Physical therapy; books, videos for self diagnosis, self treatment?

[Query]

I've been having knee pains in one knee. I thought it was a recurrence of what a Sports PT diagnosed in 2009 as poor knee tracking due to unbalanced muscle development, and had me treat with leg lifts in all directions. It eventually went away - maybe the leg lifts worked. Or that it might be arthritis - I've passed my 60th birthday. The pain only occurs, for a day or two, after doing leg exercises, like biking, walking on a treadmill, or elliptical trainers. Or skating!

I just saw another sports PT about the problem. I've seen him twice now, two weeks ago, and yesterday. At the first visit, he took various measurements, and did an elaborate assessment. He said the principle problem was NOT knee tracking or arthritis - though he says at my age, there is probably some arthritis that just isn't detectable yet. He says I have some very short muscles - including but not limited to hamstrings and ITB, as well as poor posture and alignment, and insufficient muscle strength in certain muscles. He says I have compensated for short muscles and poor muscle strength by moving in inefficient and unhealthy ways. (Maybe he is right, and the first PT was wrong?) He also says I am very asymmetric: my right side muscles are shorter and weaker. (I've try to be careful to work on skating skills in a symmetric way, e.g., spinning and jumping in both directions, but perhaps not carefully enough.)

He prescribed much more specific exercises, one of which so far has helped a little. He also says to do more cross-training, and to avoid jumping, hard impacts, and direction changes - e.g., skating.  At least for now. As a matter of fact, he gave me exercises that will take 1 or 2 hours, twice a day, and leave my muscles sore (as he says they should), so skating would have been hard.

I think, for now, that he is pretty good.

But my insurance company will only pay for 30 visits. That sounds like a lot, but at about one/week, it will run out. And I've always liked to figure things out for myself.

Are there any good books or videos that will help me figure out what is wrong with the way I move or my posture, and how to fix it? He said he didn't know of any offhand, perhaps other than medical textbooks, which may take a lot of effort to understand. (Plus, medical specialists also receive extensive practice in supervised diagnosis and treatment, that no book or video can match.) He did suggest I study "mindfulness", which he explained as awareness of body posture and muscle use. I've looked the word up, and it seems to be used in connection with Yoga meditation, but I don't think meditation is what he means.

Do you know of any good books and videos in this area?

BTW, for those who can afford it, or can convince their insurance company they need it, I've decided a good sports PT may be very useful - in some ways just as useful as a good coach. At least for a while, to make sure you are moving right. But I'm told that physical therapists differ from each other a lot. I don't know how to figure out who is good. The 2009 therapist was recommended to me by a couple relatives, neither of whom are athletes, though he claimed to have treated a fair number of dancers and skaters. He has PT, DPT, MPHTY ST, OCS, FAAOMP, ATC degrees or certifications. The current one has PT, DPT, SFMA, SCS EP-C. Both are in charge of their clinics. But I don't know what those degrees or certifications mean, or if there are good ways to figure out who is any good.

[Query]

My Physical Therapist (or rather, his Physical Therapy Assistant) gave me the name of what might be the leading introductory textbook in Physical Therapy:

Therapeutic Exercise Foundations and Techniques
Kisner, Colby and Borstad

https://www.amazon.com/therapeutic-exercise-foundations-techniques-carolyn/dp/9352703197/ref=sr_1_2?ie=UTF8&qid=1542324346&sr=8-2&keywords=therapeutic+exercise+foundations+and+techniques+7th+edition

Preview it for free at

https://books.google.com/books?id=yZc6DwAAQBAJ&printsec=frontcover#v=onepage&q&f=false

It is a textbook, and uses more words, and more complicated words, than are required. You will have to look up a lot of its terms. It is definitely not a recipe book for fixing things. And it is my personal observation that virtually all introductory scientific textbooks sometimes get things wrong at least once every few sentences - e.g., the over-simplify, or say things that are approximately right under certain restrictive circumstances, or they say something totally wrong. On top of that, the book is written from the viewpoint of the therapist, not the patient - e.g., it shows how to examine a patient to detect movement issues, not how to do a self-examination, and it shows many ways in which a therapist can assist a patient.

Nonetheless, it is a reasonably authoritative source on fixing movement problems.

