Week 3.4 Entry

Today we learnt just how long some people can be waiting for a physiotherapy appointment within the public hospital system. Our first patient of the day was suffering from anterior knee pain according to the referral for the last 2/52….this was in May. Therefore by the time he was passed onto us he was now at 24/52 and unsurprisingly did not turn up. This made me aware that by the time some patients see us they can be quite frustrated at how long it has taken and possibly also in a worse state than when the referring doctor saw them, therefore it is wise to take this into consideration when assessing a patient.

One of our patients today was returning following a conservatively managed partially ruptured Achilles tendon and a HEP we had prescribed to her. The last time we saw her she had only just had her plaster removed and we were a bit cautious with our treatment and exercises we gave her since she had not seen her doctor as yet and did not want to cause her any additional harm or damage. Our aim this time was to progress her exercises to eccentric movements and begin the realignment of the collagen fibres to make the tendon structurally stronger. This would need to be a balancing act between too much and too little progression. We made the patient aware that despite her not feeling too much pain there was still the chance that damage could be done and she’d be put back a few places in terms of recovery. She appeared to understand the situation.

We searched the depths of our knowledge from PHTY111 days and applied Deep Transverse Frictions to realign the fibres and effleurage to redistribute the swelling. The treatments appeared to be effective and the patient commented that the foot felt better. This treatment regime would be used again next time. Her HEP was progressed to involve some PWB exercises but we emphasized that she should not push it into pain and just a slight stretch should be felt.

Overall the patient appeared very pleased with her progress which showed to us that we had selected the correct treatment program and our clinical reasoning in terms of the speed of progressions was justified. We questioned her about more than the current Achilles problem and looked at her lifestyle and how she is modifying it to benefit her overall health & well being. She suffers from COPD and still smokes so we ensured that she was endeavouring to quit but obviously for a life long smoker this is going to be a long and hard road. She had modified her medication to decrease her reliance on them and begin a more “natural form of recovery”.

I look forward to seeing this patient again next week and discharging her with a continuing HEP to maintain her current recovery progress.