Why Do So Many Physical Therapists Want to Hurt Us?

A recent experience with a frozen shoulder prompted this post. It also also relates very much to my days with knee pain because I noticed a similar dynamic at play.

First: the frozen shoulder is almost unfrozen now. That’s the good news. Frozen shoulder by the way is a term for adhesive capsulitis, a condition where the movement of the shoulder becomes quite restricted and simple tasks – such as threading your belt through loops with an arm behind your back or extending your arm over your head – become difficult or even impossible.

Before I knew it was a frozen shoulder (I thought I had torn my rotator cuff), my doctor advised physical therapy. Okay, that’s fine I thought. I waited however until I got a diagnosis, thinking that it made no sense to begin physical therapy before we even knew the exact problem. After frozen shoulder was diagnosed using an MRI, I made the appointment with the therapist.

His advice: perform stretching and range-of-movement exercises. In a variety of exercises, I was challenged to move my arm to the extreme that I comfortably could, and even try to go a little further. We did some exercises together. He also kneaded the tissue a little, then photocopied a couple of pages of exercises for me to take home.

Okay, I thought. Got a plan. That’s good.

There were about eight different stretches/exercises. I did them each morning. My range of motion began to improve.

But I felt terrible. Immediately after the exercises, I would notice a clicking/snapping of a tendon in my shoulder. This may have been the byproduct of inflammation. At night, I often had trouble sleeping. Once I had to take some Advil to get through the night.

A few days after that I had this realization: this just isn’t working. Sorry, but I’ve seen this same bad movie before, when I had knee pain. Sometimes it takes courage to reject a failed course and rip up what seems like a solid plan and come up with a better way forward.

But if I couldn’t even get a good night’s sleep, I knew I wasn’t getting better.

So I poked around online, looking for exercises for frozen shoulder. I found some illustrated on YouTube that were super easy. Swing your arms, loose and easy, like a pendulum, trying to let gravity do most of the work. Swing them up and down. Swing them back and forth. Swing them in circles.

Okay, I’m going to do that, I figured. It’s motion. Motion is good for joints, I learned from having bad knees. I tried to swing my arms 10 to 15 minutes every morning.

And the frozen shoulder began to get better, over the course of weeks. Now I’m almost over it. Thank goodness.

All it took was easy, gentle motion. Sort of like slow walking, or pool walking, or easy cycling to heal a pair of bad knees.

Maybe you’re thinking: Fine. It worked for you. But this stretching regimen surely makes the most sense for most patients with frozen shoulder.

Maybe not. From a paper, Adhesive Capsulitis: Use the Evidence to Integrate Your Interventions (Phil Page and Andre Labbe):

It has been suggested that “gentle” therapy (painfree pendulum and active exercises) is better than “intensive” therapy (passive stretching and manipulation up to and beyond the pain threshold.

Anyway, this post is getting long. Let's return to the original question: Why do so many physical therapists try to hurt us to make us better, when gentle therapy might produce better results? Here are some quick theories:

* Physical therapists tend to be young, healthy individuals. They know of your condition through what they’ve read in textbooks; they haven’t actually suffered your condition. They are missing an experiential bit of knowledge that may be quite useful.

* Physical therapists tend to be well-schooled in muscle groups, in forces and opposing forces, and various stresses on different parts of the body. They sometimes sound like physics nerds. That may encourage them to focus on stretching/working muscles in a more intense manner than may be warranted.

* Physical therapists tend to be in good shape, not surprisingly. I suspect a lot of them work out. People who work out are familiar with that old saying, “no pain, no gain.” They may carry a bit of that bias into the practice of their profession.

In any event, in this case, I found what was effective turned out to be easy motion. I wouldn’t be surprised if we find that to be a more successful intervention for many joint issues.