So far my internship is fantastic! I work with a few different Physical Therapists that are in the clinic, but mostly with the therapist, Matt. I enjoy learning every time I go in and it is so interesting to hear about different injuries. The people that I am working with are enjoyable and willing to teach me. Even the simplest questions I have they answer without giving me that 'are you kidding me' look.
At the San Ramon Regional Hospital, I intern in the outpatient physical therapy wing about six hours a week. Most of the patients that come in have been coming for several weeks so they know majority of their exercises. The fairly new patients that have been coming a few weeks after their surgeries will get a deep tissue massage and an evaluation.
As soon as the appointment begins the patient is brought over to a table and is given a heat pack to warm up the muscle; ice should never be given right before exercising and working that cite because it will constrict the blood vessels. After a few minutes of heat, Ultrasound or Infrared Treatment will be administered to help loosen the deep muscles. Then, a massage will be given with two types of cream; one is a gel, biofreeze, and the other is a lotion, Deep Prep. The biofreeze helps with the pain and the Deep Prep cream helps loosen the muscles, it's a soft tissue massage cream. It is important that swelling is very minimal or not present anymore in order to continue on to range of motion; if there is still a significant amount of swelling then it could restrict the full range of motion. If the patient is fairly new, their range of motion will be focused on by stretching the muscles surrounding or participating in the injury. The PT holds the patient in that position for a few seconds, relaxes the patient, and then may continue another time. The patient is given exercises to do to strengthen the muscles around the injury to help the healing process. It is mostly body-weight exercises, depending on the patient, weights will be added.
The first patient I observed was a woman who had two rotator cuff surgeries. She is back to not only strengthen her rotator cuff (shoulder), but she thinks she tore it again. Her treatment plan consists of pushing exercises with weights, strengthening her serratus anterior, infra spinatus, and supra spinatus muscles that connect, making part of the rotator cuff, she also does internal and external rotations with weights.
The most interesting patient that came in was an elderly woman that fell on an out stretched hand and fractured her elbow. She had surgery and now has a plate and 13 screws in her elbow. She is recovering well and is in good spirits, event though she refuses to see her scar, which I told her looked cool.
The most difficult patient was this elderly man who experiences back problems. Now, the back and the abdomen go hand and hand with each other, if the stomach muscles are weak all of the strain and pressure will be compensated on the back. This man had very weak stomach muscles. When you flex your abs your stomach should flatten, and your back will depress, if you try to speak you should be able to have a full conversation. When Matt tried to get this man to flex his stomach muscles and push his back into his fingers, which were under his back, the man used every muscle in his body to actually push his back into his fingers, pushing out with his stomach instead of flexing. His body was compensating a job that one muscle can do. After controlled crutches and holding that stomach flexion, he finally got somewhat a hang of the correct muscle activation. It was frustrating because it's hard to tell someone how to use their muscles correctly when they have gotten comfortable doing it incorrectly for years. It takes a lot of patience for Physical Therapists to walk through the exercises with the patient. Telling them to lay on their back and they lay on their stomach is just a simple example. They just have to correct the patient and learn to have patience.
Ever sense I have started my internship and showed my passion in the field my friends have asked me to "Physical Therapy" their injuries. It is obviously a joke but it makes me smile because they see my potential and passion for the field. I do use them as guinea pigs to palpate things I cannot on actual patients. Matt was showing me the movements and flexibility of the hip when someone moves. A woman came in with a strained hamstring which misaligned her pelvis, the pulling of the muscle tweaked the pelvis (iliac) causing lower back pain. He evaluated her hip movement; one thumb on an Sacroiliac joint, SI joint, in-between the Sacrum and the Ilium, and the other on the Posterior Superior Iliac Spine, PSIS, the most prominent posterior part of the hip. If the right side is being tested the left thumb will be on the SI joint and the right thumb should be on the PSIS. ( for left hip it will be switched, there is an SI joint on both sides of the sacrum) The patient is then told to lift one leg, depending on the side being tested. The finger on the SI joint should move up and the thumb on the PSIS should go down. If it does not move in that way, that side being tested on the hip, is tight or misaligned. Both sides should be tested to compare bilaterally and just to see how extensive the injury is. You can also test by putting two thumbs on both SI joints and have the patient lean the upper part of their body to the left or right, whatever is being tested, if they lean to the right, your left thumb should depress into the joint, if they lean to the left, your right thumb should be depressed into the joint. So, my friend, Ally, was complaining of lower back pain and asked me if I could "physical Therapy" it (whatever that means), so since it was her lower back and that woman came in for lower back pain, I decided to test the flexibility and alignment of her hips. I did everything Matt demonstrated on the actual patient, on my friend, and on her left side I saw her hip was a little tight, which I was guessing caused the pain. This was only an attempt and a guess, I did not diagnose my friend by any means. For all I know I could've done it wrong, but it was cool to actually be the one palpating and seeing what Matt was talking about.
Working with uneducated patients on their own bodies is a tedious and patient job, yet it is very rewarding. Patients look up to you and honor your word, they put their trust in you that you will heal them. Watching the progress over weeks which several different patients is rewarding enough. They was one little girl that gets treatment in the Pediatrics Therapy room that came in six years ago completely limp and weak. A Pediatric physical therapist has been working on her and now the little girl can walk, talk, chew, run, play and most importantly smile. I do not work directly with the little girl but when I see her in the clinic it brings me hope and joy. I honor the therapist that strengthened her, all that time and patience created a life for that girl. I want to make that big of a difference in someones life, seeing that progress makes me what to achieve my high potential.
I have a long way to go on this journey and it won't be easy, but if that little girl can be strong and push through therapy then I to will push forward. It takes a lot of hard work to be successful but you won't achieve anything waiting for the future to happen, it is up to you to act.
These are just some of the things I have been apart of and experienced. Each time I go in there is a new situation and a new lesson to learn, if I continued on this may become a book instead of a blog.
