Physical Therapy

April 4, 2005

Carol V.,

From what I've read, physical therapy is recommended for the early

stages of flatback syndrome. Unfortunately, nobody told me in my

early stages, but I wish they had. Perhaps my hip would not have

developed such a severe flexion contracture if I was getting some

guidance on how to combat it with exercise.

Much later in the progression of my flatback I was given a

prescription for physical therapy for my back, at the same time I was

receiving physical therapy after my hip replacement. I think I was

fortunate in that I received more than just directed exercise -- such

as the PT manually assisting me to stretch my muscles, massage,

ultrasound, heat, electric stimulation, with the goal of, not just to

rehab my hip, but to get me in overall better physical shape and

relieve some of my pain.

Most exercise aggravates my hip or back pain, so it takes a lot of

experimentation to figure out what I can do without hurting too much.

For the exercise part, I think it is necessary to keep doing

exercises permanently, so as to continue to maintain muscle health.

I think keeping the leg and hip muscles stretched and as strong is

possible is really important on an ongoing basis for anyone with

flatback syndrome.

It is a difficult decision on whether to have revision surgery, as

there are many risks. If you get to the point where you are leaning

toward having surgery, I hope you will get inspiration from the folks

on this site who had successful revision surgeries. Maybe we should

start a thread for newcomers (or even a file in the file section of

this site) called " Why are you glad you had your revision surgery? "

At this point, I am becoming too afraid of getting worse to NOT take

a chance on revision surgery. I've used a wheelchair to get around

theme parks, and I definitely would not want to have to use one

permanently.

Yeah, scoliosis does suck. I'm glad we all have each other for

support,

loriann

>

> Thank you all for your responses to my posts last week. I am trying

> to get into a local Orthopedist, but someday I'm sure will have to

> see Dr. Hu or Dr. Berven at UCSF. However, one question came into

my

> mind yesterday and I was wondering if any of you " flatbackers "

(like

> me) have had their doctors recommened physical therapy for their

> pains. I have been referred twice (at two different times several

> years apart) for physical therapy, and it does seem to help--for

> awhile--and then the pain comes back. But perhaps that's because I

> don't follow through and continue the exercises long-term. I just

> wanted some responses from some others if physical therapy had been

> of any help to them--especially long term, or does it do no good

for

> us " flatbackers " long term? Do we just all have to face future

> surgery, or are there other alternatives for the pain?

>

> As a side thought I read someone's description of surgery and how

> she's in horrible pain now and some screws have come loose and had

to

> be taken out--now I'm wondering whether I should ever consider

> surgery in the future or just plan to be in a wheel chair and live

on

> chronic pain medication? What a choice!! Indeed--Scoliosis does

> suck!!

>

> Carol V.

April 4, 2005

Hi all:

I'm 5 months post-op today (yeah!) and have been doing PT-only to improve

quads/hams strength and upper arms/shoulder strength through stretching and

strengthening exercises. For now, the 2 x/week PT routine is heat application

to shoulders, then the stationary bike (both arm and leg bike), stretching done

passively by the PT, strengthening exercises (such as straight leg raises and

resistance tubing for the arms) and then ice to knees and shoulders, since those

are my problem areas at the moment. Presently, I am not to do any core

strengthening exercises and my only exercisesfor abdominal strength are

isometric (laying on my back and not moving any muscles except contracting the

abdominals).

I have gone into our local warm water therapy pool and walked around,

which feels very good. I've not yet put on my Aqua Jogger and gone into the deep

end, as I used to do, but hope to be ready for that by summer.

Martha

joannhueth <joannhueth@...> wrote:

-I´m also 6 months postop and was told not to do anything except

walk. What kind of stretching and core strengthening do you do and

for what part of the body?- And what does the PT do with you? Thanks.

- In , K Sutton

<suttoncgnj@y...> wrote:

> Hi Carol V. Physical therapy really did help me and it

> got me off pain medications. I highly recommend it.

