I shadowed at the front desk this morning, and since it was a pretty busy day, they had a lot to do. They had a lot of calls, appointment check-ins/check-outs, and referrals to take care of. After that, I observed treatment on patients with shoulder and knee injuries. The entire staff at BreakThrough Physical Therapy then had a meeting from 1PM-2PM during their lunch break. After the meeting, they were back on a full schedule. I shadowed multiple patients with glute, back and neck injuries. Kenny discussed the reasons behind why his was having pain and tenderness in certain areas, emphasizing that he didn’t have enough blood flow to these muscles that are attached to the rib. I was also able to observe dry needling done in these areas. He explained to me that the longer needles were used in areas around the pelvis, while the shorter needles were used in more shallow muscles such as the neck. Since a woman’s pelvic muscles are convex around the pelvis, they need even longer needles than those used on men in order to reach the deeper muscles.
This morning, I shadowed Kenny treating a patient with a back injury. He used techniques such as dry needling, massage, and use of a lacrosse ball to target the trigger point areas and promote muscle relaxation. Afterwards, he had two more patients with back injuries in similar ways. Back and pelvic injuries seem to be the most common issues here at BreakThrough Cary. I then watched treatment done on the people with neck, hip, and foot injuries. I was able to shadow Kenny in the morning, but his hours are 6am-12:30pm on Wednesdays, so it’s a bit odd in that sense. Around 1pm, I was able to partake in a therapeutic yoga class with Rachel Gorman (CA alum). Some of the people in her class had cancelled, so since there was only one other person she invited me to participate. I really enjoyed it!
I was able to observe treatment and exercise guidance done on people with back, ankle, and kneecap injuries. I was also able to watch some dry needling and shadow some of the front desk work. After extensive viewing of dry needling, I have learned about the science behind it. The muscle tightness can be determined by how far in the needle goes into the muscle. If the needle goes all the way down to its base, the muscle isn’t super tight. However, if the needle only goes in up to a certain point, that means that the muscle must be tense and needs to relax, which will be aided by the dry needling process. Kenny explained the differences to me between how the Medicare and normal appointments work. At the front desk, they sometimes receive fraudulent phone calls that call to book appointments, but the way they deal with this is by checking the caller ID to see if it matches the name of the person given. During my time at the front, I continued watching their scheduling and appointment organizations. They gave me the task of peeling the excess labeling off of their sign-in sheets. Later, I observed one of the physical therapists treating a patient with an ankle injury. She informed him that she had been doing her at-home exercises consistently. He then told her that he already knew this not only because of the significant strength improvement, but also because she was coming in with new symptoms. These changing symptoms are a sign that she had been doing her exercises because there was a significant change every time.
Room where ice and heat pack supplies are stored with washing machines.
Today, I watched various physical therapists perform treatment on people with back, shoulder, glute, ankle, and back injuries. One of the key important phrases that is widely used in the BTPT Cary facility is “Motion is Lotion”. This was a really cool funny phrase that reminds patients that they need to have a lot of movement and physical activity incorporated into their daily lifestyle in order to produce more lubrication for their joints, which in turn aids in faster recovery and healing for certain injuries. They also stress to their patients the importance of R&R (rest and recovery) in the healing process, however. Our bodies need time to recuperate before jumping back into the active lifestyle that we may have had before our injury. One therapist saw his patient looking down at her phone for a long period of time while she was waiting to be treated, and he made it clear that doing such actions has a negative impact on the body and causes muscles in the back and spine to tighten. Today I mainly helped out with creating an ice pack as soon as I walked in the door, throwing away and retrieving supplies, and collecting a patients’ waiver for dry needling. I was also able to observe an internal pelvic floor release done by a physical therapist that specializes in pelvic health. This was really interesting and different from anything else I had observed over the past week. It was very interesting to me because as a dancer (outside of school) I learn a lot about the pelvic floor muscles and she was able to teach me a lot about this particular topic that isn’t very commonly discussed. When observing a dry needling session of the back, Kenny noted that repetition of symptoms is something that is looked for when needling. If the same symptoms appear when dry needling as in the patients’ daily life, that means that the PT found the correct spot. It was a very different experience to not only observe him dry needle the back muscles, but also the neck muscles both in the posterior and anterior. The anterior neck muscles were right next to the throat, so I was on edge watching this particular session of dry needling in fear that something might go wrong, but of course everything went smoothly because he is very experienced.
Mobile Vault System! Moves back and forth smoothly when spoke handle is turned.
