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Physical Therapy: Choose Wisely

Finding the right physical therapy regimen is the first step to feeling better

I never longed to be a Marine. Probably it was that aversion to physical punishment that kept me from physical therapy, too. The prospect of hurting so I could eventually feel better holds little appeal. For years, physicians and family have told me that I’d likely benefit from PT, but I’ve resisted — until now.

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Richard Cohen

Courtesy Richard M. Cohen

Richard M. Cohen was diagnosed with multiple sclerosis more than 30 years ago.

Now, after multiple surgeries, my back is so weak that I can barely walk. My doctors have made it clear that my only hope of regaining strength is an intense physical therapy regimen. And so my days of denial have ended, at least on this front.

As with any practicing hypocrite, I became an instant convert, deeply committed to challenging myself with the most rigorous PT program I could find.

Of course, I had no idea where to look. I talked to friends, only to learn that each of them knew the perfect person. Their shoulders — or their knees — do not hurt anymore. What more proof could I want?

But I decided to play it safe. I called and made an appointment at a highly regarded rehab facility about 20 minutes from my home. They needed a prescription and an insurance card, and the deal was done. The grounds themselves were magnificent, with quiet roads leading to a series of buildings that provide hospital-based and outpatient services. I arrived and walked down a long corridor, passing patients on canes and walkers and in wheelchairs, all casualties of neurological or other conditions.

My hopes were high for about 10 minutes, before Nurse Ratched set out to evaluate my condition. She began by simply watching me walk. She kept shaking her head. “You’re a danger to yourself, even with the cane. You look like you’re going to fall,” she announced. “You need a walker.”

“I haven’t fallen yet, and I’ve used a cane for years,” I replied. Already I disliked her.

Next we ran some simple tests: She had me walk a course she had laid out in the large room. She had me sit in a standard chair and stand — five times. “You’re failing every challenge I’ve given you,” she announced soon enough.

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I had walked the course too slowly. She never told me to walk it as fast as I could. I had asked her if I could use my arms to help me stand up from the chair. “Do what’s most comfortable,” was her reply. Then she deducted points because I used my arms to help me stand. Her conclusion: “You’re very weak. I don’t know what we can do for you.”

You don’t talk that way to a patient looking for help. Care providers are powerful people in our lives. She could have encouraged and motivated me — but instead, she did the opposite.

Based on the nurse’s recommendations, the center designed a toothless exercise program for me that would not have challenged a grade-school kid. This was not therapy at all. Obviously, the therapists had given up on me before they even started. I had asked for one person to work with me for continuity but saw a new face every time I arrived. The treatments were not challenging; the PT staff were condescending. When I left for the last time, no one ever bothered to ask why.

I sat around at home in my gymshorts, all dressed down with nowhere to go. I remembered that my wife Meredith had liked the physical therapy she had after she tore both hamstrings while training for a marathon. The place she went was called Spears, which sounded lithe and sharp enough for me.

Within minutes of my first session there, I was sweating. I was on my back, feet atop a large rubber ball. The trainer would push or pull or move the ball diagonally. My job was to sense the direction and resist. He understood my physical weaknesses and pushed and prodded, getting me to endure difficult exercises to strengthen muscles. There was no condescension, only professionalism. The trainers wanted feedback: “Talk to me,” mine demanded. “How does it feel?”

The lesson? Physical therapy can be valuable, but shop carefully. Respect is a powerful motivating force. I am content with the blood, sweat and tears — and I’m getting better.

Emmy-winning TV producer and author Richard Cohen has lived with multiple sclerosis for more than 30 years. He writes bi-weekly about living a full life with a chronic disease.