Y3S2W3: Follow Up

By now you will have realised that most MSK physio clinics look the same: plinth, chair, anatomy posters, a few joint models, hand sanitiser - those sorts of things. It is a nice reminder that physiotherapy is a career that can be done with our head, heart and hands. We don't need too many fancy machines or products to do a good job. Nothing beats a good massage, joint mobilisation and exercise! This is one reason why I think MSK physiotherapy is so cool. Unfortunately this is the last week of my MSK placement. On Monday I got to sit back and type up my peer's notes as they were going through their objective assessment - my note taking abbreviations are coming along nicely. I got to have a follow up with one of my clients on Wednesday (other client cancelled due to feeling unwell) - this was my client with neck stiffness. Just so you know, as an abbreviation, F/U is 'follow up', and is not to be interpreted as anything else. My SNAG treatment for this patient's neck had been effective for many days post treatment, but the client felt that there was some tightness creeping back in. After a follow-up assessment I performed some more SNAGS, massage for upper traps/levator scap and taught this client how to self-SNAG using a tea towel. Although my placement ended this week, the client  will have another follow up next week with the clinical supervisor. Great MSK placement!! P.s On Friday we were shown another manip for Cx-Tx junction, this one was a rotational rather than a PA thrust. In addition we were shown manips for the cuboid and navicular bones of the feet!!

Muppets' shouldn't manip...

Five reasons why MSK physiotherapy is awesome.

1. There would be quite a few occupations out there that don't have the luxury of working in a warm environment everyday! Physiotherapy is not one of these! We get to walk into warm clinics at the beginning of the day and stay there all day if we choose to - how's that for beating the winter blues?!
2. Some occupations get to drive 10 tonne diggers... we're almost that awesome! We get to play with and show people our toy knee joints and spines. Although it's not quite a Toy Story, these models are entertaining and go 'walk about' now and then - mainly because we forget to put them back after using them to educate a patient.
3. Hands of god! Oh, are you having trouble turning your head over your left shoulder? Well let me fix that for you and tell you about my powers of science. Physio's can't always 'fix' things or find replacements for worn out faulty parts, but we can help you make the most of what you've got... and occasionally, we fix things too.
4. It is possible to do voodoo... sort of. There are dry needling courses for physiotherapists', but instead of spiritual-physical parallels between a doll and the victim, physio's get to stick the needles directly in our patients (who have given consent). We practice good healthcare, so there is no bad voodoo - instead there is only triggerpoint-undo doo! On a similar note, we can also clothe people in enough tape that even the ancient Egyptians and their mommies would be proud.
5. How many people can wake up, get out of bed and go to work, pull up a blanket and type notes on a bed (plinth) if they're free from client-contact? Not many! How many people can kick their shoes off at morning tea break with a coffee and lay back on a make-shift beach chair (plinth)? Not many! Yes, a plinth is not only for the patient, it's a vital part of the awesome MSK physio lifestyle.

The MSK assessment is made up of a series of games:

• Subjective assessment = Cluedo & Charades: piecing together a story to find the location, weapon, and suspects (Cluedo), whilst observing body language (Charades).
• Posture analysis = Spot the difference: draw an imaginary line down the spine and note the difference.
• Active RoM = Simon Says: have your client move to your instruction.
• Special Tests = Guess who? Who isn't the cause of the pain... does your pain wear glasses (have a positive Speeds test)? No, cool - I can ignore all sources of symptoms that are wearing glasses (come with impingement or the biceps brachialis).
• Palpation = Tiddlywinks: press through the muscle (counter), find a spot that is familiar pain for the patient (makes the counter jump). 

The two labs for Integrated Studies were game-like too. The first was differentiating (subjectively and with special tests) between peripheral nerve symptoms, radiculopathy and myelopathy. The second related to a McKenzie method diagnosing - this was an exceptionally fun lab. We worked in pairs to diagnose 12 case studies, with four minutes for each case. Cases were presented on a McKenzie Institute cervical spine assessment form. Some diagnoses included: reducible and non-reducible (e.g. cervical radiculopathy) derangements, dysfunction syndrome, posture syndrome, chronic pain, osteoporosis (compression fracture), ankylosing spondylitis, space occupying lesion, meningitis (we weren't given fever or rash as a symptom), mechanical vs non-mechanical headache.

Cardiorespiratory lectures & lab had us back to interpreting x-ray imaging, revisiting COPD management strategies, and learning new performance and outcome measures such as the 10m incremental shuttle walk test (10mSWT), arm ergometer protocols, physiological cost index (PCI) and 'Chronic Respiratory Disease Questionnaire for Quality of Life'.

We've got two presentations to add to our assignment list. One is an individual presentation about a clinical technique relating to our last placement (I'm picking Mulligan's SNAGs) and the other is a group presentation about a cardiovascular condition as it pertains to physiotherapy (my group has Peripheral Vascular Disease). Looking at the current research report on spirometry (data taken from my lab group), it looks as though respiratory measurements (spirometry) should be taken in standing... but I'm sure it will depend on the patient. Below is a table with interesting info. The p-value with '*' next to the number indicates that the Paired T-Test (a relevant statistical test for the research design) are significant - this means that we can be 95% sure that there is a difference between the two means (standing spirometry versus supine spirometry measures). The reduced measures in supine may reflect a displacement in abdominal content, reducing the action of the diaphragm on inspiration - which when contracted pushes against a higher abdominal pressure in supine lying.

Comparing lab group means for spirometry measures taken in standing or supine lying. 

To be fair, I used the free statistics programme 'R-statistics' to calculate most of this... it's not an interface-friendly software - but it's super powerful. Here's a snapshot of how the software R looks with my data put in (and some added commentary at the bottom so I knew what the info meant)!

Yay, statistics!!

Fourth year placement preference forms should be submitted by now.
This Sunday I've got a discounted First Aid refresher course - organised by the student exec.