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Wear and Tear
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Wear and Tear - June 18, 2008 9:03:19 PM
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jnyles
Posts: 5
Joined: July 4, 2007
Status: offline
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Hi,
I was recently accepted to a DPT program, and will be starting my first year in August at 29 yrs old. I have been working as a rehab tech at an inpatient hospital for about 5 months, and about 6 wks ago possibly strained my biceps/brachialis (pain in neutral grip 90+ degrees flexion). I'm not certain what it is - I have consulted with PTs, used ice & heat, etc... and have laid off using the arm for heavy loads. Yesterday I noticed some pain in my other arm, maybe from overcompensating. As I have only been doing this job for 5 months, I am having some doubts as to my longevity in the profession. I have to say also, that I have a history of weight training & personal training, in pretty good shape, and watch out for proper form during any physical activity. I suspect that lifting BI/SCI pts with gait belts repeatedly might have to do with this.
It's sad because this setting is growing on me, but I might avoid inpatient care in the future.
I would love for feedback on everyone's experience with sustaining injuries on the job as a PT/PTA/OT.
Thanks!
J
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RE: Wear and Tear - June 19, 2008 10:48:21 AM
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rwillcott
Posts: 440
Joined: March 20, 2006
From: Canada
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Look out for your body first. You're going to need it in this profession. I see many nurses with chronic LBP and shoulder injuries. If you can find a position in outpatients that you enjoy I think you'll find this less of a strain on your body than inpatients.
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RE: Wear and Tear - June 19, 2008 12:38:38 PM
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jnyles
Posts: 5
Joined: July 4, 2007
Status: offline
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Hi there. I appreciate your replies.
Crevidence, may I ask, how tall are you? I am 5'5" and was thinking my lack of leverage could have something to do with it. That's unfortunate you couldn't work where you wanted to, SNF. How long ago was that, and how do you like outpatient? I am also interested in OP, especially interested to learn manual techniques.
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RE: Wear and Tear - June 19, 2008 9:10:49 PM
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ginger
Posts: 662
Joined: February 26, 2005
From: Melbourne Victoria
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jnyles , your reported referred pain to your upper limbs is not necessarily any indication of industrial disease, any more than it would be had you been entirely sedentary. The nature of spinal protective events leading to pain in the limbs is the very thing you would be treating in clinical situations , so you would be aware these events happen without the percieved stressors included in lifting. Protective behaviour leading to referred spinal pain will occur in those confined to a desk job at least as often. As long as you have skilled colleagues capable of turning off spinal protective behaviour and not misinterpreting these common events as pathology you are in luck.
All the best.
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RE: Wear and Tear - June 19, 2008 9:20:43 PM
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PTupdate.com
Posts: 1478
Joined: October 8, 2001
From: Pittsburgh, PA USA
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I personally feel like **** every day when I get home, as I am a high volume clinic, and put my paws on everybody. At 43, I just ain't the same any more!
A few years back, when upping the life and disability insurance to cover the family, I found that PT's are ranked very high for risk of job injury, and have to pay accordingly. While I know of nobody who ever went on disability, it must evidently happen quite often. I know for a fact that most of my colleagues have numerous aches and pains, mostly in the hands.
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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RE: Wear and Tear - June 19, 2008 11:42:06 PM
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ginger
Posts: 662
Joined: February 26, 2005
From: Melbourne Victoria
Status: offline
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Duffy , being human has it's drawbacks thats for sure. suggest return in the next life as a sea slug. I understand turtles live long and (sort of )prosper. The best I think would be at the top of the food chain as a great white shark. No cancer , no predators, no attachments, just the wide blue sea and lots to eat.
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RE: Wear and Tear - June 20, 2008 1:24:14 AM
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jnyles
Posts: 5
Joined: July 4, 2007
Status: offline
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Ginger,
Would such protective behavior leading to referred pain necessarily indicate an injury, or the possibility of one? Is this something I would see a specialist about, if so whom? PT, PM&R, Orthodoc...?
