Name: Magdalena Letki

Journal for Module 2 Dates: 01/20/2019-01/27/2019

Site location (Name of facility): Moncrief Army Health Clinic
Supervisor’s Name: 1LT Lindsey Duckworth

Describe the four most significant experiences that happened to you this week. Why are
these experiences important to you?

1. I learned about a tracking system, it was one of the most advanced technological things
that I have seened. It is often used to treat radiating nerve pain. Patients are put into the
machine by essentially getting “strapped in” that is connected to a chord. This cord pulls
on the body in the opposite direction. This treats the nerve pain by stretching the spine
out. The spinal facets where the nerves run through are opened up to relieve a pinched
nerve or pressure. I discussed how one can do manual tracking as well. It made me
think of a technique another therapist I have shadowed before would do. She would do
manual manipulations of the spine to reproduce and then ease off nerve pain. We
discussed how she prefers tracking for radiating nerve spain as a treatment. I realized
that there are many different ways to treat things and that different therapists have
different beliefs and techniques. I also realized that a therapist needs to remain open
minded because some patients could respond to treatments differently than others.
There is not always one correct answer.
2. 1LT Duckworth told me about how she learned a type of order for treatment in school.
The three R’s: reset, reinforce, reload.The reset phase of the body seemed self
explanatory to me. You basically need to reset the body to its “proper” form. If it is
inflamed, that needs to be reduced. If the muscle is tight, it needs to be stretched to get
the proper muscle length and mobility back. Once the body is reset, the goal is to protect
the reset by reinforcing it. This can be done with protective and corrective measures to
maintain the reset. Then the body can be reloaded via exercise to establish motor
control again. I thought that this was a very good concept/theory to use when tackling
treatment.
3. 1LT Martinusek decided to treat muscular hip pain on a patient with dry needling (this
would be the reset phase. He said something that promoted a lot of thought. He had to
drape the patient so that nothing was showing during the treatment. He said “actually,
one of the first things you learn in PT school is how to drape patients, if you can maintain
dignity and trust your patient will listen to you”. This really plays into the psychological
and emotional aspects of treatment. It is important to establish trust through respect and
honesty with patients. I have learned the importance and difficulties of this. I have seen
that it can be difficult telling patients certain things. Often people want to “get back” to
where they were much quicker than possible or they might not even be able to.It is
difficult to disappoint patients but important to be honest or else they will lose trust later.
This could affect their opinion of the entire field of physical therapy or medicine
practitioners itself.
4. 1LT Duckworth discussed the force and velocity curve with me as one of the
explanations for why a treatment was working. It was really cool because in Exercise
Physiology and my Biomechanics class we spent a lot of discussing it and I could see it
in action on a patient! It felt really great to know that what I have been studying in school
applies so directly in the career path that I am pursuing. This came up when a patient
was complaining of anterior shoulder pain. This is often the cause of irritation of the
biceps tendon that connects right on the inside of the shoulder joint. It easily gets
inflamed and causes pain. Her preferred way of treating it is with eccentric extension of
the elbow to put tension through the tendon and strengthen it. I began asking her why
concentric didn’t work, it does work but not always as well as eccentric. She gave me a
report to read that compared the results of concentric and eccentric tension loading.
Heavy slow resistance training which is a concentric movement has been seen to be
causing quicker improvements of strength but can be more uncomfortable for patients.