PhysicalTherapy – Page 2 – CA Work Experience Program

Day 4

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.

Day 3

Today I worked mainly with Kristina, but her 10am appointment cancelled, so I got to work with TJ for the first time. He had a really interesting case with a teen who recently had a femur lengthening surgery on his right femur. TJ had never treated this patient before, so the hour long session was focused on testing flexibility and improving mobility. I actually got to help stretch the quads and it was surprising just how tight it was post-surgery. I had to hold his ankle still just so his knee flexion could be measured without any slipping since he couldn’t hold it in place himself yet. I also got to see just how far he had come, as he showed TJ that right after the surgery he could barely hang his leg off a table because the tendons in his knee were so tight, and today he got well past 90 degrees.

I also did a few sessions with Tyler again, and even got to see a returning patient from earlier this week. It was interesting to see how much improvement there was in just a few days because this patient was dedicated to doing his at home excersizes. When I saw the patient earlier this week, he came in on crutches, but today he was able to walk in the boot and put some weight on the injured foot without the boot. Tyler used a blood flow restriction machine on this patient, and many others, to make simple exercises harder. When a patient has limited mobility but still needs to build strength, the machine can be used to allow the patient to keep getting stronger while doing the same exercises.

One really cool thing I happened to get to see was dry needling. I had never seen it before, and by chance I was with Kristina in a room when she noticed that one of the staff members was about to have dry needling done. He had 4 acupuncture needles placed in his hamstrings and then the needles were connected to an electrical current. It was intetesting to see his reactions when the needle hit a certain spot in the muscle, and how his muscle would twitch due to the electric current.

With Kristina, I got to see patients on complete opposite ends of the compliency spectrum. Two of her patients were well educated in athletics and how to take care of their bodies. Another two were known for missing appointments and not doing their at home exercises. One huge part of PT is patient compliency. They need to actually do exercises at home to get better. She told me that they do what they can in the clinic to help, but if the patient is known to be non-complient, there isn’t much more they can do, especially with older patients. While it would be nice to get really good patients all day, part of the job is definitely learning how to handle challenging patients.

Day 3

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

Day 2

My second day was with Dr. Tyler Cope again, and I also did one session with Dr. Kristina Wulff when Dr. Cope’s patient cancelled. I was surprised after seeing over the past two days how many people cancel their appointments the day of or just don’t show up. I got to see how more of the machines were used, and how different weights are utilized. Dr. Cope also had me do some exercises with the patient so I could feel what muscles it was working.

Today the patients were a bit more engaging, and it was nice to talk to them and hear about their journey whether they were 2 or 12 weeks out. One patient in particular was a very successful scientist turned business manager, so he had some very interesting life advice to share with the college intern and me. The patient I saw with Dr. Wulff was older, and very reluctant to do the exercises, but got through them all with a little complaining. He told me he hated doing the exercises but it all paid off in the end. Overall, I learned that one of the most important things to do as a PT is to create a safe trusting environment for your patient and to communicate effectively.

Day 2

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.

Day 1

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.

Day 1

Due to unforseen circumstances, my schedule for the day actually changed just last night. The doctor I was originally working with is out for a few days, so I got to shadow Dr. Tyler Cope and Dr. Kristina Wulff today. I went in at 10:00am instead of the previously scheduled 7:30am and met up with Dr. Jaime Blanton to complete orientation and fill out some paperwork saying I’d abide by Duke’s rules and HIPPA. I then met Dr. Tyler Cope to tour the facility, which I had actually seen before since I used to go to the clinic for my own physical therapy. Aside from the physical therapy area upstairs, the Duke Physical Therapy Sports Medicine Clinic also contains a gym downstairs, indoor pool, outdoor track, and is adjacent to a more traditional doctor’s office. At the end of the tour and before Dr. Cope’s first appointment, I learned how the station carts are organized and how each station is set up. Each cart contains everything needed to reset the tables between appointments and some basic tools needed during sessions.

The top drawer of each cart contains gloves, scissors, gauze, tape, lotion, a goniometer, and other basic essentials.

The upstairs clinic area is split into 4 main sections: The waiting room, exam rooms, the open gym area, and staff desks. Dr. Cope stayed in the open gym area and used the tables there to assess his patients, but the doctors can also use one of the separated exam rooms. In the open area, there is a cart between every few tables, and there is also a cart in every exam room. Of the exam rooms, some are like the first one pictured below, with curtains separating them between each other and the open gym area. There are also more closed off rooms like the ones in a standard doctor’s office.