Definitely something I haven't heard suggested from anyone, which I will hopefully learn much about in school. Also frightening. However, today for the first time in 6 wks I noticed no pain when doing light work with an exercise band. Maybe I delayed too long before recognizing the pain and taking it easy on my arm...?
Thanks for your thoughts.
Crevidence, I've heard from some PT's to be selective about the OP clinic I might work in. Some negatives I hear are lack of time to treat pts, and one-size-fits-all care. I would definitely like to work in an intellectually challenging environment and not advise only pelvic tilts for all LBP. That's another one I've heard.
PTupdate, That's rough John! Like **** huh? Any specific parts of the body? Your hands like others? I'm curious about the OCS certification. Are manual techniques at the core of OCS training? If you don't mind me asking, and this is open to anyone, how would you rate your satisfaction as a PT day to day?
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RE: Wear and Tear - June 20, 2008 6:08:59 AM
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ginger
Posts: 662
Joined: February 26, 2005
From: Melbourne Victoria
Status: offline
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jnyles, the notions that pain is associated with pathology is still , unfortunately , still one of the medicine led precepts that remain entrenched in the institutions where you are likely to be enrolled. An alternate view that pain is related to nerves that are irritated not associated with pathology , though gaining ground , is still not mainstream within either the physiotherapy or medical communities. This site and its many posters is something of an illustration of the wide variety of viewpoints and theoretical models extant.
Should you find a therapist skilled in the manual therapies often described here , including continuous mobilisation ( CM ) who would apply him or herself to the business of returning spinal joints/nerves to a non protected , fully mobile state , you would also find the solution to most of the non traumatic and may of the trauma related limb pain and dysfunction problems endemic in the community seeking PT treatment. By orienting yourself to these phenomena as provably referred first, you will advance in effectiveness at a pace far in advance of those still mystified by the aetilogy of most MSK problems.
Your description of upper limb pain is in keeping with the majority of those presenting and treated at my clinic in Melbourne australia over the last twenty years , whose problems are solved in short order by attention , not to the limb , but to the likely source of limb pain at the spine . It is possibly the easiest thing to prove in any one patent, whose limb pain is suspected of being referred from the spine , I suggest you read the posts I made several years ago on this site under the headings , "the physiology of spinal pain " and "continuous mobilisation ". They can be found in the archives in the manual therapy section.
Keep your mind focussed on results and you will find much to enjoy in being oriented to the spine first in any consideration of MSK pain.
All the best.
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RE: Wear and Tear - June 20, 2008 6:15:42 AM
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Sebastian Asselbergs
Posts: 1211
Joined: September 29, 1999
From: Barrie, Canada
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Mmmh. I must be doing PT differently.
I am 56 and this month celebrate 25 years of being a PT. I have been heavily involved in local, National, World and Olympic teams for about 16-17 years - hard physical stuff at times (at 12,000 feet in the Alps work IS harder..), with busy days back home in the clinic - 55-60 hours a week in those days - and 50 of them with patients.
Now - 44 hours, no Teams to look after, but still sports injuries and an increasing number of chronic pain patients.
I am 6 feet short and have a occasional tight back from having to muscle out of the woods on the golf course, and occasional sore hands from home renovations. And NOT too often from slamming my thumbs! I am not in chronic pain of any kind. I get regular massages - because I can and like them. I have never been a very big or strong (muscular) guy - lean.
My present status: happy as a clam in PT, healthy, with time for family, and I would not do anything differently if I were asked!
BTW, I have my own little clinic (1500 square feet) with 3 offices (one for the MT) and a beautiful view over a wooded ravine teeming with birds and occasional deer. Sounds nice? Darn right it is.
_____________________________
Mundi vult decipi
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RE: Wear and Tear - June 20, 2008 8:32:13 AM
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PTupdate.com
Posts: 1478
Joined: October 8, 2001
From: Pittsburgh, PA USA
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J: I typed in sh-t but an automated censorship program created **** instead.
As far as the OCS, from what I can remember (1996) nothing specifically manual comes to mind. It was more about theory and proper thought methods for problem solving. I am not sure how they currently test, and I re-certified last year using the professional developmental portfolio, and therefore did not have to take the test again.
