POI Physical Therapy for Degenerative Disc Disease: Review, Sessions, Costs at Philippine Orthopedic Institute Makati

My orthopedic doctor recently diagnosed me with Degenerative Disc Disease (DDD) affecting my lower back, specifically the L1-L5 vertebrae, and referred me to physical therapy at the Philippine Orthopedic Institute (POI) in Makati City, located on Dela Rosa Street. It’s a convenient location as it’s close to Makati Medical Center.

The intense pain in my lower back started and ended last month. I could barely walk due to the lower back and hip pains, tightness, and spasms. I managed to avoid the emergency room thanks to some resourcefulness — Yoga by Joelle’s video for “herniated disc pain” provided significant relief every time I used it.

Before you proceed, please note that the following information may have some inaccuracies as I’m relying on my memory. Even though you and I may both have DDD, our treatments could differ depending on our individual needs and conditions.

First Physical Therapy Session for DDD at POI in Makati

Reluctantly, I attended my first session at the Philippine Orthopedic Institute (POI) today. During the initial session, the therapist conducted a quick interview about my lower back pain, asking when it started, whether I had experienced any accidents, and the intensity of the pain.

By this time, the pain had already decreased significantly compared to last month, only flaring up when I neglected my posture during my desk job.

Here’s what was done during the physical therapy session:

Part 1 – Treatments

• I was asked to change into a patient’s gown, remove my footwear, and lay on my belly.
• Application of a heat pack on the painful area, with electrodes
  • This treatment lasted 15 minutes, supported by two pillows.
  • The sensation was more relaxing than painful.
  • I requested to turn on the fan because the room was a little too warm, especially with the heat from this treatment.
• Ultrasound on the painful area
  • Almost fell asleep at this point; it felt like a very gentle back massage (UwU).
• Shockwave therapy
  • The therapist warned me it would be painful, but it was supposed to relax my back muscles. The gun-shaped device did sound like it was going to inflict serious pain! lol.
  • Surprisingly, it wasn’t painful for me. I found it relaxing too, like a massage gun!

Part 2 – Stretches

• Inner thigh stretch, performed three times on each leg
  • The therapist moved my thigh close to my chest, bent my knee, and let the sole of my foot press against their torso, then applied pressure by leaning towards me.
  • It was an awkward stretch and very challenging because it took a lot of effort to keep gas from escaping… (⸝⸝⸝- ᴗ -⸝⸝⸝ ; )
• Hamstring stretch, performed three times on each leg
  • The therapist lifted my leg and straightened it, with the sole of my foot facing the ceiling.
• Glutes stretch (figure four), performed three times on each leg
  • The therapist asked me to assume a figure 4 position, then pressed my thighs close to my chest until I felt my glute muscles stretch.

Part 3 – Warm-up and Strengthening Exercises

• Core muscle warm-up x 10
  • The therapist asked me to place my hands underneath my lower back (palms facing the bed), then activate the abdominal muscles and keep them engaged for 10 seconds — I timed this with my exhales.
  • During my inhales, she had me relax the abdominal muscles.
• Bridges x 10
• Modified sit-ups x 10
  • Lying flat on my back with my knees bent, I performed small sit-ups, lifting only the upper back, with my hands reaching out to my knees.
• Cat-cows, holding each pose for a count of six, repeated 10 times
  • Cat pose: I focused on drawing my navel toward my spine (I had to be careful with this because if not done properly, I felt like the bending motion could worsen my disc issues) — I timed this movement with my exhales, like in yoga.
  • Cow pose: I focused on lowering my belly, lifting my tailbone, and stretching my head upward — I timed this movement with my inhales.
  • From this point onward, my therapist supported my waist/hips area because my scoliosis (mostly lumbar) was getting in the way.
• Bird-dogs, repeated 10 times (my scoliosis made this challenging, but the therapist helped me balance my hips).
• Supermans, repeated 10 times
• Press-ups, holding the stretch upward for a count of 15, repeated 3 times
  • This is similar to Pilates “swan” pose.

My wrists hurt from the exercises done in the all-fours position. I think it would have been a bit more stable and comfortable for my sensitive wrists if I had performed them on a hard surface, like an exercise mat on the floor. POI uses a bed wrapped in a plastic cover (which smelled nice, likely evidence of regular disinfection). I’ll bring up my concern to the therapist next time.