> When my PT ended, I even joined the local gym and used

> the treadmill and recumbant (<sp?) bicycle - along

> with continuing to do the stretches and core

> strengthening exercises I was given. As for surgery, I

> choose to have it last year for various reasons. It

> was rough. But I am almost 6 months post-op and am

> thankful I did it. I am also going to physical therapy

> now and take no pain medications. I wish you good luck

> in your search for a doctor. Keep us posted on how you

> make out. Take care -Kathi in NJ

>

> --- Carol <dcvaughan@s...> wrote:

> >

> > Thank you all for your responses to my posts last

> > week. I am trying

> > to get into a local Orthopedist, but someday I'm

> > sure will have to

> > see Dr. Hu or Dr. Berven at UCSF. However, one

> > question came into my

> > mind yesterday and I was wondering if any of you

> > " flatbackers " (like

> > me) have had their doctors recommened physical

> > therapy for their

> > pains. I have been referred twice (at two different

> > times several

> > years apart) for physical therapy, and it does seem

> > to help--for

> > awhile--and then the pain comes back. But perhaps

> > that's because I

> > don't follow through and continue the exercises

> > long-term. I just

> > wanted some responses from some others if physical

> > therapy had been

> > of any help to them--especially long term, or does

> > it do no good for

> > us " flatbackers " long term? Do we just all have to

> > face future

> > surgery, or are there other alternatives for the

> > pain?

> >

> > As a side thought I read someone's description of

> > surgery and how

> > she's in horrible pain now and some screws have come

> > loose and had to

> > be taken out--now I'm wondering whether I should

> > ever consider

> > surgery in the future or just plan to be in a wheel

> > chair and live on

> > chronic pain medication? What a choice!!

> > Indeed--Scoliosis does

> > suck!!

> >

> > Carol V.

> >

>

> __________________________________________________

>

April 4, 2005

My latest PT was to strengthen my shoulder muscles because I was

having (and still do sometimes) pain in my shoulder and down my arm.

This second round of PT was for the shoulders and arms. I use Thera-

Bands and also some light weights. The other time I did it, they gave

me exercises for my lower back, but I didn't follow through on them.

I still have the pain there, but now I know WHY thanks to this group.

I am fused from T5-L4, and L5 is obviously taking a lot of strain,

and that is what causes the pain. Now I've also found out why I'm

tired all the time--the strain of trying to keep myself upright and

the almost constant pain (somewhere in my body). Pain just drains a

person. The problem with taking medication, is that I don't want to

go on narcotics because I have to work 40 hrs. a week. And very few

non-narcotic pain relievers help that much. If anyone out there has

advice on what pain relievers to take, I would appreciate it. I take

800 mg. Ibuprofen, but it hardly takes the edge off most of the time.

I've started using Methocarbamol (generic) muscle relaxant every

night to go to bed. By the end of the day, I'm very tired and in

pain.

> > >

> > > Thank you all for your responses to my posts last

> > > week. I am trying

> > > to get into a local Orthopedist, but someday I'm

> > > sure will have to

> > > see Dr. Hu or Dr. Berven at UCSF. However, one

> > > question came into my

> > > mind yesterday and I was wondering if any of you

> > > " flatbackers " (like

> > > me) have had their doctors recommened physical

> > > therapy for their

> > > pains. I have been referred twice (at two different

> > > times several

> > > years apart) for physical therapy, and it does seem

> > > to help--for

> > > awhile--and then the pain comes back. But perhaps

> > > that's because I

> > > don't follow through and continue the exercises

> > > long-term. I just

> > > wanted some responses from some others if physical

> > > therapy had been

> > > of any help to them--especially long term, or does

> > > it do no good for

> > > us " flatbackers " long term? Do we just all have to

> > > face future

> > > surgery, or are there other alternatives for the

> > > pain?

> > >

> > > As a side thought I read someone's description of

> > > surgery and how

> > > she's in horrible pain now and some screws have come

> > > loose and had to

> > > be taken out--now I'm wondering whether I should

> > > ever consider

> > > surgery in the future or just plan to be in a wheel

> > > chair and live on

> > > chronic pain medication? What a choice!!

> > > Indeed--Scoliosis does

> > > suck!!

> > >

> > > Carol V.

> > >

> >

> > __________________________________________________

> >

April 4, 2005

Thank you for the thoughts. I know what you mean. I think most of my

problems come from L5 or some other vertebrae down there. Since I'm

fused from T5-L4, so I guess L5 would be the culprit. So yeah, I

would be real leary of some kind of therapy that would make it worse.

I did finally get a consultation to a local Orthopedist for next

Tues. the 12th. We'll see what he says. I'll bring my info.

about " flatback " and I'll ask him if he's heard of Serena Hu and

Sigurd Berven and their research and surgery. I don't want to have

surgery, but we'll have to see how it plays out in the future.

