Why Physical Therapy Sometimes Fails

Final part of a 3-part series

You religiously attend your therapy session and perform the home program, but you don’t seem to be making improvements. You appear to have hit a plateau. Maybe some of the pain that brought you to therapy is returning, but you are still completing the daily exercise routine. Or your strength is decreasing. Frustration rears its ugly head. Who’s to blame? You? The therapy team? According to John Iams, the developer of the PRRTTM, there are 50 reasons physical therapy may fail with a home program compliant patient. In this three-part series, the top 10 will be discussed.


Hypothyroidism is a disorder of the endocrine system in which the thyroid does not produce enough thyroid hormone. Although there are many signs and symptoms of hypothyroidism, the ones that cause the most problems for physical therapy are abnormal sensations, shortness of breath, swelling, delayed reflexes and fatigue.

An easy test to check you thyroid.

  1. Get an old-fashioned mercury thermometer and put it by our bedside.
  2. Shake it down to 95° F.
  3. Upon arising in the morning, before you get out of bed or eat or drink anything, put the thermometer deep in your skin with the tip facing up into the armpit region.
  4. This process allows you to measure your lowest temperature of the day.
  5. The temperature should be taken for 4 consecutive days.

The standard body temperature is 98.6° F, but the normal underarm temperature is 97.8-98.2° F. If your temperature is consistently under 97.4° F, then you may have under functioning thyroid activity. If the temperature is consistently above 99° F, then you may have hyperactive thyroid activity.

If you think your thyroid may not be functioning properly, see your healthcare professional.


According to Wikipedia, insomnia may result in many different symptoms, but the symptoms that may affect physical therapy include muscle aches, headaches, malaise, increased blood pressure, increased risk of diabetes and fibromyalgia, and seizures.

Try these tips from the Mayo Clinic to improve your sleep

  1. Stick to a schedule…even during the weekends, try to get to sleep at the same time each night and wake about the same time each morning.
  2. Watch food and drinks….don’t go to bed too hungry or too full. Nicotine, caffeine, and alcohol can effect sleep patterns.
  3. Create a restful environment…a room that is dark, quiet, and cool. Don’t use electronic devices right before bed.
  4. Limit daytime naps…and if you do, limit the nap to 30 minutes or less.
  5. Include physical activity in your daily routine…but not too close to your bedtime.
  6. Mange your stress….try to resolve your worries. Make a list to set aside for tomorrow. Try meditation, get organized, set priorities, and delegate tasks. If you continue to have sleepless nights, it may be time to contact your healthcare provider.







Proper nutrition is important for optimal function of your body. And what is proper nutrition? That is such a broad subject, and everyone has their own answer as to what is proper nutrition. Along with vegetarians and vegans, food allergies, age, activity level, and illness, proper nutrition is not an easy answer.




But, everyone should follow these simple rules.

  1. Watch the added sugar…included in processed foods, white sugar, syrups, even agave and honey. Added sugar provides empty calories and is believed to be the cause of many diseases that kill people every year.
  2. Make sure to get enough Omega-3 fatty acids…which are in fatty fish, fish oils, algae, and grass-fed beef. Most people do not get enough Omega-3 fatty acids.
  3. There is no perfect diet for everyone. The best diet is one you can stick to and works best for you.
  4. Avoid trans fats as they are chemically processed and linked to many chronic diseases.
  5. Eat a lot of vegetables as they contain an abundance of nutrients and is associated with increased health and decreased disease.
  6. Don’t become vitamin D deficient. If you don’t get enough sun, make sure to consume a teaspoon of cod liver oil each day or take a supplement.
  7. Don’t consume too many refined carbohydrates, which is highly processed bread, baked goods, and basically junk food. In these types of foods, the nutritious parts of the food—the fiber and antioxidants—are stripped away.
  8. Supplements can never replace a healthy diet. It is more important to eat a balanced, healthy diet than to count on supplements for needed nutrients.
  9. Diets don’t work—a lifestyle change is required for long term weight loss and improved health.
  10. Unprocessed food is the healthiest—if it doesn’t look like real food or looks like it was made in a factory—don’t eat it.


#10…pH imbalances

 Although a healthy body does an excellent job of keeping a normal pH of about 7.4, in a sick or diseased person, acidosis, or, a decrease in pH can cause many health issues and can be life-threatening. There are two types of acidosis, respiratory and metabolic, each having different causes and symptoms.

 Respiratory Acidosis Causes                                                                     

  • Asthma
  • Chest injury
  • Obesity
  • Alcohol abuse
  • Weakened chest muscles
  • Nerve issues

Respiratory Acidosis Symptoms

  • Fatigue
  • Confusion
  • Shortness of breath
  • headache


Metabolic Acidosis Causes

  • Poorly controlled diabetes
  • Diarrhea
  • Vomiting
  • Lactic acid buildup
  • Kidney disease

Metabolic Acidosis Symptoms

  • Rapid breathing
  • Confusion
  • Fatigue
  • Headache
  • Jaundice
  • Increase heart rate

If we feel you have a pH imbalance, we may refer you to your primary care physician, as this can be a life-threatening issue.

As you can see, there is so much more to physical therapy than just exercise. We must look at, evaluate, and treat the entire person, not just your shoulder or knee pain.

Mike Pennington

Mike Pennington

Michael Pennington is a physical therapist and the owner of Turning Point Physical Therapy, which is located in beautiful southern Oregon. He is a loving husband, father of six and a master of his trade. Before studying at Pacific University, Michael earned his Eagle Scout and served a full-time 2 year mission in south Africa. He is as accomplished as he is hard working. Al l of his experiences culminate together at his clinic and are evident in his patient care.
Mike Pennington

We Help People in Medford, Ashland, Grants Pass, Klamath Falls, Yreka Areas Aged 40+ Become More Active And Mobile, Live Free From Painkillers and Surgery!


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