Rather than a simple index of poses, like you might find in a book of Yoga poses, it tells you what you are trying to achieve with each exercise, and to at least some extant, what muscles you should use to do so.

I would love to see something more concise written at a lay level. Anyone know of one?

[Doubletoe]

Sounds like your physical therapist is giving you exactly the right exercises.  If you get 30 sessions with your PT, you ought to be able to continue the exercises on your own.

[Query]

Actually he only gave me 6 - he said I was cured.

And I was - of the knee pain. But I had hoped to get more sessions, so I could use him like a personal trainer, to give me tips on exercise. He said PTs are for disabled people, and that I didn't qualify. I could have responded that I was seriously disabled compared to most figure skaters, but that wouldn't have convinced him.

I gave up trying to read the PT textbook I mentioned above - it would take many months to understand even the basics.

For tips on exercises, I may go back to reading The American Physical Therapy Association Book of Body Maintenance and Repair. One of the authors Marilyn Moffat, is a PT who used to be president of the American Physical Therapy Association (APTA), which many U.S. PTs belong to. Published in 1999, it might be out of date, the anatomy drawings omit some things mentioned in the text, and it too uses Latin names for body parts, but I haven't been able to find anything better.

Unless one of you knows something better?

[rd350]

Both saying that PT is for disabled people and giving you the name of a textbook (without instruction on proper execution of technique) are equally wrong and ridiculous.  I'd find a new PT.

PT is also for neuromuscular reeducation, instruction on proper body mechanics, muscle firing patterns.....so, so much more. 

[Query]

>PT is also for neuromuscular reeducation, instruction on proper body mechanics, muscle firing patterns.....so, so much more.

But his time was paid for by the health insurance company. It is hard to justify insurance paying for using "proper body mechanics", unless it causes immediate health problems. Health insurance companies aren't there to help me become a better athlete.

Anyway, some of what he did involved proper body mechanics, things I didn't understand before he showed me.

E.g., I had learned a walking gait from a backpacking book called "The Complete Walker" (by Colin Fletcher), many years ago, that involved binging each foot directly in front of the other. (Colin called it "Indian Walking".) The PT said that, for a male with my poor flexibility, that was an unnatural and unhealthy technique.

Also, he and his assistant showed me that a straight posture should mostly be created by tightening the butt (which I had thought should only be done on the toilet), and to some extent by tightening the lower abdominals - not by consciously bending the spine, which creates an unnatural and unhealthy curvature.

He also had me stretch my hamstrings and nearby muscles, and my piriformis. Not only do they severely limit my range of motion, but those short muscles, he said, were the main cause of my knee pain.

And he had me strengthen a number of lower body muscles, which he thought contributed a bit to the pain. (Note that I had mostly stopped skating, and other lower body exercises due to a hernia and the aftermath of the surgery that the hernia created. Now I should be able to get back to them.)

The fact that the pain disappeared in 6 weeks of doing the exercises he and his TA showed me shows he was right.

>giving you the name of a textbook (without instruction on proper execution of technique) [is] wrong and ridiculous.

He and his assistant showed me how to do the exercises they told me to do.

I ASKED for the name of good book, because I wanted to learn more on my own, and to continue with more things after the insurance sessions were done. He did not know one, but finally relented after much pestering, and told the PT-assistant to give me the name of the textbook he was training with, which may be the most common textbook for PTs as well.

In fact, everything he did was excellent, and, I believe, was done much better than what a previous PT, many years ago, had me do for knee pain. That other PT thought I had knee tracking problems, due to unbalanced muscle strength, and had me do generic leg raises. It took that prior treatment a year of exercises to fix - if even it was responsible at all for the fix. It is a tribute to this PT that he didn't just take the easy way out and accept the previous PT's diagnosis, but conducted systematic tests and measurements, came to his own diagnosis, and created an effective treatment.

I only regret that I can't use him in an insurance-paid fashion, and that I can't afford him on my own.

P.S. He also showed me something that I find very strange. I can balance fairly well standing on one leg. In fact that was one of the exercises he gave me. But - if I close my eyes, it becomes an order of magnitude harder. I didn't realize I was using my eyes for balance. (Try it!) How weird is that?