Although I’m familiar with all the exercises the therapist asked me to do, I think it’s much better to do them with a therapist’s guidance because they can correct any incorrect posture or positioning.

The therapist also corrected me when I tried to get out of bed with a swift sit-up movement. (°ー°〃) They taught me that while lying on my back, I should bend my knees and roll sideways to get out of bed.

Second Physical Therapy Session at Philippine Orthopedic Institute (Makati)

During my second lumbar back pain therapy at POI, the same therapist led the session, but most of it was supervised by an intern. I wasn’t asked to change into a patient’s gown this time and was instructed to lay on my belly immediately. They had a hard time applying the hot compress on my lower back because of my outfit, so I asked if I could change into my PT clothes to make it easier.

The intern performed the same treatments as before, and she did well:

• Heat pack: Application of a heat pack on the painful area with electrodes for 15 minutes, supported by one pillow this time.
• Ultrasound
• Shockwave

Then, the main therapist returned to the room and did the same stretches on me while I laid on my back:

• Inner thigh stretch: Performed three times on each leg.
• Hamstring stretch: Performed three times on each leg.
• Glutes stretch (figure four): Performed three times on each leg.

For the warm-up and strength exercises, the intern took over. Unfortunately, she barely checked my posture and positioning as I did the exercises, so I felt it wasn’t a very productive session. We did the following:

• Pelvic tilt (Core muscle warm-up): x 10.
• Bridges: x 10.
• Modified sit-ups: x 10.
• Cat-cows: Count to six per pose, repeated 10 times.
• Supermans: Repeated 10 times.
• Press-ups: Count to 15 while holding the stretch upwards, repeated 3 times.

However, there were no bird-dogs this time. The intern said it wasn’t part of the set exercises for me that day, but I wasn’t sure why.

One thing I did learn from my therapist on this day was that with a meniscal tear in the knee, I should avoid fully bending the knee and try to keep it at a 45-degree angle at most.

Third Physical Therapy Session at POI Makati for Degenerative Disc Disease (L1-L5)

A new therapist was assigned to me this time. Her name is Nam (not sure how it’s spelled) and I really appreciate her. She was very professional in the way she communicated and even in the way she was dressed. I felt that every step of the way during my 3rd DDD therapy session at POI, Ms. Nam ensured that I was performing my exercises correctly by visually examining my posture/position and by palpating (any more accurate word?) my core muscles to check if they’re contracting as expected during my movements.

Part 1 – Treatments

Also not asked to change into patient’s gown on this 3rd session. So I don’t know why it was done during the first. Anyway, I had already changed into my physical therapy attire before I checked in to POI’s reception area.

Same old initial treatments were performed:

• Heat pack: With electrodes for 15 minutes.
• Ultrasound
• Shockwave

Some things I learned from Ms. Nam’s related to heat/cold treatment:

• Cold pack treatment: Best for freshly-injured muscles to lower inflammation, e.g., right after weighted exercises.
• Heat pack: Best after about 24 hours if I did weighted exercises and had DOMS.
• Heat pack usage: Since I only have a small heat pack at home, Ms. Nam suggested using it on my lower back one side at a time so that it remains effective.
• Heating pad: The heating pad that POI uses requires boiling water.

Part 2 – Stretches

Nothing new in this part of the session, except that I observed how precise Ms. Nam was in the way she performed these stretches. She’s amazing!

• Inner thigh stretch: Performed three times on each leg.
• Hamstring stretch: Performed three times on each leg.
• Glutes stretch (figure four): Performed three times on each leg.

Part 3 – Warm-up and Exercises for Strength

I didn’t expect today’s therapist to impress me even further. She was detail-oriented and I was really thankful for that. The exercises felt waaaaay more effective when done correctly.

