When not seeing clients much of our time is spent preparing for the next client (or the next day’s client) or going over our own personal study – generally things we felt we need to brush up on. I have found I spend a lot of this time writing up the notes as well. I now understand how if you don’t write everything down (especially what you plan to do with the client next time they come in) it is so easy to forget!!
There are text books in the office we can refer to as well as protocols and some info on the computer. I also take the little physio pocket book with me each day and it has come in handy! I like how they are giving us the freedom to manage our own time around seeing clients (and letting us book clients in – probably dull when you have been working as a physio for a while, but exciting to book our own clients in when we first start!!). They are trusting us to use the time constructively and giving us some tasks like writing up goals for the clients. So far I feel Matt and I have definitely been making the most of this time.
I decided to write about the following particular client in my journal (our second client!) as his condition is one I have suffered from myself, so I found it particularly interesting. We saw this client yesterday, on our first day.
1. The client was referred with bilateral anterior knee pain. He had lateral mal tracking of the patella and a high Q angle. When I first read this I was pretty confident as we have covered this condition in class and I felt as if I knew what to do.
On assessment we found the client had a tight ITB (both left and right) and weak VMOs (bilateral). Our thought was the tight ITB was pulling the patella laterally while the weak VMO couldn’t pull it back medially. We got the client to do a squat, which caused him pain. When w applied a medial glide on the patella there was no pain on squatting. The lateral tracking of the patella was causing the knee pain.
The client was very keen to learn about what was happening in his knee in detail, so we spent time explaining it to him. I felt as though we gave a good, clear explanation and the client was certainly happy and said he understood what was going on. In terms of communication I found it difficult as he had a very strong accent, and I couldn’t understand everything he said. I had to keep clarifying to ensure I had heard correctly. In the history taking I did not ask him enough about the subjective history. My supervisor pointed this out and I asked him some more about it while performing the treatment.
Our treatment consisted of a massage to the ITBs to loosen them up and increase the length. The client was wearing long business pants but said next time he was happy to bring along shorts. We taught him an exercise for VMO strengthening (legs over a rolled towel, knee extension with foot turned out). He said he would do this at home. We also taught him a stretch for his ITBs to do at home. He said he could manage these two exercises at home and seemed keen to do anything that would improve the situation and get rid of his pain.
We asked him to come back in a week. I thought the treatment went very well. Next time he comes in we plan to do more massage to the ITBs and maybe progress the VMO exercises, depending on how he is going.
2. Overall I think this session went very well. The client was happy and I think we gave an appropriate treatment. We did not reassess the squat after treatment, and this is something we definitely should have done, and will do with all the clients in the future.
3. I felt quite comfortable as I knew about the condition and this was the second client we were seeing (after the first one I wasn’t s nervous!)
4. Reassess after treatment!!! This is something very important that I will not forget again! I think I could also have explained the ITB stretch a little better and shown him how to lean up against something.
5. Be more thorough in the history taking – find out about the social history.
6. Overall I think things went very well. I missed a few points in the history taking but overall we gave effective treatments and assessed the necessary things for each client. I was exhausted after my first day!
7. The Q angle – have since checked in an anatomy book :-)
I also needed to check how to use the
No comments:
Post a Comment