P4R4W2: Private Practice Physiotherapy

 ^Near Motueka (short drive from Nelson)

Physiotherapy private practice is primarily MSK orientated. Some practices specialise as a point of difference between other clinics - it's a business after all. Specialities may include: holding an ACC approved return to work contract, womens health, breathing, using a certain approach / philosophy e.g. a McKenzie orientated clinic, or having certain facilities like pilates equipment.

I am placed at Sports Therapy... the name says it all. It's a Sports Physiotherapy specialist clinic that is accredited as a High Performance Sport NZ service provider. Each team member works outside of clinic hours with a sports team. The regional sports team affiliated with Sports Therapy, with very successful players and a history of being champions is the rugby team, Tasman Makos.

Sports Therapy doesn't only treat athletes, their physiotherapy services are available to the general public too. Therefore, they treat painful backs, post-surgical conditions (e.g. knee replacement).

http://sportstherapynelson.co.nz/

My week looks like this:
Monday 7am-1pm
Tuesday 1pm-7pm
Wednesday 7am-1pm
Thursday 1pm-7pm
Friday 7am-1pm.

I am fortunate to spend Tuesdays with Michael Monaghan (from 1pm-4pm) at the Nelson Hospital Outpatient Clinic - something I was not able to do last rotation as Michael was presenting at different academic institutions around the world. I'm pleased I didn't miss out on this opportunity.

The Michael Monaghan session had myself and another student perform subjective assessments on three new patients. As I was effectively stealing the other student's time, I took the lead for the second patient who was referred to us from their GP as having a frozen shoulder, but I found they had a rotator cuff tear. Unfortunately for older persons, the public system is bias toward younger persons when it comes to surgery and orthopaedic assessments. So we done a bit of advocating in our email back to their GP. After the subjective assessment we would present the case to Michael (who wasn't present during the subjective assessment), then he would take us through how he would do an objective assessment.

I'll mention another patient whom had a saw lower back. This condition wasn't particular interesting as such, rather it was the approach Michael took to objectively assessing and his magnificent manual handling skills that I found most beneficial.

• Michael discussed how to do a spring test on the spine with the patient in prone, which pertains to how springy the spine feels. As we had our patient in side-lying, Michael's approach was to use a reflex hammer to perform the spring test. 
• The next interesting technique was assessing passive flexion / extension of the patient in side-lying (which most physiotherapists are familiar with), but then we assessed lumbar flexion / extension / rotation with the patient in a supine position (crook lying). Flexion involved fixing the spinous process at a particular level with a finger assessing the movement between this and another spinous process, then rocking the knees up / shifting the hips up to feel the movement between spinous processes. 
• Extension was done in the same position and using the same method of fixating and feeling the spinous process movement, but instead of rocking the hips upward, we fixed the hip toward the plinth with a downward pressure through the thigh (through the long axis of the femur) and then used the thigh as a lever to piviot the hips in a way that extended this lumbar spine. This was quite effective.
• Michael's approach is very biomechanical orientated, which had us appreciating the whole body posture / biomechanics as potential contributing factors for lumbar dysfunction.

My week at Sports Therapy was great! My supervisor, also named Phil, is very much a people person and a great physiotherapist. Jokes were made that client's would be "seeing the Phils'", and that my supervisor was Phil A and I was Phil B - just because our surnames conveniently allowed for this. I brought in some chocolate brownie which got me some brownie points on my first day. 

As you would expect, many of the clients I saw over the week were sport injury related or back pain. A big difference between the hospital outpatient and private physiotherapy client's is their enthusiasm. Private practice client's appear more upbeat and positive, which at the end of the working day doesn't leave you feeling drained (the hours I work may also leave me feeling upbeat as often I finish and have the afternoon to myself). Contrastingly, when we have a successful treatment in the hospital outpatient clinic, the changes/improvements seem more meaningful for the clients - probably because they've been struggling with the condition a longer time (given the long waiting list to be seen at the hospital).

Another perk of having a placement at Sports Therapy is being in contact with a new graduate who completed their training in Nelson in 2015. I'll name drop, because he's such a genuine, hard-working and helpful guy: Jeffrey was there for some after work banter (chat) about the placement in Nelson - I appreciated this.

Top Tips for Week One:

• When massaging a sore muscle on a patient, give yourself enough room to react/move should the patient decide to kick or lurch forward to hit you. 
• Whilst massaging a sore muscle on a patient, and the patient gives you a the 'puppy dog eyes' to make you stop or press less hard, avoid eye contact & look at everything else there is to look at in the room.
• When massaging smelly feet, use a scented massage medium like Antiflam (which smells of peppermint). For really smelly feet, leave the antiflam pottle open and near the feet / closer to your nose.
• Avoid installing a TV on the ceiling for patients in supine lying to look up at, because you, the therapist, will inevitably get a sore neck from looking upward too. 
• When massaging the patient on the plinth, the optimal balance of pressure is not so hard that they will hit you, and not so nice that they fall asleep.

Week one was a success!

I'm looking forward to some Olympic banter next week.