Sara Reese Internship Dr.

Kendig Professional Sports Care and Rehab I did my internship at Professional Sports Care and Rehab in the Shepherdstown office. I completed my 400 hours under the supervision of both Dr. David Croxton and ended it with Dr. Kristen Lumm. My office is located at 39 Maddex Drive Shepherdstown Wv Suite 2. I worked at the clinic on Mondays, Wednesdays, and Fridays from 7-7 in the beginning and ended with the hours of 7:30-7 on Mondays and Wednesdays and 8-3 on Fridays. I started at the clinic on January 13, 2014 and will end my internship hours on May 9th 2014. However I have been offered a job as a tech starting on May 12th. The beginning of my internship was done with David Croxton. However, my daily life changed a little bit in the middle of March when DJ went home to practice in Kentucky; I then was supervised by Kristen Lumm who primarily treats out of the Hagerstown office. There are only a few ways that this changed my daily routine at the clinic. The hours changed when Kristen took over because she has to treat in both the Hagerstown and Shepherdstown clinics. So she extended some of the hours and fully booked the schedules for the day. It also changed because then DJ was the therapist there was a 2 hour lunch break from 12-2 and Kristen only has one hour lunch breaks and some days we dont get lunches at all. The style of therapy also changed a little bit when Kristen took over the clinic. DJ is more about stabilitating exercises and exercises that help with fixing posture and fixing the problem from the inside when its not dealing with an injury. Kristen is more about strengthening the muscles and gaining strength. Because of

these changes in treating it was a little difficult to change the names of different exercises and learn the different ways she does some of the original exercises. My daily day to day routine pretty much remains the same. I come into the clinic in the morning and put away all the heat pad covers that I left out the night before and then look at the flow sheets and prep for the first patient. I then use the Webpt system for the rest of the day to track patients exercises and treatment plans, writing down any changes to the flowsheet or adding and changing exercises as patients progress. I am in charge of making sure all of the patients do their exercises correctly and teaching and showing new exercises daily. After the patient has completed there exercises and been given manual treatment from the therapist I then hook the patient up to the electrical stimulation machine and administer either heat or ice depending upon the injury. Patients with muscle injuries typically get heat in order to relax and heal the muscles and patients who have bone injuries tend to get ice. When helping patients with there exercises I am in charge of getting there weights, getting the certain therabands and cords they need, changing ankle weights and timing patients on there exercises. The majority of the patients would rather be timed in an exercise than made to count because when the clinic is busy and with the TV being a conversation piece patients tend to lose track and cant count the repetitions. I work with multiple patients at a time and have to multitask a great deal with doing exercises, giving treatment and answering patient questions. I also do ultrasounds when a patient needs them. Ultrasounds are helpful because the use a small crystal inside the head of the machine that vibrates against the ultrasound gel

and creates vibrations in order to break up scar tissue and give the muscles that are injured a mini massage. I have ultra sounded a repaired ankle, a torn calf muscle, and an injured hand experience pain in the lunar nerve. I also learned during my internship that if you suspect a fracture in a bone, turn the ultrasound on for just a few seconds and if the patient has extreme pain in the injured area then the bone is probably fractured. The mornings at the clinic usually consist of Medicare patients and just an older generation because they like to get up early and get things done for the day. After lunch it is usually more college students and teachers. These two patient groups are entirely different to work with. The Medicare patients require a lot more attention and reminders on their exercises and what they are supposed to be doing. The college students and working adults are more likely to remember their exercises from session to session and are more about just getting them equipment and general reminders if they happen to forget something. The attitudes of the patients are also very different. The Medicare and older generation are more set in their ways and more verbal about things they dont like and if something hurts or isnt comfortable. The younger crowd tends to just sit back, get through the exercises, and leave. I have grown to love my Medicare patients and have a lot of fun treating and rehabilitating them. Because of this internship I am looking to work in a hospital dealing with rehabbing replacements and older patients. I liked working at an out patient clinic. Its mostly a cluster of knee patients, shoulder patients, and back patients with some additional injuries thrown in. Eventually I learn everyones routine and very rarely need to check the flowsheet

for exercises and weight. Once you have 10 knee patients you pretty much know the general exercises that all knee patients are going to do. The only difficult part is when you get a new patient and have to remember their weights and repetitions for each exercise because they change from patient to patient. Because of this internship I have decided that I either want to work in a hospital setting or stay in a clinic type setting. I have also learned about myself that I get attached to patients and I get upset when they are finished with treatment and are discharged from care. I have grown to have a relationship with many of my clients and enjoy spending those 3 hours a week with them. Some of my additional daily and weekly tasks, aside from working with the patients and assisting both DJ and Kristen, are taking out the trash daily, filling the hydrocolator weekly, wiping down the tables, weights, and equipment every night before we leave, and laying out the heat pack covers every night before we leave. It would be hard to describe my day to day contact with every patient so because I work with so many patents at a time and my patients change about every 4-6 weeks due to getting better and new patients. Knee patients tend to start with riding the bike as a low impact warm up and then continue with their exercises. Heel slides on the table are typically next followed by some timed hamstring and quad stretches. Weighted exercises are next and usually consist of single leg raises, where the patient has a weight around the injured ankle and is lifting the ankle to the height of the other knee while it is bent. Then they move to the end of the table and do what we all long arm quads. This is where the patient straightens their legs to increase range of motion in the knee. After the LAQ they slide off the table and

