Should I continue to taper not sure if flare or part of physio for ankle recovery ?

[Buttonshutton]

Hi. As some of you know from my questions previously, I broke my ankle in March. Currently having hydro therapy and land physio to learn to walk on it and increase mobility. When I did it I was on 18.75mg. I know funny dose but was slow tapering from 20mg. Anyway down to 15mg all been ok PMR wise but the last week or so I’ve felt a few twinges in my shoulders and back/tops of legs I’m struggling to tell whether it’s a possible flare or simply my body protesting at the physio obviously using different muscles to compensate especially my shoulders and my back hurts when I walk Physiotherapist says this is normal due to different gait and walking with a crutch etc I am staying on each pred dose for 3/4 weeks I was going to drop to 13.5mg yesterday but haven’t done I wondered if any of you had any thoughts . No point asking the rheumy as she will start her get off pred rhetoric, again some of you will know she is one of “those” Due a call from her this month which I am dreading as last time I spoke with her she said “when we speak in June you’ll have dropped another couple of doses” (from 16mg when I spoke with her at the beginning of May) had to battle to get her to agree to the slower taper. Anyway won’t get into that now, just wondering on any thoughts re tapering whilst body is protesting a little

Thank you as always

[PMRpro Ambassador]

As well as dropping in small amounts - are you also using a slowed taper to introduce the new dose more gradually? That does often make a difference to how much your body protests - I found after the third presentation of the new dose it calmed down. And by the sixth I was starting to feel better on new dose days than old dose days...

One of the problems with physiotherapy is that their exercises use repeated movements for a muscle group - and in PMR that is often poison, resulting in an exaggerated development of DOMS (delayed onset muscle soreness) which then takes much longer than you would expect to resolve. You say walking with A crutch - that makes things worse in my experence as it emphasises any imbalances.

[Buttonshutton in reply to PMRpro]

Hi. Thank you for coming back to me. I haven’t been doing the alternate dose taper but you raise a good point. I showed it to my rheumy she ignored me ! (Via email - made no comment on it on my phone call following the email just said I need to drop). But yes. If I try the new dose tomorrow then back to 15 for few days etc. forgotten the science to ot but I’ll find it again. Good idea. Thank you. Hmmm physio double edged sword. That’s annoying isn’t it. I’ll try and wean off the crutch too. Think half of that is psychological ! Thank you again !

[PMRpro Ambassador in reply to Buttonshutton]

Can always use 2 crutches if it helps! That's what I do when I feel I might need them

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

Or two walking sticks ..I found crutches are apt to be more unwieldy-or perhaps that’s just me!

[Buttonshutton in reply to DorsetLady]

Horrible things aren’t they !

[DorsetLady PMRGCAuk volunteer in reply to Buttonshutton]

When using them for first couple of weeks after knee replacement they weren’t good for my shoulders!

[Buttonshutton in reply to PMRpro]

The physio took one off me. I’ll acquire another !

[PMRpro Ambassador in reply to Buttonshutton]

I've heard of cost cutting but that is ridiculous!!! We have to pay a deposit for ours - 20 euros many years ago seemed a bargain! But they come in pairs ...

[Buttonshutton in reply to PMRpro]

Really ! Wow. I’ve got a walker they don’t know about …

[PMRpro Ambassador in reply to Buttonshutton]

I didn't have to pay anything for OH's walker - but I did have to return it