• Pelvic tilt (Core muscle warm-up): x 10
  • Therapist’s correction(s): Do not lift your butt!
• Bridges: x 10
  • Therapist’s tip: Contract your glutes and core as you lift your body up.
• Modified sit-ups: x 10
  • Therapist’s correction(s): Your shoulders and neck look so tense; Contract your ab muscles and let them do the work for you in this exercise.
• Toe taps: x 10 — Added by Ms. Nam today.
• Dead bug exercise: x 10 — Added by Ms. Nam today
  • Therapist’s correction(s): Straighten the leg that you are lowering, but without touching the bed (my muscles hurt more that way but I felt it was the right kind of pain — the kind that will build muscles!).
• Cat-cows: Count to six per pose, repeated 10 times
  • Therapist’s correction(s): The therapist realigned my hips whenever they moved the wrong way (thanks to scoliosis grrr).
• Bird-dogs: Added back today
  • Therapist’s correction(s): Ms. Nam patiently corrected my hip positions repeatedly; the left side of my core feels weak. So when I raise my right hand and left leg, I always fell off balance. Towards the end I tried my best to contract the weak core muscles further and finally got a “very good” from therapist-sensei.
• Supermans: Repeated 10 times.
• Press-ups: Count to 20 while holding the stretch upwards, repeated 3 times (Yes, it’s 20 instead of 10 counts today)
  • Therapist’s comment: This is just for stretching the core.

Part 4 – Traction Machine

I was surprised to find out that there was a door by the waiting area of POI Makati Therapy area. This room contained two traction machines.

Ms. Nam first measured my weight to determine how much “lower back stretching” the traction machine should perform on me that day. This machine can help decompress the tightness in the lower back.

They strapped my hips, and then my upper torso onto the machine. The traction device was stretched and then released in repeated cycles of about 10 minutes.

Fourth Physical Therapy Session at POI Makati for Degenerative Disc Disease (L1-L5)

I visited Doc Carlo Borbon, my orthopedic doctor, before my 4th session. I told him that I’ve only been able to attend physical therapy sessions once a week. His face expressed disappointment, until he heard me say that I do the exercises almost everyday at home, and that I feel that my significantly strengthened core muscles have been protecting my lower back as I carry out the same daily activities that used to trigger my lower back spasms. He said that it’s a very good progress, and that I may conclude my series of PT sessions by only attending 3 more.

The 4th session was more or less the same, but Ms. Nam added/modified a little bit:

• Added a new exercise: Push both knees to chest, while pushing them away with your hands
  • Create resistance between thighs/knees and hands/arms
  • Feel it activate the core muscles
  • It was inserted before toe-taps, if I remember the sequence correctly
  • Done for 8-10 counts each repetition; Repeat 10 times, if I remember correctly!
• Modified the bird-dog exercise: Do it on one side 10 times, then on the other side again 10 times. Finish it with the classic alternating sides, I think only 5 times for this one.
  • Done because my lumbar scoliosis was making one side more difficult
• Configured the traction machine with a heavier weight.

I learned a few things during that session:

• Of all DDD physical therapy devices used on me, the TENS device is the most recommended for patients to purchase. Ms. Nam said that if I purchase one, I can bring it to my PT session and they can teach me the proper configuration that should be applied to my condition.
• The knee-to-chest stretching at the beginning stretches superficial glute muscles, while the figure-4 glutes stretch is for the deeper glute muscles.
• The superman stretch are mainly for lower back muscle strength, but it also works the glutes

Fifth Physical Therapy Session at POI Makati for Degenerative Disc Disease (L1-L5)

More or less the same as the third physical therapy at POI. But this time I opted out of the traction machine because the total cost exceeds the budget I get from HMO (Intellicare) per physical therapy session, and I cannot justify the extra cost as I don’t feel significant improvement from the traction machine.

Sixth Physical Therapy Session at POI Makati for Degenerative Disc Disease (L1-L5)

The 6th and last PT session at POI Makati was most tiring of them all. There was a seminar being held in the building that day, which the physical therapists attended in AM/PM batches to keep the ops rolling, according to Ms. Nam. Patients were fewer than usual that day. I also noticed that there was a new office at the ground floor — that will be for consults and bone scan procedure.

On this therapy session we skipped the knee-to-chest stretching before the exercises. Ms Nam added 10 flutter kicks, 10 crossed flutter kicks, elbow planks, and several weighted exercises. I didn’t expect this and was really exhausted after the session.

