Physical Therapy-3/15/11

I spent my day in physical therapy because Jeanie (Dr. Williams’ nurse) was out for the afternoon tending to some personal errands. She did, however, inform the physical therapists that I would be coming over. Richard Jean, PT, took on the burden of mentoring me today. I have worked with the physical therapists before but never had the pleasure to work with Rick. Like doctors, I’ve noticed therapists like to work within a niche. I was able to reach this conclusion by comparing the cases I’ve seen with Kent (another PT) and Rick’s cases.

Two of Rick’s patients in the afternoon were new patients referred to him to rehabilitate their adhesive capsulitis or frozen shoulder. Adhesive capsulitis is a disorder in which the shoulder capsule, the connective tissue surrounding the glenohumeral joint of the shoulder, becomes inflamed and stiff, greatly restricting motion and causing chronic pain. The body has a tendency of scarring down inflamed joints, placing more tissue to reinforce the joint and acting like a saran wrap. This is why patients have limited range of motion after surgery. To restore all or most of the patient’s motion, it requires the gradual break down of this scar tissue and more so the loosening of the glenohumeral joint to relieve pain and instill confidence in the patient to move the joint. Rick walked the two patients through a series of exercises to loosen and strengthen the shoulder. The exercises involved internal and external rotation of the shoulder as well as adduction (moving towards body) and abduction (moving away from the body). Ultimately circumduction (full circular motion of the limb) can be achieved if the patient is persistent with his/her home exercises. It is essential that the patient puts in the time and effort at home to receive desired results.

Another of Rick’s patient’s had low back pain as well as numbness of the knee. The patient had a history of a discectomy/laminectomy, where herniated disk material was removed from her spine. While examining the patient, Rick found that the patient’s glutes were also tight. Rick suspected that much of the patient’s low back pain is a result of neural tension, which means the path a nerve takes through the body is narrowed or impinged. This disrupts its normally smooth movement. Typically this occurs as the nerve passes through a muscle or around a bone. Rick also attributes the numbness in the patient’s knee to the neural tension. To treat this, Rick composed a home workout program with exercise software which provides the patient with a visual of how the exercise is performed as well as the number of sets and repetitions. The workout consisted of hip stretches, glute and core strengthening/stretching and neural tension stretches. Unlike tendons, nerves are not stretched but technically pulled on to create a “flossing effect or motion.” The intent of neural tension stretching is to decrease the tension in the muscles and increase the mobility of the nerves.

Overall, it was an interesting day. I learned more than what I usually learn on a typical Monday. It was a bit tiring though, I hope my fellow interns are faring well with the new time change.