Ask Linda

by Linda Wobeskya, M.S., P.T., GBPPA Member

This column originally appeared in the Fall, 2001 issue of TRIUMPH.

Dear Linda,
I fell recently and twisted my ankle on my good leg. My doctor says it’s only a sprain, but I’m having a hard time getting around. He wrote me a prescription for physical therapy. Since I injured my good leg, do you think I need a therapist who knows about polio?
Curious in Cambridge

Dear Curious,
The answer is yes. The situation you are describing is called “polio as a secondary diagnosis.” Your primary problem was not directly caused by polio. However, the fact that you had polio should influence the decisions your physical therapist makes about your treatment. The same would be true for recovery from illness or surgery; i.e. any non-polio related physical problem.

Polio survivors’ bodies often respond differently to the physical therapy treatment normally prescribed for non-polio related problems. In your case, standard rehabilitation after ankle sprains includes aggressive strengthening of the muscles that surround the ankle. This means exercising these muscles until they fatigue. Exercising polio-affected muscles to fatigue can cause damage, resulting in weaker rather than stronger muscles. I have seen it happen. I evaluated a woman many years ago in the Spaulding Post-Polio Clinic who had undergone surgery to repair a ligament in her right knee. She received the standard physical therapy rehabilitation program, which involved exercise machines to strengthen her quadriceps muscle (the large muscle on the front of the thigh). The woman began to have problems with increasing weakness in this muscle. Her therapist, who did not know about polio as a secondary diagnosis, thought she was getting weaker because the exercises weren’t hard enough and made the program more aggressive. The client continued to worsen, until she stopped her Physical Therapy and came into the Post-Polio Clinic to find out what was going on.

“But,” you say, “the injury is in my good leg.” Unfortunately, even your good leg may have polio-affected muscles. Muscles that are polio-affected can still be strong enough to allow you to function. These muscles can even test “normal” with the manual strength testing method used by most doctors and physical therapists. The only way to be certain a muscle was not affected by polio is electromyography (EMG). This test is administered by specially trained doctors and uses electrodes to measure the electrical activity of your muscles. A polio-affected muscle has a very distinctive electrical signature. If you have not had an EMG to determine whether the muscles in your good leg are polio-affected, you are taking a risk with any standard rehabilitation program.

A physical therapist that knows about polio will know to consider this when planning your treatment program. If you cannot find someone, or if your doctor or insurance plan restricts whom you can see, I recommend you politely remind your therapist of your polio diagnosis and refer him or her to web-sites and literature resources so they can educate themselves. Physical therapists are dedicated healthcare professionals who want to give you the best treatment possible. Most therapists will be grateful to you for helping them to treat you safely and appropriately.