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How does the iWALK2.0 compare to traditional gait aids?

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How does the iWALK2.0 compare to traditional gait aids?

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https://www.youtube.com/watch?v=9KBXDJRj-XM

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When something you're taught in class works on a "real" patient

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When something you're taught in class works on a "real" patient

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Hey guys, Happy swotvac, I wanted to share this nerdy success!
I did a shoulder assessment on my dad, who was complaining on pain in L flexion and end range of abduction . His L scapula was moving a bit funny so tried the scapula assistance tests. He was so surprised when his pain was completely gone and so was i!! :D It's so nice to see something we learn in class work! :D I gave him a lower trap strengthening exercise and postural exercise. Anyone else had success practicing on family members? :) Tisara

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This video is about Assessing the shoulder

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Lever ACL Test - Not as great as we thought

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Lever ACL Test - Not as great as we thought

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Hey Guys,

No doubt some of you may have already seen this on "Physiotutors", however I thought I would share it with those who may not have seen it yet.

The infamous ACL Lever Sign test we learnt this semester has recently been evaluated and it turns out the test may not be s superior as first thought.
See post below and link to article:

"LELLI TEST - NEW EVIDENCE TO SHOW THAT THE THIS NEW ACL TEST IS NOT AS GOOD AS ONCE THOUGHT!

Jarbo et al. (2017) have evaluated the Lelli Test, also known as Lever Sign, in 102 patients with acute knee pain within 4 weeks of their injury. The test was performed awake and under anesthesia next to the Lachman test, Anterior Drawer Test and Pivot Shift Test.

Results: The Lelli Sign had a diagnostic overall accuracy of 77% with a sensitiity of 63% and a specificity of 90%.
Conclusion: This means that the Lelli Test is not superior, but actually inferior to the commonly used tests for
ACL injuries." (PhysioTutors, 2017)

Jarbo et al. (2017): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5639970/

Happy Reading,

Graeme

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Cardiopulmonary assessment mock prac exam

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This video is about Cardiopulmonary assessment mock prac exam

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Even more fun...

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Uploaded by Phillip Hughes PDB on 2017-10-26.

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Clarifying forearm position in the pivot shift test with Confused Debbie

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Clarifying forearm position in the pivot shift test with Confused Debbie

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A bit of fun...

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Confused Debbie asks about forearm supination in the pivot shift test

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Uploaded by Phillip Hughes PDB on 2017-10-26.

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Mock exam - Treatment of a post-immobilisation wrist

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Mock exam - Treatment of a post-immobilisation wrist

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This video is about Treating a post-immobilisation wrist

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Mock exam - Assessment of medial elbow instability

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Mock exam - Assessment of medial elbow instability

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Assessing medial instability of the elbow Mock Exam

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Uploaded by Phillip Hughes PDB on 2017-10-26.

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Everything you wanted to know about muscle stims

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Everything you wanted to know about muscle stims

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Here is Maryam's prac class demonstration. The movie stops prematurely. Parameters for a smooth contraction that are not provided in the movie are:
Frequency - 25Hz
Duration - 250ms

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This is my take :)
Debbie

Great job, Debbie.
Thank you!

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Here is the movie of a subjective examination that formed part of the Guillain Barre Syndrome presentation for Group 3.3 (Bundoora).
Well done Natalie and Taliah.

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Uploaded by Natalie Platt on 2017-10-10.

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Ralph decided to jump up quickly, from the chair to the plinth and caught everyone by surprise... Rebecca suddenly realised that he needed support from behind.

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Maria falling 3

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Maria falling 2

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Maria falling 1 - What happens when you're not close enough to the patient?

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Some further thoughts on treatment and exercises

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Some further thoughts on treatment and exercises

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Some further thoughts on treatment and exercises

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Uploaded by Phillip Hughes PDB on 2017-10-17.

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Some thoughts on treating shoulder impingement

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Some thoughts on treating shoulder impingement

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Uploaded by Phillip Hughes PDB on 2017-10-17.

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Who's prepared to think about these questions and try to come up with an answer?
Reply on Padlet.
- Phillip

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2 features of tendon pain: Pain is localised and  increases pain with increased load
Example of high tendon load for patella tendon is jumping
Rehab stages for an achilles tendon insertion
Stage 1: pain reduction : isometric calf raise exercise
Stage 2 : strength (isotonic): calf raise (concentric/eccentric), seated calf raise
Stage 3: energy storage: splits squats, skipping
Stage 4: sport specific /elastic function:  increasing the frequency of calf raises
Nancy

Thank you Nancy. Good job.

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An explanation of why we do clearing tests

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Uploaded by Phillip Hughes PDB on 2017-10-15.

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Uploaded by Phillip Hughes PDB on 2017-10-14.

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A subjective and physical examination and treatment of posterior wrist pain

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A subjective and physical examination and treatment of posterior wrist pain

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Assessing and treating posterior wrist pain - a demonstration

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This video is about Assessing and treating posterior wrist pain - a demonstration

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Testing for carpal tunnel syndrome and de Quervain's tenosynovitis

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Testing for carpal tunnel syndrome and de Quervain's tenosynovitis

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Testing for Carpal Tunnel Syndrome and de Quervain's Tenosynovitis

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Uploaded by Phillip Hughes PDB on 2017-10-05.

