Hi guys,
I'm just looking for opinions or for experiences anyone is willing to share.
In approximately the last 18 mos. I've been to 4 different PT offices and seen 6 different PT's.
My current PT is, I think, pretty good. She at least wants to attend or at least communicate directly with the Ortho Surgeon I go back to see soon.
She's been treating me since late November, post first rib resection surgery.
Currently the last few sessions we've been getting to know the TENS unit. I've been using it in PT sessions and at home.
Basically, I don't think the TENS is making much of a difference. Is a week long enough to tell or does it take a long term to see benefits from a TENS.
We moved it to my arm the last session and I did it at home the day in between.
Well, my ulner nerve started going ballistic the afternoon after my last PT session and yesterday. It feels better this AM.
I've been using the TENS on low setting so I really dont think that the two 20-30 minute sessions each day are overdoing it.
Also, she wants me using it up and down my back. Well, I can't reach my back with my injured side and I can't turn my neck far enough to see in the mirror to put those thing's on.
My PT seems pretty intent on using the TENS even though I've told her I really haven't seen any benefit.
Should I just keep going through the motions with the TENS and do what I'm told?
At what point and how do I explain that I think it's a waste of time?
Hope everyone's having a GOOD day! We are getting ready for another deep freeze here

Ask if they have an Interferential stimulator- {IF/INF stim} {TENS - i believe is more for pain blocking }
IF stim is able to go deeper into the tissues because of the interfered electric signals - less zapping- so to speak.
it will work the kinks out of the muscles - way better than the TENS.
feels like an all over massage on my back.
but still don't turn it up too high.

yep - placing the pads is very hard if no helper is around.

or Low Level laser? chiro has used it too - pain , TrPs etc

links about both -
Electrotherapy
http://www.medi-stim.com/overview.htm
from medi-stim site- see site link for more info
[

Frequently Used Modalities
TENS - Transcutaneous Electrical Nerve Stimulation
Primarily used for managing chronic pain. Works by blocking the pain signal, and by increasing endorphins in the body. Can be worn all day or on an as needed basis. Device features include adjustable pulse rate, pulse width, and amplitude (intensity). Higher priced units offer modulation (variations) of pulse rate, width, and/or amplitude settings, and other user friendly features. Placement of electrodes are usually at pain site or along the nerve channels, called dermatomes.

T.E.N.S. devices are the most often prescribed modality in electrotherapy. These devices are easier to use than other modalities. Please Click Here to learn more about how T.E.N.S works.


NMES - Neuromuscular Electrical Nerve Stimulation
Primarily used for preventing disuse atrophy (muscle wasting). Stronger than a TENS unit, with a wider pulse width to elicit muscle contraction for a period of time. More than just nerve stimulation, muscles are contracted and relaxed on and off to strengthen muscles, increase blood circulation to the area, and/or to reduce edema. Device features include adjustable pulse rate, width, amplitude, ramp, alternating or synchronus stimulation. Higher priced devices offer accesory jacks for remote switches, AC Adapters, and other user friendly features. Electrode placement is very important, mostly over motor points or on the belly of muscles.

Please Click Here to learn more about how N.M.E.S works.

HVPG - High Volt Pulsed Galvanic Stimulation
Primarily used for quickly increasing circulation or reducing edema in a specified area. Also used widely by PT's for wound healing. Uses high voltage and direct current (DC) as opposed to low voltage and alternating current (AC) common in TENS or NMES. Device features include adjustable pulse rate, positive or negative polarity switch, alternating or synchronus stimulation. Large "dispersive" pad is needed to ground the current. Smaller "active" pads are placed over treatment site.


INF - Interferential Stimulation
Primarily used to manage deep chronic pain. INF current uses very high pulse rate. usually 4001-4150 pulses per second. This higher frequency goes through the skin and muscle better than TENS or other modalities, thus can be more effective in pain control. Provides more analgesic, or nerve blocking effect. Device features include adjustable pulse rate, two or foue electrode treatment selection, and modulation of pulse rate. Because of suche frequency, these devices will require a lot of power. Batteries will not last long. AC Adapters are usually provided with device. Electrode placement should be in an "X" pattern, as the point of intersection provides a third stronger frequency.

