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*** Post Deleted *** - February 8, 2007 2:48:00 PM   
rru2s

 

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*** Post Deleted ***

Are you happy now?

< Message edited by rru2s -- May 23, 2009 1:58:23 AM >
Post #: 1
Re: Pose Method runner w/ Hip pain, post meniscus rehab. - February 8, 2007 7:13:00 PM   
PhysioThis

 

Posts: 84
Joined: October 24, 2006
From: New York
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A little knowledge is dangerous. Go to a PT or orthopedist and get your hip/back/pelvis checked out. It has gone on too long. You are in absoulutely NO position and obviously lack the qualification to rule in/out anything based on the symptoms you describe.

BTW - You have, in this post alone, provided me, a clinician, some insight into your self-centered and ultimately self-destructive way of thinking about yourself and your ability to manage potentially serious health issues. You do not have the capacity to self-diagnose and treat - even if you were an MD,PT,DC,etc.

I am absolutely not bashing you, I am genuinely concerned. PT's are extremely accessible and qualified to help you figure things out and there is no reason you should NOT consult someone who can thoroughly examine you and get OBJECTIVE info from your situation. There are so many other things you could be dealing with here, and it appears you are hanging your hat on a lot of pop info you have read.

Your meniscal injury certainly may be responsible for some other sort of overuse situation - however, to exemplify my points above, you let an extremely common injury and subsequently routine surgical intervention go on for a long time while causing you impairment and disability. A course of PT with/without surgery with a running-oriented clinician would have expedited your return to function - undoubtedly.

Get worked up by a qualified health care professional. You are an older athlete, these things are going to start happening to you more and more, and you need to get a handle on them early, not only after you have failed yourself with inappropriate pop management.

_____________________________

Ed, PT, MTB-XC

(in reply to rru2s)
Post #: 2
Re: Pose Method runner w/ Hip pain, post meniscus rehab. - February 9, 2007 9:13:00 AM   
PhysioThis

 

Posts: 84
Joined: October 24, 2006
From: New York
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You need to be a strong advocate for YOURSELF - screw the HMO and your primary MD if he/she is having clinical decisions being strongly driven by an insurance company.

Perhaps use of the term "self centered" is inappropriate - I apologize and certainly did not mean to offend. Your first post gives the impression that you take it upon yourself to take care of your medical issues, and there was no indication that you may have been limited by bad medical advice/insurance coverage. And make no mistake, you are recieving bad medical treatment- for the "best" ortho in your area to have you wait 6-8 weeks before seeing your locked knee is ludicrous. Your approach to your meniscus tear and your plan for return to running are very obviously not being medically directed, and they should be.

Like I said, you are an older athlete, and obviously a passionate one. Your doc obviously has no appreciation for that. You need to assemble a team of healthcare players that are going to be responsive to your needs, as it is likely that you will continue to be athletic for years to come and will face issues unique to older athletes. The sooner you take proactive steps to find the right people, the better off you will be in the long term.

I have no confidence in a primary MD's ability to perform a clinical musculoskeletal exam on an athlete's hip. I have further concerns that your MD did not do any sort radiological study.

You will be hard pressed to find anyone on this forum to give you specific clinical or self treatment advice - we just don't know enough about you. This is why I urge you to get yourself checked by the appropriate clinician(s).

If you live in a PT direct access state, consider going to a good sports PT clinic and paying cash for a thorough evaluation - it will be tremendously worth it. I'm sure there are plenty of people on this board who can help direct you to a clinic.

THIS IS WHAT YOU SHOULD DO NEXT!!! DO NOT WAIT.

If you reply/PM me with your state/zip code I can PM you with some PT's in your area.

_____________________________

Ed, PT, MTB-XC

(in reply to rru2s)
Post #: 3
Re: Pose Method runner w/ Hip pain, post meniscus rehab. - February 12, 2007 7:54:00 PM   
PhysioThis

 

Posts: 84
Joined: October 24, 2006
From: New York
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I'm glad you were able to make contact with them. It is unfortunate that they are not CIGNA providers and I agree that it IS ridiculous for you to spend additional $ out of pocket - but it is an unfortunate reality that many people face in order to get the best and most appropriate care.

Your point about putting the cart before the corse in regards to getting a thorough PT evaluation is highly debatable. PT's are highly qualified to perform detailed clinical examinations of the neuro-musculo-skeletal system and recognize signs of serious pathology. There is no necessity for prior MD consult in many cases. The goal of a PT eval is NOT to diagnose medical pathology, but to identify impairments that are amenable to PT treatment. If serious pathology is suspected, referral to a qualified practitioner will be made. A good, sports/ortho oriented PT will do an extremely thorough clinical examination that compares to one performed by an orthopedist. Your second article citation by Browning describes a portion of what a typical PT will do for someone with your complaint - did your PCP do anything resembling what was contained in the article?

