Clinical Insights

3 Things I Have Learned As An Intern

Today's blog post comes from the perspective of one of our interns.  Fresh faces offer new perspectives, so we think it would be interesting to share the insights of a soon-to-be physical therapy student and his perspective on what we do here at Perfect Stride Physical Therapy. 

My name is Joseph Santangelo, and I currently intern at Perfect Stride Physical Therapy. I am a senior at George Washington University studying Exercise Science with a concentration in Pre-Physical Therapy.

The next question you may ask is “Why did you decide on Physical Therapy?” The fundamental reason is; I want to empower people to have healthy, functional and pain-free lives. I’ve always appreciated the stories of people who have bounced back from gruesome or nagging injuries to carry out functional lives. Studying anatomy, therapeutic exercise, and injuries in a classroom setting is a lot different than learning about it in a practical application. I have learned a great deal of information; however, I will share three lessons from my experience.

1) Functional Range Conditioning (FRC)

FRC aims to improve functional mobility, articular resilience (improving threshold of loading muscle/joints), and articular health/longevity. This is done using a number of different modalities including Controlled Articular Rotations (CARs) and PAILs and RAILs contractions to reduce injury and improve performance.

PAILs and RAILs are valuable for acquiring larger ranges of motion (think mobility). Where CAR’s are used to improve awareness and control of our outer limit of our mobility, and serve as a great form of self-assessment.

The main point is that these tools are used to train and bolster the nervous system to not only have flexibility but also have strength and control in different positions. It is equally important to realize that there are many other layers to consider when treating a patient other than FRC (FRC is one part of the total system).

 

2) Individuality

Individuality is a major component in rehabbing an injury and/or developing an exercise program. Since the limitations/injuries stem from multiple areas, a good and concise assessment process should be taken to determine where to start.

Being creative with exercise choice, tissue mobilization, and patient positioning can make a big difference. I’ve seen this first hand whether that was me being challenged to create exercise programs or just noticing how each physical therapist at PSPT tries to target joints, muscles, and movement patterns in different ways.

For example, two patients could walk in with the same injury, but may need different levels of stimuli (depending on current health, level of fitness, genetics, age, etc.) to produce some form of adaptation.

These same two people may also have that injury because of different movement deficiencies and differences in their anatomy. This clearly demonstrates the varying degrees of individuality that have to be taken into consideration. Creative exercise choice and a good assessment tool go a long way towards helping patients succeed.  

 

3) Clinician/Patient Relationship

Because people have stressors and anxieties (aka life), trust and confidence will go a long way towards a holistic recovery. It is a lot more than just the physical injury! Getting to know the person for more than their injury/limitations really helps develop a better clinician-patient relationship. Therefore, being able to understand a person’s desires, goals, and ADL’s can help you become a better healthcare provider while also creating a plan of care that fits each patient.

My internship here at PSPT was full of learning and fun. Rehabilitation, like learning, is never a linear process. However, the ability to meet people where they are and challenge them appropriately will yield positive results. These three things I have learned will help my future career for a long time. I would like to thank Joe, Vikash, Dan, and Austin for the opportunity to become a better future physical therapist to help fulfill what I want in my life.

Strength and Conditioning in the Rehabilitation Setting

When you think Physical Therapy, what do you think?  If you imagine it is a place where you get a massage, do the same exercises as everyone else (on a table) for an hour, or simply a place where you are told what you cannot do/should stop doing, you are thinking of an older model of care.  

It seems more and more that the gap between the rehabilitative field and the strength and conditioning field is becoming narrower by the day, and for good reason.  Rehab IS strength and conditioning, just on the opposite side of the continuum.  

 This graph does an excellent job demonstrating the idea of a TEAM approach to a patient's care.  Worth noting is just how long we as healthcare professionals and strength and conditioning specialists can have in the rehabilitation of the strength and conditioning athlete. 

This graph does an excellent job demonstrating the idea of a TEAM approach to a patient's care.  Worth noting is just how long we as healthcare professionals and strength and conditioning specialists can have in the rehabilitation of the strength and conditioning athlete. 

When tissue gets injured it is our job to influence the healing process while maintaining progressive overload to create resiliency.  Better known as the act of accepting the demands of weight training, running and sports without being re-injured or suffering set backs.  In order to do this we must use the appropriate load, intensity and volume that challenges the injured tissue without irritating their symptoms.  

  • LOAD >> CAPACITY = INJURY
  • LOAD = CAPACITY = REHAB
  • LOAD << CAPACITY = PREVENTION

This sounds a lot like what I used to do as a strength and conditioning coach.  Create an exercise program that uses the appropriate loads, intensities and volumes that will help create positive adaptations without hurting my clients.  

The goal of rehab after all is to get the person in front of us back to their prior level of function. This can be anything from being a desk jockey to the All-American Jockey. 

When healthcare professionals do not understand strength and conditioning protocols, it will be hard to help that patient to continue to train around injury.

This is an e-mail that I received this morning from a trainer that I work closely with:

"Hey Joe. I have a question.  I have a client that is seeing a PT for some shoulder issues.  The client introduced us through email so we could work together to figure out an alternate plan of training that would allow her to get the treatment she needs for her shoulder while continuing her training. The PT responded that he wants the client to abstain from any and all exercise, like do nothing at all."

No one should ever have to hear that have to abstain from all exercise unless it is 100% warranted.  If I person can go into the gym and perform pain free movements, they should, not just to keep their body some-what conditioned, but to help keep them sane.  There are plenty of activities one can perform while still "protecting" healing tissues.  

This is where a healthcare professional who also has experience as a strength coach can really help.  It becomes very easy to understand regressions and lateralizations of exercises that will allow them to still have some training effect while recovering from their injury.

For these reasons, it becomes highly important for rehabilitation providers to understand performance, and on the flip side strength coaches and trainers to understand more of the rehabilitation world.  This will allow for better communication, and make for a much better transition from being hurt to getting back to your previous self. 

It is okay to not know everything, actually it is perfectly normal.  However, identifying areas of opportunity in our practice and linking them with patient's needs should force us to build a reliable network of providers in order to ensure that each and every patient receives optimal care and has the greatest chance for success.  

 

 

 

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