Please Click Here to learn more about how Interferential Stimulation works.

MENS - Microcurrent Electrical Nerve Stimulation
Microcurrent electrical nerve stimulation (M.E.N.S) uses micro-amperage current as opposed to millamperage current which is found primarily in T.E.N.S. devices. Microamp current is 1/1000 of a milliamp current and is closer to our own body's natural healing current.

Wheras TENS is used generally for relief of pain, MENS is thought to work more on a cellular level and aids in the healing process while relieving pain. It has been found that MENS can help increase levels of a chemical called ATP (adenosine triphosphate) which promotes protien synthesis and healing in tissue cells. MENS is a very subtle, yet powerful current, and treatment levels are usually sub-sensory--the patient barely feels the stimulation. In many cases where TENS or other electrotherapy modalities have been unsuccessful, MENS has been proven to be an effective alternative.


EMG - ElectroMyoGraphy
Sometimes referred to as biofeedback, this procedure is very similar to routine electro-cardiography (ECG). While ECG measures the activity of the cardiac muscle, EMG measures the electrical activity of contracting skeletal muscles. Muscle activity produces electrical signals that can be detected through the skin with surface electrodes. The magnitude of electrical activity is proportional to the strength of the contraction. Thus, surface EMG can quantify muscle activity non-invasively. Common uses include muscle re-education, post-op knee rehabilitation, hand rehabilitation, work hardening, posture training, relaxation, stress management training and incontinence.
]
http://www.rehabpub.com/features/82004/3.asp
http://www.spine-health.com/topics/c...ctro/el01.html
http://www.skylarkdevice.com/web-site/ele_thera.htm
http://www.bmls.com/electrodes/epc.php
http://rehabilicare.com/protocol.html

Laser/ Infared/ far infrared
http://laser.nu/
http://www.purehealthsystems.com/infrared.html
http://www.purehealthsystems.com/mus...in-relief.html
http://www.toolsforwellness.com/far-infrared.html

They are doing more than the TENS ??like -- heat, massage , TrP work, stretches, posture work etc?

Thanks jo55,
At this point I'm not sure what they are doing.
Last week I got the impression my PT was burning out or getting frustrated working with me as we've made little progress since surgery.
I've been dealing with this for a while and have seen it with the other PT's I've dealt with.
The last few visits have not had heat or massage. She said she was going to be doing less of that.
Today she cancelled, but the aide said my PT could call me if I had issues and also offered to call if they had a cancellation.
Not sure if it's legit or if she feels like she is putting to much time and effort into me.

gbsb-
I talked to Super Joyce the wonder PT yesterday about a similar though not identical topic. First of all your PT should really listen to you. I mean, they're here to make you feel better, right?

Anyhow, she has told me that my wrist joints are so stiff that clearly I had a wrist injury a long time ago that never healed properly. And before she can really do much for my TOS she has to work on the wrist flexibility to even do a proper nerve glide. I asked her why it was that another PT wouldn't pick up on such a thing. And she said that some people are so busy looking at the global problem (In this case TOS), that they miss the little things. So I think what that translates to is that you need a PT who will examine your body for all its wrongs, if you will.

For instance, I personally think that the reason so many people with TOS have problems with circulation in their feet is that one of the things that lead to getting TOS was improper posture. If your hips and legs aren't aligned properly then your backs not aligned properly, then your shoulders aren't aligned properly and hey things start to moosh and smoosh in places where they're not supposed to, leading to nerve entrapment and RSI's.

One of the things that really sold me on Joyce the first time I saw her was she aligned my hips and then she started from the outside and worked in. She looked at my wrists and my feet and my general posture. I think she's dead on in thinking that these are all big contributors to my TOS and that they need to be fixed before she can work closer to the point where the entrapment is.

So I'm not 100% sure what the answer is for you but I do think that if the TENS isn't working for, you, certainly don't bother doing it at home. JO's idea that maybe the other kind of stim would work better is a good starting point. I didn't even know there were two kinds.

