Changing Priorities.....

watermark

Right I tend to ramble in these kinds of posts so ill keep it simple:
Im a gym instructor (full time)/physical therapist (part time) and have become increasingly peed off at gym members with pain or discomfort in a joint or muscle who have been told by a physio/doctor that strengthening this area will help relieve their pain.
Such twisted logic it is!! From my own studies and experience anybody "working" a dysfunctional joint/tissues will only compound the problem.

Just as an example, a client in the gym was told by his doc to strengthen his shoulder as he was suffering reduced ROM and pain when abducting his arm (lifting it to the side). He asked me for some exercises and I told him until the ROM had been improved and pain gone that I wasn't going to give him exercises. He gave out to me for not doing my job!! I was right in my eyes anyway. He came back to me 2 days ago and said he went to his doc as pain got worse. He referred to a physio and was told he had torn ligaments!

Has anybody ever fallen foul of this logic i.e. been suffering from pain only to be told to exercise the joint/muscle group only to have a recurrence of the original injury or made it worse?

So...discuss I guess!
Mark

Hanley

Don't try to add strength on top of dysfunction. Simples!!

I'm on your side for sure. Almost everyone I see has sh*tty thoracic mobility, poor scapula control and no hip mobility or glute activation.

The fixes are painfully simple and you look like such a stud for correcting them in a short space of time and eradicating a clients knee/hip/shin/shoulder pain. I don't know why more trainers aren't clued into it.

watermark

spot on Hanley. the problem lies with the courses offered to train the trainers. they teach you about strength and weakness in relation to muscular imbalances. the opposing muscles aren't weak as such, they are inhibited and therefore lack the neuromuscular input to function properly.

it just annoys me when young trainers (i was no different!) think that doing upper back strength work will correct rounded shoulders.

kennyb3

Just to throw a spanner in the works are you talking about specific injuries here?

Just as an aside i've a badly damaged hamstring tendon - and no amount of physical therapy was helping (i'm talking 30 sessions plus as i didnt know what it was until i got an mri ). Eccentric exercises (stretches and strengthening) and its improving. So to me strengthening does work in certain circumstances.

Perhaps when you use 'working' you are talking about properly trying to use the injurated area?

Always interested in these topics

watermark

spanner indeed!.......

an analogy i use with clients from time to time is if they have an injury or just unexplained muscular pain is to imagine hanging off a cliff face and the rope is frayed. now imagine if they were told the best way to fix the rope is to dangle more weight on it and hope it heals.

eccentric exercises are supposed to be great for increasing tendon density but if you are still injured it may over time weaken the tendon and cause a relapse.

restore ROM, ensure joint stability around the injured site and then you can worry about increasing strength.

when i say "working" i mean any form of movement of a dysfunctional joint will cause an inherent risk of injury.

Hanley

kennyb3 wrote: »

Just to throw a spanner in the works are you talking about specific injuries here?

Just as an aside i've a badly damaged hamstring tendon - and no amount of physical therapy was helping (i'm talking 30 sessions plus as i didnt know what it was until i got an mri ). Eccentric exercises (stretches and strengthening) and its improving. So to me strengthening does work in certain circumstances.

Perhaps when you use 'working' you are talking about properly trying to use the injurated area?

Always interested in these topics

I'll chime in and say tho I'd never go near this from a professional point of view as it's not my area of expertise, it's a complete "horses for courses" scenario.

What ever you Physical Therapist was doing obviously wasn't working. It's no different to a personal trainer trying to smash an upper back issue with strength work as discussed already.

The eccentric loading for tendon recovery thing is fairly well documented as being successful, as is cross friction massage and the likes. The issue isn't always trying to lay strength on things, it's trying to "strengthen" at inappropriate points in time.

...and it goes without saying that identifying the underlying cause of the injury and fixing that once you've recovered is crucial.

Thud

When I tore my cruciate ligament i had two Dr's in a Dublin hospital tell me it was a bruised Medial ligament.
They set me up to see the physio in the hospital for several weeks, physio gave me lots of exercises to do and then tested me and signed me off as fit to play football again. The first turn I made my knee popped out again.

Needless to say i found another Dr and physio after that.

watermark

Thud wrote: »

When I tore my cruciate ligament i had two Dr's in a Dublin hospital tell me it was a bruised Medial ligament.
They set me up to see the physio in the hospital for several weeks, physio gave me lots of exercises to do and then tested me and signed me off as fit to play football again. The first turn I made my knee popped out again.

