DaveQ24

I’m considering it. I faxed a letter with my thoughts and some questions to the orthopedist on Friday but assume it will take a few days to get a response. Currently, he gave me orders for 3 X a week for the next 4 weeks.

Here’s the thing - I guess I’m supposed to be having bone/joint pain, stiffness, and instability in my left leg, but I’m not. It feels perfectly normal in that respect. Part of the current week’s goal was to “wean off” crutches - which was extremely easy, I was able to walk better and safer without them. After that the brace goes away.

I have the therapy plan through the 1st week in November, and it is just basic exercises at low to moderate intensity that I could do entirely on my own at home or at the gym. Nothing special like massage or ultrasound that I couldn’t do.

I also found several complete PT protocols that go out six months for my major injury, the tibial plateau fracture - just progressive exercises and some stretches that concentrate on mobility and flexibility and then add increading force to strengthen.

Just wondered if anyone else has been given the green light to do it on their own? This is exhausting me because I can only fit it in in the evenings, and it’s cutting significantly into what sleep I do get. On my own I could just incorporate these routines into my regular gym time.

FBinNY 

Years ago when I had PT related to a spinal issue, the therapist was great about teaching me the exercises, and getting me independent of the need for regular PT. We worked it down to once a week for 15 minutes just to monitor progress and ask me how I felt, then once a month until we decided that we'd gotten whatever we would out of it, and it was all about maintenance from here in.

So, if you're recovering as well or better than expected, it's only about followup, and you should talk to either the PT or doc about eliminating the visits or stretching the schedule.

Sometimes, I suspect that some of it is driven bu $$$$$. The doc gets the insurance carrier to agree to X number of sessions, so folks don't want to leave any money on the table.

Deb just had a case in Coz, where a patient was recovering from paralysis on a HBO2 protocol. As they came to the end of the series and the patient was able to walk with a cane, the carrier wanted to fly her home on a medical evacuation flight.

This isn't cheap at something in the 30-50k range, but it was expected early on, based on her prognosis at the time. The patient knew she wouldn't get HBO2 treatments at home and was unhappy with the likelihood of an end to progress. It took many conversations to convince the carrier that a few more treatments as an outpatient, followed by a commercial flight home was better for the patient, at about half the cost.

Oddly enough it took the intervention of Nate, which made the planned flight impossible, and once the carrier saw she'd be there 2 more days anyway, they came around to the idea of doing it the cheaper way.

Cyclist0108

I discontinued it early. My surgeon screamed at me, told me I was walking like a pirate with a peg-leg, and sent me to a more "hands-on" place that really worked me over. It was for the greater good.

If you aren't screaming withe pain and agony and referring to you PT as the Bitch of Birkenau behind her back, then you aren't doing it right.

DaveQ24

Yeah, it’s literally nothing - 10-12 minutes on a stationary bike with almost no resistance, 30 reps on a leg press with 70 lbs of weight (vs the 360 - 400 I put on it at the gym pre-injury), some leg lifts, knee bends, leg/ab movements and stretching. Then they put ice on it for about 10-15 minutes then send me home.

Yes, I have really good health insurance so that could be a factor - the Dr probably sees no reason to push aggressively. Well, I do - ready to be done with all of this.
Aat

canklecat

Sounds like you could handle that level of PT on your own. Any fairly self-motivated cyclist or amateur athlete is already familiar with what it takes to overcome discomfort in pursuit of better fitness.

A friend who's now 75 had her second round of joint replacement surgeries this summer (I don't recall if it was hips or knees). She's always been active, playing tennis, walking, puttering, etc. She went into surgery in remarkably good condition and was discharged from the live-in physical rehab center much earlier than anticipated.

After a 2001 car wreck (I was t-boned by a driver who ran a light at highway speed) I had six broken vertebrae, two in each major section, and still have a permanently damaged C2. The settlement provided only a few months of physical therapy and a $5,000 cash settlement after attorney's fees. It didn't come close to covering my actual medical expenses, let alone the years of lost employment. But that's the nature of Texas tort reform, in which only collisions involving commercial vehicles provide those six-figure settlements. Private vehicle operators are required to carry only a minimum for liability, half of which goes to attorneys.