>

> Carol V.

>

> Before I had the flatback diagnosis and thought most of what was

> going on was in my hip my local orth prescribed vioxx and PT.

>

> Alot of what the PT did was core strengthening stuff....but to be

> honest, working with her coincided with the onset of the beginning

> of the most severe symptoms and pain onset. In retrospect, I think

> that it is possible that working on the swiss ball and a couple

> other moves might have actually pushed ol' L-5 over the edge..but

> that was just me. It did drive me to find and set up an

appointment

> with a qualified revision surgeon, pain is a great motivator.

>

> At that point I was offered epidurals as interim care and long term

> relief solution was surgery...which I had 7 weeks ago. The only

> excercise recommended in the interim was swimming, which I did. I

> definely felt that my swim program (actually I didn't do much

> swimming...mostly working out in the deep end with an aqua-jogger)

> did alot for establishing and maintaining abdominal, paraspinal and

> quadricep strength (also cardio endurance)........good muscles to

> have in shape pending the recovery phase of flatback revision

> surgery.

>

> When I spoke with my surgeon regarding when I could resume a water

> workout during recovery he said that in the water was the only

place

> where the spine was supported on all axis.

>

> Maybe your local ortho can at least guide you in selecting an

> appropriate hydro-therapy program if you happen to be lucky enough

> to have one. I wasn't so lucky, but I spoke with the intructor of

an

> Aqua Aerobics class about my situation and then took her class once

> to see if it was right. I didn't care for the class, I had to

modify

> too much, so the instructor lent me the Aqua Jogger video and after

> a study of that I figured out what was going to work for me, and it

> seems to have worked for me.

>

> As always, consult with your doctor and remember to listen to your

> body! Good luck, Cam

April 5, 2005

Martha's post reminded me I'm 5 months post-op, not

almost 6. Anyway, I go to PT 3 x week. When I first

started PT in February (surgery was November), I was

not driving and was in constant recovery pain. The

therapist did a lot of massage, occasionally used

ultrasound on my muscles, used moist heat, and helped

me stretch my legs. Then I started stretching

hamstrings, adductors and abductors, quads on my own

using a strap, and started using the recumbent bicycle

and the elliptical trainer for a few minutes each

session. I also added ball core strengthening. My

routine built up from there adding more exefcises and

time and workload on the machines. Last week, I was

doing squats into and out of an armless chair, using

small weights on legs for the ball exercises

('marching'), doing leg pushes on the total gym and

balance exercises on the small trampoline (not

jumping!). My therapist also has me practicing the

golfer's bend to pick things up off the floor.

Sometimes he drops things just to make me pick them

up! I also practice kneeling on the mat and getting

myself back up - while holding onto a support. By the

way, the therapist always 'spots' me. JoAnn, hang in

there. Your surgery may have been more involved or

your doctor may not want to start you in PT just yet.

- Kathi in NJ

--- joannhueth <joannhueth@...> wrote:

>

> -I´m also 6 months postop and was told not to do

> anything except

> walk. What kind of stretching and core strengthening

> do you do and

> for what part of the body?- And what does the PT do

> with you? Thanks.

>

__________________________________________________

April 5, 2005

I went to PT after being diagnosed with flatback

syndrome, grade 2 spondylolisthesis (slipped spine

L5/S1) and obliterated disc. My PT was 3 x week and I

went for 12 weeks while waiting for my surgery. It

really helped me get off the constant pain meds and I

believe it prepared my muscles for the assault - I

mean the surgery. Just to let everyone know - I

researched physical therapy facilities and therapists

the same as I did revision surgeons. -Kathi in NJ

-- cammaltby <cammaltby@...> wrote:

>

> Alot of what the PT did was core strengthening

> stuff....but to be

> honest, working with her coincided with the onset of

> the beginning

> of the most severe symptoms and pain onset. In

> retrospect, I think

> that it is possible that working on the swiss ball

> and a couple

> other moves might have actually pushed ol' L-5 over

> the edge..but

> that was just me. It did drive me to find and set

> up an appointment

> with a qualified revision surgeon, pain is a great

> motivator.

>

__________________________________________________

April 5, 2005

Carol,

I am sorry I can't remember exactly where on the revision " merry-go-

round " you are, if you have consulted a surgeon or are actually

moving toward it.

