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.
I belive that overall my progress on the semester was good. This has been the busiest semester of school that I have ever had, that coupled with some other things I have been dealing with outside of school has honestly not made it my best. My grades are good and I feel that I have performed well in clinical situations, but I have struggled to feel connected and to feel like I have put my best foot forward. With that being said I am ready to end this semester so I can have some reset time to get refocused and come into next semester locked in. The best thing I have experienced this semester is being placed in clinical with the football team. It was frustrating at times and I really had to work at it, but the amount of hands on experience I recieved along with the independence in clinical scenarios has benefitted me greatly. As I previously stated, this semester has not been exactly ideal in any sense, so I plan on making the next one of my best. I hope to take many lessons away from this semster and use them to better myself going into my last three semesters.
I feel as though I am confident in almost all situations at this point in my education. I feel like we cover so many topics, and in such depth, that we are prepared for just about anything. That being said, I feel as though I am the least confident in situations where communication is not clear between the athlete and myself or situations where I cannot make sense of what an athlete is describing. There have been a few cases this semester where, for lack of better terms, I have wanted to pull my hair out because an athlete was not communicating with me or was not making sense during an evaluation. It makes me less confident in the evaluation itself as I feel that the diagnosis is not a solid as it could be if the communication and understanding was there. Above all, these situations just frustrate me and especially so if I cannot come to a clear decision. My most confident situations tend to be in emergency care situations as the facts of that section of knowledge have been reviewed so many times that I feel as if it is a reflex to react to those situations.
This semester I have not had the opportunity to do a very in-depth therapeutic rehabilitation or plan for a patient. This semester I was supposed to have had the opportunity to help design and carry out a rehab plan for an athlete with a shoulder injury, but said athlete decided to do his/her rehab at an offsite physical therapy clinic. The best example of carrying out something such as this probably comes from my strength and conditioning project with our client. Though the project is for Advanced Strength and Conditioning and is supposed to be focused on the aspects for the class, a huge part of our project has been on the rehabilitation side for his injury. We created a plan to address his hamstring issues that includes strengthening, stretching, mobility work, and anaerobic capacity in order to address the issue. We are constantly reevaluating and tweaking as we go in order to make the fastest progress possible. The overall goal of the project for us is to allow our client to return to his competitive running time and speed without any hamstring pain. We did baseline testing to determine what areas we wanted to work on and decided to focus on glute and core strength while working on overall flexibility (mostly in the posterior chain). As of now, we are exactly in the middle of the project and will be performing our tests again to assess our progress thus far. We have a daily journal that we and our client post to in order to keep things very up to date. As of now, it appears that we have made great progress, but still have a lot of work to do and some variables to shift. Our goal at the end of the next 3-4 weeks is to completely negate the pain and have him back to his competition speed. When the project is all said and done, I will be able to use it in similar future cases as well as how I will go about future rehabs such as this in order to produce the fastest and best outcome that is physiological process.
I would like to reflect on my goal of: expanding my knowledge of evaluation skills and executing of special tests in order to become more accurate in diagnosing injuries. I feel like I have definitely made a lot of progress in this category of my goals. Being with the football team has allowed me to have a ton of opportunities to perform clinical evaluations. In doing so, I have gotten a lot of practice with the special tests and diagnosing a variety of injuries with accuracy. I have also gotten comfortable with the hip, a section that i struggled with severely last year and was nervous about coming into this year. I believe the independence with evaluations has pushed me to be more analytical and pick situations apart more in order to come up with my ideas and how I should proceed in an evaluation. As for my other goals, I am on track with my goal of completing my clinical question research in the Month of November. My goal of completing 10 masteries per week has slacked as of late. I started off strong early in the semester with filling out everything I did and getting signatures, but I have not been doing so well with it lately. I have a lot of attempts and masteries that I can get credit for from both clinical experience and PBL's, but I need to fill them out and get them signed. I feel like I am in a more comfortable position with attempts and masteries this semester than the past two, despite slacking as of late.
My favorite part of clinical experience this year has been the independence and being able to be with one sport and really learn the team and their tendencies. Last year when we rotated, it was very hard to keep up with injuries from week to week and to be able to read the athletes. We were also watched closer by our preceptors and supervised in evaluation situations more. This year we have been able to perform evaluations more freely and been able to make more decisions and voice our opinions in the clinic. Being with one team gives us the opportunity see the athletes injuries and know what they each need from week to week. Also, constantly being around the same athletes allows us to get to know them better, which, in turn, allows us to read them better when they are injured or sick. Being with football has also given me the opportunity to see a lot of injuries I typically would not see in other sports and a higher volume of injury evaluations due to the contact nature of the sport. I feel like this will experience will translate well to my next clinical sight and feel that I will be more prepared wherever I go.
The inspiration for this clinical question came from one of the members of my investigation team. Originally I was thinking about doing a question involving turf research, but once my team member came forward with this idea I found it much more interesting. I am always excited to learn more or partake in research regarding the field of strength and conditioning and how we can benefit athletes better in the setting. Brittany, Chandler, and I agreed to work together as we know we can depend on each other and all have a deep interest in the topic. I am looking forward to how the research will show us whether supervised workouts or unsupervised workouts produce better results. I am interested to see if the unsupervised produce results that may seem better, but produce more injuries as well due to the fact that there is not a coach present. A side piece that could be explored, but is not a specific part of our research would be looking at one on one sessions with coaches vs. group workouts.
I have shared quite a few pieces of advice with the sophomores this year, so it would be very difficult to say everything on here. One of the first and best pieces I have offered is to not procrastinate on the clinical packets and clinical assignmnets. I presonnaly did this my first semester in the program and it made the last week of the semester very miserable and added a lot of tress to finals and conpetncy exams.
So far this semester my most challenging course has been physiology. It is my first senior level course in college and also happens to be one of the toughest courses in any science department. I believe it has been very challenging for me due the fact that it has been almost four years since I took biology 117/118 and two years since I took chemistry 111/112. The parts of the class that involve things learned in exercise physiology and modalities are coming easy to me, but a lot of the basic concepts from biology and the chemistry aspects as a whole in the course are difficult. The course has a lot of biochemistry, microbiology, and cell biology material, all classes I have not had. The class is very intriguing though as I love studying the physiology of humans and learning about the biological pathways of the body. I am definitely having to study more for the course than I have for any other science course due to the detail and volume of what we learn. We also have an offsite project we must obtain hours for which can be very difficult to do around our class schedules and clinical schedules, so balancing that has also been a challenge. But as I said, I am studying more frequently and more in depth than usual for the course and trying to stay ahead as much a possible. So far the course is going well for me and is very interesting. It also plays into a lot of my course material for other athletic training classes as well!
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!