I was on a cane for years, until 2013 or so, and didn't resume cycling until 2015. I'm very self-motivated, but my background when I was younger was amateur boxing so I was already familiar with enduring pain in pursuit of a goal. That would apply to any serious amateur athlete, although most sports don't involve deliberate physical contact even if painful contact and/or collisions are a constant risk (as with bike racing).

I have pain after every long casual ride or short high intensity interval ride. Today I can barely move my head after Friday's 33 mile ride, where I was trying to set some new personal bests on various Strava segments (and I did improve on two segments). Nothing that I can't handle with a rest day, alternating between hot and cold packs on the neck. Just goes with the territory. But the good days make it worthwhile. If Sunday is a good day I'll get after it again.

Light to moderate physical therapy is for folks like my mom and granddad, who absolutely refused to do any PT on their own and resisted any directed PT, tooth, claw and cussing. While my granddad was always physically active -- an avid gardener and all around putterer -- my mom is, frankly, lazy. Granddad had a worse temper about pain and chased away every visiting nurse and physical therapist. Mom was just infuriating because she'd rather sit like a lump all day with her body and brain atrophying (she also suffers from the early stages of dementia, which has been responsive to meds and moderate exercise).

I pushed my mom through PT after her knee and shoulder replacement surgeries with every psychological trick in the book, including stuff that no ethical professional physical therapist would have done. I'd describe in lurid detail the sight of my granddad's entire lower leg dangling from the disjointed knee, as from a rubber band, because he wouldn't cooperate with PT to strengthen the connective tissues. And the long, lingering death over a year or so from congestive heart failure and COPD because he'd given up on moving from his recliner.

That wasn't enough to motivate her. So I described granddad sitting in his own urine and feces because he couldn't move and was too big for visiting nurses to move -- which meant I had to physically lift him to clean him up.

That motivated mom. The thought of someone else needing to clean her up was terrifying.

Now she takes at least short walks almost daily, and has dropped nearly 70 lbs over 10 years.

Those are the types of folks who need professionally directed light to moderate physical therapy. Folks who cannot or will not do it on their own.

qcpmsame 

I would be asking the physician as well as the therapist, as suggested. Since you asked for experience with stopping early, yes I did make that particular mistake with PT for my spine following the initial injury. Mistake on my part in cutting short the rehab to return to full duty. Workmen’s compensation insurer held the fact I elected to stop early over every order and problem that was sent to them, and then have things go worse but not due to the work I was doing.

Bottom line was that my judgement was clouded by others and the insurer pushing me off of PT for their benefit, not for my well being. It probably led to the two level vertebra fusions and the paralysis I endured for over 14 years.

Your call of course, that’s my two cents worth.

Bill

canklecat

Good point @qcpmsame makes regarding insurance, worker's comp and potential future disability. Seemingly insignificant choices and accidents can have long term consequences.

Don't discontinue physical therapy if there's even a remote risk that it may affect your long term prospects for employment, worker's comp, disability (short term or permanent), insurance settlements, etc. (A combination of bad luck and misguided advice resulted in my inadequate settlement for injuries that turned out to be far more serious than original diagnosed.)

Even if it's boring and seems to do little good, it may be wiser to continue with the recommended PT.

qcpmsame 

@canklecat is spot on about things down the road getting bad for you. I ended up with a disability rating for quite a while when the physician picked by the W/C carrier got bent out of shape about stopping the PT and refusing to treat me further. I had to fight to get my benefits restored to at least medical care. It was not pleasant or fun in any way.

Bill

Maelochs

Ask enough people and eventually you will find the same number will say "Yes" and "No," each with a perfectly true story to back up his/her opinion.

Lots to weigh here. I think the most important issue is liability if you don't heal or hurt yourself after leaving treatment. In some cases that's a crazy gamble .... in your case, it seems safe.

By that, I mean it seems safe for me to give potentially life-altering medical advice based on no examination and absolutely zero formal medical training to a complete stranger over the internet ....because it would be so hard for you to track me down.

