P4R3W3: Therapeutic touch

This was my second week of the MSK placement. I have seen quite a few different cases now and the complexity of each case is slowing increasing. Having a waiting list (and triaging the most important cases) allows for me to select cases / pathology I haven't seen before. Last week I saw quite a few total knee joint replacement cases and an acute low back pain case. This week I saw more chronic back and neck pain cases.

One interesting neck pain case was of a lady who had been doing McKenzie neck retractions 'double chin' to relieve neck pain. It had not worked. The neck was very tender on palpation, especially around C2-3, so I worked on C0-C2 with some simple isolated neck rotations. I wasn't able to reduce the pain on palpation to these joints, but neck rotation was able to be increased and the patient reported a relief in severity of discomfort.

Another interesting non-specific back pain case was relieved with some grade 1, gentle rocking, trunk rotations having her shoulders stabilised. The client must have been so exhausted, not being able to get a good nights sleep and the fatigue of persistent  pain, that they fall asleep with less than five minutes of gentle rocking. They reported it to be the most comfort they have had in three months!

View from my outpatient treatment cubical on 5th floor.

Our physiotherapy assistant is amazing!! Five star quality scones!

Hydrotherapy is enjoyable for everybody. The patients love the hot water and relief from pain or stiffness. It really is quite therapeutic. I had a follow-up with both clients from the first week, with much progress made already!

In-services are a fortnightly event, and it was the 4th year student's turn to present a topic of choice (with relevance) to the team of physiotherapists. Coincidently, all three of us working in the hospital chose topics relating to elite performances. Hamstring injury and return to sport, the use and evidence for elevation training masks, and I had a quick spiel about the use of mental skills training / sports psych skills and methods applied to the clinical setting. I argued that these clients are also aiming for a best performance in abnormal environments or with unusual tasks that are probably stressful. Sure they have some physical constraints (yes, we should work on these too - and we do), but they are not totally dissimilar to elite athletes. Some patients may benefit from informal mental skills training.

ED on Friday was again quiet for most of the day. It seems that the team gets busy around 4pm, which is the time I finish up for the day. During the quiet periods I helped put together a draft patient information leaflet on gout and assisted a doctor reduce a displaced fracture of the distal ulna of an older adult. Otherwise I attended to a person who had acutely sprained their ankle. There were a few other cases that I sat in on, all equally exciting.

Weekend paint run fun!