For this semester, our clinical question developed out of our advanced strength and condition project from last semester. Dr. Grossman reached out to us a few weeks in regards to creating a training template for him to follow as he gets himself ready for a marathon in April. As we discussed last semester, Dr. Grossman is an ultra runner who suffers from proximal hamstring tendinopathy. We realized what a great opportunity his reaching out was as we knew we could continue to collect data and research the topic. Seeing as we hope to expand this into a greater research topic and a possible case study, we decided it would be a great topic for our clinical question. Chandler and I make up the team as we were the two who worked on the project last semester. We chose Dr. Barret Blevins PT, DPT, ATC, Matt Harris PT, ATC, and Dr. Eric Grossman as our committee members. Matt is acting as our faculty advisor as he carries dual credential, Barret as our AT advisor as he carries dual credential, and Dr. Grossman as our content expert as he is a long time ultra runner. Since we are working on this from a rehab standpoint, we wanted to use our off site physical therapy preceptors as we figured they would be a great source of information. They have already given us many useful ideas and research articles as references. We are very interested in studying this as proximal hamstring tendinopathy has only recently began to be studied and recognized as a separate diagnosis from overall hamstring issues. There is not one widely accepted rehab protocol for the injury, nor is there a specific cause, but a correlation has began to emerge in ultra runners and other long distance athletes. One of the interesting ideas that Barrett and Matt opened to us was the possibility of hip flexor tightness leading to less activation of the glutes and thus more activation of the proximal hamstring as a hip extensor. This is the first stand we have decided to explore. We began immediately trying to address flexibility in the training program last semester, but did not put a large emphasis on the anterior aspect of the hip. Given the new research we have discovered, we have been integrating more anterior chain work in flexibility. We are extremely excited to see where this goes! This week I was able to receive two attempts.
I would have to say that my clinical placement from last semester and the one I am currently in feel like complete opposites. Being with football last semester felt a lot more hectic mostly because of the pre-practice setup and the sheer number of athletes on the team that we dealt with daily. The physical therapy setting does not feel as hectic, even on our heaviest patient load days. I enjoyed being with football as it gave me an opportunity to be around a sport that I grew up loving and playing, gave me a lot of opportunities to work on my emergency care skills and taping, and allowed me to practice my evaluation skills in a huge way due to the amount of injuries we saw. The aspects that I enjoy about the physical therapy clinic are being in a clinic setting, building relationships with patients, and getting to be creative in a rehab setting while working with patients one on one. My ideal situation as of now for my future career is working in a clinic setting, so seeing that I am truly enjoying that aspect has helped cement that goal in my mind. I also really enjoy being able to apply my evaluation skills in the PT setting. Each of my placements have very unique aspects to them. I feel like you see a higher volume of different injuries in football more so than in other sports, so it gives you a great opportunity to deal with a variety of things in one setting. You also have to deal with a lot of different personalities and moods depending on the day, so it helps to develop your patience. In the PT setting I am dealing with a much wider range of patients from backgrounds such as work related injuries all the way to sports related injuries. These experiences have had big impacts on me. Being with football I learned a lot about patience and knowing when to draw a line with certain things. In the PT setting I am learning that I really do enjoy the field. I feel very comfortable and confident in the setting which further makes me want to pursue a future in PT. I can honestly say that my evaluations during football have helped me in the PT clinic as I have been able to translate a lot of the knowledge I picked up into everyday practice.
