PT and Exercise

Okay. I have been in PT for over two months. Here is my question.

All the literature says we need exercise. I started PT because of loss of range of motion. Now, 2 months later, the PT leaves me in a lot of pain. My question is this:

Is the PT helping, and causing the pain from pushing unused muscles.


Is the PT causing pain just because it is irritating the entheses more.

I am willing to continue PT if it is actually helping. But I don’t want to continue if all it is doing is causing me more pain from aggravating the PSA.

Any suggestions or information?

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I had a question first. Are you being given home exercises and completing them? Or is the PT limited to the two or three times a week that you’re with the PT?

I go to PT two times a week for an hour. She is teaching me things I can do at home to stretch my shoulders, back, and hips. She is also working on rebuilding my core muscles. The work on my core muscles is causing me a lot of back pain.

I try and do the exercises also at home between visits. Some days though I am hurt so bad from the PT visits I cannot perform all the exercises. Some days at PT, we will have to back off some exercises because of the limitations from pain.

The goal is to teach me what to do at home.

That’s very frustrating. I’m guessing you’ve raised these issues with her already. When I’ve been in PT we usually don’t push to where I’m sore after, but I do find it rather interesting that you’re saying that you are fairly consistently sore and in pain after. I would encourage you to also share this with your doctor.

Absolutely not a PT here but a consistent exerciser & stretcher. I’ve taught fitness for over 20 years and these days I don’t teach the hardcore classes, just water classes from the deck to seniors with joint issues (which ironically helps me as I must demonstrate & move all my joints). I have had to modify my own exercise program over time due to PsA. I no longer run, I avoid certain weight training exercises, I rest more, I do low impact type activity. Maybe you need a different PT or you need to have a good talk with yours - with PsA we will probably never be without some soreness but we do need to move so if you are questioning your program, it’s likely not a good fit…and needs to be modified ?

I have tried PT and though he is very good at what he does, he really only had the regular common stretches for hamstrings etc. He said that the inflammation in my knees is causing enough pain to be a barrier to my range of motion and “pushing” through that sort of pain will aggravate more than help. I appreciated his honest approach rather than booking 7 more visits at great $$. Keeping all muscles stretched and in good strength is always a goal but knowing limits BEFORE exceeding them is just plain smart. Some PT’s and trainers only think about building muscle by going to the max…from my limited experience, pushing myself has always been a step backwards since PsA set in. I used to be a sprinter, ran like a rabbit but have now adopted the slow and steady lifestyle! I don’t care anymore who crosses the finish line first, just glad to get there! All that said, @tmac, i think it is great that you haven’t given up and are still seeking new approaches to improving your life, keep going!

The young lady I have is good. She at least knew what PSA was. I have explained some things to her. I have made some progress with more range in my shoulder movement, but it is limited. She has helped my hips too. It is mostly stretching exercises as you say, but I have lost all my core muscles, plus put on about 40 lbs. After the first few exercises to increase my core muscles, I had talk with her because it left my lats and my low back in a lot of pain. The next time I saw here I told her that my core muscles were starting at zero, or less than zero, so she back way off on that work. I now have some less strenuous exercise for my low back to stat with,

The person that triaged me for PT asked if I felt SSDI was in my future. I told him probably. He said that I should go ahead and try PT because social security would make me do it before they would grant disability. He said the PT would either help, or aggravate the PSA so much I couldn’t do it. I am somewhere in between I think.

I see my rheumy next week. After nearly three months of PT, I think he and I can decide if I should continue. I have learned a lot of things I can do at home that I will continue either way. I think the biggest thing I need to do to help me is drop the COVID weight. But, when you can’t exercise it is hard to lose weight.

I also tried PT and it was too “for the average person” for me. Everything was too much.

I have tried PT twice over my 25 years of PsA and RA. Both times it left me in more pain. So I stretch before getting out of bed, and move when I can. It’s not easy…hang in there.

I have a feeling that other than stretches I can do at home, PT will be too much for me. I have been at it for almost 3 months and hurt more now than before. I had hoped the pain would subside, but it hasn’t and it has been very hard on my low back and SIJ.

That’s how it was for me, too. Stretching is the most I can manage. PT just made inflammation worse.

Tarmac, I too have been in PT for a couple of months and like you and others have found, I seem to react to it. The neck and shoulder work give me headache pain for 2 days. My shoulder, elbow and wrist hurt too much to do exercises. And he talk about my pain like I’m over exaggerating it or really wimpy. I don’t know what to do but I have more range of motion- missing strength. Good luck to you. I also lack muscle but I’m 87 pounds so I lack other things too… don’t know how much impact this has.

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Just came from my rheumy. We talked about the pain PT was causing, mostly in my SI and back. He said that if I felt it was causing more pain than it was worth to stop. I told him the exercises for my shoulders and hips were okay because the soreness from them is tapering off, but that even after my PT dialed down the core exercises several notches, I suffered for days after even minimal core work. I’ll have a long talk with my PT lady Friday.

