Physical Therapy

I’ve been meaning to be more regimented and organized about what I write about and why and when I publish, but it seems life is chaos and discipline is hard when the day to day schedule requires an intense amount of intentionality in order for me to set aside time. I had also meant to organize the categories of writing into 3 different ones: health topics, health ministry events or faith community nursing tips and growth, and my own personal health challenges/experiments. The holiday season is always a constant barrage of events and tasks. Hopefully, as the new year rolls around, I can squirrel away some more time to write, but until then, I’ll keep trying to move through each of these categories. For this entry, I’ll be walking through a personal health challenge as well as a health-related topic, which I hope will be helpful. 

One day, maybe about a month and a half or so ago, as I happily grabbed a bag of chips and a glass of water to take to my desk to work, I walked down the stairs, missed the last step somehow, and crashed to the floor. After several seconds, and a mildly anxious call to my husband (with me still holding my now half-spilled glass of water while sprawled awkwardly on the floor), I did a slow self- assessment. I had twisted my ankle going down, but I didn’t feel or hear a pop or crack. There was definitely a snapping feeling as I fell, but I had full range of movement, albeit somewhat painful, and with some ice and rest, I was OK. 

THEN… during this past Thanksgiving, my oldest son set a trap for me. I was walking down the stairs of my in-law’s home with my 18 month old in my arms, and I missed the 3 lb hand weight that my oldest had lain at the bottom of the stairs. In landing on it with the entirety of my weight on my left foot, I had another crash. Thankfully, the child in my arms was fine, but I had twisted my ankle again. But again, amazingly, no broken ankle, no real sprain, just a need for rest.

However, with these two falls, and also due to some issues with that foot earlier this year, I realized the muscles on that side were probably not as strong as they had been, and they could use a bit of work. Also, since having my kids, I hadn’t really had a good workout regimen, and my entire back regularly aches. So, after some thinking, I decided to message my primary care provider(PCP) and see if I could get some orders for physical therapy (PT). 

Physical Therapy tends to sound a bit intimidating to some people, since it sounds like the kind of thing one might do after severe injury, like a car crash or even a stroke. However, I’m sure if you asked a physical therapist what they do, they would probably say almost everyone should see physical therapy. The Illinois Physical Therapy Association defines the work of physical therapists as follows; “PTs provide services that help restore function, improve mobility, relieve pain, and prevent or limit permanent physical disabilities of patients with injuries or disease.” 

If you really think about it, that covers a lot of ground. I’m 33 years old, so still relatively young, but I’ve had pretty chronic lower back annoyances, a C-section, CHILDBIRTH!!!, a possible stress fracture to one of the tarsals of my left foot, and plantar fasciitis from walking around so much for my work. (Listing it out like that makes me feel old… and gross). Any of the listed medical issues, injuries, and conditions fall under the kinds of injuries or diseases/conditions that could use some physical therapy to improve quality of life. 

I will also say, I’m blessed to have good insurance, I have access to a responsive medical care team, and we have money saved for medical emergencies, procedures, and needs. This is not the case for everyone. With that in mind, my experience getting physical therapy might be not be the same as anyone else’s experience.

It started off with a message to my PCP, with some details regarding my weak left ankle and lower back pain. My doctor is in a larger hospital system, so he was able to put in an order for PT and I could choose one of several facilities in that system to go to. PT orders are also not uncommon in oncology care, and due to the fact that so many of our patients travel to see us, and we’re not part of a larger hospital system, we do one of two things to send PT orders. The first is that we can discharge our patients with a handwritten prescription with PT orders, specifying the area of injury or medical condition that we believe warrants treatment. The second method is that we can fax records and orders over once the patient lets us know where they’ll be going.

A few years ago, the state of Illinois signed into law that it is no longer required to have a qualified clinician’s order to go for physical therapy (woot!). This means that there’s one less barrier to care. I had decided to go ahead and contact my PCP anyway, since I didn’t know any physical therapy locations near me, and I knew my hospital system had PT available somewhere. It’s nice to “have a guy who knows a guy” to go to. However, every state has a different system. Your PCP is a good person to go to, since PT is not uncommon for them to refer patients to. 

There’s a chance that your insurance company requires referrals in order to go to certain specialists. If so, then you may need to be seen by a clinician, whether that’s your PCP or a different specialist, in order to have PT covered. 

