PhysicalTherapy – CA Work Experience Program

Day 8

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.

Day 7

Today was my last day at Duke Physical Therapy and Sports Medicine, and it was the longest. I started my morning at 8:00am with Ashley and saw around 4 patients. 3 of the patients were in the Joint Health Program (JHP). The program was created by the Department of Orthopaedic Surgery and the Department of Physical Therapy and Occupational Therapy to try and find a better way to treat osteoarthritis and osteoporosis, which is hard to treat and comes with a lot of pain in the joints. Ashley is the only one in the clinic who does JHP, so she sees a number of patients in the program. It focuses on education about pain management, nutrition, sleep, stress management, exercise, and general lifestyle changes that can be made to better manage the pain. One big focus is making a change from overexerting yourself by doing a bunch of an activity until you’re in pain, and then taking a prolonged break. It’s better to break an activity into manageable time chunks and take breaks in between, and it makes you more productive since there will be less rest time overall due to pain. I saw a couple patients with Tyler today, one of which had a period of time in college where she was aspiring to become a doctor. Tyler took the opportunity to start quizzing me, one of the college interns, and the patient about anatomy. Needless to say, we have some brushing up to do on our anatomy knowledge. The rest of the day was just spent seeing more patients and observing various exercises until 5:45. I’ve had a great 7 days at Duke Physical Therapy!

Day 7

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!

Day 6

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.

Day 6

Today was a bit of a shorter day due to Ashley having meetings in the morning and mid-day, but I still got to observe four appointments (30 min is the normal length of an appointment) and talk some things over with her. The first patient was very active and only came in for occasional check-ins about every 4-6 weeks. She used Graston tools on him to loosen the muscles and tissues in his back/shoulder. The second patient was an older who had a mini-stroke earlier, and is now working on balancing. Ashley talked through the 3 systems the body uses to balance and how each exercise challenged a system. She walked over and balanced on foam, which provided a different surface and challenged the tactile system. Balancing on uneven surfaces is much harder than a flat surface, and is something most people come across. The next system is visual. Ashley had the patient hold a weighted ball and raise it up and down while looking up and down. This gets rid of the ability to spot a point. Sometimes they’ll also have patients close their eyes. The last one is the “inner ear” which is what creates your body’s spatial awareness and helps with movement and balancing. The third patient was a dancer who had a “pump bump” aka Haglund’s deformity , which is a bony bump on the heel caused by the soft tissue near the Achilles being irritated and becoming inflamed, which can lead to bursitis. The last patient was having neck/shoulder tension and had dry needling done.

WEP Hand Center and Physical Therapy – Day 5

Today was my last day working with the Hand to Shoulder Center and Cary Athlete’s Performance Center. Both were kind of slow days at these two locations, but there were a few things that I took out of each. Firstly, the coolest thing that I saw today at the Hand to Shoulder Center was a patient with trigger finger. This is like the opposite of Duputryen’s Disease, where you aren’t able to bend your fingers down, as they lock up. We saw a patient who didn’t have severe trigger finger, but it was bad enough to do treatment right there. Dr. Messer injected a cortisone shot into the patients hand and right away, you could see how the finger was loosening up. The patient was able to bend his finger further down to his palm. I did get to see what happens when the finger “triggers” and becomes locked in a bent position. Then, the coolest things that I saw at Cary Athlete’s Performance Center was that there were quite a few new patients who hadn’t been in yet and were getting everything checked. It was cool to see how they measure the angle of every joint to see what needs to be loosened and what is concerning. Another interesting thing that I saw today was two different types of dry-needling. There was the type that I saw on Friday where one needle is placed into the sore area and moved up and down and the other one was multiple needles in various spots of the sore area. I asked Mr. Meszler what the different purposes are and he told me that the one needle is for a specific muscle and is used to get deeper down in the muscle and the second with multiple needles is for a tendon where multiple spots of the tendon hurt. Overall, I was very grateful for this experience to shadow two new people and I learned a lot!