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The WHAT test for de Quervain's tenosynovitis

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The WHAT test for de Quervain's tenosynovitis

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Wrist Hyperflexion Abuction Thumb (resisted) 😀

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WHAT is the test for de Quervain's tenosynovitis

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This video is about shoulder impingement tests

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The sleeper stretch for shoulder posterior capsule tightness

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The sleeper stretch for shoulder posterior capsule tightness

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This video is about stretching the posterior capsule of the shoulder, using the sleeper stretch, which is a treatment for shoulder impingement.

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Strengthening the rotator cuff with resistance tubing

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Strengthening the rotator cuff with resistance tubing

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This movie plays, even though the thumbnail indicates there is a problem

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Some thoughts on progressing strength exercises around the shoulder

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Some thoughts on progressing strength exercises around the shoulder

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This video is about the progression of strength exercises at the shoulder

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I was working in a clinic tonight and came across LE where the grip pain was worse than the palpation pain. This movie shows how a lateral glide can decrease grip pain.
- Phillip

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Uploaded by Phillip Hughes PDB on 2017-09-28.

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Hey Phil,

In the video Stevie posted with the example of scapular dyskinesis - Would the muscle affected be serratus anterior?

If it is due to a long thoracic nerve neuropathy can much be done in the way of physiotherapy intervention? - Would strengthening SA be the best bet to try and relieve some of the patients symptoms?

In what situation would surgical intervention be performed?
- Graeme

Good job, Graeme.
Yes, a neuropathy of the long thoracic nerve will result in dysfunction of serratus anterior and produce significant winging of the scapula. Not much can be done about it. You have to ensure that the mid- and lower-traps are functioning optimally.
- Phillip

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I have placed this, and some other recently completed movies, on the LMS Shoulder tab. I'm adding them here in case you don't notice that they're on LMS.
- Phillip

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Uploaded by Phillip Hughes PDB on 2017-09-21.

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Thank you to Stevie for providing this example of scapular dyskinesis.
He has a Type 1 as he's going up, but on recovery there is no control, as his medial border flips out for a significant Type 2. He also has no control of upward rotation when high in elevation.
There's a good chance he has neuropathy of his long thoracic nerve, which will knock out which muscle here?

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Taping for resting pain in lateral epicondylagia

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Taping for resting pain in lateral epicondylagia

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Taping for resting pain in lateral epicondylagi

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Uploaded by Phillip Hughes PDB on 2017-09-21.

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Cervical glide for elbow lateral epicondylagia when palpation pain is worse than grip pain

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Cervical glide for elbow lateral epicondylagia when palpation pain is worse than grip pain

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Lateral cervical glide for lateral epicondylalgia when the palpation pain at the tendon is worse th

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Uploaded by Phillip Hughes PDB on 2017-09-21.

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Manual therapy for lateral epicondylalgia

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Manual therapy for lateral epicondylalgia

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Lateral glide of the elbow for lateral epicondylaglia

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Uploaded by Phillip Hughes PDB on 2017-09-21.

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The 4 tests for elbow medial ligament tears or instabilty

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The 4 tests for elbow medial ligament tears or instabilty

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4 tests for elbow medial ligament tear and instability

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Uploaded by Phillip Hughes PDB on 2017-09-21.

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Biofeedback for increasing muscle activation

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Biofeedback for increasing muscle activation

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Using biofeedback for increased muscle activity

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Uploaded by Phillip Hughes PDB on 2017-09-21.

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I think that this could potentially be due to a rupture of middle/inferior glenohumeral ligaments (or lax ligaments) along with weakness of subscap? If so, then yes this is an issue.

Therefore one thing I would do is strengthen subscap in particular, along with the other rotator cuff muscles to ensure that the scapulohumeral rhythm remains normal. I would strengthen subscap so that it pulls the humeral head anteriorly, preventing posterior sliding of the head in the socket.
- Daniel

Thank you for giving it a go, Daniel. I'm very impressed with your clinical reasoning.

It is a problem because the humeral head dislocating backwards can damage the labrum and lead to easier dislocation.

This can occur in adolescents and the voluntary nature of it (it becomes almost habitual) often reflects pyscho/emotional issues at play.

Often, it is the capsule that is very lax and requires reinforcing with muscular support.

I agree that the rotator cuff needs to be strengthened. More likely, subscapularis will be weak (it was), however we have to assess all muscles of the cuff and strengthen wherever we find them weak.

We also need to check for scapular dysfunction. This can be checked 3 ways:
1) If the scapular posterior tilt test reduces the pain or weakness with empty can or full can tests
2) If the scapular assistance test gains extra elevation range or reduces pain in elevation
3) If there is scapular dyskinesis

Well done, Daniel.
- Phillip

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Voluntary posterior dislocation in adolescents

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Voluntary posterior dislocation in adolescents

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Any thoughts on how this could be handled? Is this an issue?
- Phillip

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Voluntary posterior shoulder instability in adolescent

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Biofeedback for lessening muscle activation

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Biofeedback for lessening muscle activation

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Using biofeedback to lessen muscle activity

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Uploaded by Phillip Hughes PDB on 2017-09-21.