TCR Rider

I'll be starting my third week of PT tomorrow for a total knee replacement. I was also prescribed 3 x a week for 4 weeks. I wanted to go to an inpatient rehab from the hospital but Medicare and my insurance wouldn't cover it. I was sent home with what they call intensive home PT which is 5 x a week for 2 weeks. The therapist was actually better than I expected but then again I had low expectations. He worked a lot on range of motion and some light strengthening work to get the quads firing again. He had me walking and doing the stairs without a cane by the time he finished. So good progress was made.
I know how you feel about PT a lot of the exercises seem fairly easy but at this stage I'm getting what I feel is as much as I can handle at this time and I continue to improve. I'm retired so I go to PT early in the day and I walk there and back so that gives me another mile of walking which I need. Generally when I get up I do my regular AM workout for core and upper body then head over to PT. On days I don't go to PT I do the exercises at home but actually add some difficulty by increasing the weight of the ankle weights and resistance of the bands. I will most likely keep going to PT as long as I continue to improve since aside from the $20 co pay it works into my day nicely. One thing I get from PT is she keeps my form on target which is something I need so I don't get sloppy with the exercises. From the warm up on the bike to icing at the end I spend about 90 minutes there. When I get home I have lunch and hop on the trainer at home for 30 min.
I saw from your other post that you have some significant injuries so while it can be tedious I would think twice before pulling the plug. Sometimes having another set of eyes on you can keep you on track and not cause more problems. Personally I push as hard as I can but my mantra is no setbacks. Ultimately you have to make the choice what is right for you just think it through before you decide. Best of luck to you.

GlennR

I went for tendentious and after 4 visits, I had the routine down and didn't need to pay for what i could do at home. It would of been a waste of my co-pay and the insurance.

FBOATSB

I think the majority of physical therapy patients on the non cycling, non sports side of the spectrum really need to have that human watching and coaching them in order to assure compliance. I was on that side of the spectrum when my spine and legs failed. Doc said I was about a mm away from paraplegia. When I started PT, it was a struggle just to get from the car to the door of the place, I was so doped up. After learning how to walk again, I took the full six months of disability and pt I was eligible for before getting cleared for work, and that's when I started cycling again. It's all about compliance. If you can have honest discussion with your doc and pt, they should trust your judgment to remain active and compliant with follow ups. Face it, you can't fool them on healing progress.

Retro Grouch 

My personal experience with PT wasn't good. At the time it seemed to me like a lot of bother for no discernible benefit. I eventually just stopped going.

I'm thinking they aren't all the same. If the situation comes up again, I think that I'll just go to a different place.

canklecat

One reason I stuck it out with the prescribed PT after my car wreck injuries years ago was for the massage machines and TENS unit treatments. I thought the chiropractic treatments were useless (yeah, I know, some folks swear by it), but the chiropractor's clinic had the nifty heavy duty massagers and muscle zappers, which did feel good. The kinds of massagers and mini home TENS units I could afford to buy were nowhere near as effective.

_ForceD_

I have...but with the physical therapist's recommendation and advice. And, it all depends on the injury/recovery that the PT is for. If it's just doing reps of light weight, or easy stretching. I'll get the PT's advice and instead of going 3x per week...I may go in once every couple weeks just so they can check on my status. Conversely, when I was in recovery from surgery for torn rotator cuff...I went until they told me I was done. With that recovery there were just things...torture-like stretching...that I just could not do myself. They had to physically stretch my shoulder so that I would regain my range of motion. Bottom line...get the advice of the PTs and your doc.

Dan

DaveQ24

Thsnks again. Work, disability insurance, etc are not a factor. The accident had nothing to do with my job (primarily tax law/IRS negotiation) and other than the day after the accident and the day I had surgery on my thumb, I’ve been at work at least part of the time every day. I could sit in my office with my leg propped up just as easily as at home.

I guess I should be more precise in what I’m asking - did those of you who stopped prescribed PT early get any grief about it from either the physician or PT?

Also, just to clarify a point - this is a pretty minor injury in the grand scheme of things. If it were something serious, such as those of you with spinal injuries, or if my leg bone had been shattered into pieces and put back together with a lot of hardware I probably wouldn’t question this.

FBinNY 

I think there are all sorts of possibilities, and every case is different. But in the end, it's not about anything else but the progress. If you continue making progress at home as the same rate as with PT, then there's no real reason to continue with the PT.

One legitimate concern of the pros is the reality that many who stop PT aren't good about continuing exercises at home, and so may backslide, or plateau short of a complete recovery.

