Passively Insufficient Physical Therapy Student

There's no crying in pt school! This is a blog about physical therapy school. It applies to SPTs, and anyone else who feels stretched a little too thin.

[movementspecialistintraining]

Me, during an eval: tell me about what happened.

Patient: well it all started when I quit my job last winter....

Me: no about your knee

Patient: *ignores me and continues to tell me irrelevant information like the name of the street they tripped on which happens to be undergoing a name change which she thinks is ridiculous given it’s been called maple for 27 years and highway 63 really just won’t hold the same character as maple did*

[movementspecialistintraining]

STORY TIME

So I am a female human being. I have short hair.

I am giving a presentation at a community center to a group of older adults (geriatrics amirite). I have a microphone. I am speaking. Suddenly, from the elderly gentleman sitting at the table immediately to my left comes:

“WHAT IS HE SAYING??”

I wish I could say this wasn’t the second time that DAY that I was misgendered by these people.

OK edit: To be fair, I am the type of gay that LOOKS gay, you know? And old people are confused as it is so 🤷🏼‍♀️

[movementspecialistintraining]

THINGS I AM LEARNING ON CLINICALS

1: You’ll be wrong sometimes. You’ll be right sometimes. But usually when you’re right, you’re also wrong, so it’s all a wash - make sense? idk

2: Patients are going to say some RUDE shit. Just make sure they don’t say it in front of other patients.

3: Working for free is degrading. I don’t care what your university tells you about how the experience is “priceless”; getting to the end of a 45 hour work week unpaid is actually one of the worst experiences.

4. That being said, it’s true what they say: you learn best by doing something. over and over and over and over

5: You’re might actually miss the safety of the classroom.

6: But there really isn’t anything like walking someone through some painful, shit-ass surgery and hearing them thank YOU personally for your help. Honestly, the first time that happens changes things. 

7: You’ll figure it out someday. There are just some things that you cannot learn from a textbook. Some things just come with time and experience.

[movementspecialistintraining]

Patient comes in with a diagnosis of “systemic involvement of connective tissue”

[movementspecialistintraining]

Anyone else have their clinic voice on speed dial in case you see a patient outside of the clinic 🤷🏼‍♀️

[anarticleaweek-blog]

Activation of Rotator Cuff Muscles during Phase 1 Exercises and ADLs

Title: Shoulder Electromyography Measurements During Activities of Daily Living and Routine Rehabilitation Exercises Authors: Gurney A, Mermier C, Laplante M, Majumdar A, O’Neill K, Shewman T, Gurney J Journal: Journal of Orthopedic and Sport Physical Therapy Year: 2016

Protocols vary from super conservative to more aggressive approaches after rotator cuff surgeries. The usual progression of exercises is PROM to AAROM to AROM to resistance training, but how much do you really use each muscle of the shoulder during these beginner, phase 1 exercises? This study looked at the activation of specific rotator cuff muscles through EMG during common phase 1 shoulder exercises, as well as during common post surgical ADLs. 

Nitty Gritty

Who: 28 volunteers What: Electromyography measures of Biceps, Upper Trapezius, Middle Deltoid, Teres Minor, Supraspinatus, Infraspinatus, Subscapularis. How: 28 healthy volunteers were chosen for this study. The participants were instructed how to properly perform the following exercises and EMG data were collected during:

AAROM pulleys in sagittal plane and in scapular plane

Pendulums

AAROM Wand/Dowel Flexion

AAROM Self Ranging (interlocked fingers) Flexion

The shoulder muscle activity was also measured while walking 10 steps, donning and doffing a button down shirt, donning and doffing a shoulder sling

Results: (see table below for more detailed information)

High supraspinatus, infraspinatus and subscapularis activity during ambulation.

Donning/Doffing sling yielded high infraspinatus, subscapularis and biceps activation. 

Donning/Doffing shirt showed high supraspinatus, infraspinatus, subscapularis and teres minor activation.

Higher rotator cuff activation during scapular plane pulleys than sagittal plane pulley

Pendulum exercise had more muscle activation than AAROM with interlocking fingers.

Limitation: healthy individuals be pathological individuals. After surgery people may be even less inclined to activate those muscles during their daily activities in attempt to protect themselves or avoid pain so the recruitment may differ.

Clinical Relevance

Logical progression of pulleys is to start a patient using the pulleys in the sagittal plane and then gradually progress to scapular plane exercise due to increased activation of RTC in scapular plane.

As new grads especially, PTs are sometimes overly cautious when prescribing exercises to patients in order to protect the healing tissues. Some PTs may be nervous to give 1-2# dumbbells to grandma in fear of hurting her, when in reality grandma is lifting 1-2# objects around her home doing every day chores without even realizing it. This leads me to the interesting finding of this study. The ADLs listed in this study yielded the higher activation of rotator cuff muscles than any of the exercises performed. This further supports the safety of the phase 1 exercises given to post surgical patients. If the patient is taking his/her sling off and shirts off independently than they are able to do some gentle AAROM exercises without over stressing the healing muscles.

Citation: Gurney AB, Mermier C, Laplante M, et al. Shoulder Electromyography Measurements During Activities of Daily Living and Routine Rehabilitation Exercises. J Orthop Sports Phys Ther. 2016;46(5):375-83.

[enthusiastudy]

here is a gif showing how blood flows through the heart in case you need extra motivation 

[movementspecialistintraining]

This will save those of you visual learners in your cardiopulm classes

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When you know graduation is near

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Coming back refreshed from my LAST SPRING BREAK LOL

[movementspecialistintraining]

“Women’s health isn’t THAT important. There just isn’t a need for it, you know?

ALSO LOL IM BACK KIDS

[movementspecialistintraining]

How I think pelvic PNF goes idk

It really just feels like I’m pushing your ass around but you’re gonna pay me for doing it.

[movementspecialistintraining]

When you’re thrilled to just pass an exam

[movementspecialistintraining]

When a classmate challenges a professor on an exam question HARD

[movementspecialistintraining]

WE BACK

So after a EXTREMELY short summer, we are back in session. My condolences to y’all. Try not to panic during your first practicals, drink some coffee, and make sure to stretch out those pec minors bc hunching over a book all day will ROUND those shoulders ✌🏻

[movementspecialistintraining]

Squeezing by on grades like

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Metaphor for my first ever independent soap note upon review by my CI

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Medicare eval notes