Tuesday, 9 March 2010
Wednesday, 24 February 2010
Technique - Knee and Ankle
13/11/09 - Kiera Kinch Tutorial - Knee Examination
It wasn't until Keira Kinch gave us a tutorial that I really appreciated how observation is the first key step to assessment. When a fellow student was asked to perform a knee examination to the rest of the tutorial group. She did as I would ... stand the patient up and look at their knees etc and then get them straight onto the table to perform a passive examination.
When the tutor repeated the examination she look at the patient in greater detail and got the patient to do active movements. She asked the patient to engage their quads whilst standing to see how the patella tracks and she asked the patient to do squats to see how the different muscle groups engaged.
24/02/10 - Knee examinations were okay, could not explain which bursae were for which conditions need to revise those.
It wasn't until Keira Kinch gave us a tutorial that I really appreciated how observation is the first key step to assessment. When a fellow student was asked to perform a knee examination to the rest of the tutorial group. She did as I would ... stand the patient up and look at their knees etc and then get them straight onto the table to perform a passive examination.
When the tutor repeated the examination she look at the patient in greater detail and got the patient to do active movements. She asked the patient to engage their quads whilst standing to see how the patella tracks and she asked the patient to do squats to see how the different muscle groups engaged.
24/02/10 - Knee examinations were okay, could not explain which bursae were for which conditions need to revise those.
Wednesday, 17 February 2010
Technique - Hip
17/02/10 - Good examination, think of more ways to ttt than supine.
15/04/10 - Treated my first OA Hip patient today in the Royal Free Hospital. His presentation was exactly as it says in the text books. I really struggled to treat him has his limb was so heavy ... I understand now why it is so important to make techniques effective and easy to perform else there is no way the osteopath will have longevity in the profession.
15/04/10 - Treated my first OA Hip patient today in the Royal Free Hospital. His presentation was exactly as it says in the text books. I really struggled to treat him has his limb was so heavy ... I understand now why it is so important to make techniques effective and easy to perform else there is no way the osteopath will have longevity in the profession.
Saturday, 13 February 2010
Wednesday, 10 February 2010
Technique - OA Joints
25/11/09 - During a technique tutorial in clinic today I was shown another approach to manipulating the OA. The technique is basically the same as we are shown in technique class but with full rotation, then you take off half, then you put on full side-bending, test your levers, add on side bending and shift if required and then thrusts. Ive tried it a few time now when practising, but Im not sure its C1-2 that's cavitating.
10/02/10 - After practising technique with Nandeep it was apparent that occasionally we loose the rotation when side bending is put on.
11/04/10 - Today I had a patient that I needed to thrust their OA joint. I don't know why but the thought of doing this panicked me as I haven't had the opportunity to practise my thrust as the students that I practice technique with don't want to practice OA thrusts hence I didn't feel confident. The tutor thrust the patients OA for me. He used a different technique which was a combination of a cradle and a chin hold. The technique worked for him. It heiglightened to me how techniques can be adapted to suit the individual practitioner as long as good anatomical knowledge and a clear idea of what your trying to achieve is used.
10/02/10 - After practising technique with Nandeep it was apparent that occasionally we loose the rotation when side bending is put on.
11/04/10 - Today I had a patient that I needed to thrust their OA joint. I don't know why but the thought of doing this panicked me as I haven't had the opportunity to practise my thrust as the students that I practice technique with don't want to practice OA thrusts hence I didn't feel confident. The tutor thrust the patients OA for me. He used a different technique which was a combination of a cradle and a chin hold. The technique worked for him. It heiglightened to me how techniques can be adapted to suit the individual practitioner as long as good anatomical knowledge and a clear idea of what your trying to achieve is used.
Friday, 5 February 2010
CPR Training
Well as an ITU Nurse with a certificate in Advanced Life Support (ALS) this is something I would have done well in if it was examined.
Tuesday, 5 January 2010
ADVANCED SPINAL MANIPULATION
05/01/10 - Had our first ASM lecture today. I'm really excited about this module as having seen tutors who are able to use this technique in clinic look so professional and slick, they make it look effortless and the patients say that it is so comfortable to have it done to them.
12/01/10 - Okay so this week we revisited the principles of ASM. I'm still struggling with doing HVT with long levers that I don't think I'm at the stage where I can learn minimal leverage yet.
19/01/10 - Today we discussed junctional areas and looked at mobilising the T/L and L/S. Now normally I can manage to cavitate a T/L as the rotational element of the joint means it is an easy joint to cavitate with rotation, but with ASM I just cant feel the tension in the joint.
What has been good about today is the discussion of the L/S and that its plane of movement can vary quite considerably hence why is a standardised approach to winding up the L/S then it may not be possible to cavitate it, but the direction of the plane needs to be tested before hand.
