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Tell me who can fix my body and teach me how to keep it balanced!
April 26, 2014 10:58 AM   Subscribe

I’ve been seeing physical therapists for pain in my shoulders and hips, but I’m looking for someone who really understands what is causing the pain from a whole-body perspective and can work with me to fix these specific problems and teach me how to keep my body healthy. Who is this person? What do they call themselves or the work that they do?

I am a late-30s female that has participated in various forms of intense exercise and physical labor throughout my life, though I now have a desk job. The shoulder pain is impingement that came on suddenly and has persisted for about 8 months (following some cross-fit exercises I was doing at home without the guidance of an experienced teacher). The hip pain also feels like impingement and has been present for at least 5 years, but has recently been exacerbated by martial arts training I started a few months ago.

I have seen two physical therapists; one just gave me exercises to strengthen and stabilize the muscles around my pelvis and scapular muscles, for the hip and shoulder pain, respectively. She thought the hip pain may be caused by femoroacetaular impingement. Subsequent x-rays have revealed “no significant bony abnormalities” (whatever that means).

I felt that there was probably more that could be done than just strengthen the muscles, so I switched to a new PT. PT #2 found the right side of my pelvis (the painful side) was tilted forward. She did not suspect femoroacetabular impingement (her reasoning seemed to be that it mainly occurs in older people, but that’s not what I’ve read, so I don’t know if I trust her judgment on this part). She has given me exercises to move it into the correct position, and once positioned better, we added some strengthening and stabilizing exercises. For the shoulder pain, she has done more manual work (trying to stretch out the shoulder capsule) and has given me stretching and strengthening exercises to do at home.

I started the PT about 5 months ago, and while the pain has been alleviated by the various exercises, it still persists and I’m unable to participate in all of the activities I once was. If the hip pain is indeed femoroacetabular impingment, I understand the pain may never go away completely. And I know PT just takes time. My issue is that I still don’t really understand what’s been causing the pain, or the best course of treatment. I don’t think any of the PTs I have seen really understand either. I am very tired of seeing “specialists” who have a very narrow view of what may be causing pain and what the best treatment is.

I want to understand the relationship between my physical history, current habits and activities, and how the muscles, bones, fascia, etc. work together to keep my body as pain-free as possible. I think that some combination of strength work, massage, maybe chiropractic work, and a thorough understanding of body mechanics is what I’m interested in. I don’t want someone that just makes me feel better while I’m there and immediately afterward (eg. a traditional chiropractor or massage therapist), but someone who can give me work to do at home to continue fixing my body in the shorter term as well as keep my body balanced throughout life so I can keep up an active lifestyle. Does this magical person exist, and what would they call themselves? How can I tell if they’re right for me? Is it worth seeing someone else in the medical field, such as an orthopedist or sports doctor? I’m disenchanted with medical professionals currently, as they don’t seem to see things holistically, and the insurance system doesn’t encourage this. Bonus points if you have any specific recommendations in the Portland OR metro area.
posted by feidr2 to Health & Fitness (19 answers total) 10 users marked this as a favorite
 
For the exercise portion, I can't recommend Pilates enough. I, too, have overly tight shoulders, and hip flexors (as a result of being hypermobile), and Pilates has helped tremendously. Here's a studio that also offers a rehabilitative area.
posted by gsh at 11:11 AM on April 26


I would indeed start with an orthopedic doctor. It is very important to get a proper diagnosis. If you start doing exercises or even stretches recommended by people who have no idea what is wrong with you, then you could actually make your injuries worse.
posted by Seymour Zamboni at 11:17 AM on April 26 [1 favorite]


I am a late-30s female that has participated in various forms of intense exercise and physical labor throughout my life, though I now have a desk job.

How long ago did you start the desk job? Did the pain start around then, or have you been working a desk job for much longer (hard to tell from your question)?

Standing desks are not for everyone and they need to be set up properly for your body just like any other workstation, but using one has been extremely beneficial for me (and my hips).