Needless to say i found another Dr and physio after that.

Personally I would NEVER take a doctors diagnosis on an issue relating to injury as they just don't have the expertise to deal with it. Many people I know (family, friends etc.) have suffered from chronic pain for years and have just been medicated for it with anti-inflammatory meds.

When this doesn't work - scans and x-rays. When they show next to nothing - exploratory surgery. When this doesn't work - then people start to turn to alternatives.

The worst I have seen lately is a chap I know who tore his ACL being given the leg extension machine to "strengthen it up! this machine puts direct pressure on the ACL and has no functional basis for if/when he returns to sport (i.e. twisting and turning)

Would love to hear any more stories of doctors mis-diagnosing injuries. Is that weird? :rolleyes:

Thud, did you ever question the doctors/physios or formally complain regarding their "diagnosis"??

Doug Cartel

After I had a clavicle plate put in, my shoulder mobility was at almost zero. When I did my rehab, I only regained partial mobility before I was put doing what I would consider "strengthening" exercises. I was also in still in quite a bit of pain at the time.

Anyway I kept plugging away at it and it's all better now. God knows how long I'd have been if I'd waited to be pain free with good ROM before starting to push weights. I don't even know if I'd have gotten the ROM back, because it wasn't until I started trying to do things that were difficult that I got past my sticking points.

kennyb3

My own injury was misdiagnosed (multiple times). I basically had pain at the fibula head, pain with resistive flexion and a tight biceps femoris.

I attended a couple of therapists who treated it as a biceps femoris strain, did work on this and the popliteal. All the time they were advising to do light cycles etc but it was getting tight after each one.

Anyway after xmas (about 4 months after the initial injury) i went and got an mri. This showed nothing (misred). I then went to the laser clinic and they finally diagnosed damage to the tendon. Got treated twice but never really explained exactly what it was. Tendon was much better (70%) but not right yet.

I then went to a consultant in the SSC and i was shown the very obvious 1cm longtitudinal split in my biceps femoris tendon. (not picked up by radiographer in place i got the MRI)

Its even more complicated than i've outlined above and i tried everything (osteopath, physical therapist, physio etc etc) but thats a rough outline.

Hanley

kennyb3 wrote: »

My own injury was misdiagnosed (multiple times). I basically had pain at the fibula head, pain with resistive flexion and a tight biceps femoris.

I attended a couple of therapists who treated it as a biceps femoris strain, did work on this and the popliteal. All the time they were advising to do light cycles etc but it was getting tight after each one.

Anyway after xmas (about 4 months after the initial injury) i went and got an mri. This showed nothing (misred). I then went to the laser clinic and they finally diagnosed damage to the tendon. Got treated twice but never really explained exactly what it was. Tendon was much better (70%) but not right yet.

I then went to a consultant in the SSC and i was shown the very obvious 1cm longtitudinal split in my biceps femoris tendon. (not picked up by radiographer in place i got the MRI)

Its even more complicated than i've outlined above and i tried everything (osteopath, physical therapist, physio etc etc) but thats a rough outline.

Jesus. That sucks hard.

Was it correct to reply on the radiographer tho? Should the consultant not be the one reviewing the MRI?

Thud

watermark wrote: »

Thud, did you ever question the doctors/physios or formally complain regarding their "diagnosis"??

no, but i didn't pay the ER fee out of protest.:rolleyes:
Probably should have formally complained though in hindsight.

Physios didn't spot it either though and they had me in for probably 6-8 weeks building it up.

Had another incident in the same hospital with a cracked bone in my ankle. two doctors looked at the x-ray and saw nothing, told me it was bruised, was hobbling across the car park when someone came running after me and called me back to say radiologist had arrived in to work and spotted a cracked bone.
Was told to come in the folowing day to get a cast, arrived in the following day to another doctor who couldn't see the crack and told me it was bruised. i told him to look again so ended up getting more x-rays and eventually he spotted the crack and put the cast on.

kennyb3

Hanley wrote: »

Jesus. That sucks hard.

Was it correct to reply on the radiographer tho? Should the consultant not be the one reviewing the MRI?

The consultant was from the SSC who reviewed the MRI disk i was given. The MRI was with euromedic and their radiographer picked up nothing. I even wrote to them asking for a review and they changed it to minor tendinopathy - i've wrote to them again asking for a refund and apology and expressed my disappointment.

