Monday Memo 9/26/17

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

September 26, 2017 |

Monday Memo 9/18/2017

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.


September 18, 2017 |

Monday Memo 9/11/2017

The Monday Memo

September 11, 2017                                                                           PITT DPT STUDENTS

Physical Therapy Abroad

This summer I had the opportunity to travel to the town of Chichicastenango, Guatemala for my 6-week full-time clinical.  An American physical therapist started the program there and now they have a Guatemalan PT on staff as well. Therapy services were provided free of charge as many of the patients would not be able to afford it otherwise.

One thing I really enjoyed about this clinical was the variety of patients I got to see. The program was started to treat children with disabilities, so the majority of patients were pediatric with the most common diagnoses being cerebral palsy, spina bifida, and Down syndrome. We saw adults with neurological diagnoses such as traumatic brain injury, spinal cord injury, and stroke. We also saw patients with orthopedic problems like back pain, meniscus injuries, arthritis, and one man with a transfemoral amputation.

Most patients were seen in the clinic, but at times we would see patients in their homes if it was difficult for them to make the trip in. Not much is handicap accessible in Guatemala, which is different from most places in the U.S. Many people have to traverse rough terrain or steep stairs just to leave their homes. Paths are often narrow and uneven, which makes using a wheelchair or walker difficult, if not impossible. This creates unique challenges for a physical therapist and requires creative thinking and problem solving.

I also had the opportunity to travel to some other areas to see patients. One was a smaller town where ASELSI has started a clinic, and the other was a rural village in the mountains where they are in the process of starting one. That village took us nine hours to get to even though it was only about 100 miles away. Due to the rough conditions of the roads we were driving only 5-10 mph for much of the trip. It was definitely eye opening and it seemed that the more rural and further from access to medical care we got, the more serious the disabilities were.

There are so many unreached children and adults living with disabilities in Guatemala that could be much more functional and have a higher quality of life if they had access to physical therapy. I am thankful I was able to have a small part in treating some of those patients.

I had been to Guatemala three times before, but only for about a week each time. This time I learned more about the culture and saw more of what daily life is like. I was able to build relationships with the staff, those I lived and ate with, and others I met along the way. It was an incredible experience and I learned a lot about PT and about Guatemala. I have fallen in love with the people and country of Guatemala and I hope to return soon.

-Laura Smith, SPT


September 11, 2017 |