On Fridays, the entire staff finishes with their appointments by 3pm, so the they close early. For a change of scenery, I was behind the front desk for the entirety of the morning after watching therapy done on the upper back. Lori Glass gave me a tour of the space, which consists of a small cubicle and vault in the back part, and a desk facing the lobby in the front. In the administration, I was shown exactly how the scheduling works: checking in and out, inputting and cancelling appointments, and blocking out the therapists’ schedules. The system they use is RevFlow, which easily allows them to do all of their scheduling and keeping track of payments. A fun fact that I learned is that Breakthrough Physical Therapy is one branch of many under a national company called Confluent Health, which owns many different PT companies throughout the nation. Something that I’ve had to get used to while working over the past couple of days is the no-phone policy. We aren’t allowed to have our phones out in the central gym area and lobby to maintain professionalism, so instead of keeping it in my pocket throughout the day, I leave it in the PT office and only check it during breaks. This is definitely something that is practiced in a wide variety of offices and workplaces, so it’s been a good experience to have to get used to because it’s different than usual. The administrators had quite a bit of work to do wrapping up and completing a stats deadline since it is the last day of the month. However, they had no problem with this because they distribute their workload throughout the month. They have an established system worked out for patient check-in by placing a sticker on a personal card for each therapist and delivering it when a patient is arrived and ready. This change in view has allowed for me to observe and note a lot of the front desk’s interaction with the patients–greeting, casual conversation, and customer service. The customer service is very notable here at the front; Lori told me that she never answers a call when she is talking to a customer face-to-face, and doesn’t put a call on hold when she gets another incoming call. She says she also makes sure to greet each customer on their way in and out. Since they were running low on business cards for some of the doctors, she had to order more so she showed me how she designed and sent out the proofs. I also learned a lot about insurance: it plays a big role in healthcare facilities. There is a lot of paperwork and computerized inputting involved with getting people’s insurances approved. The two admin at work take alternating lunch breaks so that there is always someone available at the desk. They are constantly being given new tasks to complete on top of what they are already doing which can be very overwhelming, and it can be easy to get behind on certain tasks that need to be completed. For this reason, they complete tasks as soon as they receive them so that they can complete everything fully and accurately. They are definitely very busy people and don’t have nearly any down time aside from their one lunch break, which is why I believe that they are pretty much the powerhouse of the Breakthrough Cary functions to keep everything running smoothly. In the afternoon, I observed massage and exercise guidance done on people with shoulder and hip injuries. I was able to get supplies for the therapists as well as make an ice pack.
In the morning, I continued shadowing a few different physical therapists; each has different methods and insights to offer. The patients had injuries of the glutes, back, neck, shoulder, and wrist. In the past couple days, I haven’t been able to do very much because much of the work done here needs certification such as touching patients, teaching exercises, and giving information. The other manual work such as cleaning, washing and folding towels, taking over exercises, and putting together heat and ice packs is usually done by the other interns, known as “technicians”, who are physical therapists in training. However, today I was able to learn how to make a heat pack: place a hot pack from the steamer in a wrap, then place a towel on it for an extra layer of protection. I talked to a few of the patients and watched more dry needling. Although I’ve had dry needling done on me before, I had always been scared of needles and wasn’t able to watch it. However, after extensive viewing of patients having needles stuck into their various muscles, I have gained an understanding of some of the science behind it, and therefore have become less scared of watching it being done on other people. Continue reading Day 3
For my second day of shadowing at Breakthrough, Kenny had his shift from 6 am until 12:30 pm. He didn’t want to make me come in that early, so I did my regular 8:30-5. I watched while various physical therapists treated patients with back, rotator cuff, hip flexor, back, and piriformis injuries. Many of these were treated with dry needling, which is a faster alternative to long periods of massage in order to relax and loosen certain muscles. Usually, when a patient comes in for their appointment, the physical therapist will begin with discussion and updates of the condition, then move to treatment and massage, and finish off with exercises follow by heat or ice. One piece of insight that I found interesting today was from one of the PTs, which was that many people tend to come in for treatment immediately after an incident that causes them pain, but what they should do is wait about a week to see if the pain subsides or if the minor injury heals itself. If not, then they should come back in to seek help. Many of the physical therapists at Breakthrough have developed personal relationships with their longtime/recurring patients, asking about updates on their personal lives. I really enjoy it when the PTs explain the reasoning behind what they are doing to the patient and why it helps them. Another interesting observation I had is that oftentimes, many of the stretches are done as a sort of cross-training. For example, one woman who had back issues had her hamstrings stretched. This may seem ineffective, but many muscles in the body are connected in a way that stretching and strengthening of one muscle can benefit other nearby or distanced muscles. The PTs have back to back appointments, which can be very exhausting. However, long breaks aren’t really desired, as it is probably better for their work schedule to leave earlier than later–many of them are in from 8am-7pm, which is the length of almost 3 shifts. Prior to lunch break, I watched a client who performed exercises in the pool, as well as someone with a knee injury. Afterwards, I observed treatments on people with knee injuries, wrist tendonitis, and scoliosis.
Front view of Breakthrough Physical Therapy building
Today was my first day interning at Breakthrough Physical Therapy under Mr. Kenneth Biggs. Breakthrough PT has multiple locations: Raleigh, Apex, and Cary (the one I am at). It has its own building located at the intersection of High House and Cary Parkway. I began at 8:30 AM and was given a tour of the entire facility, which I was fairly familiar with considering I had previously been a patient here. The facilities include a pediatric space, gym, pool, multiple offices, and the general physical therapy room. I then met the team of 6 therapists/trainers as well as the administrators. I was able to observe multiple different patients who received treatment. Their injuries were wide-ranging, and all over the body–it is clear that these physical therapists are very knowledgeable about all parts of the body. Kenny’s first patient came in at 9:30 with knee pain and back spasms, which he treated through dry needling and massage, which resulted in an overall improvement in her flexibility and pain levels. Next, he treated patients with injuries in their ankle, knee cap, feet, shin, calf, back, and hips. After a lunch break I was able to observe the work of Melissa (my former PT) and she treated patients with injuries in the rotator cuff, feet, and back. At the end of the day, I was able to observe her working with a patient in the pool, which was very interesting and different from the rest of the treatment that goes on at Breakthrough. For some of their clients, the regular activity and exercise they do on land is too intense or harsh on the muscles of people with a certain degree of injury or sensitivity. Therefore, they are given the opportunity to do some of their exercises in the pool which has more resistance, but less exertion and impact on the muscles.