For my first appointment, I filled out some “paper work” beforehand via our electronic charting system, as well as a few consents and assessment forms at the office prior to seeing my first therapist, who then shuffled me off to a side room to do a full assessment. I unfortunately spent too many minutes describing too many general aches and pains, and it took me a while to get the hint. The orders from my doctor had said Ankle and Lower Back pain, so we focused on these two. She did a detailed interview on when I have pain, what makes it better or worse, and medical histories relevant to treatment. Now, per my PT office, each area of concern requires its own level of focus and exercises, which might translate to more PT sessions than would be merited just for one body part. 

The entirety of the appointment was a little over an hour, during which we accomplished the interview, then some physical manipulation of my leg/ankle and back to see how much I could or could not do. We did several exercises and stretches that I would also be doing at home 1-2 times per day, which I was given a printout for, and finished with 8 minutes on a recumbent stepper (think elliptical but sitting). The following appointment, we started with the stepper to warm up, and the remainder of the appointment hour was doing additional exercises that I could tell was meant to strengthen my ankle, stretch out my legs and lower back, and strengthen my core muscles. 

In going through this process, I had a few internal and external barriers to care that I thought would be good to discuss. 

1. Time

I’m a full time nurse, a wife, and a mom of 2 young children. Time is always in short supply. Taking time to do PT means that I won’t be doing something else. My appointments are at 7 am, which means I won’t be doing the full morning routine with the kids to get them ready for the day or for daycare. That a;sp means asking my husband to take up a lot of that role. 

I know in this day and age, there’s a big emphasis on sharing home tasks with my husband and women-empowerment and all that, but even with knowing that I could ask my husband to do these things, the mom/wife-guilt is real. I felt guilty for asking for this “extra time” to work on something that hadn’t really been a thing until now. It helps so much to have a supportive husband and partner, but leaving in the midst of the chaos that is the toddler morning routine, with my usual tasks undone, has been hard for me to stop feeling guilty about. 

For anyone who is in a similar situation, but would need to ask someone else for help in order to do physical therapy, I would encourage you with a few things that helped me. The first is that, at least for myself, I have found that there are people in my life who are able and willing to help. I don’t have to do everything. Learning to accept help (Accept, not demand) is a valuable skill. 

The second, and I think most important, is keeping an eye on your goals. The reason for PT was so that I could increase my capacity as a mom and wife. I want to be able to chase my kids around, pick them up, do the chores, all that good stuff without me making that groaning noise that keeps making its way out of my mouth whenever I do any of it. I want to have the energy and the strength to be more present, as well as go through it without pain. 

1. Money

This was a big conversation for my husband and me. The initial evaluation cost, after insurance coverage, was around $150, with the remaining treatments being around $130 total for I believe 12 treatments. (For a while I panicked because I thought it was $130 for each treatment day, but it turns out it was a bundled deal!) Again, I am fortunate enough to have good insurance. But, it’s still around $180-200 for treatments, and I debated just getting a gym membership to do strengthening exercises and do my own personal research. 

Then I realized a few things. The first was that I had no idea what I was doing anyway. How much was I willing to pay for an expert to help me figure out what was wrong and how to fix it? And I was more glad for it after the first few visits, since I would never have thought to do most of the exercises or stretches they asked me to do. The second was that the time I would save on research was more valuable to me than the cost. 

It also helps that we have a sinking fund for medical expenses, as well as a budgeted amount each month for things like cold medications and prescriptions, since my kids are sick every other week for one reason or another. If you have not started one, I would highly recommend starting a sinking fund for possible emergency medical expenses in future. After having my kids and seeing the subsequent hospital bills, although the fund didn’t cover everything, it definitely helped keep us from Panic mode. 

If the cost of physical therapy is prohibitive, you might need to do some research on physical therapy locations and whether or not a location has a sliding scale based on your insurance and income. Certain hospital systems might be able to cover a portion of your cost if it seems there is financial need. Ask your doctor or medical center’s financial department to see what the options are for you. 

1. Goals

Although I’ve already touched on this, doing PT, or rather, taking care of and strengthening my body, helps me to accomplish a few goals I have. I want to increase or maintain my capacity in a few realms of life, such as with my family or in doing God’s work (there’s no way to say “God’s work” without it sounding weird). I want to have the space and room to be able to enjoy what I do without having to constantly lug my body through it. Picking up my sons, going on adventures with my husband and family, taking care of others, all of these require a level of physical presence, and I want to be able to be as fully present as possible. 

Ultimately, the taking care of my physical body is meant to be an act of practical worship. It is an offering up of my physical and mental energies in order to do what God calls me to do and be to the best of my ability. It requires a certain level of faith that the effort and knowledge gained will eventually be used for Christ’s mission and purpose. And my hope will be that through these sessions, the energy invested will eventually lead to output that can be utilized to show people (and hopefully even myself) that Jesus is worthy of the efforts of our lives.