Community Forums Recommend Your Physical Therapist / PT Discussion Meet your moderator: Katie Phares, PT, DPT

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    • #465

      I was diagnosed with Ankylosing Spondylitis (AS) in February of 2019. My journey to diagnosis and personal experience with AS have shaped my career as a physical therapist (PT). I have a doctorate in physical therapy (DPT), and have 3 years of clinical experience. I work at an outpatient orthopedic clinic for a physician owned medical group. I see a wide range of diagnoses from ankle sprains to walking disorders, and have treated all sorts of patients from ages 8 to 99. Some of my specialty knowledge is in neurological disorders such as Multiple Sclerosis, Parkinson’s, and stroke. I also am trained in intramuscular dry needling, LSVT BIG, and Parkinson’s Wellness Recovery (PWR). Since diagnosis, I have taken an interest in the treatment of rheumatic diseases such as spondyloarthritis.

      I have discovered that there is a disparity of knowledge concerning this disease in the medical community, including in physical therapy. Having been through the diagnostic process myself, I know the amount of self-advocacy that goes into it. I was armed with the knowledge necessary to guide the process but I recognize that most people do not have this benefit. I hope to increase the education of physical therapists on the signs and symptoms of spondyloarthritis. Not only that, but also what the barriers are to treatment in sponydyloarthritis and need for frequent modifications to prevent flares. I believe PT’s have an important role to play in timely diagnosis and referral, as we are often the first line of defense in chronic low back pain. My goal is to also help those who have spondyloarthritis arm themselves with more knowledge about safe movement, posture, fatigue management, and more.

      Some of my interests outside of work include hiking, exploring nature, serving with my church community, cooking, and reading. I recently began writing for AnkylosingSpondylitis.net so feel free to take a look at my articles (and future videos) on that platform. I look forward to being an integral part of this community!

    • #574

      Katie, Thank you for volunteering your time to moderate on this site!

      Joan Polzin

    • #579

      Katie,

      Thank you for your post! I am also in the medical field as a nurse practitioner. I could not agree with you more regarding the disparity of knowledge regarding this disease. It took me 4 years to get a diagnosis after seeing numerous providers and specialties. I still do not feel I am well-managed.

      I see patient after patient with stories like yours, or mine, or other patients with a chronic disease. I do believe that the experiences I have gone through as a “patient” make me a better provider. I understand the helpless feelings many people feel.

      Do you as a physical therapist recommend continuing physical therapy or having a “go to” physical therapist for maintenance and with flare ups? Do you have recommendations on how to find (questions to ask) a PT that has this experience?

      • #580

        Great question Alyssa!

        As with any chronic condition I recommend that once patients find a PT they trust, that they stick with that therapist for periodic bouts of PT. I would say that you don’t necessarily need to be in a flare to see a PT, and actually it is probably better to go to a PT when you are not in a full blown flare. Although PT is very helpful for pain modulation, because AS is inflammatory, a lot of times exercise if not done carefully can create more pain. In my own experience, until I was controlled with medication (in my case Humira) any and all attempts to self treat ended in more pain.

        I like to think of PT like I think of the dentist. You wouldn’t go to the dentist once and then never return, right? Of course not! The same goes for visiting a PT. If you haven’t had an episode of PT care for over a year, your pain is worsening, your mobility is decreasing, or you just generally feel things are declining, it is time for another bout of PT.

        The best way to find a PT is to ask your doctor whom they would recommend. Another great idea is to ask friends and family. Although everyone’s experience with PT is different, word-of-mouth is often quite helpful. Since spondyloarthritis may not be a common diagnosis seen in most clinics, it may be helpful to call prior to scheduling and inquire. Ask if any therapists there have experience treating this condition. If not, ensure they are at least willing to do some research. All PT’s are highly trained medical professionals but the school they attended and experiences they have had can vary.

        Best,
        Katie, PT, DPT

    • #581

      Katie,
      Thanks for doing this! I’m wondering if you can share the typical modalities or techniques you use with patients with AS. Especially with regards to gait, balance, SI inflammation and how to strengthen without causing a flare (if that’s even possible).

      I have my first appointment with a PT tomorrow and I don’t know how much experience they have with spondyloarthritis. Would be great to know what you think a new patient should look out for, inform them of, ect.

      Thanks so much!

      • #582

        Hi Chani,

        That is wonderful that you are starting PT tomorrow! An open line of communication is key. A good PT, even if they don’t have experience with AS, should be willing to listen to you and work with you to figure out a tailored treatment plan. Encourage them to do some reading about it on their own if they haven’t had a patient with it before.

        Expect to have some discomfort but you should never have increased pain. If you do, communicate that with the PT, don’t be afraid to speak up. I would direct them to this site as there are resources on here to help educate them.

        Typical techniques used may include heat, ice, soft tissue mobilization/massage, intramuscular dry needling (if your PT does not do this ask if someone else in the clinic does-it is a great treatment for myofascial trigger points).

        Exercise wise, they will most likely start you with hip and low back flexibility exercises. For strengthening, typically isometrics are best tolerates to prevent aggravation of the inflammation. Later on they may add in more weight bearing (standing) exercises.

        Please let me know if your PT wants to connect with me. I’d be more than happy to share some of my own experiences with them. You can also direct them to AnkylosingSpondylitis.net as I am a writer on that site too.

        Best,
        Katie, PT, DPT

    • #583

      Thank you so much for your quick response! Since you seem so knowledgable, let me throw one more thing your way. I also have bilateral hip labral tears, hip joint fluid and bone marrow edema in the ilium I believe. The doctors I have seen said everything besides the labral tears could be due to AS. Have you seen that in your practice? Would that change anything in terms of stretching, strengthening?
      I’ll let the PT know you are a resource, appreciate that.
      I’m a sports massage therapist and have been confounded on how to stretch and reduce stiffness while trying not to further damage the hip.
      Thanks again!

      • #589

        Hi Chani,

        Yes, I believe that edema and bone marrow edema are a characteristic sign of AS. The labral tears are most likely due to another pathology but they are not uncommon alongside arthritis like conditions.

        With labral tears typically you want to strengthening the gluteal muscles especially the hip extensors and abductors, as well as the core. Keeping these muscles strong helps to unload the hip joints. As for stretching, it is unlikely to cause damage. Just listen to your body, if there is pain or pinching it needs to be modified.

        Good luck,
        Katie, PT, DPT

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