WEEK 5 POST 3

Well this is my final post, Sorry its taken so long Jodie and Jo, i didn't realise i hadn't completed it untill i checked my email!!!
Today i performed treatment on a 16 year old boy with extensor tendinopathy. He had limited range of movement in extension, although there was only pain on resisted extension with radial deviation, third finger extension and power grip, there was no pain with unresisted extension. My supivisor decided that we would perform, deep tissue massage with triggerpointing to ECRB and ED, dry needling * although it would have been cool to perform this, my supivisor took over there :P* interferential therapy and also that we would give him some home exercises to stretch out his extensor tendons and strengthen them with some excentric loading.
I performed DTM ( deep tissue massage) with triggerpointing to his extensor tendons , and i progressed it with placing the extensor tendons in a more lengthened position, ie with his wrist in a flexed position. I felt that after treatment although he seemed a little sore, he was able to gain more movement; my supivisor then decided that dry needling the tendons would also be benificial.
On application of the interferential modalitiesi found it difficult to place all the electrodes around his arm without allowing them to touch eachother!. as the forearm is quiet a small area, i later asked my supivisor who said that placing the channels furthur down the forearm is still acceptable as long as the current is still going through the muscles. I still believe that the treatment was successfull.
Teaching the boy the exercises was easy enough as he seemed co-operative and willing to learn. however weather he will do them or not is left to be seen!!!.
In addition to this; on my final day i went to the gym!. My supivisor took me to the gym to look at a patient that he was performing a shoulder rehabilitation for. it was really interesting to see the last stages of rehab; as most of the time while i was in this practice i would only see the initial acute stages, most people managed themselves after a while and it was interesting to look at the different exercises that were prescribed. most being shoulder external rotation, internal roatation abduction and scapular setting with loading sorts of exerecises.
anyway thanks for reading!

WEEK 5 POST 2

Today i treated a young patient who had dislocated his patella 7/52 ago.
I had seen my supivisor treat this patient before; and was quiet confident that i could perform this treatment session on my own.

I applied a medial glide to the patella.I then performed DTM on the boys ITB, and lastly finished the treatment with a dose of interferential therapy, that was aimed at stimulating the VMO muscle. i then gave the boy a exercise that aimed at switching on VMO.

Reflecting on my performance (:) there you go Jo!) i think i performed well; i was confident that what i was doing was correct and i continued to ask the patient whether they were in pain, or they felt an ''adequate'' stretch. I probably think that my exercise i prescribed to the kid was maybee a bit to hard for his stage of rehab, so i asked my supivisor who had a look at the child and decided that yes maybee it was a bit difficult. My supivisor then showed me a more effective stregthening exercise for VMO at this stage of the boys rehab. I feel confident now that i could presctribe some good exercises for switching on VMO! :). Overall my supivisor said i did well and i feel as though compared to the begining of my placement i am alot more confident in treating patients.

WEEK 5 POST 1

Today a client walked in with pain in his wrist/hand. From my supivisors subjective assessment i found that: He was a security guard who had been chasing a offender and had tripped, he had fallen onto an outstretched hand ( FOOSH). I also noted that pain was felt both sides of the hand and it was a constant pain that was felt about 20 min after he fell.

My supivisor asked me to do an objective assessment of the patients wrist pain... immediatly alarm bells were ringing and i was thinking a fracture.. the most common being of scaphoid, however he said his pain was on the oposite end to scaphoid, so i started thinking possibly a fracture to other carpal bones....

Immediatly the patient was TOP on his carpal bones. I asked him to do active flexion, extension in supination and pronation. He was very painful on all these movements. ulnar and radial deviation were non painfull.
I performed AP's of his carpal bones and found him stiff in the 2nd carpal row as well as between capitate and hamate. He told me that in particular this was a very painful movement and it was the pain he was experiencing.
My supivisor performed AP on his carpal bones as well as medial and lateral glides to his carpal rows ( my supivisor said it would be a good idea to perform them next time in the objective assessment as he found them a bit stiff..). we then placed interferential therapy on the hand and my supivisor wrote him out a referral for an x-ray.
I found it interesting that we still performed physiotherapy on the patient even though we suspected a fracture to hamate. But my physiotherapist replied that the patient had come for phsyiotherapy and doing some physio wouldn't harm the wrist anymore than it had already been damaged.

WEEK4 POST 2

Today i did hydrotherapy. I was pretty confident that i would be okay if asked to perform/direct clients on what to do because i remeber doing hydro last year- and also remeber doing it for our clinical ed tute!!.
It went fine and most of the time i simply observed.
One particular patient had had a menisectomy, and also still currently had a bakers cyst at the back of her knee. I found it interesting that the physio leading the hydro session was able to do manual therapy on the patient in the water ( she did alot of accessory mobilisations on the knee cap and tibia, with also some massage). My supivisor said thatwater has many benifits for all types of problems; those including.

- provides a 'weightless' feeling for those patients that can not move under the forces of gravity.
- enables a traction force to be applied
- the warmth can create a soothing relaxation feeling to sore muscles.
- has a boyancy force direction ( that can aid in exercising certain muscles etc)

My supivisor said that hydrotherapy is especially important in people with longstanding chronic back pain. She said that there has been alot of research into chronic LBP and they have found that significant relief from pain can be found with traction forces produced during hydrotherapy.

WEEK3 POST 1

Well this week started off a little strangly.
In walked a new patient who was in his 50's. I originially observed that he didn't seem to have any "musculoskeletal" problems. I was right. The gentleman had come in with a chest infection. I found this particularily interesting as i was not aware that the general public knew that physio's can help people with sputum clearence etc. The man explained that the only reason he knew phsyio could help with such problems is that when he was much younger he had chest physio for another infection.
Anyway my supivisor then proceeded to perform percussions on the gentleman on a plinth with the headrest lowered. The gentleman came back for 2 more sessions after this treatment and i could tell each time he came back he sounded better.
I was able to listen to the clients lungs and i could hear which lobe seemed to be affected.
I found this client situation very interesting, as i was particularily unaware that chest physio was even really performed in a private practice!

WEEK 3 POST 2 and 3!

Well> ~the rest of week 3 was fantastic. I'm sorry i havent got around to blogging much but i have written down all the interesting things i learnt last week
On one particular occasion; my supivisor asked me to assess a young patient who had been comming into the clinic for approximatly 3 weeks. He had been comming in because he dislocated his patella following a sports injury.
I was asked to perform a subjective and an objective examination. I 'am getting a bit more comfortable with performing these examinations; practice is helping i think!.

My supivisor said that my subjective examination was great- i just needed to be a bit more direct with my questioning- he said that often comes with practice. He said that my objective examination might need some work, though. He said i could have performed'
- Obers test ( assessing the length of ITB)
- He said i could have obersved the general position of the patella and its tilt and rotation.
- He said i could have observed the "bulk" of VMO.
- and also observed how the patella was being pulled as the quadriceps and the various other muscles tugged on the patella in knee extention.
- my supivisor also said that depending on the stage of rehab that someone like this patient is in ( ie. acute, or furthur down the track in the healing process) you assess different things. My supivisor said that right now in an acute stage he wouldn't be assessing the length of rec fem or gastroch, but later on down the track something like the thomas and thompson test may be useful for physiotherapy treatment. He told me its important to know your short term goals and treat what you want to improve imediatly. somthing like mlatracking of the patella and strength is important ATM as the young boy was falling over.

Again sorry for the lack of blogging but it was my brothers wedding last week and ive been incredibly busy!.