Physical Therapy

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IHave PMR and taking predesone.   No pain right now.  Is physical therapy of any use with PMR.  My doctor referred me there.  

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  • Posted

    I'm not sure the average PT therapist knows what to do bedsides make you feel better for a short time, much as a massage therapist would. Ive found that even in a trusted PT practice, there is only time for about 15-20 minutes of hands on or deep heat etc. To fill in the 50 min to an hour they start you on excersise equip or movements that can make you feel worse. They have to make a living too.
    • Posted

      I went one time so far.  They seem to just do muscle strengthining for my shoulder.  
    • Posted

      I find that the pred does make me quite weak over time.
  • Posted

    Check with the physiotherapist that they have experience with PMR patients.  Mine has and she is great, but I've heard some horror stories from others whose clinicians didn't know what they were doing, that PMR makes one more "delicate" really.  Had a physiotherapist pre-diagnosis who did me no good at all.  Responding to Paul's comment it does make a difference with the physio business as well.  My current one is independent because she did not like the way patients were sort of hustled through when she was with a group.  So successful is she that she has recently hired an associate who also will work one on one with a patient for 45 minutes.
  • Posted

    I do go to a PT  but she has a lot of experience with people who have PMR. I also get massage, particularly leg massage which I love and it helps the fluid retention from the steroids.
  • Posted

    I agree with Paul, PT did not help me last year because the therapist was not familiar with PMR.  They want to strengthen muscles, and if you do what they tell you, you end up with bad pain in shoulders and hips.  I gave up on this, and do my own stretching for my hips in the morning before I get up.

  • Posted

    I found that PT did not help at all. Massage seemed to help a bit. As soon as I got on prednisone I started back at the gym lifing medium to heavy weights and have been doing so for over a year now. I have managed to get back to the strength I had prior to the onset of PMR. I actually have to eat extra snacks to keep my body weight up. The weight lifing will help me maintain bone mass as well as strength.
  • Posted

    I'm one of those who's PT said he understood PMR, I ended up with worse pain in my shoulderblade/upper back area after that. He asked me 3 times why I was on Prednisone. They worked me out to failure. Said I needed to join a gym, ... 

    So...just because they say they know...

    However!!! I'm grateful for some things they did teach me! Like how to squat better to pick things up, though my Bowen gal corrected it a bit and I feel better doing it, and yoga tough me to press against floor and rotate thighs outward, this helps to NOT activate the PMR spots. 

    And they tough me how to use my shoulders better, though I often forget and feel the pain. 

    My my muscles are atrophying big time. So I'm trying to lift weights using non PMR muscles, biceps, triceps, lats, quads, ... But LESS reps! Only about 5-6 at a time. Maybe twice a day or more, but I forget. Ugh. 

    Before my back hurt too much, but Bowen helped with that.

    • Posted

      My physiotherapist is the person who is giving me low intensity light therapy, as well as other passive treatments, like try needling and a little gentle manipulation of my spine.  Not once has she suggested exercises, although I asked her for some to help with kyphosis, which she gave me.  She has checked with me what exercises I was already doing before I started with her.  Every visit she asks how I'm doing and if, say, a shoulder is bothering me we talk about how to handle it, or if anything needs to be done at all.  She seems very aware of possible effects of prednisone on muscles.  So, like the doctors, support medics also need education so they can all become angels like mine.  
    • Posted

      I am also lucky that I have PT who does know about PMR.  I would say that if you can find one that listens what you need, and is familiar with PMR, that it helps a lot...

      Here is what I try to do during PT session...

      1- Use high freq electro massage to worm up the area that you will be working on

      2. Start with gentle massage and increase intensity if comfortable. The goal is to worm up and relax the muscles.

      3. Now that the muscle is worm, focus on streching and flexibility

      4. Ask about what you can do at home to

      Streanght is not a priority at this point... and I have never done it after I was diagnosed with PMR in Nov last year.. I think it is too early and it may cause inflamation and pain.

