My Day

Prelude: "we" refers to either me and my CI or me and the patient/client... and generally we call everyone "we" work with a client...

I was in from 10:15 AM-6 PM

Started at 10:15 with a client who has MS and some hypertonicity mainly in her right hip. We worked on some manual resistance for upkeep with some patient education and she came to use our UBE which she can't access in too many other locations as they are rare and she also gets around with a scooter.

10:45 I had a client s/p a RC repair. We have been working on increasing his ROM through loosening up the restrictions around his shoulder from the injury (including the surgery). He had adhesions and tender points that we have been able to almost eliminate. He is still very tight in the periscapular area probably because of the muscle guarding he tends to have in the right shoulder to minimize the movement of that shoulder which we try to get at with some PNF scapular patterns. We warmed him up with some moist heat before we started treatment. He had some real tender points in the teres minor and supraspinatus on the side of the repair that were worked out with SCS.
Then we went and did a lot of shoulder exercises... I won't go into details here...

My CI was treating the next patient so I caught up on my paperwork, then had lunch, ran to the registrar to get some loan stuff done... I don't complain about loans enough but BOO LOANS!!! (another entry, another day)

Got back at 1:15 for a client who sprained her L ankle and had some RSD symptoms but nowhere near a true RSD, she was just sensitive to deep pressure on the area of the injury. She mainly had some remnants from the ankle injury, some tight peroneals (or fibularis muscles as some "official" tried to change it to --> check out this site that I just found - pretty cool). We are working to get her ankle stronger, increase proprioception, all for a better gait and future prevention of further injury. The ankle was also starting to go up the kinetic chain and affecting her knee, hip and back, so we are making sure we minimize that and prevent it the best we can.

As I finished up that client I took over the exercises for another client who had cervical, lumbar, and knee pain. We did plenty of work on the reformer including squats, heel cord stretching, bridging, etc; worked on the recumbent bike; to finish up we put IFC e-stim on her cervical and lumbar spine, moist heat over the back, and ice on the left knee.

My CI was treating pt's that I observed in between some paperwork.

At 4 my hopeful tri-athlete client came in who recently had arthroscopy on her right knee to repair her meniscus. She is a little more aggressive than she should be, but we keep preaching to her to ease up. Her patellar joint mobility was a little less in the R than the L today so I did a few patellar glides to free that up before we worked out. We then went over to the reformer for similar exercises to that last pt. with more focus on the VMO with External Rotation squats. One of the important ideas we stress with this client is to avoid how deep she squats in any aspect of life, even tying her shoes as deep squatting puts a great deal of weight on that just repaired meniscus and could reverse the positives. The benefit of the reformer is it places the individual in a gravity minimized position thus lessening the forces on the joints and allowing for movement that is less stressful on the body. We then moved over to the cable column to do some resistive walking which is very functional and helps build strength and proprioception. We then got on the treadmill which was pseudo-emotional for the client as it was her first time back on one since before the surgery. We only did 3 minutes fwd, and 3 bwd at 2 mph and 1.5 mph respectively. She jumped on the bike for 10 minutes and then we put some ice on that knee to help the healing process along.

The rest of the time I met with my CI to talk about the day and the overall progress I am (or am not:) making. Good day. I know it is a lot slower than a few of my classmates are used to, but I am learning a great deal every day. 'Till the morrow...

On a side note kudos to espn, and mike and mike in the morning for their support of the V foundation... cancer is an ugly word and in order to erase it we need more research which needs more money... keep fighting.