"Tell me if this gets unbearable," Arden Wilkins said, as he pulled back my arm and twisted my wrist.
I was lying on an examination table at In Touch Physical Therapy in Silver Spring, hoping Arden's labors would relieve the persistent tendinitis in my shoulder and elbow. I had tried (admittedly sporadic) exercises, stretches and ice on my own, but had made little progress in the six months since my sports doctor diagnosed tennis elbow. The pain had hampered many of the activities I love: kayaking, mountain biking, guitar and the activity that brought on the pain in the first place, tennis.
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I chose Wilkins because he gives patients hour-long, one-on-one physical therapy, or PT. I had PT elsewhere years ago for an ankle sprain and was turned off by the number of different people treating me over several visits. Also, my trusted sports doc had recommended Wilkins. (Most patients with sports injuries go first to a sports doctor, then -- if necessary -- head to a physical therapist for rehabilitation.)
The therapist should first examine you to confirm and possibly refine the diagnosis. Wilkins spent 45 minutes of my first visit working to understand precisely where and how much I hurt. On my second visit, he applied heat to both areas, then hydrocortisone cream and ultrasound (to help the cream penetrate the skin). Then he massaged the trouble spots and directed me in some basic exercises before icing both areas.
Good PT addresses range of motion, strength, endurance and agility, so you return to your sport as good as you were pre-injury, says Carl MacCartee, an orthopedist and my long-time sports doc. "It is not just bending the knee again so your heel hits your buttock." This means I must put in some effort -- including doing the (boring) stretches, exercises and icing at home.
You should consider physical therapy when an injury greatly hinders your ability to exercise and doesn't improve over a few weeks. (So, yes, I waited too long.) D.C. law requires a physician referral to see a physical therapist; Maryland allows direct access; Virginia allows direct access, with restrictions.
Try to find a sports doctor who has experience with your type of injury. Once you get to the PT stage, don't settle for a business that treats you like a budgetary item. Choosing a sports doc and physical therapist is "like picking a surgeon," says Mark L. Fuerst, co-author of the "Sports Injury Handbook" (Wiley). "You want the guy who has experience with your type of injury."
If you're clueless on where to start, Fuerst advises looking into sports medicine clinics with multidisciplinary teams including doctors, physical therapists and other specialists, such as a podiatrist. "They will have more experience treating sports-related injuries." Also, the American Physical Therapists Association has a database of therapists, searchable by specialty, on its Web site (www.apta.org).
If your insurance doesn't cover PT, expect to spend about $150 to $200 for an initial consultation and $50 to $100 for each subsequent visit.
We'll be back in the chat room, perhaps fully rehabilitated, on Thursday, Dec. 2. In the meantime, e-mail us at email@example.com.
-- John Briley