How can I speak openly with my physical therapist?

I’ve had RA since 1979, and it’s been in sort of a remission. I take Xeljanz daily and Naproxen when needed. I do have a lot of deformity in all my fingers and knuckles of both hands. I’ve been taking physical therapy for over a year dealing with back pain due to herniated and bulging disks. My pt also does some hand therapy. Just recently she used the Jamar hand dynamometer which measures force in kg and lbs from 2kg to 5 lbs. I squeeze the instrument as hard as I can to measure strength. A couple hours later I noticed a severe flare on my left wrist which is the weaker hand and wrist. My question is I should have known better that this instrument is difficult for RA patients. How do I politely tell my physical therapist that this tool is not suitable for me? She knows I have RA but may not fully understand the consequences of the gripping causing pain and flares. Thank you so much for replies.


Community Answers
  • Mary Sophia Hawks moderator
    4 days ago

    Hi Janet. Thanks for reaching out. Good for you for telling the PT what happened. Honest communication is the only way they learn. I myself had a poor experience, and I never returned to that PT. I also reported her to my MD. Since that time, I have been blessed with excellent therapists, because I have communicated. Keep doing what you are doing, and reach out here anytime. Encouraging hugs to you. Mary Sophia (RheumatoidArthritis.net Team)

  • Janet Hurtack author
    4 days ago

    Thank you Mary Sophia for your reply and support and for sharing your experience. I’m so glad you now have excellent therapists. I continue to have therapy at the same place, but have been working more closely with one of her Assistants who is more gentle and understanding of how RA affects a person. I am grateful i can com here to this community for support. Thank you again and hugs back to you.

  • Daniel Malito moderator
    1 month ago

    @Janet Your experience, unfortunately, is not unique. I have been to at least six different PT places in my thirty some od years of RA. Only the last place I found is what I would consider informed and caring about RA. The others were basically sports medicine in disguise. One PT put my elbow off the side of the table and pushed down on it so hard I saw colors and stars. I mean my sight actually turned different colors and stars started to pop off in my vision. He had no idea how to treat RA but he sure wore a ton of sweatbands. You have to find a PT who understands that RA isnt an injury, it’s a condition, and if you feel like the one you are using doesn’t understand that (which is totally possible) it may be time to find another. I’m sure some of our users here have suggestions for wherever you live. It might help to check out Facebook page too, http://www.facebook.com/rheumatoidarthritisdotnet/ Keep on keepin’ on, DPM

  • Janet Hurtack author
    1 month ago

    Hi Daniel,
    Thank you for your response. That had to be so painful with the elbow exercise by that PT. I hope it was a lesson learned by the PT. You mentioned they need to think of RA as a condition, not an injury. That is so on spot as I think they are so used to treating injuries that they may think the same with RA>

    I hope you now have a good PT. Thank you for the FB link. This will be great to hear of others’ experiences and for the support. I wish you the best.

  • Janet Hurtack author
    2 months ago

    Getting back to “How can I speak openly with my Physical Therapist” about an exercise that caused a five day flare in my left wrist using the Jamar hand dynamometer. I didn’t mention in my first post, but I do have severe deformity in both hands due to the rheumatoid arthritis. I was diagnosed in 1979.

    So my next appointment when my PT asked how was I feeling, I stated that doing the procedure on the hand dynamometer caused a severe flare, she didn’t have any feedback on it. So I responded “did I squeeze the instrument too tight?” I had some pictures on my camera to show her the swelling. She didn’t add anything, so then I asked if I should be using this instrument at all, and her response was “well, it won’t do any good anyway.” I didn’t have a chance to ask her to elaborate, as then she quickly took a patient into a room for his appointment. I was left there standing with no answer or positive outcome. The next two appointments she was already busy with patients when I arrived. I was waiting for her to ask about my wrist and the flare, but there was nothing. So I am disillusioned and not sure if I will continue. I’ve been getting pt weekly for about a year and a half, but not sure if I will continue with this pt, but will continue getting exercise elsewhere. I feel like I have been ignored by her.

  • Richard Faust moderator
    1 month ago

    Hi Janet. Very sorry that you have had this experience with a therapist. If you do not feel you are being heard or you feel the therapist does not understand your condition and limitations it absolutely may be time to look elsewhere. I do think it takes a certain kind of therapist/person to work with RA patients, particularly those with extensive damage. I don’t know how you found the current therapist, but perhaps your rheumatologist would have a suggestion of someone. Also, if you know others with RA in your area, someone may have suggestions. Even in the rheumatologist’s waiting room another patient may have thoughts (just trying to think of anywhere you may come across others with similar circumstances who may do PT). I think my wife has been luck in finding a good therapist for RA, but also know they are out there. Hoping you find one who can help. Best, Richard (RheumatoidArthritis.net Team)

  • Janet Hurtack author
    1 month ago

    Hi Richard,

    Thank you so much again for your reply and advice. I agree it may be difficult for my Therapist to understand my limitations with the disease with regard to physical activities. Thank you for those suggestions for a search for a PT who understands RA, very helpful. This last session she did mention the flare to the Assistant PT who was working with me and said to her “we can’t let this happen again.” That made me feel good that at least she realized my limitation with the gripper.

    I am so glad your wife has a good PT who understands RA. I agree they are out there, and I plan on searching and talking to my doctor and others. Thank you for your advice and support.

  • Janet Hurtack author
    2 months ago

    Thank you so much Richard for your response and advice on how I can talk with my PT on one of the tools she used on me to measure grip and how it caused a flare with me squeezing too tight on it. I do definitely plan on talking with her the next pt session. I’m not sure why I was questioning myself on how to communicate, but now I realize this is very important as the pt should be geared towards my benefit.

    I read with great interest Your wife’s story on returning to pt for refresher treatments. I am really inspired by Kelly’s story and plan on responding. Thank you again.

  • Richard Faust moderator
    2 months ago

    Thanks for writing Janet. It is good that you are getting physical therapy, but sorry to hear one of the exercises led to a flare. You shouldn’t worry about telling a physical therapist when any part of treatment is causing pain – a PT is there to help and a good PT will want to know. My wife, Kelly Mack (a contributor here), was diagnosed at two and has used a wheelchair since her late teens. She has used PT extensively throughout her life, including re-learning how to walk several times. PT can make a huge positive difference and in this article she writes about the benefits of going back to PT for refresher treatment, even with extensive RA damage: https://rheumatoidarthritis.net/living/return-to-physical-therapy/. My point is that working with, including straight-forward communication with, a PT should always be geared towards the greatest benefit to you – the patient. Wishing you the best. Richard (RheumatoidArthritis.net Team)

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