Why can’t I just get a prescription for physical therapy

Hi Mitch,
In your post you mention that you're working on your posture. So am I for my several back issues: osteoporosis, multilevel degenerative changes, disc herniations loss of disc height, central canal stenosis, foraminal narrowing and nerve compression.

This book was recommended and I am finding it very helpful: Back Mechanic, The secrets to a healthy spine your doctor isn't telling you. The author is Stuart McGill Phd. You can also find him on YouTube. I'm taking classes with a McGill trained and certified practitioner. Progress is slow but worthwhile.

All the best,

Diana

Jennifer, thanks as always for your thoughtful and detailed replies! The only PT I have had so far was because of my C5 nerve palsy, which thankfully has mostly cleared up. Before, I could not lift my right arm. Now I can, with the caveat about the continuing nerve pain in my hand afterwards.
I remember my surgeon stating that PT for my post-surgery would have to wait a while... I do see him on June 7, and will basically revisit my post with him there. If he is willing for me to continue PT I will try to get to the bottom of what my ongoing issues are. Remember that the surgeon is stating that the recovery from any nerve damage that had been caused pre-ACDF could take a year.. and that pretty much matches what everyone online says.
I know that posture is important, and I probably do not have good posture. I have been trying to work on it.
My research so far on TOS (including your posts) pretty much do NOT indicate that there is a simple fix... clearly I had bad spine issues before based on my CT scans... there seems to be no comparable definitive diagnosis for TOS.. or am I wrong?

Thanks again,
Mitch

@birdman518 Hi Mitch. Often TOS goes undiagnosed because doctors are not familiar with it, and there are some different varieties of TOS. It is glossed over in most medical schools (according to my neurologist). Generally speaking, it is a compression of nerves and vessels passing through the shoulder between the ribs and collar bone. The nerves pass between parts of the scalene muscles that are attached to the spine, so a scalene problem compresses it, and there is another compression point near the arm pit under the pec minor muscle. TOS can be affected by physical build because if the collar bones are lower, there is less room under them. A person with this build appears to have a longer neck. Some is posture related because if you slouch forward and always have your arms reaching forward, you are putting compression on this bundle of nerves and vessels and bad habits lead to bad posture that you may be doing all the time and not realizing it.. The scapulas start to wing out because there is more tension on the front pulling everything forward, and the muscles that are supposed to hold the scapulas on your back have relaxed too much. They are supposed to stay flat on your back. The scapula movement is interesting because that is what allows you to raise your arm as the scapula rotates on your back as a lever to raise your arm above shoulder height. TOS can be caused by an injury like a whiplash which may be also causing a spine injury at the same time.

If you have more than one issue, you may not be able to determine what is causing the pain and to separate the causes for while when you are healing your nerves. I hope as things progress, you will be able to find and address things that you find. I had a nerve irritation from a spine epidural injection that caused a paraestheisa and cold sensitivity in my hand for a year and a half. It did resolve completely after that time, and that would be lesser degree of insult, so I don't know if that qualifies as an injury. Another example is having some numbness from the surgical incision on the skin after surgery. My sensation is the same now as the side where there was no incision, so the nerves there have healed. I am 5 and a half years post spine surgery.

I found the information that Diana @lebanon100 shared very interesting from Stuart McGill, and I found and watched a video lecture he gave about figuring out where pain is coming from and resetting things to avoid pain. I kind of have a similar view about how physical movement affects mechanics and pain. I have learned a lot of that in anatomy classes with a biology degree as well as art school anatomy studies and drawing from live models, as well as from being a patient of a good physical therapist who has taught me things as well. I will be interested to hear what you think after you get the book. It sounds very good.

I know personally, horse back riding has helped my spine a lot just riding at a walk. To get the benefit from it to build core strength, I make sure to sit straight with good posture which works my back and will tire it out as I counter the movements of the horse's steps, but as I do more of it, my back gets so much stronger and good posture become effortless and that supports my neck with a better foundation. There are a lot of therapeutic riding centers where you could try this if it would be safe for you and when the time is right to try it. I actually own a horse and the other chores of grooming, care and saddling are all physical things that help keep me in better shape. In riding, I keep my hands low near the horse's neck, but I am holding them up which also works my shoulders and strengthens my back. I will be doing this again soon as better weather is returning. They would be leading the horse at a therapeutic riding center, so you wouldn't need to worry about controlling the horse and could focus on physical movement.

You're right, there is no simple fix when you have spine issues, but small steps help a lot and can lead to real progress and change when your habits become good ones. Remember that recovery from major surgery takes time to get to what your optimum healing will be. Setting your goals always helps as long as you are patient and listen to your body. Don't push too hard because you need time. My TOS was missed and not diagnosed until after carpal tunnel surgery failed to resolve the problems of my arm pain and my hands turning cold and blue. It wasn't until I was seen by a thoracic surgeon who understood TOS, that I was diagnosed and could get some physical therapy for it. I don't know if that answers your question or creates more questions.

Have you thought about therapeutic horse back riding?

It will take me a while to plow through this (but TY), but after being thrown on my face and breaking 3 bones in my hand at Boy Scout camp, I have stayed away from horses. 🙂