Thursday, April 26, 2007

Physical Therapy II

I am prompted today to write about physical therapy after reading two powerful, different, and very upsetting links about simply unacceptable treatment (Warning -- potentially triggering?).

I have written about PT before, here, but the stuff I have read makes me want to be a little more open -- even though my experiences are nothing like as traumatic as theirs.

The first is trinityva's post, and the second is an interview with Norman Kunc. Both posts are pretty explicit about physical therapy as a kind of abuse, made worse by the fact that the perpetrators are set up as "helping figures." Both posts clearly link self-esteem and physical therapy, and both make connections between their experiences and the PTSD of people who have been sexually assaulted. Kunc is particularly interesting on this point.

I have had a lot of physical therapy in my life, and I can say that there is a big difference between going in with something fixable and going in as a disabled person. My first physical therapy was for a sprained ankle. I went in; the therapist assigned some exercises; I did them over the course of a couple of weeks; it was over. My second round of PT was for a yanked back. It was basically the same thing. A limited course: exercises, shock and rocks (ice and electricity), ultrasound, massage, more exercises.

Things are entirely different now. I remember when a PT gave up handling my post car accident whiplashed neck. Her excuse was that she couldn't tell what was whiplash and what was disability; she didn't want to be treating the disability. I didn't care. It was all still painful; she could have helped.

I jotted these notes down after a meeting with a new physical therapist over a year ago: (deep breath ... committing this to the Internet)

I think he is nice, highly qualified, understanding of the problems, and creative with solutions. I'm having a hard time with it. I respond to all conversation, but I close my eyes and lock him out. I'm too scared to make eye contact. Part of this taking myself away is a response to proximity and touch. This is BIG touch. Full on body weight to body weight touch. He's pushing my leg with all his weight. It is intense. I have my eyes shut, but he's observing all the time. All the time. I'm backing away from that contact. I have to commit to making his movements as much as I can, or at least I feel it as a commitment. I make the movement, but the physical response is not always perfect. I can't DO half this stuff; I feel bad about that. And then there's a physical sensation that is a response to the movement. It's not exactly pain, but it does feel weird. No, it's pain. I feel apprehensive going into this because of the weirdness of the physical response. It hurts and I feel separate from my body and myself and from what's going on. I feel scared. I can't do it.

Even now when I read those notes, I remember the fear and the pain.

I have had a PT who did not want to work with me at first. We talked about this, and eventually things were fine. BUT it was awful for the first couple of appointments. When she met me, she was worried about how much control I had and whether or not she was going to be able to "manage me" -- didn't ask what that meant. She was also explicit about how neurological work can be less than rewarding because people simply "don't get better."

And get my response? Did I say, "Well, stuff you then. I'm out of here." No. I did not. I wanted to be the "good client," the one who would "get better." I would show her.

When another PT had the bright idea of strapping me into a standing table before a room full of way-too-interested people, did I say no? No. I let him make a spectacle of me. I let him strap me in and watch.

When I first started doing work for my legs, my appointments were scheduled at the same time as "Richard's". I never knew what Richard's story was -- the PTs frequently teased him about having taken a dive off a long cliff into a short pool. Richard was, they informed me, a recent T-6; I didn't know what that meant. I just remember staring as they hauled the guy around (bad me -- sorry, Richard. Didn't know any better). During the months that we were there together, Richard never spoke unless he was in pain. He never acknowledged the mean joshing that went on around and above his head. He knew his failures were the entertainment for the day.

I have now been in that position.

As I wrote in my earlier post, my PT these days is mainly in a safe, private space. It's about relief, stretching, realigning, damage control, damage mitigation, performance enabling. I still hate it, but both my East and West Coast PTs and I have come to a semi mutual agreement about what to do. I am mostly safe. West Coast PT wraps anything she's not working on in blankets (of the leopard print variety ... grin). She's got a great office. The East Coast guy works in my home; I choose the music and I get to drink coffee. Neither of them forces anything. Neither of them asks more than I can do.

But I still FEEL unsafe.

I still feel like my body might do something weird and embarrassing. It might let me down. It has let me down; that's why I am there. I still feel like they may suddenly grab, twist, pull. Pain could start at any moment.

It feels bad to be lying on a table waiting for the PT to begin, knowing that his/her touch will set off a round of uncontrollable jerks/spasms.

It feels bad to be lying on a table jerking around (even when you can see the Empire State building from your window).

I still close my eyes -- turn my head -- so I don't have to see them.


  1. I'm so glad you wrote this. I've experienced PT as a place where expectations are set too low. I also avoid eye contact when working with PT's OT's etc since I experience my "limited contribution" toward goals as inadequate as a quadriplegic. My issue? Partially, sure. But I've benefitted more in terms of regaining function from playing wheelchair sports than any "help" I received that was charted or predefined and generally (in my opinion) limited what I could do more than necessary. My autonomy seems lost once I'm "charted". Bleck.

  2. thank you for this, WCD. the post and the linkage and the thinkfulness... all of it.

  3. Hey,
    I'm not an adult, so I don't know about adult PT so I won't pretend to empathise. But I've felt the same way - guilty for not being able to do stuff successfully, and obligated to try things just to get my parents to shut up. I guess I could've said no, but seeing as I am a minor, I can't refuse things my parents sign for.

    You can, though. It can take a lot of balls, but you can do it. And if you don't feel comfortable advocating for yourself just yet, you can contact an advocate at an independent living centre to work a plan out.

    You shouldn't be afraid. Physical therapy, or so they tell me, is about your goals and what you want. So, if you don't want to focus on that particular area, or start feeling pain and need to stop, say so. You owe nothing to them -- as professionals, they are required to keep you, the client's wishes in mind. If you verbally object or make a written statement and they persist, this is grounds for a report to their supervisor - i.e., potentially getting them fired. This is scary, but think of how you're helping yourself and how you're helping future clients.

    P.S. - I lurk your blog quite often and I like reading the adventures of a wheelchair dancer. So sue me for not commenting until now. You've got a great writing style and tone.

  4. Anonymous1:41 PM

    Unfortunately, I am a PT who happened to stumble upon your web-site. I say "unfortunately" because this is the first website I've visited where PT's seem to be blamed for the misfortunes of others. Wheelchair Dancers's analogy of victims of PT being akin to sufferers of sexual abuse is particularly offensive to me. Every therapist I've ever known, bar none, went into the profession to help others. They are conscientious, compassionate, and incredibly respectful of the the wishes of their patients. Causing pain is a negative by-product to some treatments, but pain is never the goal. To imply that PT's are only out there to hurt you and "abuse" you is a gross defamation to a profession that is built upon doing everything humanly possible to help others regain a higher degree of function for themselves. Your therapist isn't the cause of the underlying conditions you are all trying to overcome, but you seem perfectly content to blame them for the fact that your lives haven't turned around. It is unfortunate that you chose to strike out at the very people who try to help you. No one is ever forced to participate in therapy...if you don't want it, then say no. I would also avoid those aberrant therapists you've worked with in the past, they are the exceptions, not the rule for the profession.

  5. I am quite new in PT world, just gathering some knowledge, but I really amazed that opten I learned very interesting thing over internet. Just like yours.So many thanks for sharing.