I just finished up a clinical rotation in Montgomery, Alabama. The patient population I saw was a mix of workers comp, outpatient ortho, and sports. My CI happened to have the contract with two local universities. Each year, at the beginning of the fall semester, the athletes at those schools are required to have physicals to ensure their health before their respective seasons begin. To speed up the process, various stations were set up: height/weight, vision, general medical, and ortho. I worked with some orthopedic surgeons, performing ortho screens, to assess for any orthopedic impairments and pathologies.
Due to the large amount of student-athletes, we had to perform the ortho screens as fast as possible, while still testing the athletes' musculoskeletal system to ensure safety. We first obtained an ortho history from each individual, so we could perform a more extensive examination of the affected area. Our general screen usually included a cervical clearing test (along with mytomal/dermatomal assessment), AROM of the shoulder followed by resisted muscle testing, spinal flexion/extension overpressure, single leg hopping, deep squat with either a "duck-walk" or twisting the hips on stable ankles (clears the ankles and stresses the rest of the lower extremity as well!), and push-ups to check the elbows and shoulders for apprehension.
It was a great experience working with the ortho surgeons! I was able to look into their reasoning behind using one test versus another when examining a joint. I highly recommend being involved with the physicals of an athletic organization or school if given the opportunity.
Currently I am on an inpatient clinical rotation in Kansas City. This past Tuesday morning I had the opportunity to observe 5 surgeries, 4 of which were total joints. Two of the surgeries were total hip replacements, 1 total knee, and 1 unicompartmental knee replacement (partial knee replacement).
The afternoon following the surgery, I performed a physical therapy evaluation with each of the patients. Each day I worked with them until they discharged from the hospital today (Friday). Seeing the entire process from start to finish really pieced together the entire rehabilitation process for me.
Being able to observe surgeries and interact with the surgeon empowered me to more fully understand the patient's pain. It allowed me to answer their questions more appropriately and gain a better understanding of exactly what structures were involved in the surgery.
Additionally, the hospital I am working at has a well developed joint center. (Recently named the best joint center in the region). Each day, for a total of 3 days, all of the total hips and knees would gather together for a 1.5 hour morning therapy session and a 1.5 hour afternoon session. Each session would include basic therapeutic exercise, precautions guidelines (for the hippies), and ADL training with both PT and OT. The patients were extremely happy with the group therapy sessions. Seeing other people go through the same pains and process as them seemed to make the rehab process easier.
In conclusion, I highly recommend observing any surgeries that you have the opportunity to see. It allows you to appreciate the integrity of the human body, understand more fully what your patient is experiencing, and ultimately be a better therapist.
We set up this website for physical therapy students and physical therapists across the country to discuss what we have been learning and practicing. This blog is intended to be educational and informational, reviewing some of the key concepts of anatomy, kinesiology, and pathophysiology and discussing new evidenced based research in the field of physical therapy. Please feel free to leave a comment!
James Heafner DPT, Chris Fox DPT, and Brian Schwabe DPT, CSCS are recent graduates of Saint Louis University's Program in Physical Therapy.