[lacarroll]

I went in to this weekend expecting some in depth knowledge bombs on the mechanisms of pain, but I completely underestimated the scope of the bottom side of the iceberg. I think persistent pain is a topic that we talked about in classes, but we never really delved much deeper than the general “don’t tell them it’s in their head” and “don’t use the word pain” for their symptoms, so this course really helped open my eyes to some of the other factors that play into this cycle of persistent pain.

Biggest take home nuggets for me:
– “healing is unstoppable” attitude  creates shift in the patient’s perspective/understanding and gets them curious about what else might be going on
– Belief in what we are doing  whether the evidence supports us or not, our belief in our treatment selection plays a huge role in the patient outcome with this patient population
– Pain is kind of like an onion  lots of layers and pieces and parts and neurotags that come together to make this stinky thing that can be difficult to work with
Clinically, I think these concepts aren’t just going to pop up for me overnight. I don’t really have the “spiel” thing going, so I really want to get better at recognizing the patients that might be ready to have this conversation about where they are and what’s really happening, and then just be aware that my words are so much more important than I thought. I think this weekend was a great way to build a framework for what pain science education should look like and sound like based on the science of what is happening at a much deeper level.

[lacarroll]

I’m in the same boat as Anna with not having much experience treating patients with tendinopathies, and I feel like both of these pieces have some good points. Isometrics may have some analgesic effects early on, but eventually progressive strengthening is going to have to be worked into the plan of care to get back to previous level of function. Like everyone else has said, I think it all just has to tie back to the patient and their level of irritability and being able to find a happy balance between isometrics and progressive loading. I like Anna’s line of thought about treating up/down the chain away from the impairment while the tissue is more irritable. It seems like that way we can still make headway with treating some deficits and not just attacking one thing head on. Anyone have any good nuggets to share on that?

[lacarroll]

Hey y’all, my name is Lauren Carroll and I am currently a VOMPTI resident at the UVA clinic in Charlottesville, VA. I just graduated back in August from the University of Texas Medical Branch in Galveston, Texas so this is my first “real” job. I love working with the athletic population, whether it’s the big time athlete or the weekend warriors, and just being able to help them get back to what they love. I’m really looking forward to improving my manual skills and my clinical reasoning with these courses, as well as learning from such knowledgeable PTs. Looking forward to meeting y’all this weekend!

[lacarroll]

I really like how this article highlighted the importance of the mindset of the patient in regard to the outcomes of treatment. I think it really hit home for me that our words, demeanor, body language, and environment in general contribute to our ability to achieve that patient “buy in” into our skillset and ability, which is a big piece of the rehab puzzle. The patient’s outlook on therapy/rehab strongly influences his or her outcomes, and if we can start to shape this as soon as they walk into the clinic in a positive way, it seems like we increase our chances of positive outcomes right off the bat. As a new clinician, I feel like this is something that we can bring to the table immediately, especially since we’re still developing our clinical reasoning skills and manual techniques. I really like what Steven said about shaping the patient’s experience, and I think that question is a great way to head into every encounter, just to keep yourself accountable to every individual patient and to keep the focus on them and achieving their goals.

[lacarroll]

This article really highlighted the importance of self-reflection in building clinical reasoning for me. I think that both these tools provide a great structure to frame our clinical decision making, but it also creates a more streamlined “path” for us to follow with more complex cases or unfamiliar diagnoses. It definitely makes it easier to create and then follow your train of thought, rather than jumping around and pulling from different thoughts and ideas that pop up during an evaluation. To me, these tools can help improve efficiency, and I feel like this is an area where I definitely want to improve with this residency. I think that having to actually take the time to write down thoughts and ideas will help me get better with identifying impairments and then being more specific with treatments to get better outcomes. I think this is probably the most intimidating part of the process to me, but it’s also the most exciting because I know this will be an area that I have a lot of room for growth in. I also really like how both of these tools take into consideration tissue irritability and psychosocial factors that can play a big role in the patient’s success, and it keeps the clinician aware of other factors that might be important in the presentation of symptoms.

To Barrett and Helen, I completely agree that the subjective portion is the most important part of the evaluation. I know sometimes it’s a struggle to keep some patients on track, but the information really does direct the rest of the evaluation. I always feel like the toughest part of the subjective part is knowing when to let a patient keep going and when to redirect them back because I don’t want to miss an important piece of the puzzle.

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