You could also try asking her exactly why she thinks the stim is so important and what did she think it's doing for you. If, like Jo said. One is for pain control and the other helps with calming nerves. Then maybe you can help her talk herself into the other kind of unit or at least not using the one she has you on. A good PT should be open to the fact that treatment modalities don't always work for everybody. Of course with TOS I think there are very few perfect PT's out there and that depending where you are, you might have to take the best you can get and try to make yourself as knowledgeable as possible to help them out. I am actually planning to go and talk to my first TOS PTs about why the PT didn't work so that maybe they'll be more open to different treatments in the future. Hopefully I'll save a little bit of pain for some other TOS sufferer down the line.

I hope some of this is helpful, I know it's not a real answer. Just sharing my thoughts hoping maybe it'll help you come up with the right answer for you.

Good luck.
Johanna

Thanks Johanna,
I am still up in the air regarding my PT. We'll see what the next visit brings. I may be just over analyzing things. She's cancelled three time before but it's usually been a Friday.
Who's SuperJoyce? Depending on how my PT seems I'd like to educate her about PT's who are concentrating and giving a darn about PT and TOS together.
If it does help someone down the road then I'm feeling the need to help any folks who have to deal with this pain, confusion, uncertainty.

I used a tens unit after my surgery for months. I loved it and it did help. I do know that you can turn them too high or too low so if they are too high it's going to make your pain worse. If they are too low they won't help.

I spent over 4 years in PT before and after TOS surgery and I think that the Physical Therapist just get to the point to where they think they aren't getting anywhere because with the TOS it seems that way even for us.

I went through 5 PT'ers. I like the girl that worked on me. She was the one that helped figure I had the TOS but the three men I had just seemed like they were taking too long to get me doing better. After my surgery, I got a husband/wife team that worked on me. She worked on me for over a year and then had a baby and her husband worked on me for at least 6 months. My insurance started giving them a hard time too. Not wanting to pay.

The couple I had were great. They had trained in Holland and believed mostly in massage therapy, no lifting and pulling. They did myofasial release and stretched my hands and fingers gently to help stretch the muscles.

What I was wondering what the Drs. ask for on your PT prescriptions. Mine always wrote down what to do and not to do. A lot of therapist don't know the first thing about TOS or RSD.

I would just come right out and ask her if she thought she was helping you or not. I always assured mine when they were helping but I would let them know if they were making me worse. I made one mad at me but I didn't like him anyway so it didn't matter.

The one PT'er I had got really depressed taking care of me because he felt he wasn't doing me any good.

They do see us as hard cases. TOS just doesn't seem to calm down even after therapy or surgery at times.

I think if you would give the tens unit a little more time you would see the difference. Just make sure you don't turn it up too high. I've done that without realizing it. They sure make you move if you do.

Have a good day,
Ada

The tens unit worked for me, but it just helps block the pain, doesn't cure anything.

You sound as frustatrated as I was in the past. PT never helped me. Just flared things up worse.

I believe that was due though to the fact I didn't have someone who knew what they were doing when it cam to TOS.

Peggy

I don't think a week is long enough. I started noticing benefits of my TENS after about 3 weeks. Particularly in the middle of a bad flare, it kept my migraine at bay.

My settings were done by my old PT from Florida:

Pulse Width = 230
Pulse Rate = 8

I am happy with an intensity of 3.


Good luck!
Anne

SuperJoyce is a PT in Santa Monica. She is an OCS (Orthopedic certified specialist, i think?) I haven't grilled her long enough yet to figure out how she learned what she did. The one time I asked she said it was an "eclecetic collection of knowledge" (I know, not very helpful) She does do a LOT of body work, as Ada mentioned hers did. She has no assistant, so her hands are on me the whole time I am there.

If you are conflicted, you might feel better if you talk frankly and openly with your PT. Ask her if she is frustrated, and you can share with her that you are down b/c of lack of prgress. It isn't neccessarily anyone's fault. It is a tough condition. If she is frustrated and doesn't know what to do with you, then maybe you can agree to either start looking elsewhere or work together to find other modalities. On the other hand, if you ask her and she can explain the reasonsn for what she is doing and sounds relatively confident about her chosen course of action, then you might be more relaxed about giving her method a chance. Any method, even a really good one, is going to take time for you to see improvement.

