Weeks 14 & 15

Jessica, like most people, has a slightly forward head posture.

Since we didn't have a third person to take pictures, we set the camera on a timer and the angle that I am standing at is obviously not an appropriate observation angle.

Again, since we were lacking that third person we were trying to get good images and tried marking the spine of the scapula and the inferior angle of the scapula. Jessica's right scapula has a slight anterior rotation.

I put post-it notes on Jessica's PSIS and ASIS and then covered them in the picture with my little red dots. This image shows a slight anterior rotation. 

Week 13: leg & foot 2

My goals:
1. Learn the tarsals
2. Know the points so well that I don't crack under the pressure of being evaluated.
3. Learn other people's tricks for finding landmarks.

Week 12

Leg & Foot I


Base & Apex = Base & Apex of Patella
Red PT = Patellar Tendon
TT= Tibial Tuberosity

LCL = Lateral Collateral Ligament
JL= Joint line
LM = Lateral Meniscus
FH = Fibular Head

MM = Medial Meniscus
JL = joint line
PA = Pes Anserinus
MCL = Medial Collateral Ligament

Red AT = Achilles Tendon

Blue solid line = Grastrocnemius
Blue dotted line = Soleus (deep to gastrocnemius)

Another image of Gastrocnemius, Soleus and the Achilles Tendon

PF = Popliteal fossa
PP = Popliteal Pulse

Patient Case

Paul is a 65 year old golfer. He is fit and has always been an

active individual. Recently he stepped out of his golf cart and missed the path a bit. He got a pain in his right knee. He now is getting the pain during his tee-shots (his most powerful swing) and also notices it when he moves around in his small kitchen (pivots and twists a lot). He puts his hand over the front of his knee when he describes the pain to you. What structures of his knee should be included in your palpation assessment? Why would you include them?

I would palpate his MCL, LCL, Joint line, Lateral and Medial Meniscus. I would include all of these structures in my palpation because I would want to see how involved his knee pain was, but the hand over the front of the knee to describe the pain, and the twisting motion that is causing the pain both suggest a meniscal tear. I would then would do all of the tests (that we will learn soon!) to see if he tests positive for a meniscal tear!

It is so hard for me to think and speak while making these videos! I need to rehearse multiple times before I do them in order not to say the wrong thing at least once. It's so frustrating and surprising to me, because I feel like explain what I am feeling to people everyday, so it should just come naturally- but put me in front of a camera or in front of a teacher in my clinical exam, and my mind goes blank on easy things I should know every time. This is just not ok. All I can do is keep doing it I guess.

Lisa Chase is a Physical Therapist that I met while interviewing for Director of Massage Therapy for the Sony Ericsson WTA Tour. At the time, she was the Primary Health Care Provider for the Tour, and has recently (in the last few years) morphed into full time private practice. I have come to greatly respect her work and her philosophies, and am just generally fascinated by her. So, naturally, I was lurking the photo gallery on her website and came across some pictures of her working with clients that displayed her hand placement around the areas we have been told to palpate this week and thought I would share them!

Images of Lisa Chase, PT

I believe in the adage, a picture is worth a thousand words, but just to make sure my message comes across let me clarify...

This I believe:

If you communicate with your clients/patients why you are having them do what they are doing, you explain the physiology behind it, and you approach them with the pure intention of helping them achieve pain free function, your hand placement will not be misconstrued. Hand placement on the structures you want them to focus on is important for sensory integration. They need to feel what you want them to contract and when, and they need to be reminded of that muscular engagement during their execution of each exercise they are learning so that they can learn it correctly. This is efficiently communicated and demonstrated through touch. When your clients trust that you have their body's best interest in mind, they won't even question what you are doing for a second. You just have to approach them with respect, communicate what you are doing like you are their teacher, and maintain a pure intention to help them achieve their goals. It is with this focus on communication, education, and intention that we display professionalism in the clinical environment.

Goals for Institution

1.  I would still like to know my vertebral levels- memorize the identifying landmarks 

and be able to palpate correctly on multiple people.

C7- big one

T3-Medial end of the spine of scapula

T7- Inferior angle of scapula

T12- find 12th rib and follow to attachment site

L4- Same level as iliac crest

2. I would like to practice palpating the transverse processes at each level (knowing which ones they are) and be able to tell which way they are rotated. I know we haven't gone over this yet, but that's what I want. :)

3. I would like to go over the endangerment sites in the anterior cervical region before we palpate each other's necks.

Week 9: Lumbar spine, Sacrum, Coccyx, and Abdomen

(This is me drawing on my own back for lack of a willing participant in my home this week.)

L1- Signifies the spinous process of L1 found by palpating the attachment sites of the 12th ribs at T12 and moving inferiorly 1 vertebrae. 

L2- Spinous process of L2

L3- Spinous process of L3

L4- Spinous process of L4, found by locating the lateral aspects of both iliac crests and sliding fingers across toward the spine (medially)

L5- spinous process of L5, just below L4 and above the sacrum

SB- Sacral base

My finger- Sacral apex

PSIS- Posterior Superior Iliac Spine, found by following the iliac crest all the way to the sacrum and feeling for the little lumps just before you get there

SIJ- Sacroiliac Joint, felt for seam between sacrum and ilium (They aren't really as straight and vertical as I drew them but that was as good as it got in the mirror, all twisted around like I was.) 

I found this website as I was perusing the internet and I think it has a really easy to understand explanation of the interaction of the sacrum with the innominates if you would like to check it out!

http://thelowback.com/how.htm 

LG- Lamina groove

Unlabeled .'s- Transverse processes- unable to feel whilst standing and twisting and contracting my back muscles to label, so they are labeled on the knowledge of where they lie.

Not Shown In The Marker Chart:

Sciatic Notch

Sciatic Notch- The greater sciatic notch and the lesser sciatic notch are noted in the image above. 

(Sorry, I was not willing to bear this much skin in the photo!)

Iliolumbar ligament- runs from the transverse process of L5 to the inner lip of the iliac crest

It is a difficult diagnoses, but it is believed that I sprained this once while idiotically attempting to jump my snowboard through the terrain parks of Breckenridge like I was Shaun White.

He I am not. I ended up on my rear end, unable able to walk correctly for a over a month. The interesting learning portion of this injury was the postural deviation that I assumed in order to walk (laterally rotating my left leg- so my foot was pointed out to the side- so I could get myself through the acute stage of the pain with the help of the stability from my external rotators.) After the pain had mostly subsided, I had to train myself to break that pattern by consciously focusing on discontinuing that deviation and forcing myself to walk with both feet pointed forward again. At least I learn a lot from my injuries!