I tend to agree that an MD is unlikely to take the holistic approach that you are looking for, but if you have been having pain for the past eight months that prevents you from being active and enjoying your hobbies, I do think you should at least check in with a primary care doctor. It is possible that there could be something medically treatable underlying your frustrations.
posted by telegraph at 11:18 AM on April 26


This might not be all that helpful, but in your shoes I would find the person you're looking for using word of mouth from (serious/professional/competition) dancers your age. The person might even be a PT with a ballet or pro dance background themselves. (To me, there seems to be a fairly deep firsthand understanding in high-level dancers of how one thing here can throw out that thing there, cascading into this problem here. The nature of the livelyhood means that getting to the root cause and getting things working optimally again is of utmost importance, and people in the community know who to go to.)

That said, if (as telegraph wonders) poor ergonomics at work are the cause, then someone whose expertise is in ergonomics might be the better choice.
posted by anonymisc at 11:25 AM on April 26 [3 favorites]


Have you considered working with someone who specializes in Alexander Technique? Or Feldenkrais?

I haven't used these techniques myself, but I've discussed them with my physical therapist - they are gamechangers for many with the issues you describe.
posted by ferkit at 11:28 AM on April 26 [1 favorite]


I came here to say Alexander Technique as well.
posted by Lyn Never at 11:33 AM on April 26


I'd suggest an osteopath - their work is based on a whole body approach and the fact that if one part if you is injured or in some way out of whack, the rest of your body will shift to accommodate, often creating more problems. I've had a variety of joint/back/neck issues since I was a kid and I've seen significant, lasting (so far) improvements since going to one.
posted by scrute at 11:38 AM on April 26 [3 favorites]


There are definitely more holistic PTs and doctors, but they can be hard to find. I work (as a coworker) with a more whole body, intuitive PT. I also think an OT could help you. But you know, do your research so you find someone who has a whole body approach.
posted by Aranquis at 11:41 AM on April 26


yeah, this is an osteopath. (i am an osteopath). we work on muscles, bones, blood and interstitial fluid, fascia, organs, and the craniosacral link. the goal is to figure out what is causing the imbalance and fix THAT thing (instead of seeing a chiro, physio, massage therapist, rolfer, etc for each individual problem).

trouble is, there aren't many trained osteopaths in the US (there are Osteopathic Doctors, who are physicians, but very few osteopathic manual therapists). Don't know where you are, but if you're in Canada or the UK you can totally find one. message me if you want more info.
posted by andreapandrea at 11:47 AM on April 26 [3 favorites]


A very well trained Pilates trainer who really cares about anatomy can do this. If you are in Seattle, I can point you to someone.
posted by matildaben at 11:59 AM on April 26


Sorry, I missed that you are in PDX. Memail me if you want me to ask my trainer if she knows anyone there.
posted by matildaben at 12:01 PM on April 26


I myself have a pelvis that is out of balance due to a hip injury (mine is of known origin as I recently had a fracture of the acetabulum). I will share with you my experiences on the hip and recovering from hip injury.

On anatomy: I found the book Key muscles of yoga to be invaluable as it has excellent illustrations of hip and shoulder joints, shows related muscle insertions and how they work together, and discusses some of the ligaments. It talks about open chain and closed chain movements, how muscles work together, etc. It is great for even the non-yoga practitioner. That book and other reading on human anatomy will help you understand when professionals are bullshitting you. You will want to understand not just the musculoskeletal system but also the immune system and inflammatory response to injury. Nutrition advice also helps.

On imaging: next step if the x-ray is not showing anything for the bones for the hip (impingement can happen if there is not enough clearance in the pelvis for leg bones to move freely) would be a MRI to look for labral tear in the hip. Have you had an MRI? If there is any suspicion of dysfunction in the sacroiliac, a CT scan would help as it would also catch changes in the lumbar spine. However, I was informed that if you have some soft tissue injury related to the fascia in the hip area you may never get a definitive root cause by any sort of imaging, so you might not rush to imaging straight away unless there is a clear indication. If you plan on childbirth later you will want to avoid unnecessary irradiation of your pelvis.