Standard Exam Rooms:

At the end of the day, I worked with Dr. Kristina Wulff who was working with patients in the pool. She explained how utilizing the pool allows patients to work more comfortably since the pool takes off some body weight pressure, which is especially useful for post-op patients. Water to hip height takes off 50%, mid chest height takes off 75%, and up to the neck takes off 90%. The water resistance also forces patients to utilize different muscles.

I’m excited to go back in tomorrow and work with Dr. Cope again to see some more patients!

Day 8: Equipment

Today was a rather slow day at first. We didn’t have many patients, although most of the patients I saw were patients I have seen before. With many of them we used a lot of the tools we keep on the back wall. We have ankles weights hanging on the wall in the order of navy, white, gold, green, and black which are 1 lb, 2 lbs, 3 lbs, 4 lbs, and 5 lbs respectively. We also keep regular weights up there: lightest (1 lb) on the top to heaviest (5 lbs) on the bottom. We also keep the therabands here. We have some precut ones in the basket and uncut band on the wall. The bands also increase why tensile strength and we can cut whatever type of band and however much we need for any given patient so that they can go home and perform their exercises. In this area we also keep a multiple of other things like a goniometer which we use to measure the degrees of mobility a patient has in certain directions. In this way we can track a patient’s progress in increasing mobility. We also store a myofascial releaser in this area that can help when doing deep tissue massages. Sometimes it is difficult to get to certain muscles or the go over them we a need amount a pressure so you can use a myofascial releaser to help. We also keep a strength testing tool on the wall for dynamometeric strengths tests. This is when we test a patient’s strength (in pounds) while they perform abduction, flexion, internal rotation, and external rotation.

Day 7: Rehab Bars

Once again, we had many of the same patients today. With some of the patients, we used the rehab bars in the clinic. Typically, we use the rehab bars when working on balance exercises with the patients, and sometimes with strengthening exercises, so that patients have something to hold on to if they lose their balance. Jeffrey had a patient today that did calf raises, leg swings with weights, toe raises, and other balance work in the bars. One of the balancing exercises Jeffrey had the patient do was to stand with one foot on a less stable blue disk-shaped ball and with one foot on the ground in a sort of stagger stance. Jeffrey then held a soccer ball out at different places for the patient to reach out to and try to touch. This challenged that patient’s balance and gets the ankle working, trying to compensate for all the movement and wobbling that occurs while trying to maintain balance. Next to the bars are a lot of equipment that we tend to use with patients (depending on what they need). We keep balls, like the soccer ball Jeffrey used, on the racks there and we keep balancing tools, like the disk-shaped ball, the foam board and the bosu ball in that corner as well. Typically, we also have patients stretch their calves in the bars as well using the board seen to the left of the rehab bars in the picture below.

Day 6: The Performance Room

At this point, I have seen many of Response Physical Therapy’s patients and most of the patients I saw today, with the exception of an evaluation patient, were patients I have seen before. Today we had quite a few patients that needed to work in the performance room in the facility. Jeffrey took one patient, who had broken their tibia and fibula close to the ankle and dislocated their ankle, to the performance room so we would have more room for some of the exercises Jeffrey had planned. In the performance room, Jeffrey had the patient running, jump roping, skipping, and doing calf raises. Activities like jump roping and skipping were to help loosen the ankle and improve some flexibility while still taking on some weight. Calf raises were strengthening exercises which are necessary ass typically, after an injury, there tends to be some muscle atrophy and you want to regain all that muscle and more than that you want to build more muscle so that it can support the location of previous injury. Later in the day, Jeffrey took another patient into the performance room. The goal with this patient was to improve the strength of their hip flexors to reduce pain in the hips. Many of this patient’s exercises were strength and balance related. In the performance room there are stretchy cables attached to the floor and you can attach the other end to your waist. Jeffrey had the patient attach one end to his waist then had him walk forward until there was tension in the cable. He did many exercises with the cable were the patient would shuffle side to side or move up and back and the tension helped to work his hips. The final patient that day, a patient of Dan’s, also used the performance room. This patient was far out from an ACL surgery and was running. There were lots of hamstring, quad, and hip flexor targeting exercises for this patient to do: side-steps with a theraband, bridges while moving the feet in and out from under you, pistol squats, etc. The patient also used the sled in the performance room to push 90 lbs back and forth multiple times to continue building up strength.