26/01/10 - Today we looked at side bending as the primary lever to HVT. It would be extremely advantageous to be able to mobilise the LSpine or CSpine with side bending. I can think of numerous occasions where if I was proficient at side bending thrusts it would have been more comfortable for the patient. I can also think of alot of patients whereby side bending as the primary lever in the LSpine would have been beneficial when there has been the possibility of discal involvement hence why rotation isn't suitable hence Ive opted not to mobilise the LSpine.
09/02/10 - Sitting CSpine thrusts are something that I like and something that I find relatively easy to perform, however I'm still struggling to apply minimal leverage. One really important thing that Daryl mentioned to us today is that he thinks we possible are so used to feeling the tight tension of a locked joint pre thrust that we are missing the tension of a wound up joint, I think he is right here but I just feel that I don't have enough experience to establish if the joint is wound up. I guess the only way it to attempt the trust, but that goes against everything we have been taught about not delivering the impulse unless we feel the joint is wound up.
He also demonstrated how to perform sitting LSpine thrust as side bending .... he's very good !!!
My struggle with the CT junction continues but today we were shown a seated CT thrust. As always Daryl made it look so easy, but its not. The beauty of the technique is that apart from having your head held and vision slightly obscured it was a really comfortable position to be in during the thrust. This one definitely needs some practice so I can utilise it on my patients.
23/02/10 - Rib thrusts are interesting thrusts. But as I'm struggling with my Dog technique I'm also struggling with my rib thursts. If I'm honest I don't feel today's session added anything to my rib thrust technique ... perhaps I'm just feeling rather despondent at the moment.
09/03 - Having the same old issue here with the SI thrusts as I'm having with all the other thrusts, i.e. if I cant feel the wind up with long levers how am I supposed to feel it with minimal short levers. Daryl's SI thrust is interesting as he delivers the impulse to the SI closest to the table opposed to the SI closest to the operator. I'm not sure what to think about this technique. I know Daryl is expectational at HVT's so I can see how it would work for him but I really struggled to establish where my force was being applied into the patients pelvis so I really could not say if I was feeling tension in the correct SI !!!
12/01/10 - Okay so this week we revisited the principles of ASM. I'm still struggling with doing HVT with long levers that I don't think I'm at the stage where I can learn minimal leverage yet.
19/01/10 - Today we discussed junctional areas and looked at mobilising the T/L and L/S. Now normally I can manage to cavitate a T/L as the rotational element of the joint means it is an easy joint to cavitate with rotation, but with ASM I just cant feel the tension in the joint.
What has been good about today is the discussion of the L/S and that its plane of movement can vary quite considerably hence why is a standardised approach to winding up the L/S then it may not be possible to cavitate it, but the direction of the plane needs to be tested before hand.
26/01/10 - Today we looked at side bending as the primary lever to HVT. It would be extremely advantageous to be able to mobilise the LSpine or CSpine with side bending. I can think of numerous occasions where if I was proficient at side bending thrusts it would have been more comfortable for the patient. I can also think of alot of patients whereby side bending as the primary lever in the LSpine would have been beneficial when there has been the possibility of discal involvement hence why rotation isn't suitable hence Ive opted not to mobilise the LSpine.
09/02/10 - Sitting CSpine thrusts are something that I like and something that I find relatively easy to perform, however I'm still struggling to apply minimal leverage. One really important thing that Daryl mentioned to us today is that he thinks we possible are so used to feeling the tight tension of a locked joint pre thrust that we are missing the tension of a wound up joint, I think he is right here but I just feel that I don't have enough experience to establish if the joint is wound up. I guess the only way it to attempt the trust, but that goes against everything we have been taught about not delivering the impulse unless we feel the joint is wound up.
He also demonstrated how to perform sitting LSpine thrust as side bending .... he's very good !!!
My struggle with the CT junction continues but today we were shown a seated CT thrust. As always Daryl made it look so easy, but its not. The beauty of the technique is that apart from having your head held and vision slightly obscured it was a really comfortable position to be in during the thrust. This one definitely needs some practice so I can utilise it on my patients.
23/02/10 - Rib thrusts are interesting thrusts. But as I'm struggling with my Dog technique I'm also struggling with my rib thursts. If I'm honest I don't feel today's session added anything to my rib thrust technique ... perhaps I'm just feeling rather despondent at the moment.
09/03 - Having the same old issue here with the SI thrusts as I'm having with all the other thrusts, i.e. if I cant feel the wind up with long levers how am I supposed to feel it with minimal short levers. Daryl's SI thrust is interesting as he delivers the impulse to the SI closest to the table opposed to the SI closest to the operator. I'm not sure what to think about this technique. I know Daryl is expectational at HVT's so I can see how it would work for him but I really struggled to establish where my force was being applied into the patients pelvis so I really could not say if I was feeling tension in the correct SI !!!
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