You are right, pain is exhausting. In the year leading up to my

surgery I was unable to use narcotic medication due to my job...it's

just not permitted, so I had to find other ways.

My local ortho had started with Vioxx when we first thought this was

mostly a hip thing...then after the " scare " I was switched to

Bextra..then finally to Celebrex. I actually found the most relief

with the Celebrex and wish I hadn't been on the other stuff. Most of

my pain was neuropathic/sciatic/spasm kinda stuff.....and what I

found most useful in many instances was gel ice packs.

During a paticularly acute phase I was on Toradol/keterolac for

about 30 days...which is about 20 days longer than preferred, but it

did help.

I also asked Dr Rand to prescribe the Lidocain patches, which he

did, others on this board have had good luck with them, but because

most of the spasms were so deep I just don't think they were very

effective for me.

The only other good news I can offer is that going into surgery

without having taken much narcotic pain relief supposedly is a bit

of a benefit in terms of being able to use lower doses of morphine

based products post surgery. In other words since you will not have

developed a tolerance, less will be more. That did turn out to be

true for me. That doesn't mean that I wouldn't have used other drugs

in the periods that were so excruciating...I might have...but I

would have burned all this sick time that I needed to recover from

surgery so I just had to get through it.

I was filling out some questionaire the week before my surgery and

they were asking about pain control...none of the choices were

correct so in " other " I had to fill in " grit my teeth " .

I suspect with this group that technique is more common than the

doctors think.

Good luck in your search for relief, Cam

April 5, 2005

Kathi

You said " It really helped me get off the constant pain meds and I

believe it prepared my muscles for the assault - I mean the surgery. "

Exactly my experience in that strong muscles (which I did by

swimming)really help beginning that first time 24 hours after

surgery and the PT walks in and says they are going to get you

up...YOWEE....and I love the choice of the word " assault " because

that is precisly the way it felt.

You are lucky living in an urban area where you actually do have a

choice of Physical Therapists. After my previous experience I am

pretty frightened of what a PT might propose with this long fusion.

I don't think there are enough of us around for it to be likely that

many PT's will know what to do with us. I suspect that is why Rand

only permits walking/swimming until he feels the fusion is pretty

solid...he knows I live in the " boonies " , medically speaking!

Off for my walk..and it actually feels like spring today!...Cam

June 26, 2005

Annette,

Good luck with your PT. No matter what comes there is no reason not to

be in the best shape possible. It sounds like it is helping with your

pain and it will help to be in good shape cardio wise and in your legs

should you decide to undergo surgery.

One think to think about....I assume you have...if you get laid

off/downsized, whatever...you won't loose your health benifits will

you?

Cam

June 26, 2005

Hi Annette – I’m glad you

posted. I don’t see many members from the Baltimore/Washington, DC area.

I live in Ellicott City. MD and have pretty

much exhausted the resources up here. I have been through the doctors at Shady Grove

Hospital when I wasn’t

in much pain starting in 1995. After having my daughter in February, 2004

my pain began to worsen, so the doctor in Shady Grove suggested working with a

PT. I had Electrical Stimulation and some PT work – but neither really

helped.

I began searching for an answer. I

didn’t know exactly what problem I had. I started to go to the

doctors at the Scoliosis & Spine Center at St. ph’s

and the University

of land. The

doctors at St. ph’s

gave me Mobic (which works fairly well). Without the Mobic I cannot stand

up straight. They then sent me to their pain specialist – Dr.

Panlilio for a facet injection. Which did not work. Dr. Panlilio suggested

swimming and exercise and gave me Tramadol. I take that at night to relax

me. A doctor at St. ph’s

Spine Clinic finally told me I did have “Flatback” only after I

asked if that was what I had. I seem to agree with many members on this

board about the doctors not wanting exactly say what our “problem”

really is. I asked this doctor how many of these surgeries he had done

before and his answer was “one” and he was “confident he

could perform the surgery.” (At that point I knew I had to run!)

I toyed with the idea of going to Dr.

Lauerman at town, but instead I’m

returning to the site of my original fusion done in 1973 at the Hospital of Special Surgery and seeing Dr. Boachie.

I had an appointment with Dr. Boachie on June 3rd, but his office

called and I had to postpone my appointment to July 1st.

