Evaluating physical therapy provider

[jwtoto]

Hi,

I've done just a bit of PT so far: some in the hospital (hss requires that you learn to use crutches before check out), and then once in the hotel in NY. I just have the 5 basic bed exercises they give you. Dr. Su and Blaire (his PA) recommended some basic stretches (lean forward between legs in a low chair, get leg up on bed seated sideways, standing hip flexor stretch, quad stretch and and hamstring stretch). I have a prescription to start PT at week 6 (now beginning week 3).

My question: I believe in the benefits of PT, however, I have experienced some charlatans in this field as well. More often, I find that therapists think of themselves almost as independent caregivers above consulting with doctors regarding best practice for each case and not as assistants of the surgeon who get their specific orders from him or her. I don't know if this is universal among therapists or just an ego fixation with some of the ones I've run into. At worst, a therapist who begins to manipulate you and prescribe a regimen of movements and exercises that you just accept without any question because he is acting like a doctor can possibly injure you or at least impede your healing.  What, then, would the members of this forum suggest as a way to insure that therapists are acting as assistants of the surgeon doing only what the surgeon recommends for the individual case?

I have contacted a physical therapist in my area, told him that I have a prescription from my surgeon that I will bring to him in 4 weeks, and asked him to contact my surgeon's office for instructions. Do you think that it is reasonable to expect that the therapist actually contact the surgeon and obtain a specific plan of treatment for me from the doctor? I don't think I will feel comfortable unless this has been done before I begin attending appointments of PT with this guy. The PT group I am thinking about is very good and I have used them before for other needs. This particular recovery, however, is very delicate and follows major surgery and can be loused up badly unless care is taken. I think this may be why Dr. Su specified starting PT after 6 weeks.

Any thoughts on this topic would be appreciated.

                                           Thanks,

                                           Jerry RBHR Dr. Su 4/15/10

[resurface]

Hi.  I am set to have my hip done this Thursday.  I can tell you that my surgeon has PT already scheduled for the first 2 weeks at my home.  I interviewed two PTs.  Both indicated that they had a experience with THRs and resurfaced hips.  The one I selected has been in the same location for 10 years and have provided some services to the Boston Celtics.  For me, two factors were key: (1) past experience of the PT and (2) hands on therapy.  Specifically, they manually support range of motion.  The other mainly has you do it yourself.  I went for hands on. 

It is entirely reasonable that they speak to your surgeon.   As an aside, I did take the advise of a few others and ordered a hip icing maching from Game Ready.  Something to look into if you have not heard of it.

Odd that there are so many variations with rehab.  I am oing to post my plan once I get onto it.  My intention is to stay with a PT a few days a week for a minimum of 6 months.

One question... may I ask where the entry point was?  I am having a direct anterior and cannot find many who have done the same.

Good luck... Resurface

[stevel]

Jerry,

Check if the physical therapist(s) is registered with APTA (American Physical Therapy Association).  My insurance required a treatment plan, which needs to be coordinated with the physician.
Try to find a physical therapist that has worked with hip resurfacing patients.  I had two physical therapists at different businesses, since the first physical therapist went on vacation for 3 weeks.  One was APTA registered and the other wasn't, but they were both excellent.  The physical therapist(s) would send progress notes to Dr. Su to extend 6 week prescriptions so I could improve on range-of-motion and muscle strength.  I had physical therapy up to 6 month post-op, when all restrictions were lifted.

[jwtoto]

Good advice, Steve. I'll check into that certification. That sound's like a good credential. According to the therapist (the one I will probably use) he has worked with three other resurfacings (at least one done by Dr. Amstutz).

And as far as Resurface's question goes, my incision is centered directly over the posterior greater trochanter and runs along the side of my butt cheek. I don't sit on it but it is close to the chair when I do (made it a real pain in the &*! when I was sitting on the rim of the nation the first few times. Now I can use the regular height toilet seat but I am still striking a rakish angle to get the job done. The anterior side is the front side so I guess your's will be around near the lap crease (these terms are confusing for us mere mortals). Let us know and good luck.

                                 Jerry RBHR Dr. Su 4/15/10

[sheptr]

Jerry,
I see Dr. Su did your hip, if you live in NYC or near enough, I would highly recommend Star PT in NYC.
212-355-STAR (7827)East 56th St.  I am seeing Stash Rutkowski there and know that a lot of the PTs there have hip resurfacing experience. 

