Foot, ankle and leg examination and treatment techniques practice + Csp HVT
During the first two weeks on POS lectures we were revising and improving foot examination and treatment techniques. We have learned new ways how to HVT cuboid, talo crural joint, and subtalar joint. We were encouraged to feel what we feel (i.e. crepitus, fluid build up, restriction...). Out technique tutor Valeria explained to me that I need to keep the tension in between bones of the joint I examine. I found it quite challenging and tiring. I spent 1 hour practicing foot techniques and Csp HVT with my colleague SJ. I feel I still work too hard and I tense my shoulders and arms too much. I need to concentrate a lot and keep checking my posture and the tone of my muscles. I was not successful with Csp HVT (8 attempts) this time and I feel a little bit frustrated that I still can not master a nice, crisp, specific HVT.
The Three Clinic visit - gait analysis practice
Today I visited all together with my colleagues KF and KK Matt Harris and Chris Wilkes at their clinic with the intension of getting tutorial and help with some neck manipulation techniques. However we ended up doing analysis of KK's gait with the functional approach both Matt and Chris use in their practice. I have previously been to three Manus talks with Matt and Chris and thus I knew about their approach so the analysis was not completely unknown field for me. With KF we observed the feet and hips movement in frontal, sagittal and transverse planes. We added into the analysis tweaks of walking with the hips internally rotated, then externally rotated, and walking on the inner and then outer soles of the feet. After identifying the problem I was asked to give some treatment to KK. Matt explained to me that I need to think more simply. Instead of thinking of a technique I learned at the college, it is completely perfect to do literally what I want to achieve. So in the KK's case I wanted to achieve improvement in the internal rotation in one hip and external rotation in the other hip. Matt pointed out the the movement of KK's pelvis as I passively rotated her hips and suggested to me to hold the pelvis at the neutral position to achieve the change. I did not achieve the change in rotation of KK's hips I hoped for, so we tried to work out with Matt's help how to get patient to do it for themselves. We applied head down - bottom up approach and came up with simple squatting exercise that "gifted" KK improved external rotation in her right hip.
We enjoyed this 1.5hr session a lot and learnt a massive amount of new stuff. I have to admit that I felt really small when Matt asked me to lead the examination of the patient. However doing gait analysis for the first time, it was not that bad and I am going to look forward for some more.
We enjoyed this 1.5hr session a lot and learnt a massive amount of new stuff. I have to admit that I felt really small when Matt asked me to lead the examination of the patient. However doing gait analysis for the first time, it was not that bad and I am going to look forward for some more.
The Three clinic visit - gait analysis practice 2.
Today we met at 9.20am. 40 minutes earlier then last week. And it was worth it. We looked again at KK's gait and compared it with what we saw last week. She got homework to practise an external rotation of the right hip. On the observation we could see that her pelvis looked more symmetrical than last week. during walking her right hip was not moving so excessively in sagittal plane but the gait was still not right. KK reported some minor improvement of her symptoms since the last week.
I found very difficult to comprehend the movement of the foot and what to look at. Matt guided me through the process and again encouraged me to think simply and compare the left with the right. All together we worked up for KK a complex looking exercise called "tea pot" she will be doing through the next week until we meet again.
Apart analysing the gait and being challenged to think SIMPLY Matt showed us how to assess the foot in functional way with the pronation and inversion and supination and eversion movement and then how to assess the forefoot in all three planes and again the forefoot assessment of all three planes in supination and pronation position. It was very inspiring session as always. Am looking forward to getting hold of the dvd's of functional assessment and starting to comprehend better all the tweaks used and their exact purpose in the assessment of the patient's gait.
I found very difficult to comprehend the movement of the foot and what to look at. Matt guided me through the process and again encouraged me to think simply and compare the left with the right. All together we worked up for KK a complex looking exercise called "tea pot" she will be doing through the next week until we meet again.
Apart analysing the gait and being challenged to think SIMPLY Matt showed us how to assess the foot in functional way with the pronation and inversion and supination and eversion movement and then how to assess the forefoot in all three planes and again the forefoot assessment of all three planes in supination and pronation position. It was very inspiring session as always. Am looking forward to getting hold of the dvd's of functional assessment and starting to comprehend better all the tweaks used and their exact purpose in the assessment of the patient's gait.
Cervical HVT practice
Today my colleague LC helped me to discover what it was I wasn't doing right when trying to HVT necks. He told me to compress the neck and the occiput more. And it worked! Finally i could feel the movement of the neck held between my hands. In the afternoon in the clinic I carried on all together with MG, CD and a first year student to practice. Clinic tutor S.H. joined us and offered his own neck for me to practice on so he could give me a feedback. He was happy with my windup so only thing I need to ad is a more determined thrust. I was successful thrusting the neck of the first year student that joined us but other necks did not want to go. However I felt that over few hours my palpation and technique has improved massively. I need to carry on practicing so the good level I feel I am at can progress further.
The Three clinic visit 3 - swimming across the plinth
Today we were analysing KK's gait and also the movement in her spine during the swimming she does on the regular bases and which aggravates her rib pain. We had KK lying prone across the plinth and while she was pretending to swim we looked at the way her spine was moving. We established that her lower back was not side bending to the left. We gave her exercises to do at home in bent forward position with the aim to increase the sidebending of the lumbar spine.
