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On my first orthopedic clinical rotation during PT School, I worked with Craig Katko - then the PT for the Connecticut Sun WNBA team and now the PT for the New England Black Wolves National Lacrosse League team. As far as clinical rotations go, Craig was the best instructor for my first time working in orthopedics. I was very lucky to have that opportunity. As I prepare to take my first student, I'm reflecting on what my rotations were like and what helped me most. What I remember from my time with Craig was mirrored in the introductory portion of the knee seminar, and I was grateful for the refresher:
First - Patient history and evaluation components are essential to guiding your treatment, but learning how to do an evaluation, and getting to be good at it, is challenging. Craig recommended that I find an evaluation system that I trusted to use consistently until I was confident in recognizing patterns, and then to later on use as a fall-back plan. He lent me his copy of Grey Cook's "Movement" book to read - and I learned the SFMA - which I used for my rotation with him. Lenny Macrina has mentioned the SFMA in a few of his courses, and every time he mentions it, I think to myself - he's not checking cervical range of motion in a patient with knee pain. (Are you, Lenny?) New grads - you may want to check out the SFMA principles if you haven't yet learned them - especially if you're not confident in your evaluation skills, yet. Now, four years out of school, I don't use the full SFMA for every patient... but I use many of the principles from it constantly. Specifically - I examine neighboring joints proximal and distal to the pain region and check mobility and stability in those regions - both key concepts in the SFMA. These apply to the knee in numerous ways. You must clear the spine with patients who have pain in their extremities, and for a patient with knee pain, you need to consider both the hips and feet. When a patient doesn't fit a pattern that you've come to recognize, the SFMA is always there as an option to re-assess them.
Second - Don’t get too bogged down with diagnostics. As the PT profession moved into Direct Access and patients started coming into the clinic without seeing a doctor first, I was excited to try to identify patient pathologies. What I came to realize was a specific diagnosis usually doesn't really matter! There are a lot of structures involved in the knee (or elsewhere) that need to be checked, but special tests don't have great reliability and use of palpation to diagnose an isolated structure being injured is about as good as guessing. As I've learned more about the biopsychosocial model, and treated more patients, it has become apparent that sometimes specific tissue diagnoses do more harm than good, and they often don't help guide treatment. For example, as described in the Knee Seminar, a patient can have patellofemoral syndrome from numerous causes: foot mobility or control issues, strength deficits or imbalances of the hips, overuse, improper jump-landing mechanics, body alignment considerations... the list goes on. If you tell a patient that their leg is lined up improperly - something that genetically they're unlikely to change - you can create a fearful situation that is unnecessary. I've actually come to prefer referrals that list a diagnosis as "right knee pain" because I'm not treating a diagnosis... I'm treating the specific person sitting right in front of me with their unique presentation. While clinicians do need to be able to explain what's going on to patients, you can do it in a way that will empower the patient/client to embrace their personalized recovery strategy. I work with kids. It's really easy to tell them that I can see some reasons why their knee might be hurting... tell them they're strong... and then give them a home exercise program with some things they can do to make themselves move in new ways that should change the way their body is loaded.
Third - Use functional impairments to guide treatment. I use the slogan "find a problem, fix a problem" as my guide. This might infuriate some of my PT colleagues because it isn't how their belief system works... but there are lots of patterns that can be applied to all body parts for rehab and progressing through these in a sensible manner to achieve optimal function leads to patients achieving goals. For example... if I'm working with someone experiencing knee pain and they can't tolerate going down stairs (function), I can break that down to see why (impairments). Following the progression of working to improve inflammatory processes, then to restoring range of motion, then increasing strength, and finally focusing on proprioception/motor control/higher level activities applies to all knee pathologies, though the timeline of progression varies by person.
So these three concepts were identified in the introductory portion of the Knee Seminar and reminded me of when I first started learning about patient care. I found these concepts valuable to get my career started and have built on them and developed my habits with additional continuing education courses... which leads me back to the Knee Seminar. If you're looking for a continuing education course specific to the knee - this is the most comprehensive one I've seen.
The seminar is broken down into seven key components: 1) examination of the knee, 2) treatment of the knee, 3) ACL, 4) Patellofemoral Syndrome, 5) Meniscus, 6) Articular Cartilage, and 7) Osteoarthritis. There are videos for each section along with some key selected articles. Just like I experienced with their Shoulder Seminar - the articles they picked were really useful and I'm glad to have added them to my library for future reference. The top three considerations that I'm looking forward to implementing in my own patient care were 1) The biomechanics of the knee, particularly with regard to the forces at the patella at different points in the knee range of motion, 2) better understanding of the meniscus anatomy, how it moves, when it is stressed, and considerations with rehabilitation for repair versus removal, and 3) treatment options with regard to articular cartilage pathologies. There are new surgeries (at least new to me) being used to treat these conditions - such as the OATS (Osteochondral Allograft Transplantation Surgery) and the ACI (Autologous Chondrocyte Implantation) procedures. If you're a new grad and you haven't seen these yet, this course helped me understand the procedure and the rehabilitation protocols, but better yet - when you would use these treatments and why the rehab is progressed so slowly. This was a great continuing education course!