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Happy World Physiotherapy Day everyone September 8

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Happy World Physiotherapy Day everyone September 8

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The APA has 4 posters for the day. I will upload them
- Phillip

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Understanding persistent pain - Turning the volume down

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Understanding persistent pain - Turning the volume down

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It can be difficult to explain chronic pain to patients. This booklet is an attempt to do so. An interesting read
- Phillip

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- Will

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A few of the students at Bundoora yesterday, were performing mock prac exams and reflecting on them, as a learning exercise.
Ashlee has kindly agreed to post her exam, so that other students might analyse it and think about their own approach to the exams this week.
I'm not going to go through a full marking process as it was an adhoc exercise, but you might check the rubric after watching it and consider what you may or may not do differently.
Also, what tests were in?
What tests were left out? (do not answer these questions here - just give it some thought and you might chat about it to your colleagues).
- Phillip

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Uploaded by Phillip Hughes PDB on 2017-09-01.

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Explaining the interferential machine at Bundoora

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Explaining the interferential machine at Bundoora

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Uploaded by Phillip Hughes PDB on 2017-09-01.

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A loud, sometimes painful (groin) pain during running or flexion/extension movements may be a symptom of snapping hip syndrome. There are 3 types - internal, external or intra-articular snapping hip. Below is a description of internal snapping hip. Can anyone describe the other types? Or think of a treatment approach?
- Phillip

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(They call it capital, instead of upper)

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No consideration of hip conditions is complete without mentioning SUFE. This condition requires urgent referral to an orthopaedic surgeon for internal fixation and stabilisation.
As primary contact practitioners, we may be the first to identify this, when an adolescent presents with groin pain. This was the case on 3 occassions in my career (you don't want to miss one).
Here is a good summary from the RCH:
- Phillip

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Clinical Practice Guidelines : Slipped upper femoral epiphysis (SUFE) - Emergency Department

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Good job Zara and check out Kate's stability.
- Phillip

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Uploaded by Phillip Hughes PDB on 2017-08-30.

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PFJ pain/anterior knee pain - 5 handy hints

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PFJ pain/anterior knee pain - 5 handy hints

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This blog contains some information relevant to our Week 5, practical class #2. There are some easy tips, including suggested exercises to implement with our patients to treat anterior knee pain. I hope you find it useful!
- Andrea

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La Trobe Sport and Exercise Medicine Research Centre

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Knee cap pain is the most common form of knee pain. Pain can be hard to pin point but may be around, behind, or under the knee cap. It affects both males and females of all activity levels and ages. It can cause problems that limit your ability to complete simple daily activities such as walking, running, sitting, squatting and walking on stairs.

Knee cap pain has a lot of potential causes and treatment options.

The information contained on this page will help guide you on the most appropriate treatment for your knee pain. It is based on a 'best practice guide', an 'international expert consensus statement', and a 'patient education leaflet' developed by experts.

Information provided should not replace treatment with a health care professional such as a physiotherapist. Seeing a qualified physiotherapist to discuss and guide your treatment options further is recommended.

The above information should help you develop a treatment plan with your physiotherapist.

You can also download a detailed education leaflet called 'Managing My Patellofemoral Pain' to help guide your knee cap pain treatment:

For those who like to know more about treating their knee cap pain, please read on.

Why do I need to be sensible with how much exercise I do?

The exact reason why people develop knee cap pain is unclear. However, experts around the world tend agree that doing 'too much, too soon' in relation to exercise may be a key reason.

There seems to be a spike in the number of people with knee cap pain following rapid increases to how much exercise you do - e.g. basic military training or 'start to run' programs (e.g. couch to 5K TM).

The number of people developing knee cap pain when completing basic military training has been reported to be as high as 32%.

In 'start to run' programs it can be as high as 17%.

There are no specific rules on how much exercise you should complete in order to avoid developing knee cap pain. It is also not clear exactly how quickly to increase exercise when returning to sports and other activities if you are recovering from knee cap pain.

The most sensible option is to monitor your pain levels during and after exercise. Experts frequently recommend that if you have a large increase in pain, or pain stays increased for more than 24 hours after exercise, you may be doing 'too much, too soon'.

Further guidance on how much exercise you should do and how quickly to increase it can be provided by your physiotherapist.

The following graphs taken from the education leaflet titled 'Managing My Patellofemoral Pain' provide a great visualisation to guide you on returning to exercise.

Why is it important to complete exercises targeting my thigh muscles?

People with knee cap pain generally have and poorly functioning thigh muscles. This weakness and poor function can also be one of the reasons you might develop pain in the first place.

It is also thought your thigh muscles become weaker after you have had knee cap pain for a long period of time. This is because people with knee pain move differently - e.g. you are likely to bend your knee less when walking on stairs and when running.

Weak and poorly functioning thigh muscles are thought to lead to greater stress on, and poor tracking of the knee cap. Specifically, the knee cap is thought move too far toward the outside of the thigh (i.e. maltracking) when the knee bends and straightens, causing pain (see illustration to the right).

Based on this maltracking theory, exercises targeting the knee muscles have been a primary focus of physiotherapists treating knee cap pain for many years. There is consistent evidence that this approach can be very effective.

