Winter break has been going by quite quickly, which means that it is nearing the home stretch of the course. It feels like it was only a little while ago when I barely knew terminology for parts of the body, and was just beginning to learn about how the body moves and functions. Now I know much more than I did before, and I’m excited to see how much more I’ll learn throughout January.
On the last day of school, Travis and I met for our first mentoring session at Trailside. It was very interesting to see how information I took notes on could be applied in the clinic. We began the session with learning about the initial evaluation.Travis explained that a patient can explain what they are feeling and what is irritating them, but there is also a general check you can do to save them from having to explain everything that has been bothering them. Just by watching, there are certain things that you can notice without having to be told. This allows you to get a good idea of any problems the patient may be experiencing, before hearing additional information from the patient themselves.
This basic check consists of the following.
Ask the patient to:
- Keep their heels together and touch their toes
- Lunge forward with one leg, then the other
- Lift one leg up, and balance for 10 seconds (with their eyes closed if possible). Repeat with other leg.
- Bend knees to squat slowly, then return to standing position
- Lift arms straight upwards
- Put one arm behind their back and reach towards the opposite shoulder. Repeat with other arm.
- Lift arm over shoulder and reach behind back. Repeat with other arm.
The main purpose of the initial assessment is to determine the patient’s range of motion, and by noticing any signs of future issues. Simply by doing these tests, Travis was able to notice that I could end up having knee issues in the future because when I squatted, my knees would cave inwards. This is common for females between the ages of 16-17 because as their quads and calves develop, they stop depending on their lateral muscles, making those muscles weaker. When they stop using their lateral muscles, it requires the body to depend more on the knees and put stress on them, which could end up leading to knee issues. He also mentioned that while doing the arm tests, the dominant arm tends to be less flexible than the nondominant arm, and seeing this trend in patients is completely normal.
While performing evaluations, it is important to remember that everyone’s body is different, and therefore, cannot be compared to other people. An individual’s body may have strengths, weaknesses, tightness, and flexibility that differs from other individuals. The best way to monitor improvement or identify differences in their normal body functions is by comparing it to something that can be used as a standard form of measurement. For instance, one side of their body can be compared to the other side of their body, or one leg to the other leg. This also means that the assessment may have to be altered to suit different needs. For instance, if a patient is not very flexible, the activities in the test can be done manually with help from the physiotherapist.
Another type of test that could be performed to check strength was the resistance test.This can be done by the following:
- Have the patient spread their arms straight out to the side, with their palms facing downwards. Push their arms downwards, and ask the patient to resist.
- Have the patient spread their arms straight out to the side, this time with their palms facing upwards. Push their arms downwards, and ask the patient to resist.
- Give the patient your index finger, and ask them to squeeze the finger with their hand, as hard as they can.
Ask the patient to lay down on the clinic table, and perform the following:
- Ask the patient to position themselves so one side of their body is very near the edge of the table. Ask them to stretch their arm outwards, and resist as you press downwards. Repeat on the other side.
- Ask the patient to bring their knee up close towards their chest, and press down. Ask the patient to let you know if there is any pain or discomfort. Repeat with the other leg.
The resistance test was a good way to get a general idea about how strong a patient’s muscles are.
Next, we moved on to learning how to perform the knee stability test from the video Travis had sent me. The main purpose was to see exactly which positions cause the patient discomfort, and then to determine what area the pain was coming from. He first demonstrated the techniques on me, walking me through the process step by step. He mentioned how you must stabilize one part of the leg with one hand, while pushing or pulling the part of the leg that you are focusing on. He also mentioned that while checking the patella, you can feel around and almost under it in order to feel any clicking or shifting joint movement. Depending on the direction you push or pull, you can test different parts of the leg, such as the PCL or ACL. After explaining the process, Travis let me try it on him while helping me through it.
I found it difficult to know exactly how much pressure to apply while pushing and pulling the leg. Travis explained that it is up to how the patient reacts, but generally, being a physiotherapist requires quite a bit of strength during manual therapy. One very important thing I noticed Travis doing was always checking in to see how his patients were doing. This may seem to be a given, but he did so very frequently while he performed treatments, and even when the patients were doing exercises independently.
Near the end of the session, Travis showed me his logbook where he records what happened at each of his patient’s appointments, and what the patient felt during that appointment. It is important to do so to keep track of the improvement of the patient. Afterwards, he let me stay at the clinic for a while to look around and see some of the exercises that the patients practiced.
I was also fortunate to have the opportunity to watch a massage therapy session over winter break. My Mom was involved in a car accident a few months ago, when her car was rear-ended after coming to a stop at a red light. She experienced pain and tightness in her left shoulder, so she went to massage therapy sessions to help relieve the pain. I came along, and learned about what exactly happened.
Her massage therapist explained that when her car had slowed to a stop, both her and the car remained in one spot. However, when the other car hit the back end of her car, it was jolted forward though she remained in the same spot. For a split second, the car continued going as her body remained still, then her body also jolted forward, causing her to fling into the seat belt. Her therapist explained that since the seat belt was wrapped around her waist, across her chest, and over her left shoulder, the impact against the seat belt injured her shoulder and left it tight and sore. During the session, he used manual therapy to relieve tension within the shoulder, and to work towards reducing the pain. It was quite interesting to go to the session, especially since it had a different atmosphere than the other sessions I had been to.
Overall, the session allowed me to understand what it would be like as “A Day in the Life of a Physiotherapist”, and I am glad I got to have that experience. I’m looking forward to the rest of this course, and will begin focusing on the ankle and back over the next little while!