During this week’s prac I have been treating a patient who had transverse myelitis, which is a rare neuroimmunologic disorder affecting CNS. His main impairments were decreased postural control of his abdominals, back extensors, pelvic girdle muscles, decreased muscle activation of his LL hip extensors abductors knee extensors and overactivity of his hip adductor muscles.
My treatment with this patient involved improving the selectivity and control of these muscles. One of the exercises that I was doing with this patient was bridging in crook lying. When observing this patient doing bridging, he looked like he was able to lift his bottom off the plinth, although it wasn’t easy for him. I have also palpated his gluteal muscles and I did feel their activation, so I thought I was on the right track.
My supervisor came up to me and asked me if I noticed that this patient wasn’t doing this exercise properly and if I could identify that it was wrong and correct it as this encourages the wrong movement pattern. I have tried to observe him again and I noticed that he was using his UL quite strongly to push himself up, but what I didn’t notice was that he was also using his back extensors and hip adductors to compensate for the decreased activation of TA, pelvic floor and hip extensor muscle.
In addition she showed me a better handling skill in order to achieve the desired outcome of activating TA, pelvic floor and hip extensor muscles. She broke down bridging in three components, first the activation of TA with posterior tilt, secondly the activation of pelvic floor muscles and thirdly the activation of hip extensor muscles without compensation from back extensors, although the hip adductor muscles were still too overactive with this patient, this was hard to change from the first treatment session.
What I have learned for this simple looking exercise, that how much more is involved in being effective with your treatment, that is your observational skills, handling skills, commands to your patient are paramount in achieving the desired outcome which obviously I was lacking and I guess that will come with more experience.
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Vaidas, it sounds like you are doing quite a good job already! I think what we have to remember is that we learn the bare basics in uni and that it is on clinic where we are expected to expand our skills (both observational and manual handling). I know how frustrating it can be to sometimes not see what is right in front of you. I needed similar prompting in my neuro placement. But I think being a good physio means lifelong learning and taking advantage of continuing education sessions and using these tools that we gather over the course of our career. Just think about how much you have learned over the last two years, and imagine how much more you will know two years from now. It will come with time, so don’t be too hard on yourself!
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