Why is it important to complete exercises targeting my hip muscles?

People with knee cap pain generally have weak and poorly functioning hip muscles. It is thought that this weakness and poor function may not be the reason as to why you develop pain in the first place. Instead, your hip muscles may become weak because you have changed the way you move, or move less to avoid pain.

Weak and poorly functioning hip muscles are thought to put more stress onto your knee cap during activities like running, walking on stairs and squatting. This is because the muscles can no longer control your thigh well enough, allowing it to roll under the knee cap.

A good way to understand this, is to think of your knee cap as the train, and your thigh as the tracks. If the train (knee cap) moves or tries to derail off the tracks (thigh), this can be because your thigh muscles don't control the train well enough. However, when the hip is not controlled well enough, the tracks (or thigh) may move underneath the train, having the same derailing effect.

A number of good research trials report that hip targeted exercises are effective in reducing knee cap pain. In the longer term, combining both thigh and hip muscle targeted exercise is the most effective approach to reduce pain.

Why is it important to change the way I move?

People with knee cap pain often have more movement at their hips (collapsing in) and pelvis (dropping down) during activities that cause them pain.

Although exercises targeting the hip muscles can reduce pain, they don't always improve the way you move during activities like running and walking on stairs.

In order to improve the way you move during tasks that often cause knee pain (e.g. less hip collapse during running), you need to practice the new movement pattern you want to achieve. It is good to do specific exercises for this as part of your rehabilitation. These often referred to as movement pattern retraining, and can be particularly effective in runners with knee cap pain.

Why might taping or bracing help?

There are various ways to tape your knee. The most effective way is to use tape to control how much your knee cap moves toward the outside of your thigh.

There is also a bursa (fluid sack) below the knee cap which often becomes inflammed and swollen in people with knee cap pain. Taping to support this bursa often helps too.

The following video shows an effective taping method to control how much your knee cap moves, and how to support the bursa (fluid sack) below it:

Taping your knee can significantly reduce pain during activities like running, walking on stairs and squatting.

The most effective way to tape you knee can be different for each person, and research shows that tailoring it to your needs may optimise how much pain reduction you get. You may wish to discuss this with your physiotherapist who can assess your knee and find the most effective way for you.

Some people can have allergies to the tape required, or get tired of taping their knee. In these instances, there are bracing options which aim to achieve similar things to the tape. There is not as much evidence to support using braces for knee cap pain, but you can discuss options with your physiotherapist.

Why might shoe inserts help?

Research suggests that shoe inserts will significantly help reduce pain in anywhere between 25 and 50% of people with knee cap pain over the first 6-12 weeks of treatment. They may also help in the longer term too.

Traditionally, shoe inserts have been provided to people because they have flat (pronated) feet. However, there is a lot of debate about whether this is the right approach. In people with knee cap pain, having flatter feet does not predict strongly whether or not shoe inserts will help. Equally, shoe inserts can help people who are not considered to have flat feet.

A couple of studies have reported that people with flexible feet measured using a specific device are more likely benefit from shoe inserts if they have knee cap pain. This is something you could discuss and assess with the assistance of your physiotherapist or podiatrist.

One of the simplest ways to work out if shoe inserts will help is to try them during an activity that normally causes pain. If the inserts immediately reduce your pain, then they are likely to help. If they do not immediately reduce pain, they are unlikely to help you. It is that simple!

In one study, this test was the strongest predictor of success with shoe inserts given to people with knee cap pain. In the same study, the amount of foot movement (pronation) occurring during walking also predicted success, but not as well.

Aren't shoe inserts expensive?

If shoe inserts are customised specifically for you by a podiatrist, they can be quite expensive. However, research tells us that this is not necessary for most people with knee cap pain.

Less expensive prefabricated shoe inserts (usually less than $100) can be used to treat knee cap pain. If you complete your rehabilitation exercises given to you by a physiotherapist and get stronger, shoe inserts may only be needed for a short time.

Some physiotherapists have the knowledge and skills to provide you shoe inserts and you should discuss this with the physiotherapist treating you. If not, they can refer you to see a podiatrist to help.

Can't I just have surgery and fix my knee pain?

Current research tells us that surgery is generally not effective at helping people with knee cap pain.

Listen to world renowned physiotherapist and expert in managing knee cap pain, Professor Kay Crossley (La Trobe Sport and Exercise Medicine Research Centre) discuss surgery, exercise and other treatments for knee cap pain:

One problem for people trying to find a solution for their knee cap pain is getting the right advice and guidance on what treatments might help them. Not everyone is aware of the information contained on this page or consults with a physiotherapist to help treat their pain.

"We have a really big challenge on our hands to try and get the information out about how effective physiotherapy can be" says professor Crossley.

A lot of people with knee cap pain who consult their general practitioner are referred straight to a surgeon, without previously receiving physiotherapy and exercise guidance. They "won't even think about looking for a second opinion to see if they need to see a surgeon...... Then, the surgeon does surgery. That's what they know."

Some surgeries, including a lateral release may actually cause more harm than good for somebody with knee cap pain says Professor Crossley. There are many surgical options, but these should be a last resort.