  • Posted

    In fact I am going to ask my rheumatologist what she thinks when I see her Monday cuz I have been thinking of having someone work on my shoulders. I did have physical therapy before they figured out it was PMR and it didn't get rid of the pain but I do recall getting more limber.   I find massage helps me more. I get it 3 x a month.
  • Posted

    Hi, I am in US. I was referred to therapy, my advice, unless they are REAL LEARNED in this disorder, they don't do correct exercises. I had so much pain when I left, I had to stop them!  Good luck
  • Posted

    As the others have all said - it depends what you mean by physcial therapy.

    "Normal" physiotherapy that aims to strengthen muscles by repetitive actions is a no-no - the one thing that PMR ravaged muscles don't need is to be subjected to repetitive actions! The blood flow to the muscles is compromised by the narrowed inflamed blood vessels so they don't get an adequate blood supply with nutrients and, above all, oxygen so are unable to exercise without developing ischaemic pain. It is called claudication and is typified by the pain going when you stop only to return when you resume the action. In addition, the blood flow is unable to remove the waste products of the exercise - and you develop the dreaded lactate burn post exercise which the muscles can't recover from as well as they should - the after-effects of the exercise hang around for far longer and you are sore.

    However, some exercise IS important in PMR as it dilates the arteries and gets the blood flowing to the muscles better and that eases the stiffness. There is currently a clinical study being done in the north of England that includes exercise targets for patients on pred for PMR which helps prevent the muscle wasting due to pred which affects some people as well as helping the PMR.

    Recommendation 9 of the most recent EULAR and ACR guidelines for the management of PMR says:

    "The panel conditionally recommendes an individualized exercise program for PMR patients aimed at the maintenance of muscle mass and reducing the risk of falls. 

    There are no studies investigating the value of non-pharmacological therapies (e.g. physiotherapy, relaxation techniques, diets etc) in PMR and there is insufficient clinical experience on this issue to agree on a specific recommendation. Nevertheless, the panel agree on recommending an individualized exercise program ... in view of its benefit for maintaining muscle mass and function and reducing the risk of falls, especially in older persons GCs as well as in frail patients."

    But you must be careful your physical therapist understands the muscle problems associated with PMR and - as the others have said - the proof of the pudding is in the eating! If they don't "get" why you are on pred, if they don't "get" that exercising to exhaustion is absolutely not the right way to approach things - vote with your feet. 

    The approach taken by Anhaga's and Nick's  therapists sounds ideal but I'd suggest they are very lucky at the present. In time there may be some recommendations that physios will take notice off but at present look for one who will listen and accept that you have limitations and work with you. I haven't found one yet who really understood and I found just doing one or two reps too many left me hurting for the next few days. Walking as much as you can, climbing stairs (if you can) helps legs and you can increase it in very small amounts. I would go to a gym but here where I live you pay for individual visits and they never have a pool or spa bit - bit expensive paying full wack for 20 mins!

    • Posted

      I think I now understand where I am at. I had to go to Physio for rehab after a broken ankle. I had repetitive excercises, which was fine for the first three visits, then I developed untold other problems. I did not think I was pushing myself, but noone understood my meltdown. My Physio's do not know about PMR - they were open and honest at least.
  • Posted

    I have had a very different experience with my PMR. Even after quite heavy weight lifting my muscles are no more sore than when I didn't have PMR. Maybe it is the micronized L-Glutamine I am taking before and after workouts? Or after 50 years of heavy exercise my muscles, for some odd reason, just don't react negatively to the work. Go figure. Before my diagnosis I could not even do light lifting without severe pain especially in my arms and all joints. The prednisone took all of that away in short order.
    • Posted

      It's as much because you are already trained - you had less to do to get your muscles hack into trim. You can train to do most things even with PMR - you just have to take it very slowly. The people who already ran/lifted weights/cycled get back to it as long as there wasn't too long between. I had 5 years of being unable to do a lot of things - but I could ski and could build up over the season to about 2/3 my normal day's skiing.
    • Posted

      Hi John,

      I agree with you. When I was diagnosed with PMR April 2015 I had always worked out at the gym, lifting weights, cycling classes, Zumba, and step classes. I never missed a workout no matter how I felt. Once on the prednesone it was great. I am slowly reducing the pred now with alternating 3mg and 4mg each day. So far so good. Being active I feel is of utmost importance with our disease. Plus it helps not to gain unwanted weight. Keep up the good work.. Got to get ready for my spin class. smile

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