stand at the end of the table and do hamstring curls. Weights are then removed and we continue with exercises such as step ups on the box, ball squats with a small physio ball, 4 way hip exercises with a loop and a theracord, and typically end a knee routine with the patient standing on one leg for 30 seconds each leg to help with balance and gaining strength in both the injured and uninjured knees. Knee patients are then given manual treatment and treated with ice and stim. The beginning of shoulder patients depends on the age and the type of injury. Rotator cuff and other muscular injuries are typically started with heat for ten minutes before they begin exercises. Other shoulder injuries dealing with dislocations or bone just start right into the exercises. Shoulder patients start with a pulley system in order to increase ROM in three different directions. After pullies shoulder patients use a towel and wash the wall. Then we add weights and do pendulums, bicep curls, shoulder presses, and Is and Ys. After weighted exercises we use therabands to assist with resistance exercises. There are three different resistance exercises which are call Pull Aparts ,Burners, and Waiter Tips. After the resistance exercises we do some light stretching including upper trap stretches and door stretches to stretch each of the muscles in the shoulder and the neck. Shoulder patients are then given manual treatment and set up with stim and either heat or ice depending upon the injury. Ankle patients are very similar to knee patients as in they begin on the bike for low impact exercise. We then start them with ankle pumps in order to work some of the swelling out of the ankle. We then do more range of motion exercises such as ankle alphabets, ankle circles, BAPS board (front and back and side to side),

the tilt board in order to promote balance and step ups to work on range of motion. We also use weights on the patients ankles and pad of the foot in order to promote strength in the ankle. For surgery patients we most time use ultrasound in order to stimulate muscle strength and muscle repair. Ankle and calf stretches are used at the end of the treatment to stretch out the muscles that the ankle uses. After stretching. the patient is giving manual treatment and ends with stim and ice on the ankle. Foot, wrist and hand patients are treated differently depending upon the injury. Most times these patients are started with ultrasound and then do there exercises. These three injuries require usually just some range of motion exercises and very light weight exercises. The muscles in the foot, wrist and hand are weaker than the bigger muscles in the other body parts so therefore we dont need to use heavy weights just some light weights such as a rubber hammer, silly putty, a clothespin for hand patients, and tennis balls for squeezes and rolls. There is also a lot of stretching involved in these injuries since most times these injures are simply because they muscles are too tight or the nerves are being pinched and causing pain. Most times in these patients heat and stim are used to promote healing and relaxation of the muscles. Each day after the last patient I wipe down all the tables, put out the hot pack covers to dry, and turn off all the machines and equipment. By the end of most nights I am so ready to leave the clinic after the 11 hour work days. Its physically and mentally draining to be working with people so much but in the end the reward is greater when you get to watch people progress and get better and be in less pain.

Even though I hate when my patients leave I also know they are leaving feeling better than they came in and being healed from whatever is bothering them. Only one time recently did we have to discharge a patient because there was nothing more we could do for him therapy wise. He has a degenerative disease and we were hitting a plateau in exercises and training so we had to discharge him and give him advice on further options and surgeries. Having a client leave without feeling better upset me because I like seeing my patients leave happy. However, out of the hundreds of patients I have seen in the past few months I am thankful that he was the only person I was not able to help heal. One of the challenges I am working on overcoming is dealing with the change in therapist, and with the new therapist came a PTA student as well. When the student came into the clinic she took over some of my favorite patients in order to get more practice with some easier clients. Its an adjustment for me to not be the only tech in the clinic and not be the only person working with the patients. I sometimes get bored if we happen to have a slow time and she is working with the patient and Im not doing anything. I understand I was new once to; its just an adjustment having her work with some of my favorite patients and having to help her do exercises and treatments when I also have multiple patients myself. All in all I can honestly say I definitely enjoyed my time at the clinic in Shepherdstown and am looking forward to continuing a career both with this company and in this field. I have learned so much from DJ in the time he was mentoring me and even from Kristen in the short time I have been with her. I had experience in this before but have definitely learned a lot more in depth treatment

plans and ways of doing exercises and manual treatment. I can only hope to continue in this amazing profession and increase my knowledge. As I stated above, because of this internship I am looking at pursuing my career either in an outpatient clinic setting that I have been working in or in a hospital rehabbing patients after surgeries and hopefully working with specials and disabled kids to get rehabbed when they have diseases that dont allow them to function normally. I have learned a lot about working with people and the differences in working with different generations and how to treat different generations. The older generation requires more care and attention and the younger generation is just there to get better and move on with what they were doing before they were injured. The older patients also use therapy as a place to go in they are alone and dont do much daily. They use us as someone to talk to and sometimes spend extra time there even after their session is finished.