2nd week in Fysiotikka

Introduction

This is my last week in Fysiotikka, because next week i start my traineeship in the central hospital. It was quiet busy this week. New clients came for physiotherapy treatment, and some clients from the previous week. Some diagnosis were difficult to be found, but we tryed for our best with the other physiotherapy students, so that we could give the right treatment to them. Moreover, this weekend i faced more difficulty with my cooperation with some students, because most of the time they were talking in Finnish language, and seemed that they didn't want to explain to me the things that i didn't understand. I tryed to participate actively and learn as much i could!

Main part

Physicaltherapy treatment of the musicians of Sirkkala

The 2nd week began in Sirkkala, which is one of the Karelia Universities. We worked with musician students and showed to them the musicin ergonomian. We were separeted in 5 groups:

1. Guitar and Bass group
2. Piano and Kantele group
3. Violin group
4. Harmonica and Songs group



bass

5. Drams group

guitar

kantele

piano

violin

harmonica

songs

drams

I was in the group of Piano and Kantele, with another physiotherapy student. At the beginning, we had a discussion with the musicians who played the piano and the kantele, about the points that they felt the pain after or while playing, and also about the kind of the pain on this points.

The most common and usual points that they felt the pain was on the neck, the back, the upper limbs (wrist, fingers) and sometimes on their head. The kind of the pain was usually pungent and numbness.
After the discussion, we went to the room with the musical instruments. The musicians that were in my group were 4. Two of them played the piano, and the other two the kantele.

• First, a boy started to play the piano. We checked the way that he played, and his posture was very bad and incorrect. His head was in front, he had kyphosis and the shoulders were in front.

• The second piano player was a girl. Her posture was also incorrect. She seemed that she had scoliosis from the way that she was sitting on the chair. She also had her head in front.
• Afterwards, a girl played the kantele. Her upper body was rotated to the left, while her lower limbs were straight. She also had her head and shoulders in front and tight.
• At the end, another girl played the kantele also. Her posture was also, almost like the previous girl.

After our assessment, we showed them their incorrect posture, and tried to explain how to correct their position while playing. It was an interesting group!

Physiotherapy treatment of shoulder pain

A sportsman came to Fysiotikka, because he had pain on his right shoulder and humeral. The pain came at night, after a rowing exercise in the gym, and before sleeping. I thought that he had a rapture on his biceps, because he felt pain more in the humeral than in the shoulder. Also, he felt pain when he was groping his arm.
Afterwards, he did flexion of his right shoulder to the wall and we noticed that his right scapula was winging (because of the weakness of the serratus anterior) more than the left and that his shoulder was rounded.






We continued with exercises for the stabilization and proprioception of his scapula and shoulder.




After the exercises, the client fell better. We gave him exercises from Physiotools, to do them at home.

Physiotherapy treatment in the Gym

We did physiotherapy treatment to 4 elderly women in the Gym. I did and showed to them the warm up and then, each of them did circuit training with their own training schedule. The training included:


1. Squats with kettlebell

 

2. Leg abductions 

3. Trunk rotation

4. Biceps with dumbbells

5. Rowing with theraband while sitting on yoga ball with the legs on unstable surface area

6. Lower back exercises


7. Leg press

8. Star Excursion Balance exercise on unstable surfaces

The exercises went very good. I faced only one difficulty with an elderly woman, that didn't do the squats with kettlebell in the right way, and in my effort to help her do it in correctly, she gave up and didn't want to continue with that exercise! I was really frustrated, because the physiotherapy student that i was cooperated, didn't help me very much and i didn't know what to do, because i wanted to help the woman, but she didn't understand English, only Finnish language, so there wasn't communication between us. Except of that case, everything went very good. I was really surprised about how independent the elderly people are in Finland!

Physicaltherapy of adult woman with wight problems

An adult woman with mental and weight problems, came into the Gym of Fysiotikka to improve her physical condition. This is her 2nd year in Fysiotikka's gym, and she told that she is feeling better after 2 years. Other problems of this lady were fibromyalgia, loose joints, weakness while brushing her hair and very tight leg muscles.
Well, she started with warm up. The warm up was rowing with the theraband, 2 sets of 20 repeats. Then, she did arm extension with theraband, 2 sets of 20 repeats and also leg adduction/abduction with 30kg of 2x20 times.
When she finished with the Gym exercises, we went to the physiotherapy room, and did massage to her gastrocnemious, hamstrings for breaking the trigger points and also passive stretching to the quadriceps and gastrocnemious. Her quadriceps were very tight and stiff. At the end, she did the stretching by her-self.
It is a pity that this client is unable to be more independent in her life and do the things that she wants and loves because of her weight and mental problems.

Physiotherapy treatment of elderly man with stroke

Our client was a man with stroke and left hemiplegia, that came also the previous week to Fysiotikka.
He did again the walking with the Hp Cosmos. He walked 4 meters to the one side, and 4 meters to the other side, 6 times each side. He felt a little bit tired.

After the walking, he layed on the physiotherapy bed, and I did passive stretching to his legs. I did stretching of plantar/dorsi flexion, on quadriceps, internal/external rotation and hamstrings. His left side was more tight than the right one, and more painfull. I also did passive stretching to his upper left limb for reducing the muscle tone. He felt pain because of the stretching.

