Physical Therapy Unexpected Results

I have had pt for 11 months in 2025 and the last 3 months with a different carrier for glute tendonopathy. It seems it’s worse than better. It’s a different issue then yours but I’m thinking pt exercises isn’t a fix all. But it seems fir insurance we have to do that to show it failed.

As a patient you have the right to ask for another therapist in the practice! PT’s are trained very well and they have a large tool box to repair various ailments patients have. You need to express to your PT that you don’t feel you’re improving and let’s either think out side the box or consider another therapist. If a physiatrist or ortho sent you for PT I suggest go back to that provider for a re-evaluation and treatment recommendations. Don’t settle for what you’ve got, find something else that works.

@jenatsky
This is my first time trying PT with Mayo Clinic; all my other PT appointments were with a different medical clinic. I informed the physical therapist at Mayo Clinic to expect the unexpected. I was given light exercises for the first 2 weeks, including calf raises and plantar flexion with a towel or belt. Since starting 3 weeks ago, the leg has been getting visibly weaker each week. This week, we did single-leg presses. My left leg was capable of doing 10+ reps at 120 pounds, while my right leg was shaking uncontrollably after doing just 1 rep.

@nasbyevan I’m sorry to hear you’re having difficulty with one leg. Sometimes healing can be a very long process but don’t give up.

I have been going to PT for an entirely different problems than you describe--initially for undiagnosed hip pain, then for help with bursitis and most recently for recovery from bilateral total hip replacement.

I have have met with at least five different PT's. I would say that not all PT's are the same nor do they have the same portfolio of exercises to recommend. I have settled on two as the most effective for me. I think other patients have come to the same conclusion because these two PTs have much more limited availability. Just last week a PT cancelled my appt because of illness. I am not able to see her again until August. She had recommended that I meet with her or one of her colleagues every 2-3 weeks, but now it will be five weeks since I had an appt.

I may be biased against the third PT I saw because my femur broke during my appointment with her in April 2024, five days after my first hip surgery. That fracture was the first challenge around regaining hip mobility and function which cascaded into 18 months of no significant improvement in either side, only being able to move slowly and weirdly with no walking aids. All this due to new issues, some of which are linked to not doing PT, others are fallout from the initial hospitalization. I am now working on gait, strength and mobility but I only have three more appts left. My surgeon said to be keep in touch about my progress.

I hope you get the help you need. I do have to wonder about remote PT rather than in person but I've never been offered remote sessions. My surgeon is part of an HMO I've used since 1978. I go to PT at the HMO's facility. I am only seen at Mayo for chronic kidney disease.

@mnsansei
The remote PT I did was with Hinge Health. My health insurance, Blue Cross Blue Shield, sent a letter offering free physical therapy. I used the service until I saw a neurologist so they could see the negative impact that physical therapy had. I definitely would not recommend virtual PT as a primary form of PT. It's a great secondary source for minor discomforts and pains. For example, if your knee or ankle is bothering you for a couple of days, simply message the physical therapist and they will create a nice 10-15 minute exercise program to help relieve your pain.

Gluteal medius and minimus tears in my left hip (undiagnosed at the time) took me to the ER in severe pain about 10 wks ago. Morphine was administered after my 2nd same-day visit to ER and a heavy tapered dose of prednisone reduced inflammation from that episode. Subsequently, a hip MRI ordered by my orthopedic hip doc was done. Interpreting the MRI a few days later he expressed sympathy telling me surgery was not an option. He prescribed 'conservative PT', warning that PT is successful only about half the time. It's a bummer and I was told not to push through pain. I've had only 4 sessions but am now having unexplained pain and stiffness in my right knee. At 75 I have mild to moderate osteoarthritis contributing to pain and stiffness on a regular basis. I plan shortly to begin a 3 X daily course of Bromelain, a pineapple stem extract, at the suggestion of my arthritis doctor. Does anyone have experience with this OTC supplement?

A discussion with "unexpected" in the the title is sure to elicit responses about horrible outcomes. I don't like adding to the negative side, but problems we face are filled with lessons, and folks who are considering these surgeries can benefit from knowing about pitfalls. After my TKR my therapist did an about face: before surgery he was careful, always warning me not to push through pain with my badly damaged joint. After surgery he was constantly telling me to push through the pain. I ended up with long term repetitive strain injuries which delayed my recovery by a full year and cost me thousands of dollars out of pocket for shockwave therapy. Too late I found out that shockwave therapy can start right after knee surgery. Had I known that I would have been miles ahead. Shockwave works, and without side effects. My surgery and/or bad physical therapy also left me with a blown saphenous valve in the vein of my surgical leg. Without good circulation you cannot heal. The constant repetitive strain from over aggressive therapy gave me months of unnecessary pain and held back healing by creating a huge level of unnecessary inflammation in addition to the normal surgical inflammation. I did not know enough going into the surgery about the poor communication between surgeons and therapists. My surgeon was horrified when she found out how I was treated, and went down and yelled at them! The misinformation that many therapists seem to work under is widespread. No, there is not some magical twelve week cutoff point for reaching 120 degrees bend, no matter what they say. The warning that you will not walk right ever if you don't make the deadline is incorrect. Lots of shoulder injuries require you to be immobile for months, but range of motion DOES come back with proper exercises AFTER the incisions have healed. A stiff knee with poor flexion is NOT automatically a case of scar tissue getting out of hand; it's often swelling that's out of hand. If the new knee is put in properly, then the knee will bend when the swelling goes down. Finally, these old wives tales that only slow up healing are being contradicted. Look up the "quiet knee" approach to TKR recovery. Find a physical therapist with specific training in TKR recovery. Don't push torn up leg tissues and nerves as if you are doing a gym workout. Surgery is massively destructive. Gym workouts aim for micro not macro tearing of tissues to stimulate inflammation and lead to the building of stronger muscles. Surgical recovery needs a therapeutic approach to rebuilding, which should not be the same as a gym session. There are many kinds of exercises. Tailor the exercise to the desired result. Yelling in pain and swelling up a lot during and after therapy is a sign of poor therapy. If only I had known ahead of time. Maybe the pitfalls described in this discussion will help someone else prepare better for TKR and heal faster afterwards.

@jenatsky
I tried to get a referral to a vascular specialist and an orthopedic doctor in Rochester, but both were rejected. My next step is a muscle biopsy. I'm meeting with the surgeon soon. Fingers crossed that something shows up in the biopsy. All the other medical tests have come back normal or negative.

Have you had an EMG of your leg muscles and have you seen a neurologist and/or a physiatrist? From your self described symptoms I didn’t see a reason to see a vascular specialist or an orthopedic specialist at this point. The symptoms you note from PT are definitely diagnostic and a lead in to further investigation. You should enlist the help of your PCP to guide your care and be an advocate for you too.