Technique practice at the clinic and at home
I still feel that my success rate of the cervical HVT is low so I practised on a first year student cervical HVT and also at home on my fiance. I was not very successful as I managed only 1 cavitation on the student and none on my fiance. I feel that I need to practice when I am not tired (I was at home) and when there are not many people observing as it makes me a bit nervous. I still feel my hands working too hard. I felt so much more confident last week and now I fear I am loosing my capability to thrust again.
Occipito-atlantial joint HVT practice
LJ showed to me today a different approach to the OA HVT from the side. I was not successful however i felt that the new handhold is more advantageous and i need to perhaps practice it more. I then tried to HVT SJ's neck (mid Csp) and I was successful. So it made me happy however I feel at the moment that the amount of the technique we practice is not enough for the stage of the study we are in.
Bilateral OA and C/T thrust
today i managed successfully thrust OA and CT joint on my colleagues and at home on my parter (OA only) however it seems that i still don't have a good feeling for what i do, rather it is power i like to use and hope for a good luck and a successful thrust. in OA thrusting i took in account the advice from few days ago and CT thrust modification was shown to me by colleague DW. however CT does not work on everyone on the prone position, I am an example of it. need more practice and being more palpating then powerful.
New year, new term. Lumbar roll and dog technique practice
We spent in the study group a few hours on the revision of the lumbar spine roll and thoracic HVT technique. It was good to have LJ around as he did last term advanced spinal manipulation elective subject and the tutor teaching it is red hot on the positioning of the patient and operator too. LJ had so much to teach me and SJ! It was very beneficial study group as the handhold during thoracic HVT LJ showed us is so different to what we did until now. It allows us just to move our bodies and save our arms and shoulders from too much stress and achieve very specific cavitations. I struggled with lumbar roll. I think my problem was very weak core, I always feel i am breaking into 2 halves when trying to put the impulse through. I have learned a lot yesterday but i still have a lot to improve on those techniques. Other very helpful techniques were seated Tsp articulations when the patient sits along the plinth with the legs apart and either leans with their hands on the flattened plinth or on the raised back support part of the plinth. it is easy to position the patient into slight rotation movement and then from the behind affect the T/L and Tsp area. SJ learned this techniques on the course about the thorax ran by matt harris.
TSp HVT, foot and leg tug practice
Today we practices HVT of the TSp again, I had some difficulty to get on with it so we grabbed a first year student which donated his body and LJ watched me and gave me some feedback on what I was doing wrongly again. I caught myself not even knowing what applicator to use to HVT Tsp. how bad is that? I treated LJ's feet and managed bilaterally HVT his cuboids and relieve the symptoms in his left ankle. we practices also leg tug technique that was shown to us on the last technique lectures. LJ observed Trevor J. in demo clinic and he always METs muscles surrounding the SIJ. So he showed me how he did it on his patient today (MET to flexors, extensors, adductor) and then application of the leg tug. So far non of us was successful with this technique. The highlight of the day was my HVT to LJ's pubic symphasis. I used description from the technique lectures and it went. Hurray!
I feel I need to pay more attention to what I feel still. I can find myself having very unrelaxed hands and not feeling much.
I feel I need to pay more attention to what I feel still. I can find myself having very unrelaxed hands and not feeling much.
Cervical HVT
I still find cervical HVT difficult. even though dr sandler taught a very simple and effective approach to the HVT of the neck, it seems again i lost the capability to do it. Other day in east street everything went so well. now in last few days i am not capable to achieve one cavitation. Grrrrr!
I feel that the best practice is to do a lot of treating patients and see the results as it shows how effectively i can do those techniques. Some HVT attempts that do no produce cavitation seem to prove to be effective as the ROM of the joint improves significantly.
I feel that the best practice is to do a lot of treating patients and see the results as it shows how effectively i can do those techniques. Some HVT attempts that do no produce cavitation seem to prove to be effective as the ROM of the joint improves significantly.
Techniques from Dr Sandler practising
In the clinic today i had some spare time so I used it for practising the techniques we have learned with dr sandler over last few weeks. it was great to have his notes printed as it gave us guide how to rehearse all we have learned. I still struggle with the TSp dog and lift off he showed us as for a dog technique i did not really understand how to use the shoulder to stabilise the tsp, and for the lift off i dont seem to be strong enough. However i have to admit that my colleague helped me so much today with lift offs, i actually for the first time felt the wind up on my sternum so that is success already. Cervical HVTs seem to be working perfectly when followed dr sandlers advice. I feel that the technique he taught us was just right amount with the time to rehears it and being able to follow his notes and practise them successfully.
Visceral techniques sessions with Kylie Fitzgerald
Finally it seems that i can comprehend the point of visceral techniques. Kylie made the explanation the easiest ever. It is no longer a mystery technique only some chosen ppl can use and the others are left to wonder what the heck is going on. the class with Kylie was really packed that shown how popular the visceral techniques are and how much we would like to know to use them. we did stomach and duodenum. she showed us long and short lever techniques and techniques that use approach of looking for ease of stretching the organs. We were shown fantastic ways of examining of the abdomen by auscultation, percussion and palpation on the end.
Strain counterstrain
my most favourite techniques from strain counterstrain are the anterior points for LS, SIJ and psoas mms. During the sessions with my study group colleagues I showed them how to do them as they did not select strain counterstrain as an elective subject.