Week 3 entry

S// I have been seeing a 75y.o Pt this week for ongoing management of hip and leg pain. The Pt was BIBA after waking up with intense 10/10 hip and leg pain that prevented him from weight bearing. The Pt lives alone and is normally independent with all ADL's. He has had previous incidents of similar pain but nothing as bad as this and the pain usually eased with pain meds. PMH-parkinsons
T// I had to conduct an initial Ax of the Pt and then make a plan for treatment which after getting my supervisors approval could put my treatment plan into place. As this was a MSK case i had to conduct a detailed history of the patients pain i.e. description, intensity, aggrav and easing factors etc. It was a great opportunity to put my lumbar spine knowledge into place.
A// After completing my subjective Ax (which had to be extremely thorough in order to get the information i needed to make a suitable treatment plan) I then sat down with the information i had gathered and made a plan. I checked the patients investigations which showed NAD. I made the decision that this patient had a pain dominant problem and that my immediate goal of treatment was to help with his pain. So I found the active movements that provided pain relief to this patient and repeated these movements. My baseline for measurement of effectiveness was trunk extension, and with continued sustained treatments into the pain relieving position the patients level of trunk extension improved. I also educated and provided support to the patient so he understood his problem and the path to recovery.
R// The results of my treatment choice were mixed. His level of trunk extension (which was limited by pain) has gradually improved and the Pt feels like he is getting better. However, on FWB the Pt continues to report 10/10 pain and i have still yet to find any positon that centralises the patients pain.
E// I believe my communication skills were appropriate for this Pt and helped me gather the appropriate information i required to make a treatment plan. However, i think i could have gathered a lot more specific information related to mechanism of injury. My treatment is appropriate for this patient however as i am not making significant improvements i am beginning to question my methods and wonder what more i can do.
S// I think i could improve my performance by being more confident in my treatment plan and this will give more confidence to my patient. Also, to consider alternative treatment options i.e. TENS and consider broader options (going to trial a TENS next week).