26 year old work comp injury dislocated L patella 

While on clinical I worked with a patient who dislocated his left patella lifting a box at work. Upon his first treatment he was wearing a knee brace with a patella support and had a 10# lifting. He had swelling and minimal bruising. The patient had pain with long bouts of standing and starts. I started his treatment session with a 10min warm up on an upright bike. After the warmup I moved to the leg press the patient was nervous at first due to fear of redislocation. I had to progress slowly allowing some room for the patient to become more comfortable. I gave him a HEP of mini lunges, mini squats, marching, and side marching. Progressing the exercises with reps, sets and intensity. After exercises I ended with ultrasound to the medial knee to promote healing and reduce pain. As he progressed he had reports of no pain and had been cleared by his doctor to use a less supportive brace when working. I then moved to funcinal return to work activities. I instructed him in lifting a crate with weights with proper body mechanics. Along with pushing and pulling and overhead reaching exercises. This was progressed as tolerated, safely increasing the weight. With the goal to improve strength and stability with education on posture and proper body mechanics upon returning to work. 

48 year old from puerto rico chronic back pain 

While on clinical I got the opportunity to work with a lady that was from Puerto Rico and did not speak english and we worked together with a translator. She came to therapy with chronic back pain. She was unable to walk long distances and she had to sleep supine on the floor and needed assistance with transferring out of bed due to the pain. I started her in hooklying rocking her knees right and left. This was a very gentle stretch for the low back to help reduce some of her muscle tightness to decrease her pain. Spinal joint play was performed and my CI performed thoracic spinal manipulation. This was increasing proper movement of her spine. I performed Gusha to her upper traps, rhomboids and scalenes. This helped increase healing, blood flow and reduce tightness. This helped reduce her pain allowing her to improve postural awareness promoting neutral spine. I also had her on the nustep to increase endurance and walking tolerance. She experienced a lot of pain due to tight muscles so a big focus was to get her moving. As she progressed I moved to the leg press. This gave me the ability to control the weight and gravity on her back while still improving her strength and endurance. I sent her home with a walking program, lumbar stretch and piriformis stretch. She was also educated on chronic pain and given posture and positions (prone on elbows) to help when she is in pain. 

Gua-Sha

Within my clinical experience I had the opportunity to learn Gua Sha an instrumented assisted soft tissue modulation technique. It uses a small flat tool that slides over the muscle allowing you to feel knots and muscle tightness. As the tool slides across the muscles it works out the knots, releasing the tension, promotes blood flow and increases healing. My CI taught me and allowed me to perform the treatment on him for practice. He allowed me to practice it many times on many different patients. My CI made sure I got as much practice as possible so I was confident with this intervention upon leaving the clinical. Ensuring I was comfortable with it as I continued growing as a PTA.

Chronic Pain Neuroscience Education

During my clinical I was taught about Neuroscience education for patients with pain. This treatment is used for patients with chronic pain by educating the patient about pain. Teaching them the correlation between the brain and pain so they fully understand how pain works and affects the body. There is a workbook that is given to the patient and they are given things to fill out. This helps them identify what triggers their pain. Helping the patient look/think about their pain differently and finding them healthy ways to control their pain.