Todd
LBHR 12/31/09 Dr. Su

[jwtoto]

Hey Todd,

Great, thanks for the lead. I live in California otherwise I would not be bothering to vet my PT people; I'd just go where you are going and be confident they were doing exactly what Dr. Su recommends. On my final visit with him, Dr. Su gave me a handout showing some exercises and it had your PT office info. on the masthead of the printout.

My PT people are good for run of the mill stuff but this type of surgery is fairly rare and, as I have tried to express, I don't want to be a trial and error patient with them.

So here is what I think I'll do. Tell me if you think it is reasonable. I'll call Stash and ask him if he wouldn't mind receiving a call from my PT people and explaining in detail to them how he treats resurfacings. Then, I'll make sure that this communication continues as I progress. My concern is that I don't want to get my PT people mad at me for questioning their professional qualifications to come up with a treatment plan for me on their own. However, this recovery is too important to me to trust someone without question just to avoid hurting someone's feelings.

BTW, if you wouldn't mind, Todd, could you detail out for me what you have done so far in PT and what you have found most beneficial?

All I am doing right now is walking about 1.2 miles/day, stationary biking about 10 minutes/day, and doing the 5 bed exercises about 3 times/day, plus some easy stretches. Also I am icing about 10 times per day.

                           Thanks,

                            Jerry RBHR Dr. Su 4/15/10

[stevel]

Jerry,

I notice you live in Northern California.  Are you close to Greg Booth (Neurosport) in Fremont, Ca?  He is on a list of physical therapists provided by Vicky Marlow on her website.

[jwtoto]

Hey Steve,

I live in Soquel and I could go to Greg Booth but it would be about a 1.5 hour ride to get there. I am thinking about going to see him maybe once or twice to get some variety. I have a local therapist that is pretty good. I'll try to get my local guy to share with the other more experienced people and keep it convenient for me. I just need to educate myself to know what is good and what is not good (caveat emptor, right?). Just talked with a PT in NYC who is very experienced with resurfacings and he offered to talk to my pt guy. So we will see. How are you doing and when did you have yours done?

                           Jerry RBHR Dr. Su 4/15/10

[stevel]

Jerry,

I'm doing great and I had my LBHR done by Dr. Su on 9/29/08 about 17 months ago.
I check this website regularly to add positive comments.
It's also interesting to follow other patients stories and learn about developing complications such as infections, bursitis, steep cup angles and removal of Durom and ASR devices from the US market.
I had fun working with two physical therapists as I improved with each visit and I was ready to return to downhill skiing at 6 months post-op.  They developed my treatment plan to return to this activity and restore a normal gait, as I had some post-op leg length discrepancy until the muscles healed, strengthened and adjusted.

[sheptr]

Jerry,
Give Star a call.  I started with Star at 5-6 weeks post op.  I did have a home PT, she helped me get rid of my limp, and had me doing ROM excercises, and walking 1-1.5 miles daily, she was not too concerned with strength building.  At Star, I warm up on a stationary bike, then some hip abduction isometrics, with a theraband and a ball at the ankles. Supine bridging, and quadruped rocking. Hip Flexor Stretch on a rolling stoll, and stool rotations.  There are some balance boards, side to side and front to back.  A few machines and cables to help strengthen the hip as well.  A lot of the exercises are different variations of what Dr Su has posted on his website.  The best thing about the PT visits is Stash stretching my leg/hip.  He literally pushes/stretches it to my limits, in a manner that I could not do on my own. I believe this has helped me to be able to get my shoes and socks on without the tears.  Some hippies use no PT at all.  I needed to, I had my surgery a year or more too late, and my lower body had tightened up so much, it was painful to walk or get up and down from chair/bed. I am better now at 17 weeks post op than I was a year pre-op.  This morning I did squats, stiff leg dead lifts, lunges and calf raises, using extremely light weight, but am excited that it was all pain free.  I think you will be fine to choose a reputable PT office.  Good luck,
Todd
LBHR 12/31/09 Dr. Su

[jwtoto]

Thanks, Todd. I actually did call Stash yesterday (at your suggestion) and we talked at length. He is no stranger to rehabing  resurfacings. I will put my PT in touch with him (there is also a "local" guy, 1 1/2 hour drive from me so not too convenient, who can share with my PT). As I said, my PT has done about three resurfacings but from doctors like Amstutz, not Dr. Su. So now I feel good- with a collaborative effort I'll get some good PT. I will start PT around 5/24. Meantime I will do my thing at home- no rush, just gradual improvement. BTW, Stash said that you are doing great.

                   Thanks for the help,

                        Jerry RBHR Dr. Su 4/15/10