My biggest dilemma, like many of us, is

determining whether or not I really need surgery right now. I have a 16

month old daughter and I can’t imagine being laid up and not being able

to take care of her for the long recovery period. I’ve had a lot of

great feedback from other posters about having surgery when you have young

children and if it can be postponed, it is greatly recommended.

I am so looking forward to my consultation

with Dr. Boachie. I feel I will really be able to get an answer as to how

long I will be able to wait to have surgery or is there a less invasive option

open to me right now. I’ve come to the decision that if and when I

do have surgery, I will no doubt have one of the top doctors (like Dr. Boachie)

perform the surgery. So this week I’m composing my notebook of

questions for our consultation in between chasing my daughter throughout the

house!

Best of Luck

Lorrie Snyder

June 27, 2005

I annually review my health insurance coverage carefully as my

employer has changed it in the past. I have very good coverage, I am

fortunate to say. I plan to make full use of the tax deferred health

expense account when I'm closer to the decision. If I got laid off,

we would use COBRA and we are saving for the extra expense. That

timing makes sense for us as taking off work for months will be hard

in my job unless it became absolutely necessary. (I guess that's true

for most of us, isn't it?) You are right that there is a significant

financial component to this decision. Thanks and best,

Anentte

> Annette,

>

> Good luck with your PT. No matter what comes there is no reason not to

> be in the best shape possible. It sounds like it is helping with your

> pain and it will help to be in good shape cardio wise and in your legs

> should you decide to undergo surgery.

>

> One think to think about....I assume you have...if you get laid

> off/downsized, whatever...you won't loose your health benifits will

> you?

>

> Cam

June 27, 2005

Lorrie,

Occasionally the DC Metro area contingent surfaces. There are a few

folks I know here who suffer at varying levels and probably many more

who like many of us had a hard time figuring out what this

slow-developing chronic pain is. Great that you are seeing Boachie.

I haven't consulted with him and I may yet. But for now I'm leaning

toward someone local. I haven't been back to s Hopkins since

Kostuik retired, but I suspect that the doctors there who studied

under him would be very good also.

Best,

Annette in VA

June 27, 2005

Annette,

Yeah, I guess having the opportunity (if you can call it that) to

decide if and when to undergo surgery really underscores that this

is " elective " surgery, as they say.

Looking at Health Care spending accounts and timing them helped us

over the " hump " . I knew we would have to cover the deductibles and

co-pays so I set that up in advance, knowing I would be able to

recieve that check up front from that account.

You sound like you are a pretty savvy health care consumer so you

probably know that you need to be an employee to access those

benefits.

This surgery does have financial consequences. I had enough sick

leave to be out paid for three months. I have now used it all up

and would have to go to unpaid leave if I had needed more...but

since I carried the health benefits I was hoping that wouldn't

happen. We decided my husband would take upaid leave under FMLA to

take care of our son, me and the household right after surgery...but

we definitly figured our $$$ out in advance so we could accomodate

that.

Cam

June 7, 2006

Hi - Jacki here.

My daughter has had 4 casts in total, and two Boston braces, and has

been in physical therapy since she was 2 yrs old (she's nearly 7

yo). We found that while she was in her casts, there wasn't much

physio to be done. As soon as she came out, the therapists worked

(hard) with Siobhan to regain all the muscle strength she'd lost

while being casted.

When she came out of her last cast, Dr D'Astous sent us to the

Physical Therapy room at Shriners. There they gave us lots of

different exercises to work on, including printouts to give to her

therapists here at home.

HTH

Jacki

>

> In reading all your posts, it seems that several of your children

are in

> physical therapy for various reasons. Dr. D'Astous didn't

mention anything

> about that, should I be pursuing this further with him, or

another Doc?

> Alison is in her first cast for idiopathic infantile scoliosis.

41 degrees

> before, 10 in the cast. Please let me know your thoughts on this..