Physiotherapy treatment of Gym group

This day, we had o group of 8 elderly/middle aged/young clients (6 men and 2 women), which did Balance exercises in the room. First, we started with warming up to motivate the circulation of the body and the activity of muscles. Then, the clients did 9 balance exercises in circuit training, for 2 times and 1 minute each exercise. The exercises were the following:

1. Crossing the cones with zig zag pattern, trying to keep their balance with a thing on their head.



2. Star excursion balance exercise on the wall with the hands, while standing on the BOSU.

3. Throwing away a ball to the wall and clutching it, while standing on the BOSU.

4. Walking on a straight line, with the foot in front of the other and more progressive exercises, walking on the line while playing the badminton.

badminton

5. PNF of the upper limbs while sitting on a yoga ball.




6. Side steps with a theraband on the external side of the knees, with purpose to strengthen the leg abductions.



7. Bridge exercise and passing a ball under the back.



8. Exercises for the latissimus dorsi.



9. Foot steps and raising legs on the step.

The exercises went very well. 2-3 middle aged men, were very active and did the exercises with passion!

Physiotherapy treatment of the lower limbs

A young adult woman, about 30 years old, came to Fysiotikka, because of the reflecting pain on her right leg. The pain appeared suddenly 1,5 months ago on her gluteous. She feels pain while sitting for long time with bad back posture. The pain reflects on her right hamstrings, gastrocnemius and the internal side of her knee. Although, she said that she doesn't feel on her low back.
We evaluated her body posture from the upright position, from the supine position and prone position. From the upright position with 2 and 1 leg on the floor, we assessed and groped and measured the bone points of the pelvis-hip, and also the shoulder-scapula. From the supine possition we made the SLR test, to find out if the problem was on the sciatic nerve. The test was positive.

SLR Test

Afterwards, from the prone position we groped and tested if there are some trigger points on the gastrocnemius, the achilles tendon and the piriformis muscle, but there wasn't.

At the beginning, we thought that the problem was in her piriformis muscle, that pressured the sciatic nerve, as the SLR test was positive and there was not pain on her low back. But after the passive pressure of this muscle, that didn't give neither local nor reflected, we were very confused about the nature of the problem!
We continued doing passive mobilazation-rotation to the lumbar, to the S1-S2 nerve, passive dorsi/knee/hip flexion, passive internal rotation, muscle test with resistance to the iliopsoas/rectus femoris/quadriceps/tibialis anterior. We also did stretching on the tibialis anterior, gastrecnemius and back stretching (latissimus dorsi), PNF of the core and nerve mobilization.
At the end, we taped the client's back, parallel to the spinal cord from the both sides and gave to her home exercise the flexion/extension of hip and knee the same time as the flexion/extension of the head.

Physicaltherapy treatment of sacroiliitis

The client was a 19 years old girl, that suffered from pain in the right hip and knee, because of the inflamation on her sacrum. The exercises that we did to her were:

• Rotary movement of the femur
• Hip internal rotation and stretching of the external rotator muscles
• Stretching exercises with the knees to the chest (relieved from the pain)
• Back extension
• Core PNF patterns (relieved from the pain)
• Activate of transverse abdominal
• Anterior/Posterior tilt of the pelvis
• Controled pelvis lifting (bridge exercise)
• Active external rotation of the hip from lateral decubitus position
• Controled active hip abduction from lateral decubitus position

Finally, we gave to her home exercises from Physiotools, like the exercises that she did with us.

Physicaltherapy of metatarsalgia

Our client was a 18 years old football-player, that felt pain everytime that he was playing football, wearing the football-shoes, on his metatarsals on the left leg, but not in the rest. The pain came on January of 2016 and was getting worse time to time. I asked him in which exactly movements he felt the pain while training, and he said that he felt pain when he pressured his fingers (dorsi flexion of the metatarsals and fingers).
After this small medical backround, we checked his feet on the pelmatography and noticed that the left foot was more flat. Then, he stood on the metitur balance system for 20 seconds on one leg with opened and closed eyes, and noticed that with closed eyes, he couldn't keep the balance especially on his left leg. Moreover, he walked on the Gaitrite walkway system, in order to analyze the way of walking, the steps, the distance between the two legs, the way and the time that he stepped on each of the foot. We found out that his left toe wasn't in the center and was more hallux valgus.

pelmatography

metitur balance system

GAITRite balance system

At the end, we evaluated the metatarsal movements by passive mobilization, the tightness of the plantar fascia and also the plantar/dorsi flexion. His plantar fascia was very tight and stiff on the both of feet, and also the tibialis anterior and especially the gastrocnemius and achilles tendon were very tight and stiff. I did stretching to this muscles and mobilization of the metatarsals, to relieve from the pain and for their decompression.
Finally, we gave to him home stretching exercises for gastrocnemius and tibialis anterior and i recommended him to stop wearing the football-shoes, because they cause the problem and the pain because of the compression and squeezing of the metatarsals and fingers.

NOTE!!! At first, we thought that he might had Morton's Syndrome, but after the assessment we figured out that it wasn't, because the pain didn't reflect to other points, but was only local, which means that there wasn't any involve of the nerve.

Conclusion

The last week in Fysiotikka was interesting and busy too. I would prefer to work with my own clients, in order to do more things alone and independently, so that i could improve my skills, the way of assessment and the ways of treatment. I also would prefer to stay more time in Fysiotikka, in order to have time to addupt to the enviroment and to the working schedule.