This week I evaluated football player who was complaining of knee pain. He said he fell on his knee and it hurt on the spot of impact, but it also hurt on the back of his knee in the popliteal space. I started with history. The player said he fell on his knee, but it didn’t hurt on the back of his knee until later. The pain gradually got worse as he continued to play. He also mentioned it hurt to squat only in the first few degrees, and when he plants and cuts. Next I did an observation. There was a little bit of swelling over his patella, but I deduced it was from when he fell, and it was nothing more than a bone bruise. There was no deformity, swelling, or discoloration in the popliteal area. Then I palpated over the patella, the patella tendon, the quads, the hamstrings, the IT band, and the boney landmarks. There was point tenderness over the patella, lateral hamstring area, and around the insertion of the IT band. The IT bands also felt every tight. ROM was within normal limits, however there was pain with active knee flexion and extension. Strength for knee flexion and knee extension was 4/5. Then I started doing special tests. At this point I was between a hamstring strain and IT band friction syndrome. I had (+) Rene’s test, (-) Obers test, (-) Nobel’s compression test. I had the player do some functional tests, like the squatting and planting so he could show me when and where it hurt. At this point, I still felt stuck between IT band friction syndrome and Hamstring. I asked the preceptor to double check me and see what she thought. When I palpated I didn’t feel any roping or deformity between his two hamstring tendons. This was because I palpated on and then palpated the other, so I wasn’t able to differentiate the difference. When the preceptor palpated the hamstrings, she did both at the same time, and then had me feel it. It was obvious then that there was some serious roping and tearing of the tendon. AT this point, it was obvious he had a hamstring strain. What I learned from this evaluation was that I need to take my time when palpating and do a better bilateral comparison. I did palpate bilaterally; the only difference was I should have palpated them at the same time. This would have made my eval go a lot smoother.
This week I got 2 attempts and 1 to mastery
Think about the preceptors you have had, what characteristics did they exhibit that you have adopted or hope to utilize in your career. Explain why.
Melissa has been my life saver in many classes. I have learned many things from her, but the most important thing I have learned is administrative duties. Half the time I ever see her in the clinic she is on the computer doing some kind of paper work. This gives me insight to how being a certified ATC will be very different from being an ATS. I hope to be able to manage paperwork in a organized timely fashion to the best of my abilities when I am an ATC.
Chaypin exhibits a desire to learn more as she works. I feel like this is important in athletic training because the field is always changing and new studies are coming out daily. This is something I hope to utilize in my career after I am graduated. She also enjoys and take constructive criticism very well which, while I feel I did this well prior to being an ATS, I have a greater appreciation of because of Chaypin.
Hannah has a sense of finesse that blows my mind for her being a recent graduate. She never seems to do too little or too much of anything, and everything has a nice flow. Finesse is usually something that is built up over time, but Hannah’s just comes off so natural. I have learned a lot from Hannah. Particularly when she does certain treatments slightly different from how I learned. I am always interested in what she learned different at her college. I hope to be able to incorporate her differences into my style.
Cole is a new preceptor and I haven’t experienced him too much in the clinic, but it is very clear he has a very different way of doing things than any other preceptor I have been with. Something I find interesting is the way he uses modalities. He doesn’t uses stim nearly as much as the other preceptors and when he uses ultrasound he calculates a specific heat for an injury. This is different from how I was taught and I want to do more research and find more information that supports his way of using modalities.
Randy is my current preceptor, and once again very different from others that I have experienced. One thing I really like about what he does is that he explains the injury and what is going on to the athlete. This is something I have started doing myself. I believe it helps the athlete have a better understanding and it may lead to better treatment out comes, and prevention of similar injuries.
This week I was at a volley ball match at Virginia high school. Things were going smoothly until the JV team started their match. Right after the first play, a girl comes limping over to the side line. My preceptor had just stepped out for a minute, so I had another student go get him while I started my eval. I didn’t see her fall, but she reported she inverted her ankle and fell while going for a ball. She had never had an injury before so she was pretty worked up. I tried to calm her down and explain everything I was doing to so that she wouldn’t get scared or caught off-guard. Her ankle was really swollen around her lateral malleolus and point tender over the deltoid ligament, ATF, CF, and PTF. She had mildly limited AROM with pain. Next I did special tests. I did: (-) compression, (-) Kleiger, (-) bump, (+) anterior drawer, (+) inversion and eversion talar tilt. I didn’t believe she had a fracture, nor did my preceptor, but he gave them the option of going to get an x-ray. Our conclusion was that she had a grade I inversion ankle sprain. We iced, and elevated her foot for the rest of the game. Then after, we put a horse shoe pad and ace wrap to help push out swelling. We also put her in a walking boot. I was expecting to put her on crutches, but my preceptor said he prefers walking boots to begin mobility as soon as possible. This also makes sense because of Wolff’s law which states, “tissue will respond to physical demands placed on them, causing them to remodel or realign along lines of tensile force.” I felt very confident doing this eval and I feel like I am still working towards my goal of becoming more accurate with the assessment of injuries.
This week I had 5 attempts.
This week I did an eval on a soccer player who was complaining of hip and back pain. Something I found interesting in her history is that the head of her femur is too small for her acetabulum which she says causes various types if muscle a joint pain. She first noticed her pain when she went for a goal shot. She reported a sharp pain 7/10 when she kicked and 4/10 when running. She also reported pain with trunk rotation. I then went on to my inspection where there was no redness, no swelling, no bleeding, and no obvious deformity. Then I began my palpations. I started with her mid back. There was palpable tightness and knots on the left lateral side of her mid back and along para spinals. I also palpated her sacrum and PSIS where there was palpable tenderness and reported pain of 7/10. Her PSIS were also out of alignment. Next I did Range of Motion. I did active, passive, and resisted for hip flexion, hip extension, trunk flexion, and trunk extension. I also had the patient do active trunk rotation. From the ROMs I was able to rule in an oblique and possible para spinal strain. Her strength was a 5/5 hip flexion and 4/5 for hip extension. I then continued to special tests. I found a (+) Long sits, (+) SI compression, (+) SI distraction. Due to her strength, positive special tests, and palpation findings, I believe she had SI dysfunction. My immediate treatment for her was to correct the malalignment and to give her Ice. I feel like this eval was a good step for reaching my goal of becoming more accurate with my evaluations. I felt very confident with my findings and that I was able to flow easily from one section of an eval to another. I did use my special test book to remind me of special test. Although it is acceptable to use a resource while doing an eval, I would like to be at a point where I wouldn’t have to use one as often, especially for simple tests like compression and distraction.
This week I had two attempts, one was performed to mastery.
This is where I do my weekly clinical blog assignment. There is either a prompt I am responding to, or I just talk about something exciting I saw during the week.