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PT School Clinical: TMJ mobilizations, Modalities, and SOAP Notes

This post is included in a 5-part series about my part-time clinical in PT school, which occurred during my 2nd year of physical therapy school. Click the following links for the complete series:

Day 4

I’m still getting more and more comfortable with being in the clinic. I’m working on trying to learn as much as I can before my full time clinical affiliation this winter.

Today I learned about temporomandibular joint (TMJ) mobilizations. My CI had to put on a glove and insert her finger into the patient’s mouth in order to effectively mobilize the jaw. I believe the patient had a whiplash injury, so they had tight neck muscles and a decreased range of motion as well.

I also learned about using heat or cold with e-stim while performing joint mobilizations to prevent muscle guarding, which was really interesting because we haven’t talked much about combining different modalities together in class.

I also learned about radial and median nerve tests, which we haven’t learned about in class yet. We did learn about several ulnar nerve tests in class though, including tinel’s sign at the elbow, elbow flexion test, wartenberg’s test, and froment’s sign. I also learned about the Spurling test and saw cervical distraction while the patient was in supine (we learned it over the summer, but the patient was sitting on the edge of a table). The third year student that is also at my clinic was teaching me the biceps load tests I and II. It was nice to see a third year student at the clinic because it was reassuring that I won’t be expected to have a busy case load at the beginning of the full time clinical next year.

I also learned how to perform a posterior pelvic tilt by laying supine in a 90-90 position, having the feet rest on a chair, and then using the hamstrings to do the pelvic tilt. I tested this out myself, but I was on a treatment table, the chair was on top of the table, and my CI resisted the adduction instead of me squeezing a ball (I think a patient was using the ball at the time). We also didn’t lift the pelvis off the table, but just performed a posterior pelvic tilt by digging my heels into the chair. You can watch the video below to see something very similar to what we did:

I also learned what chin tucks are, as I initially taught a patient the incorrect exercise and had to ask my CI how to actually perform a proper chicn tuck.

I struggle with explaining exercises and coming up with ther-ex to give patients, so I need to do some extra studying and practice with classmates to improve. I was never a tech so I’m learning most of the ther-ex from scratch, but it feels like a lot of my classmates are already confident in teaching the exercises to patients.

Two of our professors held a SOAP Note Workshop this Friday and I learned a lot of helpful  information. I realized that I should be writing down the ther-ex that each patient is doing to help me with coming up with exercises and understanding the progression over the course of the patient’s treatment. I also need to read the documentation more and write down the specific phrasing that the PT’s use, since sometimes I struggle with how to word certain sentences when I write my own notes.

I still have a lot to learn, and I’m excited to start preparing for the full-time affiliation this Winter.

Have you learned about TMJ mobilizations? Have you experienced them personally? Share your story!

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