maanantai 7. toukokuuta 2018

Maitland on a new level

So it once again was the time for some Polish way of thinking! The journey started on 30.4. when rest of Finland was celebrating Vappu, the day of the labour and having a picnic outside with their funny costumes and winter jackets. Nothing stops a Finn to pop a sparkling wine bottle on the eve of, well, on the eve of anything at all.

Anycase, I enjoyed my festive drink in much more regular way and having a coffee at the airport. The level 1 of Maitland was six months away and the fever had started to rise around March. Like last year this spring had been full of changes so the start of new level came pretty fast. 








I knew in advance that level 2a was alot to do with neurodynamics, a topic which I was really looking forward to. I was also looking forward to catching up with people from the first level and it was nice to see that there was around seven of us from last years course in Gdansk. This time there was another teacher in addition to Thomas Horre because there was some English profession involved  with Matthew Newton. Daria was working as an assistant teacher and as a translator so we were definately in good hands. 

In contrast to weeks 2-4 there was more theoretical stuff and lectures, mostly concerning anatomy and pathofysiology of neural systems. We practiced the physical examination and techniques which to apply. Big part of this week was also building the baseline knowledge we had already gone through on level 1 but I did not see it as a minus. In the contrary it was useful to have some extra reassurement for the whole thinking and reasoning processes.












So it seems that manual therapy is somewhat more than passive treatments (it is me being sarcastic, in case someone is wondering). In this week we practiced treatments all and all maybe 2-3 hours in total. 

We had the patients to work with in pairs for three sessions during the course. My and my pairs patient was a young woman who’s biggest problem was neck pain which had started seven months ago spontaneously and gotten worse in last December. She first started physiotherapy in February and since the symptoms had gotten clearly easier - but still she described constant pain sensation on scale 0-10 as 5. 













When we started to screen the asterisks (the familiar symptoms for the patient) it became clear that it was not only a nociceptive problem but also a pain processing problem. The patient was a bit timid about the examination and handling of her neck so the grips and movements needed to be extra calm and firm. Also when testing for example passive neck rotation, you could easily see the muscles around collum to go in this protective spasm to prevent the supposed painful movement direction. When the patient took a couple of deep breaths in and especially out, the muscles relaxed and it was possible to go pain free a bit further. 







All and all after three sessions patient felt improvement especially in rotations and the rest pain was getting less. She was going to continue the therapy with Daria so it was good to know that she had someone to carry on the process and the patient was motivated for it too. 

This case was a good reminder of the never ending influences that pain has when treating a patient. Just the mere thought and assumption of a painful movement direction often leads to secondary problems which can intensify the original problem. She was one of the many who could probably benefit a lot of breathing exercises to calm down the sympathetic nervous system before and after the home exercises. 

















Like I mentioned, this week was clearly the best so far. Somehow it was much more easier keep going knowing that there was familiar faces and surroundings. Almost every week before this my evenings after the studies had gone in a silence in my flat doing crossword puzzles or maybe going for a walk in the old town just by myself. The days felt so intense that as a slightly introvertish type of person I really felt I needed to load my batteries to keep up during the days. 

But on this week? No clues about tiredness or exhaustion. I spend one evening in the flat after going to the beach and chickening out about the swimming in +10 degrees celcius of air and +6 degrees celcius water temperature, howling wind and changing the bikini in a open shore. I felt a bit less of a Finn being the one who was not going nude. I then swallowed my national pride and focused on capturing the whole thing on camera when two Polish went to the not so tempting looking waves.








On Tuesday I was being 100% tourist and went to a ferris wheel in the old town and found again new perspectives how to spend the evenings. On Friday we had our group night where most of us came and spent the evening partly playing Finnish card game called paskahousu. Ofcourse I lost the first game and did not win even the second round to be exact. Before that we went to Westerplatte with couple of friends and under a little pressure I had to start memorizing certain dates and times concerning the World War II. 


















The last day was shorter as usual and all about theorerical stuff. I have a hinch that Thomas saw that we weren’t exactly giving our most energetic presens after the intense week that has been. So it was decided to shorten the day one hour and continue on October on when we could start one hour before we usually start. Fine by me. I felt my brain going on too many knots already.

What were the biggest things from week 5 then? If I said that is was not the importance of knowing where the other upper limb should be during upper limb neural examinations I would probably shoot myself to the leg. So that is one. The second issue would be the importance on planning the upcoming patient sessions. In clinical work it does not go one to one like in the course because the time is sicnificantly limited, but even just a short reasoning process before the is a detail I will apply in daily work. The third is the systematical order in the making of the C/O, more familiarly known as the interview of the patient and figuring out the whole picture from the patients descriptions.











So, here I am again in the clinic and continuing the work I love but just a one week more experienced about the concept I think still has a lot to offer. I even heard someone mentioned the level 2b being held in Warsaw next year. I have a gut feeling that my Polish adventures aren’t quite not finished after next October and week 6. 

Once again I thank everybody on the course of the warm atmosphere and the feeling of being so welcomed. 








- Kerttu

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