week three blog: third placement

Situation: A patient was referred to the clinic for a mild MCL strain which resulted from an accident at work 3weeks ago. The patient presented on elbow crutches with an obvious antalgic behaviour.

Task: My task was to assess this patient and devise an appropriate management plan.

Action: After a few minutes of taking a subjective history it was clear that there alot more going on then just a mild MCL sprain. The patient expressed a high level of pain from the knee into the foot on the left side. There was no clear relationship between the different pains and it was severely irritable. The patient also had a history of depression and was on workers compensation so there were a few contributing factors. As a result there was very little I could assess objectively as every small movement was painful therefore the was too much risk of false positive results, we concluded that they were experiencing allodynia as a symptom due to the hypersensitivity to light touch. All investigations came back as a mild MCL sprain with no serious pathology evident. Therefore I surmised that there was a large central component to this patient's pain experience.

Result: As a result of these findings, the acute objective was to maintain range of movement and strength and to find pain relieving positions. I explained to the patient that because the injury was now 3 weeks old, the pain that they were experiencing was becoming maladaptive and that it is important to move the knee through bearable pain so they did not decondition. I also monitored their symptoms closely to note any physical exacerbation objectively compared to the subjective reporting from the patient.

Evaluation: I realise that when I first read the referral I assumed it was a fairly straight forward patient. Clearly now I know not to assume anything from a referral letter and that although physical finding may be relatively mild that doesn't translate directly to the patient's experience. This patient was in a lot of pain and yet it appeared it was a mild mcl strain with minimal bruising and swelling.

Strategies: In future I will not presume a patient's condition from a referral form or previous investigations. It is important to do make an educated decision on a patient's presentation after a thorough subjective and objective assessment. I've also realised the importance of education in a central pain presentation or one with yellow flags as it is vital to reassure and explain pain to the patient to prevent catastrophisation.

third placement- week one blog

Situation: This week I had a patient who was 10 weeks post subscapularis tendon repair, he had been seen previously by another physio student in which I was taking over from.

Task: My task was take over the rehabilitation of this patient from a previous student and progress his home exercise program.

Action: I had little time to prepare my session with this patient so I began with a brief subjective and objective assessment and then continued on from the previous student's treatment plan. To conclude the session I went over his home exercise program and gave him another exercise to try.

Result: As a result of knowing little about the patient the session didn't run smoothly and I constantly had to refer to the patient's previous notes to keep on track. I stressed that the patient may become impatient if I took too long reading over their previous notes as it may look like I was incompetent.

Evaluation: I felt that the session was very disjointed and I didn't feel confident that it was effective for the patient. I felt that I didn't know the patient's history thoroughly and therefore was unsure how best to progress the treatment session and home exercise program.

Strategies: In future if I'm restricted for preparation time I will take the time during the appointment to fully comprehend the patient's history and not stress that they will become impatient. It is more important to take the time to devise an appropriate treatment plan so that is beneficial for the patient.

third pacement- initial entry

This round I am in Margaret River for my rural prac and it is a musculoskeletal placement. I am looking forward to this placement as I have yet to do musculoskeletal and I'm interested in learning about how a private practice functions. I assume that I will have 4-5 clients a day and that a large majority of those will have back pain. I will also be conducting an exercise class each week for the senior citizens so I will have an opportunity to put my gerontology experience into practice as well. This placement will involve time spent at both the Margaret River and Augusta practice so I am looking forward to getting a taste of both areas. With this placement I'm mainly concerned about the diagnostic process and whether I have sufficient theoretical knowledge to link up my subjective and objective assessment to come to a diagnosis. I'd like to be able to get into the habit of having a fluid assessment process to make the diagnostic process easier. I know that this will all come with practice so I'm definitely going to make the most of this opportunity, and also enjoy the country life!