I initially recommended that you seek a PT or orthopod, you enlightened me to your HMO situation, I then suggested an out of pocket PT evaluation (assuming you are in a direct access state), ONLY because it became obvious to me what you are up against with your gatekeeper. It is a sensible, low risk, cost-effective, and expeditious way for you to get some insight and answers, not a difinitive diagnosis. I never intended to suggest you see a PT INSTEAD of an MD, only while you were waiting for them to get their acts together regarding your care.

I will not argue with you regarding the biases that exist in health care. You are right. However, insurance companies are more interested in cost containment rather than objectivity.

If, in fact, the articles you posted were studied by you prior to your initial post (and not collected over the weekend), you should be quite angry. There is some very good info in those articles,(I have not read all of them) and as you've acknowledged, there are gold standard methods for diagnosing hip pathology - they are imaging studies, not 4 weeks of rest.

Please continue to advocate for yourself. And keep us posted on your progress.

_____________________________

Ed, PT, MTB-XC

(in reply to rru2s)
Post #: 4
Re: Pose Method runner w/ Hip pain, post meniscus rehab. - February 13, 2007 7:06:00 AM   
PhysioThis

 

Posts: 84
Joined: October 24, 2006
From: New York
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You should never fear discussing anything with your MD, especially well researched info. Although an MRI would probably not be a first-line diagnostic imaging choice in your case, He should have had some discussion with you regarding his decision NOT to investigate your pain further (via XRAY or orthopod referral).

It is difficult for untrained people to fully comprehend the complexities of diagnosis and treatment of musculoskeletal disorders. However a patient like yourself - one who is obviuously intelligent, diligent, and inquisitive and who strives to be an educated consumer of health care, deserves better consideration.

Again, keep us posted.

_____________________________

Ed, PT, MTB-XC

(in reply to rru2s)
Post #: 5
Re: Pose Method runner w/ Hip pain, post meniscus rehab. - February 13, 2007 9:38:00 AM   
FLAOrthoPT

 

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From: West Palm Beach
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It is like watching 24, I am waiting fo rthe next episode!

(in reply to rru2s)
Post #: 6
Re: Pose Method runner w/ Hip pain, post meniscus rehab. - February 14, 2007 9:47:00 AM   
USAPT

 

Posts: 284
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My vote is a consult from House, MD

rru2s,
Don?t be afraid to speak to your GP (you're paying for the visit). Be demanding but couth as they do lose $$ should they refer you out. But that is their job when the s/s are out of their expertise/ knowledge base (which most of all would agree that musculo-skeletal assessment is).

you pay $500/mo for coverage??..thru work?

_____________________________

Jason, PT
Board Certified Orthopaedic Specialist

(in reply to rru2s)
Post #: 7
Re: Pose Method runner w/ Hip pain, post meniscus rehab. - February 24, 2007 8:34:00 AM   
Rwantz

 

Posts: 84
Joined: December 11, 2004
From: Middletown, PA
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This is definitely an interesting post. I absolutely agree that, while worthwhile to educate yourself, it is not wise to diagnose yourself based on what you are able to Google about "Hip pain in runners." The resources are definitely available to help you understand your diagnosis.
I think that what you have learned so far is very important. Your GP is responsible for guiding you through the medical hierarchy, but many times you are responsible for guiding them.
It is prudent that during those 4 weeks of rest that you are doing something to improve the problem (which could very well be used to get an accurate diagnosis). Rehabilitation, including physical therapy or athletic training, to help you return to function is appropriate during that time whether you have a clear diagnosis or not. PTs and ATs are able to evaluate and treat you based on your hip/knee pain. It is unfortunate that some insurances restrict who you may see.
Best of luck with your appointments and getting through this.

(in reply to rru2s)
Post #: 8
Re: Pose Method runner w/ Hip pain, post meniscus rehab. - March 11, 2007 10:16:00 PM   
PhysioThis

 

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Joined: October 24, 2006
From: New York
Status: offline
Keep us posted.

_____________________________

Ed, PT, MTB-XC

(in reply to rru2s)
Post #: 9
RE: Re: Pose Method runner w/ Hip pain, post meniscus r... - May 29, 2008 3:15:01 PM   
Tom Reeves DPT ATC

 

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Wow, what a story.

There is no true gold standard for measuring leg length discrepancies.  A standing AP pelvis Xray is considered the gold standard but really it has to be done perfectly.  i.e. everything that is not in the film MUST be exactly the same (knee flexion, foot pronation) and even then, it is only a 2 dimensional measurement.  When I do an assessment for LLD, I look at 10-11 items and if a large majority says one side is longer, i give the patient a lift.  (the reason is that no single clinical indicator is very reliable.  they are simply indicators. 

There is a reason that you have the stress reaction on one side and not the other.  i would suspect an LLD or asymmetrical foot structure.  I didn't see in any of the above posts where you commented on your foot type and if R was the same as L.

Look at the wear pattern on an older pair of shoes.  Does it look the same R vs L?  if not, it could be an indicator of asymmetrical pronation which could be either from bad foot posture/structure, or a LLD.

