Finding the culprit

Yesterday's physio session at Ox city after the game revealed a new lesson after discussion with Leigh.

Player comes in complaining of tightness in anterior proximal thigh.

Q. Which muscle is it?

Process: Think what's likely to be tight in footballers? Running. What muscles originate from that area?

A. Narrowed it down to rec fem and sartorius. You had to palpate deep but resisted isometric strength test for sartorius came out on top. Resisted hip flexion did not.

The process of elimination!

I was helping out at Ox city footy club again earlier this week and we came across an acute adductor strain. When trying to diagnose which adductor muscle it was I was given a handy tip by Leigh:

"it's easier to cross off all the one's it's not than try to immediately pick which one it is"

Turned out to be adductor magnus after I'd originally guessed gracilis. When I thought about it, you could quickly cross off pectineus and brevis because they're only one joint muscles and much higher up than where the patient was complaining. Longus potentially but the magnus 2 heads:

Oblique head
ORIGIN: inferior ramus of pubis & ischial ramus
INSERTION: gluteal tuberosity, linea aspera, proximal supracondylar line of femur

Vertical head (hamstring head)
ORIGIN: ischial tuberosity
INSERTION: adductor tubercle

Remember that anatomically speaking the oblique head FLEXES & ADDUCTS the thigh @ hip
(much like pectineus) and the vertical head EXTENDS thigh at hip (like a hamstring!)

The important thing to remember though is that these muscles work differently in function, but that's for another day.

Bronchiectasis

Classed as an obstructive lung disease in which there's localised irrevisble dilation of the bronchial tree.

Involved bronchi DIE! ... By which I mean the bronchi are:

DILATED
INFLAMMED
EASILY COLLAPSIBLE

This results in:

• Airway obstruction
• Impaired clearance of secretions

http://www.youtube.com/watch?v=zMKaJEgmTT4

Causes:
Necrotizing (flesh eating) bacterial infection

S&S:
Look for frequent GREEN/YELLOW SPUTUM
Smell for bad breath
Productive cough

Frozen Shoulder aka Adhesive Capsulitis

Mr. Francis Lam is an upper limb surgeon and shoulder consultant, he gives some really great explanations on frozen shoulder in a simple easy to understand way.

Q. What is frozen shoulder?
A. Essentially a chronic fibrosing condition in which fibroblast cells become overactive and lay down abnormally thick layers of collagen causing marked thickening of the shoulder joint capsule. The capsular lining of the joint subsequently contracts and leads to shoulder joint stiffness and pain.

Q. What are the features of frozen shoulder?
A.

• Slow onset of pain felt near insertion of deltoid
• Trouble sleeping on affected side
• Restriction in both active and passive elevation & external rotation

Q. What's the difference between primary and secondary frozen shoulder?

http://www.shoulderspecialist.org/Frozen_Shoulder.html

See also Bowen technique

ABG's Normal Values

Interpreting ABG's is an important especially if working in a respiratory setting, but to recognise abnormalities you need to know the normal values of blood gases.

pH - 7.35 - 7.45

pCO2 - 4.7 - 6.0 kPa (35-45 mmHg)

pO2 - 11 - 14 kPa (80-100 mmHg)

HCO3 (bicarbs) - 22 - 26 mmol/l

BE (metabolites) - +2 - -2

BELIEF

I'd like to share something that isn't strictly physio related, but in this context involves it.

"Hello it's Thursday the 19th, it's the day after the viva exam and was there any point in worrying? Not at all."

Were my first words that I said on a recording of myself made about a week before my PAM 2 viva exam. I go on to speak about how I was comfortable and settled in very quickly, had an answering for every question, was able to elaborate on every question and that it went better than I thought it would and I had expected it to go well. Also that movement analysis was easy and was just a case of looking and working it out.

I had realised and taken action on the insight about BELIEF and visualisation. The more vivid, the more real, the more tangible you can make it the more likely it will become your reality.
I was constantly thinking and visualising myself doing well, not just well but great! Thoughts enterred my head during this with comments such as "come on, that's not realistic", "you can't really think that, it doesn't happen". But I just suspended those thoughts and accepted that it's just conditioned thinking and not a part of me. Like Tony Robbins advised, I dared to be powerful beyond measure. Or to put it more accurately, beyond expectation. My own expectation to be precise.

If you want to do something that nobody's ever done, that you've never done and/or that you think you can't do. DON'T EVER PUT A LIMIT ON YOUR DREAMS! That is your power! No one can tell you not to dream big, no one can stop you and for every person that says "it's just not realistic" (including yourself) shut them the fuck up! Like Will Smith said, "it's not realistic that somebody could walk into a room flick a switch and light would appear, that's not realistic". Thomas Edison didn't think so. "It's not realistic that someone can mould metal into an object and design it so that it can fly across oceans, that's unrealistic". Fortunately the Wright brothers and others didn't agree with that. Every great moment, every achievement that's wowed and surprised the world and made history has occured as a result of somebody saying "NO!" to thinking realistically and "YES!" to daring to dream, visualise and act upon creating something never done before, something incredible in their eyes.

Reality matched my voice recording to the letter by the way. To the absolute letter and I now have even more belief that the level we vibrate at, that energy you feel when you think of an idea or something you want to do that gets you so excited is sending out a signal to the universe that then conspires to assist you in making that a reality. If this sounds stupid to you, I don't care because it's worked for me on many occasions now and it seems like the more in tune I get with it, the better the results.

My advice to you is this. If you want to do something, be something, reach your goals and dreams start living them in your mind. Really living and experiencing them! If you get a thought that tells you to pull the reigns back because you're getting a bit to ambitious dream even bigger! Great moment are created when beyond achieve things beyond their own expectations of themselves. So work your imagination and stretch it as far as it will go and with action you'll go far :)

Colle's Fracture

Fracture of the distal radius in the forearm with posterior displacement of the wrist

Clincally reffered to as 'dinner fork deformity' due to the resultant shape of the forearm

Usually caused by falling onto outstretched hands (falling on flexed wrists would cause a Smith's fracture)

Common fracture in people with osteoporosis