On FAI: FAI and the closely related labral tear are injuries that can occur in runners as well as older people. A competent physiotherapist should be able to rule out severe injuries of that nature by winging your leg around at all sorts of strange angles and asking where it hurts. There is a distinct protocol for testing this and if they are simply measuring your pelvis from a standing position they are not getting the full picture. For what it's worth I had to go to two different professionals to get the leg winging and measuring procedures done.

On corrective strength: there's a lot of related muscles for strength training. I had been assigned and was doing all of the typical strengthening programs in the area, including but not limited to:
- gluteus medius program (clamshell, bridge, etc) on affected side
- core abdominal program (including work for transverse abdominus, multifidus, kegels for pelvic floor)
- various strength exercises on affected side for hamstring, abductor, quad, mild adductor
Those strengthening exercises were assigned by physio. As pain moved around I was even given exercises for upper abdominals and received manual work on the intra-costal muscles and lats in physio, as tightness in this area was causing some of the low back and hip pain.

On functional strength: I was cleared to progress to a functional strength program (squat, lunge, balance work, push/pull, etc). At that point I started active rehab from kinesiologist. My exercise program included functional strength along with corrective strength and mobilization. At a certain point a regular functional strength program was not helping as I was further strengthening my strong side along with the weak side. I had to give some functional work a rest after a while.

On flunking functional strength and finding balance: My kinesiologist diagnosed the imbalance after working with me on the functional strength program and finding that I was not progressing and pain persisted. I was given a mobilization program around the affected areas including foam rolling and stretching. Foam rolling is on glutes, hamstring, calves, IT band, quads, tensor fascia latae. I am to focus on quads, IT band, TFL on the affected side, with stretch on psoas. Hamstring and glute is on the unaffected side with the theory that stretching the tight muscles on affected side will allow the weakened muscles on the back side to strengthen more effectively. This paper describes the theory. My kinesiologist will refer me to the osteopath if the stretching program does not improve.

On massage: I do also have a massage therapist and this is very helpful since work in the glute area, IT band, quadricep, calves etc is time consuming work. I have found lasting effects. You do have to go on a regular basis for the work to be more effective longer term, a one-off isn't super useful.

On self management: Foam rolling and the tennis ball for self-release is also an effective maintenance technique. Getting instruction on this is very helpful. You can also supplement with treatment at home with combinations of heat and ice. I have received instruction on these from a combination of physio, kinesiology, massage therapist.

On ergonomics: Understanding ergonomics and taking a log of which activities hurt more than others can help you manage your own symptoms as you go. Driving was causing me problems, I had to support my spine with pillow and have a more upright position. Seated positions with hips below knees are a problem. Solution is to raise chair (or use sit disk periodically to change height), take standing breaks. I also work from home on bad days to allow full extension of leg forward and use of lying position to relieve pressure. Bending to do things such as empty dishwasher, etc is troublesome - this is relieved by focusing on form in up and down (both with squat motion in legs, focus on hinging at hip, rising with flat back). I was having pain with walking and received much feedback on things to focus on (full leg extension, loading weight onto straight leg, engaging upper abdominals) which resolved that issue. By paying close attention and complaining noisily about every little thing you can help resolve issues one at a time.

On your shoulder: I have not even got into your shoulder program or ergonomics. I had shoulder pain as well as a result of my accident. I am surprised that you have not mentioned rest (keeping arm below shoulder height on affected side) or work on your neck, pectorals, lats. My physios wouldn't take shoulder pain seriously as my hip problem was more pressing. My massage therapist worked out shoulder, kinesiologist had ongoing exercise, better overall full body ergonomics resolved the shoulder in a couple of months. It was frustrating for me not to have the shoulder treated more aggressively as it was extremely painful but it was something that I could manage myself with a bit of research and work.