Day 5

Today Dr. Ashley Lake was back! The first patient we saw had dry needling done which was cool to see again, and Ashley used a different device for the electric current. The next patient didn’t want an extra observer, so Ashley had me read the post-op report of another patient coming in 5 days post-op who had surgery to repair his ACL. Although it was very confusing and had a lot of new terms, it was interesting to read and I got a vague sense of the procedure that was done. I then talked it over with Ashley to more fully understand what to expect. Another patient that came in was a young (middle school age) dancer, and it was cool to see Ashley giving her some of the same exercises she gave me when I got treated by her.

Day 5

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.

WEP Hand Clinic and Physical Therapy – Day 4

Today I had an even newer experience as I wasn’t with Dr. Logel. I started my day off at the Raleigh Hand to Shoulder Clinic with Dr. Messer. He has been doing hand and upper extremity surgeries for years and was a great teacher today, explaining to me before and after each patient he saw. There happened to be a big theme today in the hand clinic and according to Dr. Messer, it was very uncommon to see so many Dupuytren’s disease cases in one day. Dupuytren’s disease is where the “cords” under the skin become thick and tight over time and cause the fingers to curl downward into the palm of the hand. It was cool how today played out because I started the day by seeing a few patients who had come in for other issues, but Dr. Messer had me feel their thickening cords that weren’t bothering them. I then saw a patient who recently had shots injected into her hand, a treatment for Dupuytren’s disease, and was back for a check up. Without even seeing her before pictures, it was crazy to see how straight her fingers were able to get. However, I was still very interested in seeing how bad Dupuytren’s disease could get, and lucky enough, an elderly man came in as he had a cyst on his nail bed, but happened to also have severe Dupuytren’s disease on his other hand. I was shocked to see how deformed the fingers really could get and their lack of mobility, yet the patient was used to it. I saw some other patients with broken bones or arthritis, but Dupuytren’s disease was definitely a common theme.

Around noon, I left the hand clinic and went to Cary Athletes Performance Center with Mr. Meszler. He works with Raleigh Ortho as their sports therapist and does a lot of their physical therapy work. I got to observe all of their therapists there and saw a variety of different cases. This was very interesting because I could watch the patient through the whole process of getting dry needling, to laser treatment, to their exercises. One of the main therapists that I stuck around was Damion who was from Ireland and he would also explain to me what the purpose of each machine was and would even let me test out some of the exercise machines and stretches. Although I didn’t see as many patients as this morning, I still learned a lot and it was a great experience!

Day 4

A new day, a new PT to shadow. With more appointment cancellations and schedule differences, I ended up shadowing 4 physical therapists today. I started with Zach who was working with a runner trying to regain strength. The patient ran on the treadmill for a while, and then did some isolations and strength building exercises. This was the first patient I’ve worked with who actually had the strength to do cardio and run. I also shadowed Ann Marie for the first time today while she did an ankle evaluation on a patient who came in after going to an Orthopedic Urgent Care. I got to see how she assessed the injury first, and then gave strengthening exercises. This particular patient was already in the habit of doing high intensity workouts regularly, so she would likely have a faster healing time due to her built up strength. I was also back with Tyler for a couple appointments today, and got to see one of the patients again from earlier this week.

One of the most interesting cases of the day was with Kristina. A patient came in 3 days post-op after getting 2 screws taken out of the front of his knee. He had been a regular patient before, and had other sugeries done in the past. Since he was only 3 days out, Kristina had to do a dressing change, and it was cool to see the sutures and how it’s healing. We worked mainly on strength building, since his mobility was still very good, likely due to the fact that he was a young adult and the placement of the incision at the front of the knee and not directly over the kneecap. I also got to see the Alter-G (anti-gravity) treadmill being used for the first time!

Throughout this week I’ve noticed that the majority of patients come in with either shoulder or knee mobility issues. I’ve seen patient after patient doing the same arm strengthening exercise or balancing exercise, and they’re all based around strength building and gaining mobility.