Another avenue-does you surgeon have any specific PT'er reccomendations? My doctor has one he is very fond of (I didn't know that until I asked, 4 months after I started seeing him) and Joyce was a recomendation specifically from another TOS doctor. As a TOS surgeon, he/she might have experience with someone specific. It is probably worth travelling a bit for good PT if you can swing it.

I would also call and "pre-interview" pt's if you are thinking about switching. Ask them if they have ever heard of Edgelow, or how they approach TOS. If they look at you with a dumb expression, pass!
On the other hand if you get one that says, there is no protocol, each patient has to be evaluated and treated individually....go and give them a chance (that's Joyce's answer).

MY first big clue that the first PT was of limited use was when they could observe adn comment about how my trapezius felt like a rock but would only massage and treat the front part of my neck/shoulder because "that's where TOS is". (duh?)

Seems like something someone should write a manual on. Of course, all the good ones are probably too busy fixing the broken people.

Good luck to you. I wish I had a better answer to your problem.

Johanna

Hi gbsb,

Johanna and I both go to 'SuperJoyce the wonder PT". She is wonderful and a TOS specialist. I wish we could clone her. Before JOyce, like Johanna, I went to a PT that was aware of TOS and some exercises but did not touch my body and had me do exercises and strength training after 3 weeks and told me I should be doing better. I did the best when they actually worked on the area of injury with ultrasound. The ultrasound helps break the adhesions but I don't think it can break them all the way. Also lilt therapy helped me too to calm down the nerves.

I agree with Peg, the tens unit calms the nerves and is for pain and is only temporary, atleast for me. I agree with astern though give it more time.

I also have a chiro I work with and pain doc/aupuncturist. I am guinea pig and try anything. The chiro made a big difference when they started workin on lump at my T1 spot.

Then I found Joyce. She is one of only 12 TOS specialists in the state of California. She studies how your body moves and finds the areas that do not move so well and works on them with her hands. Like today I went there and she could see that the head of my shoulder and clavicle were pulling forward so she worked on stabilizing it and releasing it. Why because my lats were extremely tight today. Other days it's the ribs she works on and mobilizes and pushes them back into place. Joyce says it's all connected so your PT really needs to find the trouble area and slowing work on them. When I first went to joyce I only had 45% rotation from my injury. Today I am at 80% but Joyce and I worked on it for 9 months and then I still had surgery to try to take it the rest of the way.

I will always go to Joyce for a long time. She makes my body feel almost normal.

It's all in the mechanics of how the body should work. Strengthening should come much much later. And posture is so important. It seems that atleast for me, my body is pulling me forward and the muscles have shortened and pulled the ribs out of place causing compression of nerves for me. And then the nerves irritate the muscles and they spasm and crush the nerves. Fun cycle of pain. It made everything swell and then inflammation made scar tissue that further entrapped the nerves. And boy did my pain radiate. Like I said in my PM I seriously thought that my thoracic spine was in trouble and sure enough it was the nerve trapped in the TOS area.

I asked Joyce today if she had any ideas for you. She recommended that you call a PT place in northern california called Edgelow. They developed a specific TOS PT program. She thought they may have a reco for your area since they train PT's in TOS. They have a home program that maybe you and your PT could explore. Ask you PT to do some homework on Edgelow. Maybe your PT could call Edgelow and talk to them about your treatment and seek advice. I found the website along time ago through another website called www.doctorellis.com

She also recommended Sharon Butlers book which she refers too. I found it on Amazon. And there is a book(s) that Joyce also recommended that I'll admist some parts were over my head but they had exercises at the end for TOS. It was called mobilisation of the nervous system by David Butler. He also has a second book. I read them both and some things I got and others I did not. BUt I know Joyce has read all three books and put them into practice.

Maybe a little gift of books for PT is in order. Make them a better PT. Push them. Have a heart to heart and say I am as frustrated as you and it's ok to be that way but don't give up on me and let's try some new stuff.

But whatever you do, don't let em make you feel like you are not able to improve. Keep trying and try someone new that will learn about TOS with you. Each of us is different and has TOS for different reasons.

And I will be so mad if they cancelled you because they are frustrated.

I also thinkyou may need some meds to calm the nerves down. I forget have you tried neurontin?

Go get em gbsb, we are here to back you up!