Good luck, new grad PTs! I hope this is helpful. And just remember, ask for help. And teach us more seasoned PTs the things you're learning in school so we can all make the profession better!
First - Patient history and evaluation components are essential to guiding your treatment, but learning how to do an evaluation, and getting to be good at it, is challenging. Craig recommended that I find an evaluation system that I trusted to use consistently until I was confident in recognizing patterns, and then to later on use as a fall-back plan. He lent me his copy of Grey Cook's "Movement" book to read - and I learned the SFMA - which I used for my rotation with him. Lenny Macrina has mentioned the SFMA in a few of his courses, and every time he mentions it, I think to myself - he's not checking cervical range of motion in a patient with knee pain. (Are you, Lenny?) New grads - you may want to check out the SFMA principles if you haven't yet learned them - especially if you're not confident in your evaluation skills, yet. Now, four years out of school, I don't use the full SFMA for every patient... but I use many of the principles from it constantly. Specifically - I examine neighboring joints proximal and distal to the pain region and check mobility and stability in those regions - both key concepts in the SFMA. These apply to the knee in numerous ways. You must clear the spine with patients who have pain in their extremities, and for a patient with knee pain, you need to consider both the hips and feet. When a patient doesn't fit a pattern that you've come to recognize, the SFMA is always there as an option to re-assess them.
Second - Don’t get too bogged down with diagnostics. As the PT profession moved into Direct Access and patients started coming into the clinic without seeing a doctor first, I was excited to try to identify patient pathologies. What I came to realize was a specific diagnosis usually doesn't really matter! There are a lot of structures involved in the knee (or elsewhere) that need to be checked, but special tests don't have great reliability and use of palpation to diagnose an isolated structure being injured is about as good as guessing. As I've learned more about the biopsychosocial model, and treated more patients, it has become apparent that sometimes specific tissue diagnoses do more harm than good, and they often don't help guide treatment. For example, as described in the Knee Seminar, a patient can have patellofemoral syndrome from numerous causes: foot mobility or control issues, strength deficits or imbalances of the hips, overuse, improper jump-landing mechanics, body alignment considerations... the list goes on. If you tell a patient that their leg is lined up improperly - something that genetically they're unlikely to change - you can create a fearful situation that is unnecessary. I've actually come to prefer referrals that list a diagnosis as "right knee pain" because I'm not treating a diagnosis... I'm treating the specific person sitting right in front of me with their unique presentation. While clinicians do need to be able to explain what's going on to patients, you can do it in a way that will empower the patient/client to embrace their personalized recovery strategy. I work with kids. It's really easy to tell them that I can see some reasons why their knee might be hurting... tell them they're strong... and then give them a home exercise program with some things they can do to make themselves move in new ways that should change the way their body is loaded.
Third - Use functional impairments to guide treatment. I use the slogan "find a problem, fix a problem" as my guide. This might infuriate some of my PT colleagues because it isn't how their belief system works... but there are lots of patterns that can be applied to all body parts for rehab and progressing through these in a sensible manner to achieve optimal function leads to patients achieving goals. For example... if I'm working with someone experiencing knee pain and they can't tolerate going down stairs (function), I can break that down to see why (impairments). Following the progression of working to improve inflammatory processes, then to restoring range of motion, then increasing strength, and finally focusing on proprioception/motor control/higher level activities applies to all knee pathologies, though the timeline of progression varies by person.
So these three concepts were identified in the introductory portion of the Knee Seminar and reminded me of when I first started learning about patient care. I found these concepts valuable to get my career started and have built on them and developed my habits with additional continuing education courses... which leads me back to the Knee Seminar. If you're looking for a continuing education course specific to the knee - this is the most comprehensive one I've seen.
The seminar is broken down into seven key components: 1) examination of the knee, 2) treatment of the knee, 3) ACL, 4) Patellofemoral Syndrome, 5) Meniscus, 6) Articular Cartilage, and 7) Osteoarthritis. There are videos for each section along with some key selected articles. Just like I experienced with their Shoulder Seminar - the articles they picked were really useful and I'm glad to have added them to my library for future reference. The top three considerations that I'm looking forward to implementing in my own patient care were 1) The biomechanics of the knee, particularly with regard to the forces at the patella at different points in the knee range of motion, 2) better understanding of the meniscus anatomy, how it moves, when it is stressed, and considerations with rehabilitation for repair versus removal, and 3) treatment options with regard to articular cartilage pathologies. There are new surgeries (at least new to me) being used to treat these conditions - such as the OATS (Osteochondral Allograft Transplantation Surgery) and the ACI (Autologous Chondrocyte Implantation) procedures. If you're a new grad and you haven't seen these yet, this course helped me understand the procedure and the rehabilitation protocols, but better yet - when you would use these treatments and why the rehab is progressed so slowly. This was a great continuing education course!
Good luck, new grad PTs! I hope this is helpful. And just remember, ask for help. And teach us more seasoned PTs the things you're learning in school so we can all make the profession better!
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