I've had knee problems for 20 years, and I feel that my relationship with physiotherapy has become increasingly complicated as my injuries have become more complex.
Back when I'd only had ONE ACL surgery and ONE meniscus surgery, following a standardised rehab programme worked really well. But after surgeries number 3, 4, and 5, things have been different, and I've felt the need to adjust my whole approach to rehab.
After my third surgery, I was really committed to my rehab and followed my physio's programme very closely. In my opinion, the programme ended up being too ambitious, and my knee didn't respond well to the intense training. It was only when I stopped seeing the physio and switched to gentler gym sessions on my own that things finally started improving. After that, I had relatively good knee function for 10 years and was able to go on long walks without pain.
Then, this summer, I had another setback in connection with physiotherapy. I'd originally sought help for back pain, which I honestly believe has more to do with spending too much time sitting than with my knee problems. But because the physio noticed a strength imbalance between my legs, she gave me a fairly ambitious leg-strengthening programme.
I followed her advice to be braver, to dare to lift heavier weights, and not to be afraid. In connection with this, I developed new injuries with a loose body in my knee, a sharp fragment of bone that had broken off and somehow embedded itself in the cartilage. I've now had surgery to remove it, and after three months on crutches, my leg is weaker than ever. So I'm really back to square one.
My physio recommended that I try another clinic with access to a larger gym, and I went there for the first time yesterday. Unfortunately, it was a really bad experience, and I ended up going home in tears.
During the appointment, I tried to explain my experience of how my knee has often gotten worse with overly intense physiotherapy, and how it has responded better to slow, gradual progression that keeps pain levels from getting too high.
He didn't seem to agree with my assessment at all. Instead, he suggested that I was engaging in avoidance behaviour and said that cognitive behavioural therapy could help with that.
He was very firm in his no-pain-no-gain approach. Essentially, his view seemed to be that if you're doing exercises you feel comfortable with, you're not pushing yourself hard enough.
In theory, I don't necessarily disagree with that. But in practice, I feel that this approach hasn't worked well for me over the past 10 years.
What I've found works better is starting within my comfort zone and then taking baby steps to gradually expand it. Even with that approach, you still have to challenge yourself and tolerate a certain amount of pain, of course. But you do it in a gentler, more gradual way, which, in my experience, makes all the difference.
I guess I'm mostly writing this to vent.