TBH i found euromedic completely (in hindsight)

rebel girl 15

Thud wrote: »

Had another incident in the same hospital with a cracked bone in my ankle. two doctors looked at the x-ray and saw nothing, told me it was bruised, was hobbling across the car park when someone came running after me and called me back to say radiologist had arrived in to work and spotted a cracked bone.
Was told to come in the folowing day to get a cast, arrived in the following day to another doctor who couldn't see the crack and told me it was bruised. i told him to look again so ended up getting more x-rays and eventually he spotted the crack and put the cast on.

I had a similar experience when I broke my ankle this time last year, went to my GP the day after I fell which was a Wednesday, who said he reckoned it was broken or badly damaged because of the swelling, went up to the hospital, had the xray done, doctor there didn't even touch my foot, and told me I can a sprain, was leaving me out the door with no crutches even though I couldn't really put my foot under me. By the Saturday. I had bruising up my calf, and my toes were pulled upwards, I couldn't relax them, a lot of bruising and ankle still swollen.

Went back into my GP, main doctor in the clinic this time, who said I had definitely damaged tendons given the way my toes were and ligament damage with a big chance of a break, referring me to CUH to get the xrays reviewed and strapping my foot very securely, telling me to keep all weight off it. Four days later, was up in CUH, was seen and within three minutes doctor had found the crack on the xray and pinpointed it by touching my ankle in the exact spot.

deadlybuzzman

rebel girl 15 wrote: »

I had a similar experience when I broke my ankle this time last year, went to my GP the day after I fell which was a Wednesday, who said he reckoned it was broken or badly damaged because of the swelling, went up to the hospital, had the xray done, doctor there didn't even touch my foot, and told me I can a sprain, was leaving me out the door with no crutches even though I couldn't really put my foot under me. By the Saturday. I had bruising up my calf, and my toes were pulled upwards, I couldn't relax them, a lot of bruising and ankle still swollen.

Went back into my GP, main doctor in the clinic this time, who said I had definitely damaged tendons given the way my toes were and ligament damage with a big chance of a break, referring me to CUH to get the xrays reviewed and strapping my foot very securely, telling me to keep all weight off it. Four days later, was up in CUH, was seen and within three minutes doctor had found the crack on the xray and pinpointed it by touching my ankle in the exact spot.

after getting xrays on my ankle the doc pointed out where I broke it-I looked a bit closer and asked him isnt that metatarsal broken too? after the embarrassed/stunned silence he said yes.
BTW my qualifications go no further than an LC in biology

Inspector Coptoor

Just to say that radiographers only take the pictures in this country.
They are NOT allowed diagnose.
The final call is with a consultant radiologist who is a medical doctor.

deadlybuzzman

Inspector Coptoor wrote: »

Just to say that radiographers only take the pictures in this country.
They are NOT allowed diagnose.
The final call is with a consultant radiologist who is a medical doctor.

it wasnt a radiographer, it was the doc

Inspector Coptoor

deadlybuzzman wrote: »

Inspector Coptoor wrote: »

Just to say that radiographers only take the pictures in this country.
They are NOT allowed diagnose.
The final call is with a consultant radiologist who is a medical doctor.

it wasnt a radiographer, it was the doc

My comment was aimed at kennyb3 & was giving further credence to what Hanley had said.
The gripe can't be with the radiographer in this country.

Mellor

Inspector Coptoor wrote: »

]
My comment was aimed at kennyb3 & was giving further credence to what Hanley had said.
The gripe can't be with the radiographer in this country.

I think it's a case of people saying radiographer when they mean radiologist.

deadlybuzzman

Inspector Coptoor wrote: »

My comment was aimed at kennyb3 & was giving further credence to what Hanley had said.
The gripe can't be with the radiographer in this country.

sorry my bad! :rolleyes:

Thinking back as well, while I was waiting to get seen to I got talking to another guy with 2 busted up ankles-while standing on the top of a ladder it slid out from underneath him and landed hard on his feet.
When I went back to get my cast off he said that he was told 1 ankle was broken and was being put in a cast and that the other was just sprained and to walk on it with crutches.
Anyway after 2 weeks of the sprained ankle hurting more and more it turned out somewhere along the line wires had gotten crossed and they had put the sprained ankle in the cast and he had been trying to walk on the broken one