Should I fire my physiotherapist?

[loft33]

So I saw the PT again today.

My right hamstring STILL has no improvement. That's even after I did more than my stretching ever two hours yesterday. I stretched it every hour and also sat on a kitchen counter and attacked it with a tennis ball.

Today more than ever my right glute just feels like it won't fire and it feel like my hamstring is so tight because it's trying to prop that side of my body up on its own.

And again, today the PT said he can't have me doing anything else until that right hamstring is where he wants it. He checked my stretching form and said its fine and that I need to keep stretching because "it will get there." But until it gets there - you guessed it - no ab or glute max stabilization exercises.

If anyone could reply I would really appreciate it. I'm at a loss if I should move on to another PT.

Can you begin glute max and ab exercises with a tight hamstring? Because this current PT says no way.

[loft33]

Saw the PT again today. Had me lay in some futuristic water bed that massaged me for 15 minutes, then used ultrasound on my hams, measured them, frowned, and said "schedule 3 appointments next week."

I got so fed up and confronted him and the physiatrist who share the same office (and told me to see him) and asked that if they're just going to keep testing my hamstrings and doing heat and massage, maybe I should only come once next week to give me more time to work on my hamstring flexibility at home.

They both freaked out and said no, I must come in 3 days next week.

Again, this seems shadier and shadier. I'm getting worse because I'm not allowed to do any pelvic stabilization of glute max activation until my hamstrings are apparently perfectly loose (even though I can touch my toes and lay on my back and bend my hamstrings 90° without pain).

Really fed up. Can anyone please give me some advice? Is this line of treatment normal?

[bikelet]

Hi there,

Sorry to hear of your frustrations. I'm not really sure what 'normal' treatment is- it does vary a lot depending on level of PT experience and even country to country. But I will answer your questions from my point of view as a physio and give as much justification for this as I can.

So I think you are right in wanting to try glut max activation exercises. Basically there are two hip extensors- the glut max and hamstring muscle group. If one of them is defective, the other will work like crazy and be over active. So no amount of hamstring stretching will change the fact that it is overactive. If you learn to engage your gluts, it could actually give the hamstrings a break and a fighting chance to relax.

Muscle tightness is almost always a secondary problem- secondary to excess load, poor postures, pain, uneven muscle patterns etc and so generally speaking stretching shouldn't be the only line of treatment. Often muscles tighten in a protective pattern (which implicates neurological structures and involvement) to protect an injured joint or ligament and so needs to be a addressed at this level. Stretching a muscle while not addressing why it was protecting tensing is not likely to be helpful and may cause more problems.

There has been a lot of work done by Peter O'Sullivan and colleagues in research about best practice for SIJ dysfunction issues. Look for his papers if you can. Basically, with chronic SIJ problems, it is likely that there is abnormal muscle use around the pelvis which is a strong driver of the condition- this includes the abdominals (transversus, internal/external obliques, rectus abdominus), pelvic floor muscles, diaphragm, adductors, glut max, glut med, multifidus and lumbar erector spinae. So a good physio should assess these structures and give activation and postural control exercises around the pelvis. It is really important to consider how you are using all of these muscles and in what pattern you use them in day to day activities and sport. Stretching alone is unlikely to be helpful although it may be used as part of a solution for correcting tight strong muscles versus weak, long muscles.

Hope this makes sense.

[loft33]

Thanks so much, bikelet. I have sinced fired my PT and found a new one, who actually to quite angry when I told him my other one said I could do no other exercises until my hamstrings were perfectly stretched.