If you are not convinced yet, Rhys's story might motivate you to make sure you try other treatments properly before considering surgery. Rhys underwent 10 surgeries ineffective surgeries before finally receiving the right physiotherapy guidance and exercise advice.

Not all surgeons will operate on people with knee cap pain. Professor Crossley says when consulting with people suffering knee cap pain, "there are some good surgeons that will then stop at that point and say, hang on, you need to have some physiotherapy before we even consider surgery."

However, not all patients are given the option to see a physiotherapist and receive exercise guidance. "Exercise is really the key" Professor Crossley says.

The challenge though is making people aware of the benefits of exercise therapy and getting them to do it.

This short clip summarises the key treatments Professor Crossley believes are needed to treat knee cap pain:

If you think others might find this page useful, please share using the social media links below.

Online help to manage your knee cap pain doesn't end here. Lets us know what you like about this page, or what else we could include in the comment box below.

Feel free to also ask any questions.

Why not join our NEW La Trobe knee pain Facebook group so you can stay up to date with the latest research and talk on-line with others who have knee pain.

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5 tips to help treat your knee cap pain - La Trobe Sport and Exercise Medicine Research Centre

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Knee cap pain is the most common form of knee pain. Pain can be hard to pin point but may be around, behind, or under the knee cap. It affects both males and females of all activity levels and ages.

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Seatbelts are great tools for mobilising

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Seatbelts are great tools for mobilising

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Seatbelts are very handy tools for passive mobilising, especially for accessory movements:
- Phillip

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Uploaded by Phillip Hughes PDB on 2017-08-23.

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Differentiating fat pad impingement and patellofemoral pain

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Differentiating fat pad impingement and patellofemoral pain

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I found this interesting little movie highlighting the differences between these conditions.
The only issue I might have is that I have found that there can be some swelling with PF dysfunction.
- Phillip

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Infographic:Differentiating fat pad and pfj pain

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Differentiating fat pad and pfj pain can be tricky. Here are a few top tips to help.. For more on fat pads visit www.clairepatella.com

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I tend to use a set sequence for special tests of the knee, during the objective examination. That way, I will not forget any tests. I mentioned this to students in the practical class and they wanted me to list the sequence. I thought it would work better if I presented it in a movie.
- Phillip

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Uploaded by Phillip Hughes PDB on 2017-08-22.

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You heard about this in the lecture this morning. The facial compartment is tight and restricts the enlargement of the muscle as it starts working, leading to strong pain.
The fellow who dislocated his knee (in the previous post here) also suffered a post-op complication of compartment syndrome. They had to operate again to split the fascia to allow release of pressure on the calf.
Below is a movie from my clinic, showing the calf action, with ankle PF/DF, directly through the release.
Thought you might find this interesting.
- Phillip

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Uploaded by Phillip Hughes PDB on 2017-08-21.

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To warm us up for next week, this is what a posterior dislocation of the knee looks like. This was a patient of mine (permission to share was granted) who landed awkwardly on a trampoline, WHILE riding his BMX bike.
- Phillip

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Hey Guys :) I really liked this video detailing the most recent test for ACL damage. Including the possible bias that may have occurred in the published outlining the test (which had an incredible 100% specificity and 100% sensitivity)

The articles are attached below if you want to have a read!

Graeme
http://www.ncbi.nlm.nih.gov/pubmed/26753117
http://www.ncbi.nlm.nih.gov/pubmed/25536951

Great job Graeme!!
Interesting that the first article, by Devici et al actually gave the lever test a higher accuracy than Lachman's.
Also, I find the fist isn't a big enough lever. It works better if you place your forearm under the leg, with the hand grasping the unaffected leg. Try it for yourself and see what you think.
- Phillip

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The Lever Sign or Lelli's Test | Anterior Cruciate Ligament Rupture

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The Lever Sign or Lelli's Test is a novel test in the assessment of Anterior Cruciate Ligament Rupture. This video shows the test and explains its biomechanics. Articles: http://www.ncbi.nlm.nih.gov/pubmed/25536951 http://www.ncbi.nlm.nih.gov/pubmed/26753117 Visit our Website: http://bit.ly/29xmSzV Like us on Facebook: http://bit.ly/29GyogP Follow on Instagram: http://bit.ly/29HN0Lp

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Here is the originator of the Lever test, showing the test's effect on an ACL deficient knee. 

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Here is the originator of the Lever test, showing the test's effect on an ACL deficient knee. 

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At the end of the clip, you can see the change in test result, from pre-op to post-op.
- Phillip

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UN TEST FUNZIONALE PER VALUTARE L' INTEGRITA' DEL LEGAMENTO CROCIATO ANTERIORE

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This is a relatively new test for ACL rupture, old or new.
A very interesting development.
The article can be read in the Week 5 reading list.
- Phillip

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Here is a photo of a lateral ankle sprain. On the left is a photo of my foot normally for comparison.
- Lauren

Wow, thanks for sharing Lauren.
How long before you could start weight bearing on it and how long before your return to sport? Did icing help settle the swelling? Now that you have covered ankles, have any principles resonated with you in the light of suffering a severe sprain in the past?
- Phillip

I was unable to weight bear for a few days, after that was hobbling around for a week before I could walk normally and pain free. I returned to sport sooner  than I should have which was after two weeks. When I had started at footy again I was still rolling my ankle repeatedly throughout the day on uneven surfaces, so clearly had a lack of proprioception, but was wearing a pretty heavy  duty ankle brace for footy so couldn't move my foot. After each time I exercised the next morning it really hurt to walk until I got to the end of the hallway and it would swell up again regularly.
Icing helped initially to keep the swelling down however once I started weight bearing my foot just blew up like in the photo (and even worse to the point of having pitting oedema). Would that be to do with the extra blood flow that my foot would have been receiving once walking on it? and the same with after exercising?
What resonated the most with me in class was the rehabilitation steps that should be taken prior to returning to sport. Rather than having the "she'll be right" attitude that I had which I think really slowed down my recovery.

