Monday Memo 10/9/17

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

October 9, 2017 |

Monday Memo 10/2/2017

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

October 2, 2017 |

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 |