I Got PPS-ed Today at Physical Therapy

I’ll explain the title in a bit, but just to clarify, “PPS” (“The Patient, Physician, and Society”) is a class we take during the first two years of medical school.

"Tell me more about that..."

Anyways, I’m feeling a bit more resilient about my hip/back/IT band/whatever else today. Well, except for the fact that I am horrified that I’m probably going to get fat not running and eating Christmas candy.

I'm starting to embrace the pool, but not the smell of chlorine. PS - does this picture look photoshopped in to anyone else?

I went to physical therapy at Hospital for Special Surgery today. I know – chiropractor + PT?!? I thought I was over-doing it, too, with my “multidiscplinary approach” to my injury management. I wavered on not going (maybe I could look stuff up myself?), but, in the end, thought of my “plan” as follows.

I need the chiropractor for the “now.” Dr. Levine helps keep my pain at bay (by inducing more pain with Graston/ART?) and re-adjusts my ever moving SI joint, which, after adjustment, leads to almost immediate relief of all of my symptoms. Plus, he works me in last minute and such.

Why won't you stay in place? WHY?!?

However, seeing as I can’t get my SI joint adjusted and IT band manually dissected ever day, I need a physical therapist to help me develop the proper strength to keep everything from falling apart. The physical therapist is for the “later.” Although I can look up stuff myself, I do need expertise to make sure I’m not missing something plus authority to make me do the actual exercises.

Now and Later - like the chiropractor and physical therapist. No? Not a good analogy?

As suspected, I have horribly weak hip a-B-ductors, as evidenced by me not being able to keep my pelvis in a even plane when walking up and down stairs. In turn, during the stance phase of running, my hips don’t have the strength to counter balance internal rotation of the femur, causing excess strain on the IT band. Plus, my glutes don’t work well, or something like that. Sorry for the horrible explanations, this is all from memory.

I wish I had listened more about the importance of one's gluteus medius muscle in anatomy...

Further, she was able to explain to me why my medial most hamstring would be feeling as if it was pulled. Basically, when my SI joint gets all dysfunctional (moves inappropriately), my left hemi-pelvis tilts backward, causing excess pull on many muscles, including the one in which I feel pain.

Walking around the physical therapist’s office, I felt sort of, well, lame. There was a girl next to me with her ankle externally fixed and another working on neck control. I felt sort, I don’t know, like a whiner complaining over some pain that was keeping me from running.

External fixation of an ankle...

I mentioned to the PT that I felt sort of bad being there seeing as “my problems really weren’t that bad nor acute or severe.” She immediately legitimized my problem telling me, “No, this is bad! I’m a runner. I know this sucks horribly and you miss it.” This made me instantly feel better and I went off on my merry way to the pool, happy as a clam.

Speaking of clam shells, I've been doing this in hopes it will improve my glute medius. IT BETTER WORK.

It was then, after my pool sweat sesh, that I realized I had been PPS-ed. In PPS, they teach us this “PEARLS” mnemonic in an effort to remind us of how to build rapport with patients. You can achieve a good doctor-patient relationship by using your “PEARLS.”

You can buy me the "Breakfast at Tiffany's" peals, should you feel so inclined.

p = partnership

e = empathy

a = apology

r = respect

l = LEGITIMIZING

s = support

We used to make fun of “PEARLS” a bit. But, homeslice PT totally made me feel better by using “L,” legitimizing my physical pain and emotional pain of not running. Snaps to her.

I can’t believe I fell for the PEARLS. I guess they do work, after all.

Of course, I asked the PT when she thought I could run again. Instead of giving me a promised time frame, she told me that I have to be able to do 3 specific exercises with good form and control. The three exercises are specific to my problem and, if I’m able to do them correctly, I should have relearned the correct neuromuscular control in order to run.

I still can't believe I've become one of those "I need to run" people. My 22 year old self does not know who this person is.

For some reason, that made me satisfied. The whole “go by pain” thing hasn’t been working too well for me, as I think pain is too subjective. I have a hard time knowing if the pain I’m experiencing is legitimate or not enough to warrant a problem. I’m ok tolerating some pain, which isn’t going to help my injury.

I did ask her if she thought I’d be able to run by the New Year. She said I should be, but come to think of it, I didn’t specifically state 1/1/2012.

I also asked her if she though I had a torn labrum, stress fracture, or impingement syndrome. She said probably not, but if things are better in a month, we’d go to imaging.