Just FYI -

On another note - I asked about getting a booster. His recommendation was that if I got the Pfizer to get one if it had been over 6 months. He stated the Pfizer seemed to fall off more than the other two. He even said he had gotten a Pfizer booster. After that, he said he hoped it didn’t cause as bad of flare as the last one. I guess I’ll do that sometime over the next month.

I want to throw something else out. I have performed a search here on night seats. I know the ugly thigs that can cause night sweats, but since the weather has gotten cooler, I am have night sweats. When the AC is on I keep it about 71 degrees at night or I get too hot. Now that the heat is own at night I often wake up with my head and hair dripping wet. I am driving the wife crazy because I will get up and turn the heat off, usually set for 72 degrees and open one of the windows. She comes down in the mornings and it is 65 degrees in the house and closes the door or window and turns the heat.

I have set the heat for 70 degrees when the heat will be on at night, but still wake up sweating.

Since starting PT several months ago, I am in more pain, but i have bene in a lot of pain before without night sweats. I have been on Taltz now for over 4 months. I am wondering it it is the Taltz, but can’t find much on that side effect. I have severe sleep apnea and the Cap Machine does warm the air, but I have been using it for about 20 years. I have been running a chronic low grade fever for about 2 months due to pain and inflammation. It may be the fever breaking at night, I don’t know.

Anyone else dealing with night sweats?

Oh, I developed an occasional cough a month or so ago. Had my PCP check it and asked him to perform a chest x-ray. That all came back clear.

So we keep our heat set at 62° I think for the overnight, and we have that start at about 10:00 at night. If I have the heat set even at 66 or 67°, I would be sweating as well. One option to deal with the difference and temperature preferences is to have separate blankets for each of you. You could sleep with just a thin sheet if you wanted, and your wife could sleep with heavier blankets. But just to be clear, that’s a really high sleeping temperature in my opinion. I would not only be sweating but I’d be having crazy dreams at that temperature.

Holy cow, Stoney’s comments made me look up Fahrenheit- I totally agree - I would be literally cooking at that temperature.

I live in a hot place, in summer for sleep, the temp is set to 64.4, (that is the lowest it goes, I’d set it lower if I could), and in winter I never use the heater to sleep, though our regular overnight temperatures are around 53. I turn the heater on if needed when I get up.

I still wake up with night sweats at those temperatures often, seems to be part of the low grade fevers that happen with does strongly suggest your disease is not at all under control though. How long do you and the Rheumy plan to give Taltz? I’m not very familiar with it.

(Note I’m in a gap at the moment so my disease is not at all under control - my experience is that with control those night sweats go)

In the UK my heat is turned off at night to sleep even in the depths of winter. Off on the thermostat is 15c or 59f. Meaning it won’t come on unless my house is below 59f. And except for nights when it’s freezing or below I sleep with a window wide open. My heat is off all summer. Remember we don’t have A/C here much if at all. The highest I ever put my heat up to is 20c or 68f. If I light a fire in winter in the living room the heat get turns off. That will happens most nights during the winter. In summer I never touch the thermostat.

I’d be sleeping in my garden at night @tamac with that level of heat overnight. And feeling like I was running a fever too. My male partner thinks it’s too hot just anyway and I’m too wasteful with the heat and I should wear more clothes. In my defence I work from home stuck at a computer screen. And where I live I can get persistent north winds coming in over the North Sea (so down from the Artic) too for weeks at a time. I love a cold bedroom - my bedroom window faces north. My worst nightmare is having to sleep in a hotel room where I can’t open a window.

And as the world heats up, summer here has become my nemisis. Because it gets too hot and I can’t cool it down because houses don’t have A/C.

Also my PsA tends to do hugely better when it’s more cold outside. Freezing cold days with no rain has my capacity ability rocketing sky high. I can do pretty much anything then. Humid hot 80f heat has me swollen up and totally miserable. I hate our summers but love our winters. I couldn’t afford to heat my house at those temperatures either, it’s bad enough at my levels, more so presently with the energy crisis here presently.

During menopause, my wife was our only source of heat in the house. (Also a bit unpredictable too!) She could melt snowballs just walking past! NOW we can laugh about it. Both extremes are bad for me…if I get too cold I am as miserable as too hot. I sleep with the windows open in winter and have an electric heating pad close by. Hummmm…there seems to a similarity between flares and hot flashes!


She wasn’t alone @Amos not by a long shot! Imagine if we could harness that heat produced by women of a certain age and pump it through central air or radiator systems, we could cut our dependence on fossil fuels extraordinarily for heating building purposes at any rate! Boy was I glad when I got through the other side of the menopause. Its lasting legacy is that I stil sleep with a summer weight duvet all year around as I can still feel overly heated sleeping.

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I guess we will give Taltz the usual 6 to 12 month try. Taltz is a cousin to Cosentyx, If the Taltz doesn’t work better, will probably go back top Cosentyx.