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A staff member at Bundoora, Alice Hill, has a paediatric physiotherapy blog. It's really interesting. 

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A staff member at Bundoora, Alice Hill, has a paediatric physiotherapy blog. It's really interesting. 

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There are may aspects of PDB directly relevant to paediatric practice. I thought you might like to check out this blog.
- Phillip

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Little Movers Physiotherapy | Physio for babies & children in Newport

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Little Movers Physiotherapy | Physio for babies & children in Newport

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Physiotherapy for babies and children in Newport, Melbourne's inner west.

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Differentiating Hoffa's fat pad below the knee with the infrapatellar bursa

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Differentiating Hoffa's fat pad below the knee with the infrapatellar bursa

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From the prac classes, I had two questions concerning the difference between the fat pad and the infrapatellar bursa.
I thought this cross section diagramme would highlight the difference.
Generally, tenderness located more superiorly might be the fat pad and lower down, the bursa.
A gentle contraction of the quads will harden the patella tendon to stress shield both the fat pad and the bursa, so a reduction in tenderness during the contraction implicates either of these two structures.
An inferiorly tilted patella can result in fat pad impingement.
- Phillip

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Understanding your strengths and weaknesses, as well as effective communication skills.

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Understanding your strengths and weaknesses, as well as effective communication skills.

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These are key attributes for quality practice and are emphasised in this APA InMotion article (August 2017). It's a good read with realistic scenarios.
- Phillip

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This article is hot off the press, in the August edition of the APA's InMotion magazine. You might notice that in the SOAP notes, they use "A" for Assessment, while we use it for Action. The article reinforces some of the points that have been made to you earlier.
- Phillip

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Saw this Blog by physiotherapist, Alicia Rayner, on the anatomy of the syndesmosis and some clinical implications. Thought you might enjoy it.
- Phillip

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Would you like free access to the Journal of Physiotherapy on your phone or tablet?

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Would you like free access to the Journal of Physiotherapy on your phone or tablet?

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Go to the App Store (Apple) or Google Play (Android) and search for the JOP app. Download it and you can see the latest issues for free, as well as the most popular articles.
- Phillip

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A little bit late to the party, but nonetheless thought it would be useful to share my experience with my fieldwork placement. I had my fieldwork experience at Box Hill, and was paired up with 3rd year student Jesse Wilson. I basically followed him around for the day to get a general idea of what he did on placements, and to see what the supervisors and staff expected of him, as well the sorts of patients that he saw. From what I understand, I think we were on the general medicine ward. Much of what we studied in terms of gait aid prescription and the principles underpinning subjective assessment were very relevant. I was pleasantly surprised to see the amount of detail that we as students need to have an eye for, and the amount of emphasis that staff placed on holistic health. One patient had a fractured rib, while another had cognitive issues, all issues that came from very different areas. It's exciting to see how my buddy was able to clinically reason with his patients and with staff, as well as making referrals based on what areas he thought physiotherapy could not help with. I'd definitely say that this experience has reaffirmed my desire to work in a hospital/clinical setting in the future, purely based on the wide range of patient presentations I saw on the day.

- Song. :)

Never too late Song.
Thanks for a great reflection.
I'm really pleased that all the people I've spoken to have got a lot out of the fieldwork experiences.
- Phillip

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Wow, Nancy, Siobhan and Thania, they were great stories from your fieldwork. Thanks, so much, for sharing them with us. I'm glad they were really meaningful experiences.
- Phillip

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I attended my fieldwork on Thursday at the Angliss Hospital. I was with a 3rd year student called Pamela, who was doing her placement with neuro patients on ward 1 North.
We started by attending the ward handover, where representatives from all disciplines met to discuss any changes with patients from overnight.
We then attended the physiotherapy handover, where they discussed their plans for the day with each patient on the ward.
Throughout the day we saw 4 different patients, all with varying conditions. There was a woman with severe MS, a man who had recently had an L4/L5 laminectomy and had spinal cord compression, a man with subdural haematoma and a man who had recently had a cerebellar stroke. Each patient had a different aim for therapy, but most included getting them walking properly with good posture and increasing their strength and motor control.
It was a really cool day, but also quite challenging when patients are unwilling to do their exercises and are getting frustrated with their condition. However it was also very rewarding to see the small changes in patients after only an hour of treatment.
Siobhan :)

