Why Physical Therapy Sometimes Fails –  Part 1

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.


According to a 2015 University of Florida report, three out of four Americans are chronically dehydrated. Dehydration leads to fatigue, muscle cramps, high blood pressure, and joint pain, among other symptoms. Our bodies are made of 60% water and hydration ensures the proper function of muscles, kidneys, liver, and digestion. Also, adequate water intake keeps hair, nails, and skin healthy.

According to Dr. Batmanghlidj chronic dehydration is the cause of many disorders including arthritis, migraines, and high cholesterol.

Each person should be drinking 8-10 glasses of water a day, ideally a quart before lunch and another quart before dinner. This water consumption does not include tea, coffee, and juice. In our clinic, most patients alleviate the hamstring cramps with a glass of water. So, drink your daily water.


Osteoporosis and osteopenia are degenerative bone diseases that cause brittle bones which can lead to an increase in bone fractures. Bone is a living tissue and during its lifetime, bone size and density increases and decreases as you grow and change lifestyle habits. If too much bone is broken down and not enough is built up, bones become porous, like a honeycomb and more fragile. Osteoporosis has many causational factors, including genetics, hormone levels, and body type. Osteoporosis usually is not diagnosed until a fracture occurs, often as a hip fracture or compression fractures of the vertebrae. According to Move Forward, habits that can exasperate osteoporosis are

  • Cigarette smoking
  • Excessive alcohol intake
  • Inactive lifestyle
  • Excessive caffeine intake
  • Lack of weight-bearing exercise
  • Drugs (eg, steroids, heparin)
  • Poor health
  • Low weight
  • Calcium-poor diet
  • Low vitamin D levels


There is no cure for osteoporosis, although there are some medications that assist with bone absorption. If we have a diagnosis of osteoporosis, we can prescribe specific exercises to help with bone health and avoid fractures by increasing balance.


#3….Nightshade consumption

Nightshades are a group of fruit bearing plants that include tomatoes, potatoes (not sweet  potatoes), sweet and spicy peppers such as bell, jalapenos, and poblanos (not black pepper), and eggplant. Non-edible nightshade plants include tobacco and the extremely toxic belladonna. These plants contain the alkaloid solanine. Solanine may be toxic if consumed in large quantities or from a green potato.  It is interesting to note that blueberries, huckleberries, and artichokes also contain solanine. Alternatively, nightshade edibles include a wide variety of nutrients including Vitamin A, B, C, K, beta-carotene, and a variety of trace minerals.

Previous studies showed that the consumption of nightshades caused an inflammatory response that irritated arthritic joints. But more current studies contradict this. In a 2011 study, eating nightshades for 6 weeks reduced inflammation and DNA damage in healthy men.

Does this mean nightshades don’t irritate arthritic joints? Not necessarily. As with all foods, each one of us is affected differently. If you are concerned solanine is irritating your arthritic joints, consider an elimination diet. Stop all forms of nightshades for six weeks. Do you notice any changes in your arthritic joints? Slowly add nightshades one at a time back into your diet. Note any changes in your arthritic joints.

As you can see, there is so much more to physical therapy than just exercise. Sometimes we must look at other factors. Follow next month’s newsletter as we discuss bone spurs, statins, and inflammation.

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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