PT evaluation, what to ask and what to expect?

[Ginger_]

My cardio just referred me to get PT and I have the evaluation appointment Monday.  The therapist I’ll be working with does have experience with treating POTS patients.  What’s are some of the questions I should be asking? And general expectations? 
 

I should note I’ve never been to PT before so I don’t know what to expect.

[MikeO]

Depends on what the reason your Cardiologist put in for a referral reason. My experience with the initial evaluation is the PT will ask a series of questions related to why you are there. I would also bring up your (POTS), for me i never used the term POTS (did not want to go thru explaining that) i simply stated that my ANS (nervous system does not always work as expected) causing me (use whatever effects you) They may check your gate or range of motion, muscle strength, what hurts etc... I would ask what to expect as to how many sessions you may need (planning help for yourself). Questions will become apparent as you get into the eval.   

[Pistol]

Dear @Ginger_ I had PT for deconditioning from POTS after a year long bad flare that heft me essentially bedridden, and again a few years later, again for POTS. Both times were different providers. The first one did not know about POTS and wanted me to do too much until I was able to prove to him ( by displaying it ) that I was unable to tolerate upright or rigorous exercises. After that he changed the exercises to lying and sitting, and that was better. 

The second time was for generalized joint pains, and the exercises were more geared towards range of motion and muscle strength. This therapist was very knowledgeable about POTS and spent a lot of time evaluating my orthostatic and exercise tolerance, and then recommended exercises that were good for me. The exercises ranged anywhere form Yoga positions to exercises using a rubber band to supine exercises strengthening the core muscles ( this s recommended for POTS )

21 hours ago, Ginger_ said:

What’s are some of the questions I should be asking? And general expectations?

It's a really great thing that you have a knowledgeable therapist! For me the most important factor was determining my tolerance. Once it was established what I could tolerate ( and that changes from person to person ) he found the right exercises. I cannot stand in place for more than 2 minutes without developing symptoms, so he avoided making me stand for longer than that, but upright exercises WERE included. Also it was very important to start each exercise slowly and then increase each time I went. He also added new exercises over time. 

I agree with @MikeO that it depends on the reason why you were prescribed the PT. If it is for a particular injury or illness the exercises will be different than those for overall mobility. Good Luck - and please let us know how you are doing!

[Ginger_]

Thanks for the feedback! 
 

to be honest when the doctor recommended it, he didn’t explain his reasoning much. The script even just says to treat POTS.  I have no injuries or range of motion issues, mainly just intolerance to exercise.  I imagine this is mainly to help circulation to build up tolerance and stamina. 

[Pistol]

@Ginger_ sounds like the PT is to determine your exercise tolerance and then teach you exercises that you can gradually increase. That is a very good opportunity for you! Whenever I am not up to exercising as much I go back to the sitting exercises they taught me! The PT back then explained to me the difference between activities that GIVE energy and the ones that ROB us of energy. Sadly anything upright is in the second category for me 😒

[GasconAlex]

Physiotherapy is also really good to make sure that you do the exercises. It's much harder to backslide when you have someone making sure that you do the exercises. They can also help by giving graded exercises depending on your progress/ state of health. The exercises should help so a great opportunity. 

[Ginger_]

@Pistola little update for what its worth

i started pt about a month and a half ago, loosely going off the chop exercise program (it wasn’t one designed for kids but all pots patients) but not at the same time lol. Most exercises are laying down or seated atm, and some kneeling are starting to be added in. The improvement is drastic, I actually had a period of about a week i only had symptoms once or twice, and i’m not feeling palpitations to the same degree if at all when strength training. Stairs are still my enemy, but i feel great when doing basically everything else! i even forgot to take my morning salt dose one day and worked a full day with zero issues. 

currently i’m on a 4 lead heart monitor for 30 days (todays day 3) for getting a second opinion. The past two days were my most symptomatic as i was very active, but i didnt have to stop working at all which would happen previously. I’m also finding people who are actually interested in helping me and researching pots to better help me which is amazing.
 

[MikeO]

Hi @Ginger_Happy to hear you have made significant progress! Keep up the good work it only gets better.

[Pistol]

@Ginger_ fantastic news! Thanks for the Update, I am really happy you are finding exercise improves your symptoms! Many of us get to the point where we find exercise intolerable and therefore avoid it, but it really helps to push through, however slowly we can. Yes, my PT also started me out lying and sitting and then it didnt take long to be able to do upright exercises. Remember all the exercises, even write them down or ask the PT to give you a print out, so you can continue the regimen even after the PT has ended!

I have "graduated" to a rowing machine - I tolerate this really well bc I can exercise all my muscles at once while sitting down! Most days I am able to use it twice a day, and if I have a flare and end up in bed then I gradually start from scratch and increase the reps slowly. 

Again - thanks for the good news!

[Ginger_]

13 hours ago, Pistol said:

@Ginger_ fantastic news! Thanks for the Update, I am really happy you are finding exercise improves your symptoms! Many of us get to the point where we find exercise intolerable and therefore avoid it, but it really helps to push through, however slowly we can. Yes, my PT also started me out lying and sitting and then it didnt take long to be able to do upright exercises. Remember all the exercises, even write them down or ask the PT to give you a print out, so you can continue the regimen even after the PT has ended!

I have "graduated" to a rowing machine - I tolerate this really well bc I can exercise all my muscles at once while sitting down! Most days I am able to use it twice a day, and if I have a flare and end up in bed then I gradually start from scratch and increase the reps slowly. 

Again - thanks for the good news!

Thank you!
 

Yes! The PT is giving me a list of all the exercises. It’s amazing to me how much of an effect it had.

i had another win today!  there is a specific flight of stairs that always makes my HR hit 155-170 and today it only hit 120! My heart was pounding for a few minutes as per usual but I haven’t done that well in so long.