Good luck.

(in reply to rru2s)
Post #: 10
RE: Re: Pose Method runner w/ Hip pain, post meniscus r... - May 29, 2008 7:32:06 PM   
bonez

 

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I can think of several things to consider but self treatment/assessment at this point is certainly NOT  one of them!

(in reply to Tom Reeves DPT ATC)
Post #: 11
RE: Re: Pose Method runner w/ Hip pain, post meniscus r... - May 29, 2008 11:03:48 PM   
Tom Reeves DPT ATC

 

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rru2s,

for what its worth, it seems to me that you are doing exactly what a sensible person would do.  You have sought medical advice that you have discovered to be less than state-of-the-art.  You have investigated things on your own so that you could be an informed consumer.  You have gone through the channels that you insurance provider demands, and getting insufficient relief are looking for other channels.  you have provided this forum with interesting and appropriate  (obviously informed) information.  I understand that you are not treating yourself. 

It is unfortunate that your HMO limits your access to the best possible providers. 

I don't understand why some on this forum seem to be somewhat belligerent toward you and your posts.

My two cents:  HMOs are cheap because they decide for you who you can see.  If you have choices, pick a different provider.  Or, pay out of network costs to see the professional you want/need to see.  One of the big problems in health care( and there are many) is that the consumer does not get to chose and participate in how they spend their health care dollar.  Further, all too many of my patients want a magic wand waved to make their pain go away.  You are not that type of person and I commend you for it.

End of sermon.

(in reply to rru2s)
Post #: 12
RE: Re: Pose Method runner w/ Hip pain, post meniscus r... - May 30, 2008 2:31:38 AM   
bonez

 

Posts: 701
Joined: August 29, 2007
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Tom with all due respect I did reread the entire tree before my post and there is still no actual professional functional/gait analysis. There is all kinds of complaints about hmo etc and self research but I find no actual posted analysis. We both know that an Ortho eval is from a surgical patho direction. While the poster has done much research it is useless to speculate on causation via this format as all it will do is cause more self analysis. I would also suspect from the posts that rru2 is posting on several different forums.
With this problem obviously recurring and at one point progressing to a stress fracture the correct answer is to quit all running activities until it is diagnosed and solved. We have all been involved with people who have stress #ed and continued to play competitvely and re injured til there is never complete healing.  It is obvious that running is this persons life so why the buck against skipping on the HMO? The longer we foster this support the longer til  rru2  goes out of pocket getting to the bottom of this and gets fixed.

quote:

ORIGINAL: Tom Reeves DPT ATC

rru2s,

for what its worth, it seems to me that you are doing exactly what a sensible person would do.  You have sought medical advice that you have discovered to be less than state-of-the-art.  You have investigated things on your own so that you could be an informed consumer.  You have gone through the channels that you insurance provider demands, and getting insufficient relief are looking for other channels.  you have provided this forum with interesting and appropriate  (obviously informed) information.  I understand that you are not treating yourself. 

It is unfortunate that your HMO limits your access to the best possible providers. 

I don't understand why some on this forum seem to be somewhat belligerent toward you and your posts.

My two cents:  HMOs are cheap because they decide for you who you can see.  If you have choices, pick a different provider.  Or, pay out of network costs to see the professional you want/need to see.  One of the big problems in health care( and there are many) is that the consumer does not get to chose and participate in how they spend their health care dollar.  Further, all too many of my patients want a magic wand waved to make their pain go away.  You are not that type of person and I commend you for it.

End of sermon.




< Message edited by bonez -- May 30, 2008 2:37:53 AM >

(in reply to Tom Reeves DPT ATC)
Post #: 13
RE: Re: Pose Method runner w/ Hip pain, post meniscus r... - May 30, 2008 12:48:43 PM   
Tom Reeves DPT ATC

 

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Joined: March 15, 2006
Status: offline
bonez

Yes, he should get to someone who can watch him run with an educated eye.  Most people rru2s included, figure they pay enough for their insurance and don't want to pay outside the policy.  when he eventually sees a good PT he will recognize the value of our training.  that is the first step toward becoming the provider of choice for these things. 

(in reply to bonez)
Post #: 14
RE: Re: Pose Method runner w/ Hip pain, post meniscus r... - June 2, 2008 10:26:02 PM   
Tom Reeves DPT ATC

 

Posts: 1166
Joined: March 15, 2006
Status: offline
I would contact an elite running club in Philly and ask them who their elite runners see for over use injuries.  Minnesota here so I don't have any names for you in PA.

Not to be a negativist, but maybe your body is telling you that you are simply running too much? 


(in reply to rru2s)
Post #: 15
RE: Re: Pose Method runner w/ Hip pain, post meniscus r... - June 3, 2008 1:38:22 PM   
orthotherapist

 

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Joined: February 7, 2007
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Look at the various universities in Philly to see if they have a biomechanics lab - perhaps someone in the area does research and you could get an analysis there


(in reply to rru2s)
Post #: 16
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