A Student’s Reflection on The Scully Lecture
In the Scully lecture, Dr. Delitto discussed a hot topic issue that our country, the opioid epidemic. Each year many people go see their doctor for low back pain (LBP). While some patients get a referral for physical therapy, even more receive pain medications. The question I’m sure many of you are asking is “Why isn’t everyone being referred to PT?” or “Why don’t patients just come see us first?” As physical therapist, it seems obvious that we can best treat these individuals and provide them with the best care, but how do we get everyone else to see it this way?
As I am beginning to realize, it is going to be a slow process of building our brand and getting people to recognize physical therapists as first contact practitioners. Although this won’t happen overnight, we should not take a back seat in the meantime. As young professionals, we now have the opportunity to shape this brand and the profession that we will be working in for years to come. For one, we can use social media to share our experiences as physical therapists and inform others about what we do. This is one of the most accessible resources available to us, one that we are all familiar with, and best of all, it’s free! As physical therapists, we can also make sure to be active in the community, whether it is participating in sports for individuals with disabilities or screening runners at a local race. The more contact we have with people, the better we can educate them about what we do. Individuals who have been to physical therapy are more likely to go to a physical therapist as a first contact provider in the future. Lastly, I encourage you all to become involved with the APTA. As our professional organization, they support us through legislative advocacy, clinical practice guidelines, and campaigns for public awareness.
-Robert Jesmer, SPT
Interpreting Hip Pain
Currently, the 1st year DPT students are approaching our musculoskeletal exam involving the evaluation, assessment, and treatment of the hip. I thought it would be appropriate to post a hypothetical case study of presentation that we may potentially see on our exam or in the clinic.
Case: A patient comes into your clinic for groin pain. He is a 65-year-old independent male. You begin taking his history and discover the following; the pain began two weeks ago, but he cannot recall a specific event that brought on his discomfort and the pain is located in his lateral hip. He also tells you that at first, the pain would be worst after he had been gardening for hours, but now, he notes that the pain comes on even when doing something as simple as getting his newspaper from the driveway. He then tells you that he also has been feeling pain on the medial side of his knee. Upon further questioning, he reveals that he has had trouble sleeping because of the pain.
Using this information, think about what further questions you would want to ask and what tests and evaluation methods you would use to create differential diagnoses for this patient. Depending on what you believe to be a possible diagnosis, determine how you would decide to treat this patient.
-James Tersak, SPT, CSCS
Progressing the Clamshell
No matter the goal, it’s likely that you’re not going to get there after just one session. It takes practice. It takes repetition. It takes planning.
The mark of a good therapist, regardless of your setting, is the ability to properly progress their patients towards their end goal. In order to do so, you need to incorporate progression into the training program.
The most basic form of progression when it comes to resistance training is the manner in which you increase load. For example: Increasing by five pounds each session. A much more difficult concept is to apply progression to movement patterns & muscular development. This is critically important in a rehab setting, where patients may not be able to progress quickly enough to continually increase load.
The Clamshell Bridge is a great way to progress GluteMed strength! As a therapist, odds are high that you’ve prescribed Clamshells more times than you care to count. We can make this simple exercise much more difficult!
- The Clamshell Bridge takes the movement a step further! We’re performing abduction & external rotation of the weight-bearing hip to lift our body up off the ground.
- We’re maintaining isometric GluteMed activation at the top to support our bodyweight, which also allows us to tie in lateral chain core stability in order to maintain proper positioning.
- In addition, we begin to layer in closed-chain shoulder stability and get the benefit of an eccentric GluteMed contraction on the descent!
Add this exercise into your routine the next time you train. Play around with it and get the feel for the movement, it’s nuances, and any potential compensatory patterns that a patient may attempt to use.
If you like it, add it to your list of rehab progressions!!
-Charles Badawy, SPT, CSCS, USAW
Seeing the Bigger Picture Through the Details
As physical therapy students, we are training to become specialists of the human movement system. This means we focus not only on what our patients are doing, but how they are doing it. The key behind a patient’s complaints can often be uncovered by the idiosyncrasies in their movement. Identifying these small changes or patterns in movement can direct us along the map to successful outcomes. It’s the physical therapist who can pick up on these details that makes the difference between an “impossible case” and a treatable one.
As counterintuitive as it may seem, sometimes stepping back and removing yourself from can help reveal the details. A great example of this is gait analysis. Most of our patients walk for mobility and many of those who have lost this ability wish to do it again. Observing a patient’s gait and identifying the details that differentiate it from what is expected can be overwhelming. What is “expected” for this patient? Is the hip hike you identified actually related to an impairment at the hip? What about the knee? Ankle? This is where the step back really helps. The detail (the hip hike) has been identified, but how does it relate to the rest of the body? We are specialists of the human movement system, after all. It is our role as physical therapists to recognize the bigger picture as a function of smaller details.
Don’t get caught up in the details, but appreciate them and let them guide you.
Julie Rekant, SPT
Class of 2019 Vice President
The Monday Memo
September 18, 2017 PITT DPT STUDENTS
James Tersak, SPT, CSCS
Joint Motion End Feels
When completing an evaluation, a Physical Therapist is equipped with many assessment skills that are necessary to construct a comprehensive diagnosis of a patient. These skills include techniques that are used as parts of physical examinations, one of them being the ability to interpret joint motion end feels. A joint end feel is the sensation felt by the examiner when the end of the available range of motion is reached. There are a few types of end feels, and once identified, each can be used to guide your examination process. The end feel types include:
- Empty – end range is not reached due to excessive pain of the patient
- Soft – end range reached due to soft tissue
- Firm – end range reached due to resistance of the capsule or ligaments
- Hard – end ranged is reached due to bone on bone contact
For example, if a range of motion deficit was discovered when assessing passive hip flexion with the knee extended, a physical therapist would be able to interpret the end feel of the joint to hypothesize what could be a possible cause. If the end feel was hard (bone on bone) as opposed to soft (soft tissue), the therapist would hypothesize that the decrease in range of motion is due to some sort of impingement in the hip rather than hamstring tightness.
Interpreting end feels is a simple technique, but it can be very valuable when examining and treating a patient.