Exercises on the 6th (and last) POI physical therapy session for DDD:

Part 1 – Stretching

• Skipped: knee-to-chest on 10 counts, repeated 3 times before switching legs
• Hamstring stretch
• Figure 4

Part 2 – exercises on your back

• Pelvic tilt (Core muscle warm-up): x 10
  • Therapist’s comment: Do not lift your butt!
• Bridges: x 10
  • Tip: Contract your glutes and core as you lift your body up.
• Modified sit-ups: x 10
  • Tips: You’re doing it wrong if your shoulders and neck are so tense; Contract your ab muscles and let them do the work for you in this exercise.
• Toe taps: x 10
  • Tip: tuck your belly button in a little bit towards your spine, for activating muscles that support in this movement
• Dead bug exercise: x 10
  • Therapist’s correction(s): Straighten the leg that you are lowering, but without touching the bed (my muscles hurt more that way but I felt it was the right kind of pain — the kind that will build muscles!).
  • Tip: tuck belly button in too!
• Flutter kicks x 10 — added in the last session
• Crossed flutter kicks x 10 — added in the last session
  • Tips: Inhale as legs part, exhale as you cross them
• Knee hugs for around 10 counts: x3 — added in the last session

Part 3 – exercises on your belly

• Plank on your elbow: x10 at count of 20 seconds each
  • Tip: Tuck belly button in to support core; don’t let core drop!
• Cat-cows: Count to six per pose, repeated 10 times
  • Tip: pay attention to hips here, if you have lumbar scoliosis
• Bird-dogs: x 10
  • Stabilize core and pay more attention to hips here to maintain balance; the lumbar scoliosis gets in the way.
• Supermans: Repeated 10 times.
• Press-ups: Count to 20 while holding the stretch upwards, repeated 3 times
  • This stretches the core and you should also feel it in your upper/middle back

Part 4 – weighted exercises outside individual therapy rooms at POI

• Carry 2.5KG dumbbell on each hand
  • Engage core; Imagine you’re trying to balance while holding grocery bags
  • From one end of the hallway to the other, do high-knee marches (Tip: Straighten leg whose foot is on the floor for balance)
  • Notes:
    • Nam said I can also use a heavy kettlebell held onto the chest at home but best if they’re two weights held like grocery bags on the side of the body; sadly my dumbbells at home are mcuh lighter
    • Lost my balance as I held back my laughter upon eye contact with my partner lol
• Hold a 6KG kettlebell in one hand with the other arm held across the shoulder
  • Keeping core engaged, walk normally from one end of the hall to the other
  • Repeat with the other hand/arm
  • Notes:
    • It was like an obstacle course too as I had to avoid physical therapist and patients I came across in the hallway xD
    • It seemed to me that the POI Makati therapist were chummy among one another; their work culture must be really nice!
• Hold 6KG kettlebell on one hand like 1 heavy grocery bag, with other arm held across the shoulder again
  • Perform side crunches, leaning the torso sideways towards the arm with a kettlebell
  • Ensure that you feel core muscles contract here (lean sideways starting from above belly button only, but make sure you lean far enough to feel the ab muscles working)

Some advice from my physical therapist Nam:

• Can opt to use heat pad only on sore days
• Aim for 3 times a week physical therapy exercise to maintain my spine health

Aside from maintenance exercises, one rule I set upon myself is to maintain the “C” curve of my lumbar spine as much as possible. So far it’s an easy and effective way of preventing the muscle spasm/sprain that I suffered from for so many times.

After the 6th and last POI Makati physical therapy session, I went to my orthopedic doctor Dr Carlo Borbon for clearance. He did the same checks that he performed before sending me for therapy: Bend forward, bend backward, bend sideways to both sides… He also examined my lower back muscles, and commented that they felt less tense than before!

Physical Therapy Cost/Fees at POI (Phil. Orthopedic Institute) – Dela Rosa St., Makati City:

• My physical therapy session for lower back pain (degenerative disc disease L1-L5) costed 2400 Philippine Pesos, including usage of the traction machine. I found out because the POI Therapy Department texted me about exceeding the 1500-peso limit that HMO (Intellicare) set on my LOA/RCS.
• In initial sessions that didn’t involve a traction machine was probably 1500 pesos or less because we had no problem despite the 1500-pesos limit on the cost covered by Intellicare.

Cost update as of Sept. 15, 2024: They will increase physical therapy service fees on October 1, 2024.

Tags: Physical Therapy, Lumbar Back Pain, POI Makati, Degenerative Disc Disease, Heat Pack, Ultrasound, Shockwave, Inner Thigh Stretch, Hamstring Stretch, Glutes Stretch, Pelvic Tilt, Bridges, Modified Sit-Ups, Cat-Cows, Supermans, Press-Ups, Bird-Dogs, Traction Machine, Core Exercises, Meniscal Tear

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