When Physical Therapy Isn't

In 2006 I had my knee severely injured during combatives training.  I'll spare you the details, but the anterior cruciate ligament was completely torn, both menisci were torn, and the end of my femur was chipped.  I underwent surgery less than a week after the injury, which included complete reconstruction of the ACL using cadaver tissue (double bundle method), repair of both menisci, and a graft to my femur.  The injury itself and the recovery process rate right up there with the most difficult things that I have ever had to face.  The specter of never again being able to do all of the high speed, low drag things that had always been a part of my life loomed large in front of me.  For someone who prizes himself as a man-of-action, this was a terrifying prospect.

I was fortunate enough to have an extraordinary orthopedic surgeon, as well as a group of athletics oriented physical therapists who guided me through months and months of hard work.  And when I say hard work, I mean painfully hard work.  The muscles of my leg had atrophied.  Gaining full range of motion was excruciatingly slow (emphasis on excruciating), and any attempt to do more than a fast walk felt like someone driving a spike into the end of my femur.  My full rehabilitation lasted for over a year, but I'm a stubborn sonvabitch.  In the end, I re-gained most of my strength, range of motion, and ability to run.  It should be noted that even before the injury, I was in no way, shape, or form a "runner".  I struggled with running in any context and only did what was absolutely necessary to prepare for, and survive, PT tests for my career.  Never-the-less, my evolution as a distance runner would never have been possible without the skill and guidance of the doctor and the physical therapy crew.

After the One Man Running Marathon on January 6th of this year, I was immediately stricken by what some refer to as the "marathon blues"; the desire to run (any distance) was just gone.  I took just over 7 weeks off from any serious running, during which time I may have ran 10 times - the longest of which was 4 miles.  At the end of February I realized that I needed to jump back into training mode if I were going to make the Spring Triple Crown Races or have any chance of finishing the Kentucky Derby Marathon.  So, like the bone-headed tough guy that I am, I went out for a nice 13.1 mile run.  The shock to my body was not pleasant and my joints, especially my knee took a beating.  During that run I had also rolled my ankle - that didn't seem serious at the time - but translated into knee pain later.  The pain has lasted ever since.

Fearing that I had re-injured the soft tissues of my knee, I went back to see the same surgeon who had put me back together originally.  He assured me, much to my relief, that it was simply an over-use inflammation of the joint (did I mention I hadn't stopped training during this time?) and that it was most likely the result of stress brought on by a slight limit in the range of motion of my ankle.  He prescribed me Pennsaid to rub into the joint and sent me for physical therapy with a group that was different from the ones that I had last visited 5 years ago.

The visit with the new PT started out well enough.  The office was crowded and very busy, but I was encouraged early on by seeing one of the PTs that I had worked with five years ago at this new location.  We shook hands, embraced, and after a quick catch up he remarked how far I had come in the last five years (I'm telling you, it wasn't pretty).  The PT that I was to meet with that day was a runner and after some investigative questioning he spent a decent amount of time evaluating me; everything from the strength of my extremities, to my walking gate, my posture, my balance, etc.  The final conclusion was Patellofemoral Stress Syndrome as a result of weak hip muscles.  Not surprisingly on the same side as the knee on which I had surgery.  He recommended a series of stretches and strengthening exercises and took me out to the floor to begin with the promise that he would straighten me out so that I would have a good marathon day at the KDF.

After a 10 minute warm-up on the stationary bike, I was led through four stretches for the hamstrings and glutes.  Nothing too strenuous.  The exercises for increasing the strength in my hips, however, demonstrated just how weak they actually were.  I used both machines and a Thera-Band to really punish my hips and glutes.  While the exercises were explained to me with a brief demonstration, once I began working the technique the PT was off to manage another client.  Only when I was finished with the prescribed number of sets and reps would the PT return, only to quickly demonstrate another exercise and then be off again.  Now, I'm absolutely not someone who needs a baby-sitter, and I've spent more time inside gyms than some of the younger PTs there have been alive.  But I felt like that my health insurance was paying a healthy price for what essentially amounted to personal training.  Any good personal trainer would stick with their client to make sure that each set and each rep is done in a manner that doesn't promote injury due to fatigue, bad form, etc.  The same obviously doesn't apply to the physical therapist - patient relationship.  It also wasn't the same quality of care/personal attention that I had received all those years before.

The real kicker came when I was informed that I needed to strengthen my core.  Placed in a plank position, my feet were hoisted into bands so that my body was semi suspended.  I then did hip raises, which amounted to the equivalent of of an inverted v-up.  I like to think that I have decent core strength, but this was something new and I could really feel the strain in my lower abdomen.  Once multiple sets of these were complete, I was then told to hold the plank position and rotate my midsection from side to side for multiple reps and sets.  When all was said and done I had the same soreness that you might experience from muscle fatigue after a good gym workout.  I was told to use the stretches I had been shown daily and to come back two days later.  The PT wanted to see me two days a week prior to marathon day.  This is where the doubt started to set in.  Something was buzzing in the back of my head and I was uncomfortable, but I couldn't quite put my finger on it.

As it turns out, I strained my lower abdominal muscles.  To an extent that they were tender to the touch for days afterwards.  This has impacted my running over the course of the last week as well.  This wasn't residual soreness - this was a strain.  Obviously my own fault since I really am stubborn, still think I'm 25, and push myself 100% in everything.  I just over-did it.  But there was also an absence of the PT to monitor me as I went through each exercise.  With the marathon looming less than two weeks in the distance, this was no time for an injury.  What's more, this didn't feel like physical therapy.  This felt like a poorly managed personal training session.  One that I'm paying for now in more ways than one.  So I have elected to not return.  I received the diagnosis I needed.  I understand what needs to be done to correct the problem, and I don't need to bill my insurer for what I can do at home or in my own gym (as the PT was kind enough to provide me with a Thera-Band before I left the office.  God knows what that cost!).

My view of physical therapy was shaped by the attention and results that I achieved those years ago when I went through hell with my knee.  It was a rehabilitating, strengthening, and healing process that entailed personal attention and an obvious interest in my progress.  My recent experience ended up feeling impersonal and almost assembly line like; with the end result of me being less stable (or well) than before I went in.  What is even more disturbing is the number of young physical therapists who are employed there (their PT certificates on the wall less than a year or two old) who appeared to be regarding their jobs with the manner of a juice-gym desk attendant whose interest in how they look is somehow an equitable part of the equation.  The more experienced guys, like the PT I met with this day and the one with whom I had worked those years ago, simply seemed pulled in a hundred different directions.  The "therapeutic" piece seems to have been lost somewhere in the mix.

So for my trouble at least I am now armed with the information I need regarding what is causing my knee pain, and I also have a direction in which to go to resolve it.  I'll also be quickly rehabbing my strained abs prior to marathon day.  And I'll be doing it on my own.  Because in the end, it all comes down to just me anyway - one man...running.