Y3S1W3: Physioterrorist

Physioterrorists existed in the good old days of patient management, especially in acute care settings. Physios were deemed physioterrorists when they put too much stretch through a muscle (static stretching) that caused pain. Yikes! That's got to hurt! It's now understood that static stretching should be pain-free. Phew!!

I've got a bone to pick with you! ...especially if you have osteomylitis involving sequestrum (i.e. dying bone), whereby to curette your bone (i.e. to scrape/pick off the necroses tissue) will help your bone heal! Pathology on Monday recapped bone healing by comparing it to healing of the skin, as well as describing the pathology of bone diseases. Each week we have a tutorial and 1% pre-tutorial test. "Pathology isn't all gore & grime... well actually, it is." - our tutorial supervisor.... we enjoy our overly enthusiastic tutor. She even has Harry Potter-like-spells, for example "Functio Laesa" which will generally inflict a loss of function (a sign of inflammation) on to the targeted physio student. We also likened our immune response to war! For example; our neutrophils are the mature gunmen, once they're all in battle or dead we send out younger, less mature neutrophils (metamyelocytes; likened to teenagers sent to battle), if they then become deployed, in battle & dying then our bodies send out the most young pre-curser neutrophil cells (myelocytes; likened to 5-10 year olds being sent to war...). Then there are the battle scenes themselves... the blood stream becomes a highway of policing cells (monocytes & neutrophils) which respond to messengers (cytokines e.g. IL-8) who flag down the police ensuring they make the correct turn into the affected tissue. Once they're at the scene, it's chemical warfare (inflammasomes) and things can get messy!

You've got some [ulna] nerve! In MSK we learnt about neurological testing versus neurodynamics of nerves of the upper limbs. The premise of neurodynamics is to slide and glide nerves. All of the nervous network, in healthy individuals, will have certain properties e.g. extensibility & compressibility - neurodynamic assessment and treatment plays on these ideas. Neurodynamics is often known as 'nerve flossing' because through these techniques you're effectively moving your nerves between bodily structures like you would a string of dental floss through teeth! Physiotherapists are able to move/position the body to slide nerves into positions that stress particular neuro structures over other branches of neuro structures, for example we can position the upper limb to have a bias stretching of the median, ulna or radial nerves! This is very useful when diagnosing the source of symptoms!

I attended a public lecture on concussion on Wednesday afternoon. The lecture is very relevant to physio and sport medic professionals. I found that it was not only a nice refresher, but was an eye opener to the management of concussion and brain injury. There were a few familiar faces presenting, including our own Dean of Undergraduate Studies (Physiotherapy), John Sullivan! John's (and colleagues) research has lead to recommendations and policies implemented by government agencies and [inter]national sports bodies. The presenter whom I found most interesting was the Highlanders Rugby team doctor, Greg Macleod. High performance sports teams are interesting due to the controlled environment and data that can be collected from athletes. The presenters described different assessment strategies specific to the context in which they are responsible for people with concussion, for example: in the neuro specialist consultation, elite sports environment and community levels. There was a discussion about the process from concussion episode to return to work and sport, with medical management being the key focus. In addition, a key point of interest was that the majority of people will know that seeing a medical professional is the best action for them if they are suspected to have a concussion, however those that implement these actions is very low. Furthermore, there is a cultural norm "she'll be right" in New Zealand needs to change with regards to health, in particular, concussion. Have a talk to your health professional or national sporting body representative if you would like to know more about concussion (or have a look at ACC Guidelines or visit ACC website but note that DrABC's of first aid apply first and foremost i.e. in the document linked it is recommended that the player is immediately removed from the field however, be certain that there is no additional contraindications such as a neck fracture).

Lab group C dinner (combined 2nd & 3rd years) at  Shahi Tandoor. The original plan was to have it at La Porchetta, which is also yum, but they were booked out for the evening! It was held on Friday from 7:30pm as some students work Friday afternoon. I'm not much of a foodie, other than I enjoy a good feed! Shahi Tandoor is an Indian style restaurant, and they make a great curry. All their food is reasonable to cheap & of high quality.... although it's not quite fine dining, there were great size food portions at a low cost! Perfect for students!

This weekend is the orientation for new sport medics at the Dunedin Sport Injury Clinic. The Edgar centre is the largest indoor multisport stadium in the southern hemisphere with 21 netball courts in only a relatively small section of the stadium! The sport injury clinic is almost an emergency room for acute sport injuries at the rear of the Edgar Centre. If there was an x-ray machine, you could almost call it a real emergency room (...... almost). It does have all the acute care gear that you need. In the event a player with a fracture come in, we call an ambulance over from the public hospital and they take charge of the player from there. The sport medics were orientated to the whereabouts of all the gear (as well as how to use the ambulance stretcher - with wheels) and shown how they want the paper work for each patient filled out.

Highlanders versus Waratahs! My Saturday evening was spent with family who came down to watch the rugby, needless to say I grabbed a seat with them too! Dunedin is fortunate to have an undercover stadium which replaced an aged (now demolished) stadium 'Carisbrook Stadium, then known as the house of pain'. For a small city, Dunedin has many facilities that are of an international standard. Anyway, back to the game! I enjoyed watching the university students in the zoo generating noise and cheer and the game play itself - the mighty Highlanders won! It was also great to watch the medical team bustling about on and off the field. Woohoo!! Best of all, I attended the game and got to catch up with family!

Left to Right: My parents, Aunt & Uncle, myself & Joyce.

The 'zoo' is by the other goal post.

Rewinding back to last weekend... I got involved in a 'cycle skills training' event organised by Dunedin City Council and cycle skills instructors (South Dunedin Police and other stakeholders, including primary school teachers were also involved). The event had us bike with a large group of primary school aged children across South Dunedin from their school to a recreational ground, practising the road/bike skills they had learned at school, for some bike skill games/challenges/fun. The kids and adults also got to sit in a 50 tonne truck to appreciate the lack of visibility these drivers have (there are numerous blind-spots, even with multiple mirrors on each side). There was a bike to be won for the best skills and road practice. As a physio student, it's always nice to branch out and give back to the community - I challenge you all to do this once in a while.

There will be social sports for physios to participate in over the year starting in a few weeks. Sports include: Netball, Touch, Volleyball, Basketball & Indoor Soccer... some of these sports start next week!! I'll participate and report on as many as possible next week!