Lord, I hope I can at least social run in a month!

I miss this. Sweet sorority squat, Megan and Ali.

Finally, before I go, if you think you’re tough, go watch this video. Here I was complaining about walking 3 miles, and Beth persevered through 20 miles of walking during her 100 mile race.

CHIME IN: What do you think of Beth’s video? (I ran in her pace group in my first marathon) Recognize yourself ever being PEARLS-ed by your doctor? Been to physical therapy and/or chiropractor an had success (you better say yes)? 

Until next time…

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14 thoughts on “I Got PPS-ed Today at Physical Therapy

  1. Hey, I stumbled onto your blog a few weeks ago and today seemed like a good day to chime in. I also happen to be battling an IT band problem, and I know how annoying it is that nothing appears “injured” but you still can’t do what you want. I also happen to be a PT student though, and (biased here) was really happy to see you sought out a PT to help you out as well. There are lots of jokes about chiros and PTs not getting along, but both disciplines have their place. I really like your outlook on utilizing both. Hope your running again by January!

  2. Your Now/Then Chiro/PT approach is exactly what I use when I work with athletes managing their injuries. Multifaceted approach is the best way to handle an injury and you are exactly right, a Chiropractor will definitely help in the “now” but if you have muscle imbalances that are causing the problem (which it sounds like you do…it also sounds like you have an awesome PT) then you either will need to continue to go to Chiro forever ($$$$$) or address the long term problem with PT. Great job! And, clamshells will help. seriously. Hope you’re on the road to social running (and fast running) again soon!

  3. Happy to hear you are getting a little TLC for that hip/SI from a PT. Glad she could lure you in with her “PEARLS”. I’m a bit biased seeing as I will be a PT myself in a few short months, but I think you will notice a lasting difference after you address some of the issues you mentioned above (i.e. weak hip abductors, gluts, etc) as you begin to incorporate proper muscle firing into your running form. I hope you are back to pain free, joyful running soon 🙂

  4. Ooh, ooh, what are the three exercises? #nerd

    How does the A in PEARLS work? Is it apologizing like “I’m sorry you’re hurt?”

    And wow, I hope I never have to have any part of my body externally fixed. OW.

  5. I had PT for my IT band, and it totally helped! So I think you made the right decision.

    And yes, I have been pearls-ed, but not nearly as often as one might hope. Seems like maybe a lot of doctors didn’t pay attention during those lectures….

  6. I think the now and then later approach makes a lot of sense for your injury and will hopefully prevent injuries/issues in the future.

    It seems like every doctor I’ve been to in this city has run the Boston Marathon or been a PT for a marathon team, so I think I get PEARLS-ed a lot.

  7. I have never been to physical therapy or a chiropractor or anything, primarily because I’ve only been running for a year and a half so I haven’t had that much time to get myself badly injured. Also because I’m a poor college student so even when I did get hurt last year I had to just suck it up and not run until I got better. (Two of the most awful months ever.)
    BUT I’m sure that your leg will heal up in due course, especially if you’re putting all this effort and brain power into it. I’m of the firm belief that if you concentrate hard enough on something you can make it happen. Just like Matilda!

  8. oh my goodness, i’m glad you are documenting and explaining all of this….i think i might need to refer back to it soon. i have been lucky these last few years and haven’t had had to do much in the way of strength exercises or PT, but i fear that i’m a ticking time bomb. eeeek.

    i hope the appointments works and that you feel better soon!

    also lolz to the sorority squat 🙂

  9. HOnestly, I think the whole PEARLS thing is so important. I can’t tell you how many doctors I’ve had that haven’t “PEARLSed” me and I haven’t trusted anything they said. If you can’t treat me like a person then you can’t treat me, you know?

    I MISS THE SWEAT SQUAD TOO! Soon, we will run soon. 🙂

  10. I do the PEARLS thing at work all the time as a trauma ICU nurse! Although I sometimes feel fake doing it, which kind of annoys me and makes me feel phony, but I try to be as genuine as possible. When you try to empathize with someone, it is the sort of thing where people can usually tell if you don’t really mean it.

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  12. I am experiencing the EXACT same thing as you, in regards to not being able to even walk up stairs without needing readjusted, and I am (feels more like was, now) a runner. Getting very distraught not being able to do my favorite stress-relieving activity!

    I have also been visiting both a chiro and PT. Just wondering what those three exercises are that you need to be able to do before running again?

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