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On the 10th of August, i had my one-day placement in Box Hill. I was assigned to a buddy named Isobel, who was doing her 3rd year placement in the Orthopedics ward. The ward was very similar to the scenarios we learnt in class. Isobel prescribed gait aids, and also tried to get patients sitting, standing and walking post-surgery, which was very similar to what we learnt in the beginning of the semester.
The 2nd place we went to was the Out-patient facility in the hospital, which dealt with rehabilitation for patients who were no longer admitted in the hospital. It was a lot harder, as every person we dealt with had very different issues and hence had to use different methods in order to help with rehab.
In all, the 1 day placement really opened my eyes as to how a hospital functions and it also made me realise that there was alot more collaborative work with other health professionals than i initially thought. It was quite an awesome experience and has made me appreciate the physiotherapy profression even more.
Thania,

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I attended fieldwork exprience yesterday. It was an amazing experience. I was placed in the neuro ward in which i observed a third year physio student and the physiotherapist treated stroke patient. For the first patient, I saw a third year physio student help him got out of the bed and sat down on the chair using the the transfering technique we already covered in class, then she assessed the strength of his arm and his leg using the OXford scale that we covered last semester. As he had sufficient strength, we walk with him along a corridor then back to him room.i felt very happy to have a chance to walk next to and talked to him. The second patient i met was highly conscious and had sufficent strength to walk so we just walked with her along the corridor .With the third patient i met, i had a chance to speak to him and realized that he didn't not quite understand what i said so i had to use gesture and shorten my sentences. The last patient i met was the stroke lady with inferior shoulder dislocation, paralysis in her left side so she can not sit balance , leaning to her right side and we had had to support her while she sitting. The exercises she had to do were reaching exericse which she had to reach and grasp the cup in different direction, postural correction exercise which she were asked to shift her pelvic to the right and the left and turn her body to the right and the left while sitting. We havent learnt about those exercise so it is very helful to know about it. Another interesting thing  i forgot to mention is that the way she was transfered from lying to sit on the bed is different from what we covered in class. One person have to help her swing her leg over the edge of the bed, the other person have to kneel on the bed to support the trunk ,then slowly bring her up onto sitting.I think it is a very safe transferring techinque and i will apply it in the furture.

Nancy

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Here is information to help you prepare for the debate next week.  This explains how a debate works.  Reference: http://www.debatingsa.com.au/wp-content/uploads/2017/07/Debating-An-Introduction-For-Beginners.pdf
- Carolyn

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Is there anyone who attended fieldwork yesterday, who would like to share their experiences with us? What was interesting or surprising? Did any of it correlate with what we have covered so far? What did you like?
- Phillip

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The library has a great resource to help you with your reflective assignment:
http://latrobe.libguides.com/reflectivepractice
- Carolyn

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- Phillip

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Sim Pat experience and re: Informed consent

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Sim Pat experience and re: Informed consent

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Thank you Phil and Sky for your thoughtful responses to my question. It is good to hear that patients are accustomed to hearing risks associated with therapies we give them. I guess at the end of the day, a patient respects a health professional they can trust is honest and as inexperienced professionals, knowing the research will make us confident early professionals.
On the sim pat experience: I thought yesterday's workshop was really invaluable. From my clinical placements previously, the types of patients we had were very typical of the characters you meet in hospital and it was challenging having to find a way to "diffuse" the patient's panicked behaviours. It also challenged my idea of informed consent further. With Ralph, when I tried to gain consent by informing him we would ask him questions about his medical history and personal background and if that is okay with him, he responded defensively and said no. I was taken aback and wasn't sure how to go on with the assessment without consent. I learnt by observing fellow group member Roslyn's behaviour, that establishing rapport is essential before asking personal questions for some patients. Her small talk and acknowledgement of his situation was mature and professional, and she continued to build similar rapport with the next 2 different clients we had which I was impressed by (Well done Ros! :D) Guess I learnt to never underestimate the importance of small talk! :) Consent could have been properly obtained with Ralph later, once he started to open up. Anyone else had a similar experience with a patient?
-Tisara!! :D

Thank you, so much for sharing Tisara.
- Phillip

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“What is it?” Harry asked shakily.

“This? It is called a Pensieve”, said Dumbledore. “I sometimes find, and I am sure you know the feeling, that I simply have too many thoughts and memories crammed into my mind… At these times” said Dumbledore, indicating the stone basin, “I use the Penseive. One simply siphons the excess thoughts from one’ s mind, pours them into a basin, and examines them at one’s leisure. It becomes easier to spot patterns and links, you understand, when they are in this form” (Rowling, 2000).
- Phillip

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Hiep (independently) came up with a similar form, as an aid for day 1 of the simulation practicals. Great job. Has any one else created anything similar?
- Phillip

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Debbie Stuart came up with a great musculoskeletal subjective assessment form. Well done.
- Phillip

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While you all looked comfortable, there were still challenging times, for instance when the patient declares she has had enough and rolls onto her side, to face away from you. However, it's important you reflect on how it went, what you felt and what you might do differently next time.
- Phillip

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I was really impressed today with the standard of interviewing that took place. You all seemed to feel much more comfortable with the process (compared to PDA) and seemed to have firm ideas where you were heading.
- Phillip

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Interesting article, Phillip. Are there opportunities later on in the degree for rural/remote placements (or developing countries) for students at both campuses? A friend of mine who studied OT at LaTrobe went to NT for her final placements.
- Sky

Yes, Sky, there may be opportunities for rural and overseas electives in 4th year.
- Phillip

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Hi (not sure who this was?),
Good post.

