get an MRI scan on the NHS and it was a fight to get it.

But the over-riding feeling I have come out with after all these years,  is whether its paid for or free, be it dentist, podiatrist, physio, doctor, once you find one thats a gem, bloody well hold on to them, cos they're few and far between .

25/02/2009 at 17:03

I recently paid £48 for a session with a physio.  The woman was nice enough, just dont feel she helped or diaganosed the problem.  Just poked around and gave me a sheet of excercises and drew biro around about 4 of them.

Me, i smiled like a good girl, paid over the money, sat in the car, and worked out how many hours of work I would be doing to pay for that session.  Arrgh!

25/02/2009 at 17:04
Agreed Tigerspaw!
25/02/2009 at 17:05

I share your frustration Sophie. I have 'runners hip'. After self diagnosing probably incorrectly a trochanteric bursitis, I paid to see a sports physio.

After getting me to do a variety of exrcises, his conclusion was my biomechanics were all wrong.. i.e I drop my pelvis on one side when I run therefore causing irritation around the hip.

I too have been given a variaty of exercises to do and feel no closer to runnihng the FLM in 2 month stime. I went to my own GP and have been referred to an NHS physio to see if I can get any treatment for free... fingers crossed.

Have your exercises been working? What mileage are you up to now?

25/02/2009 at 17:51

Wow, thanks so much for the feedback.

I saw an NHS physio a couple of years ago for the same thing - she diagnosed ITBS. More exercises, eventually it went away but I'm not sure how much that had to do with the physio to be honest.

Coopster - as far as I can tell the exercises are working to strengthen the muscles they're targeting, but doing bugger all to stop my knee hurting. I was up to c. 50k a week, but haven't run fro 2 weeks and 3 days (and counting!) now.

He watched me run and said my shoes are fine, but that I should be heel-striking, which alarmed me given what's said on here about a midfoot strike being better.

 The more I think about this the more confused I get!

25/02/2009 at 18:16

If you are already a midfoot (or thereabouts!) striker, then it suggests that that is your natural running style. Personally IMHO I think that it is really bad advice telling someone to deliberately change to heel striking when it is not naturally what they do.

My problem for years was heavy heel striking, now I wear orthotics in my walking shoes and motion control Brooks for running, and have over time gradually changed to running lighter on my feet, and running more mid-foot. Subsequently I no longer have hip or knee problems.

I think that is a very bizzare thing to tell someone to do! After all, some people reckon if you heel strike its like running with the brakes on, pounding the pavement, surely the aim is to flow over the pavement, not pound it to pieces .

25/02/2009 at 18:45

"He hasn't given me a diagnosis as such"

Sophie. you are wasting time and money of this really is the case.  Ask him which knee ligaments are 'loose'.  All of them ?!!!!  You'd collapse like a jellyfish if this was the case..

I'm always getting injured (old age etc) but most 'niggles' are very localised, specific, and fixable.   I've got an excellent physio and he can spend ages diagnosing the problem (can be tricky, especially knees) and explaining to me what is wrong, and what the optons are, before doing anything.  

There is often a moment of very painful (but ultimately reassuring) agony in that first session when he finds exactly where the niggle is (says "Gotcha"!), and then makes me do an odd stretch (and/or he pokes it!) to prove the point in dramatic fashion, making me scream/squirm like in the way that only men do... 

ITB is a good example (and it may be this from what you say).  A recurrent prob for me but normally pinpointed to a small area of inflamed ligamet that he then sets to work on, with great effect.  Stretching tricky but does work v.well if shown properly what to do

Which part of the knee is it ?  

25/02/2009 at 19:49
You do need to be realistic with yourself and ask am i going to be able to run 26 miles with a knee like this.I fully sympathise with you as i have have  the same problem with my right leg,loose ligament behind the knee and it does fare up from time to time.As was given advice about a year and half ago by an orthopaedic specialist,stop running.Well iam still running and marathon training myself at the moment,as the mileage goes up the knee is not happy but its not surprising is it.Anyway i am not here to lecture you but hopefully give you an exercise that might help.I was told to do lying or standing legs curls for your hamstrings,i started this last year and it definately helped but dont go to heavy,good luck 
25/02/2009 at 20:22
Father Tim, I know - the lack of diagnosis is really frustrating. He has ruled out ITB - it feels like the problem is deep in the knee joint and it goes down my shin a bit as well - below my knee on the inside is sore to the touch. My ankle is sore too but he hasn't really looked at this - he says it's just a symptom of the general weakness.

It seems like he is building up strength where I need it, which is great, but right now I can't run a step and he seems to be doing nothing to adress this! I'm also unhappy that he seems happy for me to be necking 400mg of ibuprofen twice a day for the duration and I'm not really comfortable with that.

Geezer, as I say I can't run at all at the moment so that point is moot! I got my GP to refer me to an orthopaedic surgeon a while ago (last time it was giving me problems) and her verdict was "softening cartilage" and she suggested I take up swimming instead. But I forgave her because she told me I don't need to lose weight because I am nice and thin!

Thanks again for all the input. My current thinking is I am going to cancel my next appointment with him and not go back - I can continue with the exercises anyway and as has been said, there's absolutely no point him watching me doing them as the genera; idea seems to be that they should make my legs shake with fatigue but not hurt my knee, and I can manage that on my own! However, I still don't know what to do instead.
26/02/2009 at 07:22

I'd consider trying another physio - one who you get a personal recommendation for

I'm worried that he hasn't looked at the ankle - there's a physio rule to "clear" (i.e. rule out problems) with the joint above and below - i.e. ankle and hip

26/02/2009 at 07:44

If they are suggesting you take up another sport, that suggests to me that they don't really know what the problem is. Are they a "sports" physio? Do they run thenselves?

The usual practice with runners is to go and as many different specialists as possible until you find one that gives you the answer you want to hear, i.e. that they'll get you round the marathon no problem.

26/02/2009 at 10:18

I'd agree with the others, Sophie, ditch the physio, I don't know where you are, but if you're near me (Winchester ) then I could recommend physio and pod if either/both would be useful.

Would also recommend people in Croydon (used to live there) and London, if convenient.

If not, and as you obviously know what you're doing, don't want to appear patronising etc, but if you have no personal recommendations, why not try local running clubs - they're bound to have their own physios, or would recommend a good one - that's how I found mine.

26/02/2009 at 10:36

Bill, sorry, I wasn't clear, it was the orthopaedic woman who suggested ditching running.

The practice is affiliated to a running club and they're all apparently running specialists, which is why I chose them. But I agree, he needs ot be ditched.

CJBA, I'm in London and would be v grateful for recs - I already have s rec from one of the others on the Paris thread but backup is a good thing in case he can't fit me in.

Thanks again, everyone - it's good to know it wasn't just me being unreasonable.

26/02/2009 at 11:00

I too have problems with loose ligaments.  I went to my physio who gave me exercises to strengthen up my glutes etc.  He also gave me ultrasound treatment and another treatment that I can't remember the name of. 

It took me a while to get running again as the ligaments etc were so inflamed.  It took about 3 months before I was back to normal but I was seeing gradual improvement all the time.

Has your phizzy given you any treatment or explained what is causing the pain?  Mine was giving me information all of the time, pointing out weak areas to work on and what exactly was causing the pain.

I went to him last year for this problem.  I had 4 visits and I've not had to go back since as he has given me all of the tools to sort out problems myself.

If you are not happy with your guy then I would go elsewhere.

26/02/2009 at 11:24
Thanks Shimmy. He's done no treatment at all, just the exercises.
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