How to find a good physical therapist, Part 1: Persistence

One of the questions I get asked the most is “How do I find a physical therapist who can treat the SI joint?”

Unfortunately, the answer to this question is almost as complicated as my answers to any of the more scientific questions people ask me.

I thought I’d break everything I’ve learned about this into bite-sized pieces.  So, the first topic is persistence:

I have seen a total of eight physical therapists for the SI joint.

The PT I write about the most, Paula, is actually the fifth one I saw in this chain of events, and she’s really the one that gave me the most breakthroughs in knowledge.

However, there were several failures before her:

1. Kristen, the PT who actually helped me with the knee problem I had at the same time, but managed to make my SI joints dramatically worse.

2. Jessica, who I saw twice before being sent back to a doctor to make sure I didn’t have a labral tear in my hip.  (Looking back, I think she was probably right to do this, but I felt as though I was being sent on a wild goose chase at the time because she didn’t do a very good job of explaining).

3. Heidi, who I was really interested in seeing, because her online bio said she was certified in the Muscle Energy Technique.  However, she didn’t seem to be very good at it.  I would go directly to PT from the chiropractor, when I knew my SI joints were in alignment. and still she would find things to “fix.”  Looking back, she wasn’t actually using the same specific techniques Paula would later teach me.  I have no idea what she thought she was correcting (which is why I’ve tried to give such detailed instructions on my blog).

Heidi also insisted I try wearing a 1/4″ heel lift in one of my shoes, because my right leg technically is shorter than the other.  (This is actually a whole separate topic in and of itself, on a “functional” versus a “true” leg length discrepancy).  For now, I will just say that one of my legs has always been 1/4″ shorter than the other, and it had never caused problems before my injury.  In fact, I found the lift to be really uncomfortable and made me feel more off-kilter, so I stopped using it (and did eventually get better without it).

I stopped going to Heidi after my third visit when we more or less got into an argument.  She told me pool exercise wouldn’t be adequate and there were certain exercises I would have to be able to do on land, or I might never get better.  I knew for a fact that performing certain exercises and motions on land were guaranteed to make my SI joints lock up and send me straight back to the chiropractor.  The fact that she failed to take me seriously at all was a deal-breaker.  (And all these years later, I stand by my decision.  It’s not enough to be strengthening your muscles if you’re also re-spraining your ligaments at the same time).

4.  Amy was really nice, but only seemed to have a passing knowledge of the SI joint based on things she’d picked up in various continuing education classes.  She didn’t seem to be very confident in what she knew, or able to go very much in-depth.  She offered me an SI belt to try in the office, but seemed doubtful as to why it helped some patients and not others.

Looking back, I think Amy sort of tried to teach me the same form of Muscle Energy Technique that Paula would later teach me.  But again, the problem is she wasn’t terribly comfortable with it herself– she had learned about it once, very briefly, and it seemed like she wasn’t sure it was really working when she did it.  I now know that more knowledgeable PT’s have ways of examining the positioning of the SI joints themselves to know if the adjustment worked.

5. Paula, who I saw for an evaluation in the office, she said I’d be better off doing aquatic therapy.  She was certified in it, but didn’t currently offer it.  She referred me to a coworker, but the coworker didn’t really seem knowledgeable about the SI joint, so I kept looking.

6. Paula’s coworker.  I don’t even remember her name now.

7. Walter, who knew some of the hands-on techniques and strategies for diagnosis that I’d only read about.  There are tests called “provocative maneuvers” in which a doctor or PT purposely puts the patient’s hips into positions that will cause pain, if they have SI joint dysfunction.  The idea is that if the test creates pain in a specific place, then the patient has SI joint dysfunction.

The problem is, however, that although these tests are designed to simply diagnose SI joint dysfunction, for me they actually caused a setback.  I walked in to Walter’s office normally and I limped out, because one of my SI joints had gotten really stuck.  I had to go straight to my chiropractor’s office, and never went back  again.

To be fair, it might not have been the tests themselves– it could also have had something to do with who was doing them.   That was part of my issue– that Walter hadn’t seemed to listen to me as I tried to insist that each thing he wanted to try seemed like a bad idea.  “We need to do this to be sure we have the right diagnosis!” he said, and I know that’s what he genuinely thought.  But I would have preferred a less certain diagnosis, and not to have re-sprained my ligaments again.

8. Back to Paula (#5).

Wait, what?

Yes, my same physical therapist Paula, technically the fifth PT I saw.

I just had a really good feeling about her.  Even based on my one evaluation visit with her, I’d gotten the sense that she was a lot more familiar with the SI joints than anyone else.  She’d taken out a model pelvis (like the one I have now!) and given me a whole explanation about how the pelvis is kind of shaped like a bowl, and all of the structures in it are interconnected (including the pubic symphysis).

No one else had been able to give me that thorough an explanation.  Technically, Walter seemed to know a lot as well, but he seemed to place more emphasis on jerking my joints around than actually explaining things.

So, after my disastrous appointment with him, I made an appointment with Paula again, and went back and essentially begged her to take me on as a patient.  I explained that I’d actually started doing aquatic exercise on my own, and that I was familiar with the basic principles (based on things I’d learned while rehabbing previous injuries).

Because I sort of already knew what I was doing, Paula agreed to make an exception for me, and “treat” me in the office.  However, what we ended up doing was mostly going over my pool exercises intellectually, coming up with a routine that worked for me.  Then I’d go and do it on my own in my gym pool.

Paula was, of course, the person who helped me the most out of anyone.  This was, of course, based on her knowledge and experience, and also the fact that she was able to think flexibly.

Whereas previous PT’s (Heidi, ahem) had tried to insist that there was only one way to strengthen certain muscles, Paula had the opposite mindset.  From her, I learned that there were always multiple options to strengthen something, especially in the water.

The same was true for stretching.  Previous PT’s had given me some pretty tough stretches to do which tended to make my SI joints lock up.  Paula, on the other hand, saw that actually, many of my muscles were already so tight that it wasn’t necessary for me to get my body into very pronounced positions to stretch.  I was actually able to get a stretch in some relatively neutral positions.

In a nutshell, Paula taught me to see exercises and stretches as things that had to be right for me, not the other way around.   If a certain exercise, didn’t work for me, it didn’t mean that there was something wrong with me and I had to force myself to do it.  Instead, we modified it.  It was all about baby steps.  Even just contracting a muscle, without really moving it, still counted as strengthening if you were really weak.

So, the lesson here is don’t be afraid to do what you need to do.

There were multiple points in my journey where I got so frustrated, and couldn’t believe how hard it was to find help, that I stopped looking.

It was almost as if the problem was too crazy and too difficult, it was scary to actually admit it was real.  On some level, it was easier to sort of try to block it out and pretend it wasn’t happening.

This is why, after each failure, I’d pause, and sometimes go six months or a year without looking again.

But you can’t think that way.  You can’t take the failure of doctors, PT’s, or others to help you as a reflection you.  The SI joint is such a complicated joint, and we are still just beginning to learn about it.

Awareness is growing— I found that even as I was doing my shadowing for PT school.   Maybe you won’t have to go through eight people to find someone helpful.

But if you do, you do.  That’s what it took for me, and even though I felt crazy, it certainly paid off in the end.

So don’t judge yourself, don’t hold back.  Think pragmatically, come up with a plan, and put it in action.

Click here to go on to Part 2!

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