I agree the issues raised in Monday's lecture highlight some interesting questions about informed consent and how we would practically execute this to cover all bases. However, I largely think these become ethical questions. Here is my two-bob's worth (yes Phillip, we know what this means!).

I think the use of the word 'convince' when talking about treatment options is a little problematic. As professionals, our job is to recommend a certain treatment path based on best practice. However, I'm reminded that best practice also includes patient preferences. Can we really say we've accurately represented patient preferences if we haven't provided them with the full picture? Explaining risks and benefits is part of giving the individual all the necessary information so they can make an informed decision. I agree it may seem like overkill to go through all the risks and benefits but personally, I would want to know all these things when making a decision about my own health.

I hear your concern that as students/new grads this may make us seem more inadequate. All I can say is, don't underestimate how valuable it is to be communicated to as an equal,  by a health professional! I've often walked out of medical appointments with unanswered questions, feeling frustrated and patronised.

I like your idea that having success rates of different treatments is a good tool to help communicate potential outcomes to patients, to assist them weigh up risks/benefits.
- Sky

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When moving a patient up or down the bed have both people pull slide sheet diagonally in the direction of movement ( as in a V), making an easy job even easier!!!
- Ros

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Technology could make our lives a lot easier!

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Technology could make our lives a lot easier!

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If only this was available to us though..

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I'm really pleased with the contributions on Padlet, that have come from the students.
Tisara asked a really insightful question about informed consent. I don't think I could have answered it better than Sky did. Patients appreciate and respect a health professional who lays all the cards out on the table, be they (the health professional) young or old. They often feel that this person has a sound knowledge and recognises the importance of keeping the patients informed and places a premium on seeking their opinion. Remember, when you go in for a routine operation, the surgeon will lay out all the potential consequences that could occur, including death. That is what the modern patient has come to expect.

The iWaker2.0 is an effective way to get around and still be able to use your hands for carrying....if you are young (strong and fit) and have good balance. They are also fairly costly.

Ros, thankyou for finding a great systematic review on sensory testing. There are some great notes in there about how the accuracy of the Nottingham is improved by revisions to the procedure.

Ros' tip for pulling slide sheets diagonally, so pulling up the bed and out to the side, rather than purely up the bed, really does work. Ros found this to be the case when she was working in aged care.
- Phillip

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Hi guys, I found the consent process highlighted in this morning's lecture interesting. I wonder how we can highlight risks and benefits for each treatment without causing too much fear and whether patients are deterred by the risks? Is it useful to know success rates of different treatment modalities to convince our clients to commit to treatment and will this be something covered in our learning in the semester?  I can imagine that as student or a new physio, patients will likely have more doubts about starting treatment with us than with an experienced professional, and mentioning risks may create more doubt in their minds. Anyone else got thoughts on
this?

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http://www.bmj.com/content/355/bmj.i5652
Originally believed to accelerate the healing of fractures, a new paper by the BMJ has called for the complete abandonment of low-intensity pulsed ultrasound for use on fractures.
- Callum

Good job finding that, Callum.
Maria Parapouras has followed up with the following Cochrane review on pulsed US for fracture healing:

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Cochrane review of pulsed US for fracture healing

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Measures of sensation in neurological conditions : A systematic review

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Measures of sensation in neurological conditions : A systematic review

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This article includes the NSA
http://clok.uclan.ac.uk/6794/1/6794_Connell.pdf
-Ros

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Your physiotherapy patient notes need to be kept secure

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Your physiotherapy patient notes need to be kept secure

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- Phillip

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Bronte, thank you. I can't look at that movie without smiling at the end.

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Bronte, thank you. I can't look at that movie without smiling at the end.

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And, it is so true. We need to assess wrist movement and strength. They often need wrist extension to effectively push through a handle.

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Phillip you forgot the assessment of the wrists....

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I know this is what you meant, Nancy, but a mobility scooter is one of those motorised, 4-wheel devices that people get around on. The knee walker is an alternative to crutches. They're good if you need to cover a lot of ground and people can scoot along quite quickly. You need good strength and balance. They're no good for stairs, obviously.
You can see them here:
https://www.youtube.com/watch?v=bdtbfZ1KSzI

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We didn't talk about this gait aid during prac classes. What is it? How it is used

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We didn't talk about this gait aid during prac classes. What is it? How it is used

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Hi Phillip,

If i am not wrong, i think that gait aid is the mobility scooter. I think it is suitable for patient with weakness in legs and arms, poor coordination and balance

Nancy

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Ascending and descending stairs using the handrail.

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Ascending and descending stairs using the handrail.

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Hi Nancy, you are quire right. By holding the handrail as well as using a crutch you do add a degree of stability to the manoeuvres of ascending and descending.
The only downside (no pun intended), is that you will need somebody else to carry the unused crutch for you!
- Rod

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We didn't talk about this gait aid during prac classes. What is it? How is it used?

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We didn't talk about this gait aid during prac classes. What is it? How is it used?