This week Chandler and I made the decision to begin working with our client again from last semester, Dr. Grossman. As I discussed last semester, Dr. Grossman is a long distance running athlete who is suffering from an unspecified proximal hamstring tendinopathy. We were assigned to Dr. Grossman as part of an advanced strength and conditioning project. Each pair in the class was assigned a client to work with over the course of six weeks. After our initial meeting with him we decided to attack the project from more of a rehabilitation standpoint. We began my obtaining measurements for strength and range of motion. We built a plan that focused on glute and core strength along with a flexibility program and reassessed after the six weeks. Our final evaluation revealed increased in strength and flexibility along with a decreased pain rating while performing the same activities that irritated it before. When we last touched base with him he had began to ramp up his cycling as opposed to his long distance running and had decided not to set the goal of competing in a long distance event. This past week Dr. Grossman reached out to us again. He is planning on running a marathon on April 29 and wanted to know if we would be interested in creating an injury prevention exercise program for him to carry out as he trains for the marathon. He also wanted to know if we could meet periodically to check up on everything or discuss issues. We agreed to take on the task and asked that we could use the data for the basis of research. Our goal is to continue off of our data from last semester and build this into our clinical question for the semester and potentially turn this into a larger research project. This deadline gives us nearly 12 weeks to prepare and we have a good understanding of the situation to go off of now. We are eager to begin the process and have actually designed the first part of it today for him to begin. We are piggybacking off our preceptors and associates at our offsite locations along with our onsite preceptors to build up our information basis and to help us present this in the best fashion. I feel very lucky that we have the opportunity to do this. I feel like this is a great introduction to a larger research topic for us and we are both excited to see where it goes. The more we research the topic of proximal hamstring tendinopathy (PHT) the more we learn that is a fairly new topic of study and has only recently been recognized as a serious problem facing long distance athletes. There are no standard protocols, proven interventions, or many researched treatments, so we feel that we are on the cutting edge of a new topic. I cannot wait to see where this goes and I am sure I will have a journal later on that gives an update on our progress. I did not receive any attempts or masteries this week.
I had a great week at the physical therapy clinic. I had the chance to assist many patients in one on one situations. On Friday I had the opportunity to assist Barret in an interesting lumbar spine evaluation. We had a patient come in who was complaining of low back pain. As Barret began to ask him some questions, we picked up on some interesting information. The patient was diagnosed with in who was complaining of low back pain. As Barret began to ask him some questions, we picked up on some interesting information. The patient was diagnosed with degenerative disc disease in his late teens. In combination with that the patient works construction, has a lot of issues with kidney stones, and had a 20-inch bowel resection around eight weeks ago. We noticed that he had a lot of overlapping issues that could contribute to the pain. He began to describe his pain to us and stated that the pain was the worst in the morning, but that after he got going it would get better. I began to wonder if the degenerative disc in combination with that statement could mean that he was suffering from arthritis, but was not 100% sure as I am not very familiar with it. He told us that he had no radicular pain in either leg. Barret let me perform his strength, ROM, and special tests. I noticed that he had good strength bilaterally along with relatively normal ranges of motion. As I went through his special tests I noticed that he still had no radicular pain or positive signs for a disc herniation or a nerve root impingement. I felt confident that we were dealing with arthritis and I waited for Barret to comment. He informed the patient that he believed he had arthritis at the L4-L5 lumbar spinal segment. I thought this was an awesome experience for myself as I had not had a chance to be a part of an arthritis diagnosis and had to go off of my textbook knowledge of the condition alone. I asked him if he believed he was suffering more from facet joint arthritis or is the degeneration of the disc could lead to bone on bone arthritis in the vertebral body itself. He informed me that it could be a combination of both. I look forward to performing more evaluations in the clinic (as this was only the second I really had the chance to do). It also leads me to believe that I will have the chance to see a lot of injuries I would not typically see. To this point I have been a part of the evaluation process for this injury as well as Thoracic Outlet Syndrome. This week I obtained one attempt in my packet. I have a lot that I need to work on this week for General Medical Conditions.
Each week, the students in our Athletic Training Program are required to post a journal entry. These can be typed our video recordings. Each week we focus on a different topic relating to clinicals, research, EBP, classes, or life in general. We are also graded through our websites, so if you notice any weird notes or things that do not make sense it is probably part of an assignment. Take a minute to check them out!