Summary: Team of professionals will eventually get you results and start taking your pain seriously - I have doctor, physio, kinesiologist, massage and possibly will acquire osteopath. Having multiple is great as I can cross-check opinions. Feel free to dump ineffective people quickly and try again. Recovery is time consuming and expensive. There is some trial and error, forward and backward progress involved. However if you are committed to recovery and find some professionals that will listen and work with you, I believe you will get better. Focus on the hip, that's the hardest to fix. Good luck
posted by crazycanuck at 1:39 PM on April 26 [6 favorites]


This is woowoo of course but I just quit physical therapy after a broken ankle (was excellent in the beginning, then I felt like it's usefulness had run its course). I'm now back to Bikram yoga, and some of the "science" they say in class may not...be medically accurate...but it definitely makes you feel about a million times better after each and every class. Something to put on the list of things to try if you feel up to it...
posted by bquarters at 3:46 PM on April 26


I have long-term chronic pain and blah-blah-blah. There's one person who helps me make it through. She initially trained as a PT, then retrained as an OT, and has completed CST training as well. Most importantly, she has personal experience with broken bones, arthritis, RSI. She can identify problems, suggest alterations to posture, exercise, and provide pain relief all in one session. Ahhh.

She limits her practice to people with disabilities. If you connect with some of the diagnosis-specific support groups in your area — United Cerebral Palsy, MS Society, Arthritis Foundation — there's a good chance you'll be able to find someone like her.
posted by Jesse the K at 5:33 PM on April 26


Nthing osteopath. They can do chiropractic adjustments but don't push the same sort of pseudoscientific woo that chiropractors tend to believe in. Osteopaths also have an advantage over chiropractors in that they can write prescriptions if you need muscle relaxers etc. to complement the adjustments, physical therapy, massage therapy, etc.

Look for a doctor with DO after his/her name instead of MD.
posted by Jacqueline at 8:30 PM on April 26


Thank you all for your suggestions! I can see I have more research to do, but these ideas I think will put me on the right track. (I've marked them all as the best, since I don't know which is best yet for me!)

Regarding some of your questions-
I started my desk job a little over a year ago, and I don't think sitting made the hip issues worse, though I have been looking into a standing desk because sitting all day is energy-draining. PT improved the hip pain to an almost unnoticeable level. It was the twisting and kicking in the martial arts class that really aggravated the hip again.

After the hip flared up in February, I did go back to my primary care provider, with the intention of getting a referral to an orthopedic doctor, as well as an x-ray to see if I really have FAI, like the PT had indicated. The PCP basically told me I "just shouldn't do things that hurt" and that any specialist will tell me the same thing. In my experience with other injuries, stopping the thing that is causing the pain is not always the best answer, there are ways to modify what you're doing that can reduce or eliminate the pain while still staying active (of course I couldn't think of this response at the time!) But maybe I should see another physician, just not her.

I am very interested in learning more about osteopaths, and have heard good things about pilates. I think once I have the hip and shoulder pain under control I may try pilates. Funny, I was exposed briefly to Alexander Technique in high school, as a musician, but my primary memory was that all of the movements seemed to be like ways that old people would move, so I lost interest. But now days I feel more and more like an old person, so maybe it's perfect!
posted by feidr2 at 8:36 PM on April 26


Doesn't sound like the PTs have been very good. Todd Cruz at Therapeutic Associates in the Montgomery Park building on NW Vaughn is a brilliant experienced guy, excellent at refining a program for better results and at explaining what's happening and how your body motions affect it.
posted by olecranon at 10:16 PM on April 26


I know it's not the same thing, but I've found that flaxseed oil (which is high in omega-3 fatty acids) is good at reducing inflammation in my gums. You might give it a try to see if it works on your pain.
posted by alex1965 at 12:34 PM on April 27


I've had personal experience with this Feldenkrais practitioner and it was very helpful: http://www.feldenkraisportland.com/free-assessment/
posted by olecranon at 9:13 PM on April 27


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