>

> Thanks

>

> PS: If Oprah ever calls, I wanna come, I need a vacation...<grin>

>

> _____

>

June 7, 2006

We asked about physical therapy for Cole, but was told it was not necessary. Cole is 15 months now and in his 4th cast. Although he has not mastered walking, he is very close and still falls within normal ranges. Because of his cast he crawled later, pulled up on furniture later, etc., but all was within normal ranges. Probably 2-3 months behind what I would have expected. I did have him see my PT friend who agreed that PT wouldn't do much for him. He just has a little more weight to balance and will take a little longer. That's our experience with investigating PT, it may be different in Alison's case.Take care. <urbanmattandrea@...> wrote: In reading all your posts, it seems that several of your children are in physical therapy for various reasons. Dr. D’Astous didn’t mention anything about that, should I be pursuing this further with him, or another Doc? Alison is in her first cast for idiopathic infantile scoliosis. 41 degrees before, 10 in the cast. Please let me know your thoughts on this…. Thanks PS: If Oprah ever calls, I wanna come, I need a vacation…….<grin> __________________________________________________

June 7, 2006

If you are concerned about Alison not meeting

milestones you can always get an evaluation done by

Early Intervention- if they determine that she does

need pt, they will provide it. Or, if you feel

confident with your ped, ask him/her. Owen receives

pt, but he has other non-related health issues that

requires the therapy.

How is she doing with her cast? When are you

scheduled to go back to SLC? I think we will be there

the week of Sept 5, but I'd have to check. We were

super lucky that Owen doesn't need a cast at this

point, but he still needs to go into traction for his

brace (he had a tethered spinal cord, and since he had

surgery to release it, his scoliosis is getting better

with just the brace- at one point he measured 46d and

now is 23d out of brace. of course that can change

depending on how straight he is standing- when he's

tired it is probably closer to 30)

good luck to you, and i'll be right there with you at

oprah!

allison

> <urbanmattandrea@...> wrote:

>

> In reading all your posts, it seems that several

> of your children are in physical therapy for various

> reasons. Dr. D’Astous didn’t mention anything

> about that, should I be pursuing this further with

> him, or another Doc? Alison is in her first cast

> for idiopathic infantile scoliosis. 41 degrees

> before, 10 in the cast. Please let me know your

> thoughts on this….

>

> Thanks

>

> PS: If Oprah ever calls, I wanna come, I need a

> vacation…….<grin>

>

> ---------------------------------

>

> __________________________________________________

>

February 7, 2007

I was diagnosed with mild lumbar spinal stenosis, a bulging disc and

facet joint syndrome a year ago. For a year before the diagnosis I

tried a chiropractor and PT with no improvement. I also tried PT

again after the diagnosis but did not get practical tips like what

to do while standing in line. I am seeing a pain management

specialist who tried epidural injections with no results and have

tried radiofrequency nerve ablation for the facet joint syndrome.

Now he wants to try intradiscal electrothermal therapy.

Stenosis symptoms have progressed to the point where it is

uncomfortable to stand for even short periods of time.

Pain levels vary from mild to debilitating.

Someone in our area with both facet joint syndrome and stenosis had

arthroscopic laser spine surgery at the Laser Spine Institute with

very favorable results. Anybody familiar with this?

> I am a new member not yet diagnosed with Lumbar Spinal

Stenosis but

> with all the Symptoms. I was wondering if you might have any advice

> for me given you are moderator for SS Disability in US. I can

barely

> walk, regular daily pain, some bladder incontinence. But I am from

> Canada. Do you know of anyone that I might be able to link up with

> from Canada, with L Spinal Stenosis. Also anyone who may have

applied

> for our disability here, CPP Disability. My name is in to see an

> Ortho but I have been a yr with these symptoms and debilitated.

> Tnx, Bev

>

> ---------------------------------

> Get your own web address.

> Have a HUGE year through Small Business.

>

July 5, 2007

Alana, the pain in the shins you described sounds alot like Shin

Splints. Have no idea whether or not that's it, but maybe something to

look into? I know alot of runners get them, just how active have you

been since you've been off for the summer?

November 13, 2007

Strum, i agree with this. I try to always keep an open mind about all

of the medical professions,because i believe in chiropracters...

ALTHO the very first one i went too(nice guy) totally MISSED my face

being dislocated.so it was the second guy who picked up on it. so

there you have it...one bad chiro-one good one. I had one pt that was

horrible, nuts... thats why i was asking... but i shouldnt be against

them all Either. your right, i think it is the individual smarts of

who you get... and that is almost like the luck of the draw.in docs,

pt's and chiro's and surgeons.cindy

>

> So, I would say you just really need to get some background. Try

to get some references, ask around, ask your doctor what their

patients have said. Check the better business bureau. Ask about

their education, qualifications continuing education. But, I think

physical therapy is really important, and you shouldn't throw out the

whole kaboodle.

>

> Strum

>

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November 13, 2007