Am I satisfied? Over all yes. I am busy because of me, and am one that just cannot say no. I am happy that people come in from other states, are flown in for one visit, and come back to me for their other problems, send their families, etc. I do very good things for people, but have other things that annoy me and spoil the whole process. Some busy days I'll sit and look at the case load and realize I did up to 300 minutes of manual work in a day, and that's tough on the hands.
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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RE: Wear and Tear - June 20, 2008 8:45:24 AM
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Shill
Posts: 1098
Joined: February 13, 2003
From: Madison WI USA
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Ginger,
Forgive me, but I cant resist this one. I am a self proclaimed myth buster. You are indeed busted regarding your Great White Shark and its cancer free status. Link up below......
http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Sharks_Get_Cancer.asp
Back to the wear and tear issues. I have had my share of work related issues, one from a slap lesion from yanking a locked cardiac chair early in my career, to lumbar HNP to cervical HNP at a few levels, complete with UE weakness. I dont actually think that my work tasks (outpatient exclusively, save for a weekend or two per year on inpatient) create more bother at this point. They did, but over time I have improved to the point where I can modify most tasks through improved mechanics, and have no more pain at the end of the day. I do have a little bit of a problem at the moment when I give heavy resistance to a muscle test, and that is that my arms shake fairly obviously. Could also be that I havent been in the gym lately......
My advice to anyone just starting out, take the time to do it right, in terms of body mechanics, get help with transfers, etc. Dont do what a lot of people do, and just get it done quickly and injure yourself. It will catch up with you eventually. I actually got this advice from a relatively toothless woman when I was working as a merchandise replenisher (stock boy) in a Kmart. I didnt heed it, and perhaps I wouldnt have had such a bumpy ride if I had.
So, I guess the moral would be "Always listen to edentulous soothsayers".
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RE: Wear and Tear - June 20, 2008 6:21:14 PM
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ginger
Posts: 662
Joined: February 26, 2005
From: Melbourne Victoria
Status: offline
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Shill, thanks for that, busted. dayaaam. , well its the sea slug then.
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RE: Wear and Tear - June 22, 2008 1:24:11 PM
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jnyles
Posts: 5
Joined: July 4, 2007
Status: offline
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Ginger,
I will need to look into my college's school of thought regarding the non-pathology view of pain you mentioned. If they don't offer this other view, I wonder if there is certification, or training I could seek out here in the states? I still need to read the threads you suggested "physiology of spinal pain " and "continuous mobilisation."
Thanks so much for informing me of this idea. Actually, I was just in a bookstore the other day when I happened to come across a book on trigger points. I think it was saying the pain in my arm could come from a trigger point in the infraspinatus, if I remember correctly. Anyway, I wasn't sure how much credence to give to the book, as I haven't heard of that before. I happened to be sore in both R and L infraspinatii (plural??) due to rotator cuff exercises so...
To update on my pain though, this is the third of forth day of pain-free flexion with low resistance I have had. Just gently using light resistance bands. Occasionally there is a brief pain with fast movement of the arm - almost a soreness. The pain has never been above a 2/10 though. I left out many more details about my arm, but I wanted to give a brief summary of the issue, and my interest in learning about injury in PT. Hopefully it was just some muscle strain. Fingers crossed.
I will get to reading your posts, thanks!
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RE: Wear and Tear - June 22, 2008 3:32:21 PM
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jma
Posts: 2415
Joined: August 24, 2000
From: NY
Status: offline
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In the beginning, it was hard on my back, but thats because I thought I could handle heavy loads without asking for help. But it didn't take too long before I started asking and have been relatively pain free ever since. One rule of thumb for me, if I think I can't, then I don't lift heavy without help.
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RE: Wear and Tear - June 23, 2008 1:29:31 PM
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jnyles
Posts: 5
Joined: July 4, 2007
Status: offline
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Crevidence, Ginger, John, Sebastian, Shill, and JMA, thanks for sharing your stories and advice.
No doubt delving into this issue early on should help me to reduce or prevent the occurrence of injuries or pain as a PT.
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