I tried to post last night, but blogger swallowed my post :o( Anyway – I’ve spent the last two days in a local private hospital, shadowing the physios. They really were a fab bunch, and huge thanks to them for first of all letting me visit and secondly for taking the time to explain stuff to me, answer questions, and generally get me involved.
Monday started spending the morning with Ally, who was very friendly and quickly got me involved looking at X rays of a knee replacement. Really interesting stuff, and I could see where the hyaline cartilege had eroded (on the before pic) and why the artificial joint was needed. We then looked at the after pic, and went to see the patient. Fascinating stuff, and also seeing the exercises, which I guess on the whole were fairly obvious – to get the joint in, they have to cut through the muscle, so strengthening the muscles is all important.
We then did the same for a hip replacement, which is similar, except that being a ball and socket joint, there are more precautions to avoid it accidentally “popping out”. The exercises were again fairly as expected, but it was interesting to see how the patients tried (innocently) to “cheat” by doing the exercises slightly wrong, as it avoided using the muscle that was still sore from the surgery. Things got a tad repetitive after this, as we had three THRs (total hip replacements, medical notes are full of shorthand!) on the trot. It was interesting to hear how another physio had pushed a patient to exercise through (within reason) the unpleasant sensation on a previous TKR (knee), as that was necessary to ensure good results. I could see how being able to motivate was a key skill, as well as communicating clearly what you wanted the patient to do.
The afternoon was spent in outpatients. Here the range is far greater, and I was with Brooke. We saw two patients – one with a lower back problem (I suspected sciatica, and was right), for which we used PA (posterior anterior pressure at several levels – apparently a Maitland technique) and gave some interferential treatment (bit like a big TENS machine). The second patient had a problem with the neck and some osteophytes around C4-C7 – which seemed to be impinging on nerves. A variety of exercises followed as well as some more PA, and a sheet of exercises to take away.
I headed off to my biology A level class distinctly exhausted, but a tad worried! The afternoon had been fascinating, but the morning had been a smidge repetitive. Was I cut out for this job?
The second day followed a similar pattern – going round seeing the patients on the ward – most of whom we’d visited the previous day. This was mainly going through their exercises again, checking that they could walk safely (there are several levels of “approved” gait, with sticks and zimmer frame etc), and also climbing stairs. The physio’s main job is to make sure that the patient gets to a level where they can safely leave the hospital and be independent enough to manage in their personal circumstances, so even if the main doc says they’re okay medically, the physio review is crucial. We saw a new patient who was in for collapsing (possible blood issues) to check there was no mechanical issues, and ended up checking and icing her ankle that she’d hurt in one of several falls.
Then the afternoon was back to outpatients again – where I saw five or six people, alongside Brooke, Nick and Tristanne – all of whom had their own preferred methods of treating stuff, so it was interesting to compare the “styles”. Nick had a patient with what was probably a lower back strain, and it was interesting to see how he assessed this by checking a variety of ranges of motion (and I thought ROM was a computer term!). His main tool to treat this was acupuncture on the trigger points, and he used this again on another patient later who had amazingly tight hamstrings and an extremely limited ROM. He also used something called SNAGS which he told me was invented by someone called MacKenzie, which involved tying a belt round his waist to hold him, and leaning forward into him to stretch the muscles.
Tristanne had a patient who had had serious sciatica issues that ahd proved resistant to treatment, so she was using traction – this involved two belts round the patient, and a machine that pulled, rather like a medieval torture device! I’d heard of it but never seen it in practice. Tristanne also showed me the interferential machine as well as the ultrasound, and we talked about the laser machine too – all designed to assist healing.
The final couple of patients were with Brooke – it was interesting again to hear the communication skills at work (true for all the peeps tbh), and also how she assessed people – by free movement (active), against resistance, and also passive movement (physio moves the limb so the muscle isn’t doing work – this is to show if it’s a muscle problem or a joint one, as the joint problem will still hurt). I got to feel the patient’s muscles and could see how tight they were – particularly one woman who had a “dowager’s hump”, and only had neck movement from C1-C3, and a neck very stiff from there on down.
So – all in all a good two days. I think the rehab ward round wasn’t a great favourite among several of the physios, so I was glad to hear it wasn’t just me. Not that I gained nothing from it, Ally was fabulous and at first I was drinking it in, but it did get a bit repetitive. Tomorrow at St George's should be interesting, as there’s a whole host of other “disciplines” that I’ll see there. Roll on tomorrow :oD
