I've been diligently heading off to physical therapy three times per week since early January. Stone has a PT room in his facility but since he's an hour away and out of my insurance network, the vast majority of my pre and post op therapy has been at an in-network clinic closer to my house. They are all very nice there, have all the necessary equipment, and they seem reasonably competent. The therapists at Stone on the other hand are some of the best in the business and today I had PT with one of them in conjunction with a post surgery check up appointment. Given the Stone motto (Fitter, Faster, Stronger) and the undeniable fact that I was nearing the start of week 5 but still only barely meeting week 2 recovery expectations, I knew full well that I was stepping into a possible shit storm by seeing a Stone therapist but I also knew it had to be done. When I arrived, Dr. Stone gave me a quick once over and said he was pleased with how solid my new ACL was. He smiled in a way that made it clear that he was genuinely proud of his work, like a kid admiring his recently completed model airplane. He also pointed out that my range of motion was lacking and he told me to check with him on my way out after therapy.
The Stone therapist that I saw today has no shortage of size and muscle to adequately deliver “therapy” and as all good physical therapists do, he probably harbors some well developed sadistic tendencies beneath his pleasant and professional exterior.
As an aside, while I realize that those in the PT trade may be meeting the clinical definition of “therapy”, until the start of this whole experience I always thought the word had a wonderfully serene and peaceful feel to it. Like aqua therapy or aroma therapy. It is supposed to be after all, therapeutic. Turns out though, physical therapy is much more closely related to electro-shock therapy. And perhaps a close cousin to running-naked-through-a-hail-storm therapy.
In any case, my therapist today, let’s call him Thor, is clearly dedicated to his craft and is a fountain of catch phrases. He asked how things were going on the bike. I explained that I had tried a few days ago but still could not get over the top of the pedal stroke. “Well, we’ll fix that”, he said, as if he was talking about squirting some 3-in-1 on a stuck hinge. “Motion is lotion you know and you should be on the bike by now. You’re a bit behind the curve.” “Yes, I know”, I replied. Thor went on to explain that a big part of the reason for my limited range of motion was the swelling around the kneecap. When the leg is straight and the quads are flexed, the patella should move toward the hip. Mine, as he pointed out, looked like it was set in cement. Thor said that the swelling in my knee was “old and cold” and that it never should have gotten to this point. “But don’t worry”, he said with a quick grin, “we’ll fix that too”.As the therapeutic part of the session began, Thor hit me with another catch phrase that had something to do with eating shit and essentially was meant to explain that in physical therapy, if you don’t pay frequently with a little pain each time, then you have to make a few larger payments of pain to catch up. Today, he warned me, would probably get expensive.
All of my physical therapy sessions have had some associated pain. I mean, my knee has already been hurt, so to do anything to it or with it just hurts more. Sometimes a little, sometimes quite a lot. But today was an entirely new level of demandingly ferocious pain. It started with what seemed like days of increasingly hostile, insistent gouging and squeezing and digging around the patella. Thor used his fully double jointed muscle-bound thumbs to “get the junk out” from within the tissues around my knee. This attack nearly sent me diving off the table numerous times for the relative safety of the floor. I was told to verbally refer to my leg as someone else’s, as though we were both observing this violent work being done to some other poor sap. But this only served to confuse me – why the hell does that guy’s knee hurt me so much? Between each attempt to force the knee beyond its recently self-imposed limits, there was more targeted grinding and smashing of the tissues. Lying on my back I desperately focused on random holes in the ceiling tiles. To gain extension, my knee was firmly held down to the table while my foot was pulled upward. To force flexion my leg was bent farther and farther in short pain filled bursts. Eventually I just gave up on trying to achieve the requisite Zen master concentration and I resorted to yelling my way through the previous limits. By the end of the session I had pushed into nearly 5 degrees of hyper-extension and gained an extra 17 degrees of flexion. Significant and exhausting progress.
Afterwards my knee was iced for 20 minutes or so and I actually felt pretty good, my euphoria fueled by a combination of lingering endorphins and the relief that the session was over. Thor said it was time to burn the crutches and the brace - metaphorically, I assumed. Then he gave me a neoprene sleeve to wear to help keep the swelling down and told me not to panic if by tomorrow my knee turns a little purple. “It’s just temporary”, he assured me.
On the way home I thought about how reserved and cautious my usual PT clinic had been and although I really like the people there I tried to honestly assess their value in my recovery going forward. I wondered how much of today’s “make-up” work should have been done in their facility, the easier way – a little at a time. Later I stopped at my local clinic, paid off my existing co-pay tab (3 sessions at $25 each) and cancelled my future appointments. I have an evaluation session with another local clinic this Thursday. It’s time for a change of PT scenery.
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