In my case, it was "be sure to drop in next month so I can make sure all is well". But, I was lucky enough to have an old fashioned guy who believed in two way dialog.

DaveQ24

Very true, no doubt there is a continuum of answers from physicians from “ absolutely not” to “sure, no problem”. My gut instinct is that I’m going to get a response out of him that is on the positive end of that continuum, because I think he’s already gotten to know me enough in 4 visits that he knows I am active and intend to stay that way. At my second appointment, I asked him to lay out an approximate timetable of when I could resume five specific activities, walking, cycling, swimming, running, and strength training. And I’ve also told him on each of the subsequent appointments that I was adding additional time and increasing the diversity and intensity of the exercises I have been doing at the gym.

If anything, I’m more likely to get “I’m concerned you are pushing too hard too fast and will reinjure yourself” than concern I won’t keep up with it.

icyclist 

How would your dr. know you stopped going to physical therapy? How would a PT give you grief? With a phone call? Visiting your home? Why would either of them care, if you have a relatively minor injury?

elocs

I injured my back at work so it was a worker's comp claim--ruptured disk, L5-S1. Of course when I went to Occupational Health at my clinic they proceed with the assumption that you are faking but I was informed by my union that I could see my own doctor which made all the difference. I had PT which was fine when it was happening but any benefit disappeared by the time I got to my car. MRI was read as "no apparent nerve impingement" although at the time I complained of discomfort. So I was put into work hardening to prepare me to return to work. Eventually I ended up flat on my back on the floor and so they iced my back and sent me home. I had a 2nd MRI which clearly showed a ruptured disk so I was presented with a choice of continued PT or surgery.
Based on my experience with PT, I chose surgery and had a laminectomy. I returned to work, a physical job picking orders in a food warehouse, 2 months later and never missed a day of work for anything in the next 14 years I worked before retiring. I remember having PT after surgery but it didn't seem helpful. Everybody is different though.

Hunterdog

Over the years I have had the need for PT on a number of occasions. The last was for degenerative low spine condition that was causing significant pain in the low right back and radiating into right buttock leg. PT was not helping. and I thought making it worse. Eventually I went to physiatrist at Special Surgery in NYC. She gave me a list of core exercises to perform and sent me back to the PT to train me how to do the exercises. The PT said she was wrong and began treating me with his modalities and me not receiving any relief. I returned to physiatrist and she had her PA show me the exercises and took me out of PT. After about four weeks my pain was improved and today I am pretty pain free. I see the PT socially, usually at a golf course, and he still gives me grief for leaving his care. So that OP is a long winded way of me saying that I have received grief form my PT for leaving his care.

wphamilton

For some minor injuries I skipped PT entirely - it's ultimately the patient's decision and we don't need permission from anyone. But for the more serious injuries like some discussed here, I would value the specific medical knowledge of the therapists.

locolobo13 

I had PT for a lower back problem in '05. They wanted me to come in every day. But I told them twice a week was all I would take off work. But I would do the exercises prescribed every day. I did and it worked out. When they releases me after 6 weeks I kept up the exercises at a reduced amount. It took more like a year before I felt like the problem was really over. That's my experience.

If you are self motivated and self disciplined then sure. But why not use the program while you have it? Tell the therapist you don't think you are working hard enough. They may prescribe something else for you. Although my experience is all their exercises are boring. Good luck.

rumrunn6

yes, but for nothing major. saved some $$. do miss those professional back massages tho!

Ogsarg

I had PT to recover from a moto accident that resulted in broken clavicle (2 places), scapula, and 3 broken ribs, and resulting surgery to put a plate across the clavicle to hold it together while healing.

I basically could not use my right arm or shoulder for a couple of months so had almost no strength or range of motion. In my case, I couldn't raise my arm to the side more than an inch on my own and having someone raise it was excruciating.

I did PT once a week, where the therapist would check my range of motion and modify my exercises based on where I was having issues. It changed considerably every week and I continued going till she felt that I had recovered as much range of motion as I was going to. I still do some of those exercises now after almost 4 years later.

If your therapy is set, I don't see any harm in going it alone provided you have the discipline to do the therapy and not get lazy, but I personally would want to be evaluated regularly to make sure I was progressing normally.

About the only other thing I would say is do the exercises religiously and do more than you have to if possible.