Physio Charlie

I have a new website!!

http://physiocharlie.vpweb.co.uk

I am organising a backcare Awareness day on 20th October.  See below:

 http://www.backpain.org/pages/b_pages/bcaw-events.php

Yesterday myself and my supervisor attended a one day course at Coventry University on clinical education.  They took us through the assessment of students and we were able to ask questions in regard to this.  The students have a clinical case study exam at the end of their placement and this was discussed.  The students have a nominated tutor who visits 3 times during the placement and provides advice for both the student and the supervisor.  Feedback was discussed, we should be developing; "positive-negative-positive" feedback for the students.

My supervisor and I discussed student supervision in clinical supervision today.  Ideally we would provide teaching on a joint, we would show them an assessment of a patient, then the student would carry it out themselves on the next patient with the same joint complaint.   

As part of my PDP I visited a Podiatrist clinic in Leicester.  I learnt about a number of topics:

Hallux Valgus: genetic or due to increased pronation, correcting pronation is the first line of Rx.  Splints and toe wedges do not work.

Plantar Fasciatis: Mainly due to over pronation/dropped arches and tight fascia, benefitted by medial arch and medial heel wedge.  The Podiatrist cut the orthosis into a whale shape on the medial side and stuck this underneath an insole.

Leg Length Discrepancy (LLD): Orthoses often help low back pain (LBP) if LLD present

Ax:  obs foot posture from ant and post position.  Feel talus whilst getting patient to evert and invert foot.  Obs achillies tendon and whether vertical or displaced.

Referrals: Patients can self refer themselves or health professionals can refer.  They prefer to have a letter as it gives more detail.

Discharges:  Podiatrists do not generally d/c patients as they review patients approx every 6 months.

Benefits for practice:  Self referral for patients, knowledge of where biomechanical clinics are held in the city, LLD for LBP, d/c policy, tiara d/c letter template.

I arranged a day at the Pain Management Programme and attended yesterday.

The day was very interesting, I met 5 members of the team at the LGH; Dr, physios x 2, OT and an assistant psychologist.  The day was spent observing an introductory session for chronic pain patients.

Session 1.  Pain physiology.  The Dr described pain pathways, she mentioned NMDA receptors and how the response to a pain stimulus is amplified leading to central sensitisation.  In this way, even slight touch distal to the origin of pain can cause the patient to feel pain.  She talked about the drugs used such as Amyltriptaline, which works on the NorAdrenaline receptors.  Gabapentine and Carbamazapine work on the sodium and calcium channels and some of the latest antidepressants SNRI's help central sensitisation.

Session 2.  Pacing.  The OT described pacing as essential to pain management.  Learning not to do ADL's until you feel the pain but stop before you do.  On good days and bad learn limits to activity.

Session 3.  Exercise.  The physio discussed stretches and exercise and how this can release endorphins and close the pain gate.

Session 4.  Relaxation.  The psychologist talked about the pain pathways again in relation to relaxation and gave various techniques such as breathing and muscle relaxation to music.

Discussion with the Senior Physio.  She talked about chronic pain management in relation to the outpatients we see in primary care:  Ax; include expectations and beliefs about what they are concerned about.  Look for yellow flags which are indications that patients could develop chronic conditions.  Rx; Hands off until they have proved some coherance to the physiotherapy.  Designing an activity programme and goal setting by the patient are also useful tips to use:

activity_diary_and_goals.doc