I am currently working very hard on my goal of improving my rehabilitation skills by meeting with a patient twice a week for treatment. I am currently working with a patient who suffered a recent ACL tear with a medial meniscus tear. After discussing my goal with Melissa she asked me if I wanted to take the task on. I thought it would be a great opportunity for me to work on planning and executing a full rehabilitation. My goal is to review the stages of healing as I progress through the rehab process this semester. I really wanted to focus on this goal this semester as it was one of my lower categories on my last BOC practice test. I believe practicing the skills while reviewing will benefit me much more than simply reading and reviewing. I have also been spending some time studying the healing phases on a cellular level again as I feel that that is some of the information that I have struggled to retain. I have been utilizing my therapeutic modalities notes as well as the material we have been covering in anatomy to review. So far, I have been able to see the patient for three sessions and she is making good progress. The experience as a whole has been great review and I look forward to seeing what we can accomplish by the end of the semester. One thing that is challenging and that is interesting about this particular case is the limitation her surgeon set forth in regards to limiting her range of motion due to the type of meniscal repair she had done. We are about 10-15 degrees behind where a typical ACL repair would be. This has her slightly worried I believe, but I have discussed with her how all rehabs are individual and require different things. She is very interested in the anatomy and physiology behind her injury, so it is very beneficial that I can review while explaining to her what is going on. I have realized that I learn the best from teaching since I arrived at college, so I think this semester will help me do much better on my next practice BOC. Melissa will also be working with me on reviewing material as the semester goes on and I know that any questions I have I can refer to her for. With all that being said, I am still very confident in my knowledge and skills in regards to rehabilitation. I did well on my first practice BOC in this category and understand the material, it was that the questions revolved around one of my weaker areas in the subject. This was a good experience for me to see where I needed to improve and what I could do to be better in the clinic.
I obtained 2 attempts this week. I have many attempts and masteries to get signed this week.
I try to promote Athletic Training in everything that I do. There have been many occasions where I have been out somewhere and had AT gear on and people have asked me about it. This has always been a great opportunity to promote the profession and educate people on what we really do. I feel like it is a great opportunity to do so as many people have the wrong idea about Athletic Training. The typical things that people bring up are strength and conditioning and personal training. This gives a great lead in to inform people of us as healthcare professionals. This usually always gives me the chance to discuss things such as our program, the BOC, clinicals and other aspects of our major and the profession. People are often very surprised to learn of all that we do. I also find that we have a great opportunity to promote AT in other areas such as jobs, internships, and observations. I had a lot of opportunities at my old job to promote AT. Many people would ask what my major was and what I planned to do in the future, so that gave me a great opportunity to promote it. This past summer during my time at Duke I had many opportunities to promote AT as well. I had many great discussions with surgeons, PTs, and nurses about certain things that are unique to our field and how some of the concepts and ways we handle situations can be carried over into other fields. As far as promoting the NATA, I usually get the opportunity to do so when these conversations come up. I feel that the slogan “your protection is our priority” is shown without having to actually say anything. We make many sacrifices and perform many tasks that other students and professionals do not have to do, and all for the betterment of our athletes and patients. One example that I think illustrates this is our preparation during preseason. We come back to school earlier than anyone else and put in days of training to make sure we are prepared for emergency situations, have practiced our skills, and have everything ready for the athletes to be screened and begin their practice in a timely and efficient fashion. Things such as practicing cpr and equipment fitting allow us to prioritize athletes safety in the fall and to build a basis to go off of for the entire year and the rest of the sports.
Decided to give the video a go this week! I feel like it is a little rough, but I believe I got the majority of my points across this week. I did not receive any attempts this week, but I do need to work on filling a lot of attempts and masteries out.
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.
For this semester, I have been placed with Barret Blevins at Wellmont Physical Therapy in Abingdon, Virginal. Barret attended Emory & Henry in the early 2000’s and obtained his bachelors in Athletic Training before attending VCU to obtain his Doctorate of Physical Therapy. I was very excited and nervous heading into my first day at the PT clinic. I was excited in knowing that Barret had taken the same path I am planning on taking heading into my career. This has and will continue to open opportunities for me to ask him for advice about graduate school, the field of physical therapy, and the use of the skills I have learned to this point. I was also excited about being in a rehab setting, but at the same time this scared me a bit. Most of what I have had the opportunity to do in my on-site experience has been acute care, emergency care, and injury evaluation whereas now I am in a setting where I am dealing with a lot of chronic issues from a rehabilitation standpoint. I felt that I might not have the greatest bearing on some of the strategies used in rehab, but I also knew that going in head first would allow me to learn faster. I can already say that my experience there has been amazing so far. At the beginning, I was doing more following and watching than anything, but Barret started to slowly started to work me into being hands on. This past week I was able to do an ultrasound in the clinic, take control of a rehab leading a gentleman through his exercises, help many patient with various exercises, and perform special tests to lead to a thoracic outlet syndrome diagnosis and plan of treatment! The TOS experience has been my favorite so far as Barret really put me on the spot with the special tests, diagnosis, and explanation of TOS in front of the patient. This got me on my toes very quickly, but I was able to explain the information thoroughly and he seems satisfied with the occurrence. I am really looking forward to continuing at the clinic for the duration of the semester. Barret is from a local small-town just as I am, so I am able to ask him a lot of questions in regards to advice for my particular situation. Also, I am already seeing one of my goals play out right in front of me. One of my more important goals (from a personal perspective) is to build patient relationships by the end of the semester. To this point I have been able to see many return patients and get to know them. I feel as if I have already built trust with some and hope I am leaving a great impression with them. This week I was able to obtain four attempts in my packet.
For this semester my goals are to: Obtain six masteries per week, develop my rehabilitation skills in a clinical setting by the end of the semester, work to build patient relationships in an off-site environment by the end of the semester, and to have my clinical question picked and board established by February 15th. This semester we have the opportunity to practice our rehabilitation skills in clinical, with our rehab projects, and in my clinical setting at the PT clinic. I am very excited to have a strong focus in this area. I feel like we have a good base of understanding of rehabilitation from our class last year, but I feel that we have not had a lot of opportunities to use the skills or to focus on them. I also feel a little rusty on the concepts since we have had a year off from the course. I feel as though this semester will allow us to review the concepts, dive further into them from a comprehensive viewpoint, and to apply the skills. My first goal of six masteries will allow me achieve the 84 by the end of the semester. My second and third goals are very important to me as I plan to pursue a career in physical therapy. It is important that I develop my rehab skills early so that I am better prepared once I reach graduate school and beyond. My third goal is very important to me, as I expressed to Dr. Blevins, due to the fact that I decided to change my collegiate goal during high school to go into a field where I felt like I could help people every day. In doing so I want to build lasting relationships, build trust with patients, help people to the fullest extent, and be able to be very successful in my future field. My last goal is timed to ensure that I have the topic and board picked for the little clinical question a few weeks in advance of the due date. I believe that doing so will take some stress off of the work of the semester as well as lead to better clinical question research and a more thoroughly developed topic. I am also very excited to start the rehab project as I will be able to build on three of my goals and experience a rehab I would not typically see in this setting. I have been researching the lumbar spinal fusion and discussed some aspects of the rehab with Dr. Blevins this past week. I obtained 4 attempts this past week, but no masteries.
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!