Physical Therapy Clinical Rotations – Week 1
I started the first of my three physical therapy clinical rotations this past Monday in Shreveport, Louisiana at an outpatient orthopedic clinic. Even though the journey to this city was rough 😬 (cancelled flights, tornado warnings, snow, etc.), my time working in the clinic has definitely made up for the chaos in the beginning. My CI is a spine physical therapist, and consequently, she sees a lot of chronic pain patients. During my first week here, I learned so much about physical therapy treatment in Louisiana, treating real patients, and the difference between what we study at school and how we would apply that in the field.
Some things I learned during my first week ~
1 | Not all patients are “textbook” patients.
One of the major things I’ve learned while working with my CI at this clinic is that not all patients will present as how we learned about them in class or in our textbooks. The foundation of knowledge that we acquire in school is just that: a foundation. More times than not, the patient presentation may not fit the mold of the diagnoses we’ve learned in school. Even though some patients will indeed be the perfect representation of a particular diagnosis, don’t be surprised if your patient strays from the textbook signs and symptoms.
There were a couple patients we saw this past week that I had questions about. I remember reading one patient’s chart before her treatment session that day, and the medical diagnosis from the doctor was “bilateral leg weakness.” However, there was no traumatic event that occurred, and the neurological portion of the exam was unremarkable. She had just stated that “her legs felt weak.” I asked my CI what her PT diagnosis was and what could have caused this weakness. She said she still did not know what could have caused this patient’s symptoms, and nothing really added up during the examination.
This wasn’t the first time that we could not find an explanation for the patient’s pain. Sometimes, there are other factors to someone’s dysfunction that we don’t know about or that our scope of practice doesn’t cover. For some patients, talking to a counselor/therapist may be what they need in order for them to improve. In these cases where there may be an underlying emotional or mental issue preventing progress, my CI refers them to a counselor that comes into our clinic once a week.
At the same time, there are patients that get better unexpectedly. My CI told me one time that she had just did performed a myofascial release technique on a patient during an evaluation, and the patient told her “my pain has been persistent for months, and now its gone! Whatever you did, it worked!” Besides all of the information that we learned in school, there are numerous factors (personal, emotional, environmental, etc.) that need to be taken into account when treating a real patient.
2 | A patient’s attitude towards treatment is SO important.
Because my CI works with a lot of chronic pain patients, I learned about how important a patient’s attitude towards physical therapy and their pain is. She said that many patients come in, feeling forced to come because of their doctor’s recommendation or at the persistence of a family member. Their reluctance definitely does not motivate them to continue doing their exercises at home, which is a major part of the physical therapy rehab process. My CI told me that not too many people have 0/10 pain when they are discharged. While most people will make some progress in PT, only a small portion of those chronic pain patients will actually leave pain-free.
This week, out of the 6 or so people that we discharged from physical therapy, only 2 people had reported 0/10 pain during their last session. These 2 people were the ONLY discharged patients who reported doing their home exercise program daily, being active frequently, and had a positive attitude towards their treatment and progress. The other patients that we had released from therapy either did not want to continue coming (because they had to exercise during treatments) or felt like their pain was the best it was going to get. I was in disbelief when I realized this correlation between attitude and progress and how so little patients actually had their pain reduced to nothing.
While there are definitely lots of other factors to consider when it comes to pain reduction and increasing functional mobility, it was interesting to see how a patient’s mentality towards getting better and being physically active affected their progress through therapy. During our last class, I remember one of my spine professors saying that chronic pain patients are very difficult to treat, and trying to heal every single one of them will just cause burn out. She said that there’s only so much we can do, regardless of how much we want our patients to get better.
3 | How you interact with your CI will influence what you get out of this experience.
When I first started working with my CI, we went over what goals I had for this clinical rotation and how I wanted to learn. Because I had just taken a spine class, the information was fresh in my mind. However, I had never worked with too many spine patients before – I had experience in an outpatient sports clinic, a pediatric clinic, and an aquatic setting. I learn best by, first, observing and asking questions. The information is then solidified in my head when I try the technique or process myself.
As a result, I shadowed my CI during her evaluations and treatments during the first day. I then started to work one-on-one with some patients during their therapeutic exercises after I got the hang of what kinds of exercises my CI prefers. I also got to observe and ask questions about dry needling, which is not allowed to be used in the clinic in California. During this first week, I had the opportunity before and after the sessions to ask her questions about her methods, the patient’s signs and symptoms, and specific diagnoses. I felt like this method had been really beneficial for me, and I learned a lot at my own pace. Next week, she is going to have me perform parts of a spinal evaluation – the subjective, reflexes, MMT’s, palpation, etc.
Also, don’t be surprised if your CI doesn’t organize your time with them like mine did for me! I know a bunch of my friends in my cohort started completing evals this first week or started with hands on techniques within the first day. Everyone’s experience seems different, so be open to learning, and you will have a great experience!
4 | Being open to learning will only benefit you.
Because this is my first clinical experience after starting PT school, it feels so different from the times when I worked as an aide. During the evaluations, I try to figure out the diagnoses from what I learned in school. During treatments, I now understand the reason behind specific exercises that patients perform and could explain to patients how the exercises could help them and their condition. Even though I now know so much more than I did as a PT aide, there is still so much that I didn’t and don’t know. When I had questions about something, I made sure to ask my CI after we saw the patient. This clinic does things differently than any other clinic I’ve been to (the different staff members, treatment techniques, etc.), so I talked to my CI about everything and asked questions when I didn’t understand.
Dry needling is one thing that I’ve been trying to learn as much as I can about. When a PT dry needles, they use a thin needle to stimulate a muscle to twitch, which would in turn cause it to relax and hopefully relieve pain (at least that’s what I understand). This can be used in conjunction with electrical stimulation. This practice is not allowed in California, where I am currently studying physical therapy in school, but physical therapists are allowed to dry needle here in Louisiana. Because I won’t be able to learn about this treatment method back at home, I’ve taken every opportunity possible to learn more about it. I’ve observed my CI and other PT’s dry needling, and I try to ask as many questions as I can about it. Even though I will not be able to practice it or use it in California, I want make the most of this experience and learn as much as I can.
This clinical experience is only as much as you put into it. Be curious and eager. Then you’ll be able to learn invaluable information and experience things that you never would have been able to in school.
I actually learned SO much more than what I listed here, but then this blog post would be even longer than it already is. I hope I didn’t bore you too much and that you learned something! Just writing down my thoughts here has made me reflect on everything that has happened this week, so I encourage you to keep a record of things you’ve learned during your time in clinicals (or your time doing anything new or exciting)! Don’t forget to subscribe to my newsletter to get notified of the next blog post! Thanks for reading this far 💕talk to you soon!
