Low Back versus Hip Differentiation for First-Year DPT Students

Background

After finishing my first year of PT school and my first clinical rotation, I began developing a desire to go into teaching. I had always enjoyed giving presentations and trying to convey information or ideas to others; seeing lightbulbs go off in the audience while doing this is one of my favorites things to witness. As this desire continued to grow, I knew that during my third year of PT school I would want to use one of my elective courses to have some experience being a teaching assistant for a class in the program. With my passion for orthopedics, I knew I wanted to be a TA for either Musculoskeletal (MSK) 1 or 2, but preferably MSK 1. In this course, the first years cover the entirety of the spine and the shoulder; two areas of the body I really enjoy examining and treating. When discussing with the professor of this class, Jeff O’Laughlin, he mentioned to me in a meeting that there was a new lecture that the faculty were wanting to add to the curriculum because of some feedback that had been given from various clinical instructors over the years. The topic was low back versus hip differentiation, so essentially learning how and when to decide if the low back or hip was more implicated with a given patient. I loved this idea and thought it would be incredibly useful for both the first-year students and myself. Taking up this topic provided me with the opportunity to give a lecture in front of a first-year class and gain teaching experience. This project also provided me the opportunity to delve into information that I thoroughly enjoy and give myself a much needed refresher.

 

Statement of Need

There has been a large amount of feedback from clinical instructors over the past several years regarding the level of preparation that students seem to have when arriving for their clinical rotations. A reoccurring suggestion that has been received from these clinical instructors, specifically after having a first-year student, has been that these students would benefit from having more education on differentiating between low back and hip pathology during the examination process. First-year students receive education on the examination process as well as how to evaluate and manage pathologies regarding the entirety of the spine and the glenohumeral and scapulothoracic joints. However, hip pathology, examination, and management are held off until these students enter their second year of the DPT program and after completing their first clinical rotation. With the hip and low back being in such close proximity to one another, hip pain and low back pain can present similarly. First-year students would greatly benefit from some basic examination skills that could help them discern when the hip or low back may be more implicated before entering their first clinical experience.

 

Purpose

My lecture will serve to provide information on how to delineate between hip and low back pain by using the subjective information given by the patient and the objective information that can be obtained by the therapist in front of them. This lecture does not cover specific hip pathologies or management skills into great depth, as this information is reserved for the second-year course Musculoskeletal 2. My products were developed to review pertinent information that the first-years have already learned and provide some new, basic skills and knowledge to bolster their examination abilities. Time during my lecture will also provide opportunity to practice some of these new skills and apply them to clinical scenarios via patient cases. My “cheat sheet” also provides them with an easy and convenient way of accessing information regarding the special tests that were covered; something that could be handy during their first clinical rotation.

 

Products

Slides for the presentation:

Low Back vs Hip Differentiation Presentation

A hip special test “cheat sheet” for the students to use on their first clinical rotation:

Hip Special Tests Handout

Two different copies of the patient cases:

Patient Cases – Student Copy

Patient Cases – Instructor/TA Copy

Form used for evaluation:

Presentation Evaluation Form

 

Evaluation & Self-Reflection

I utilized the form above to allow the first-year students and the instructor of the course, Jeff O’Laughlin, to evaluate my lecture and presenting skills. From the feedback I received, a majority of the comments were positive. However, there were some critiques. One complaint that I noted from a couple of students was that they preferred to have a presentation to take notes on. I did not upload my presentation for the students to have until after I gave my lecture. This was to keep them from seeing the answers to questions that I was going to ask them, as I was trying to keep the presentation fairly interactive and wanted to see how they were thinking. In the future, I suppose I could create two different sets of slides, one for me to actually present with and one for students to use that did not have the answers to the information in it. This way the students will not have the answers in front of them but they will have some form of document that may facilitate note-taking better. Another critique I received was over my preparation for going over the cases with the students. I had additional information on my phone to provide as the students were able to ask various questions. Unfortunately, the document closed out on accident and it took me a moment in class to pull it back up. That was a preparation issue and it likely would have been better to have the additional information on a physical sheet with me. The last major critique I received was for me to be sure to offer up typical patient presentations when taking objective measures. I went over skills the students already possessed, like checking range of motion and manual muscle testing. However, I forgot to bring things more full circle, in regard to these objective measures, by educating them on what they might experience with a patient with more hip involvement (decreased or painful hip motion, weak or painful hip manual muscle testing, etc.). All of these critiques will serve as stepping stones as, I continue to sharpen my teaching skills through various opportunities. On a positive note, the students who returned their feedback forms all agreed that the material was conveyed adequately and that my presenting methods made staying engaged easy; these were the most important aspects to me. Staying engaged during the last hour of a 4-hour class can be difficult. I know this first hand, because I was in their shoes very recently. Conveying the information sufficiently and in a manner that was engaging were my greatest concerns and I am glad that it seems like I was able to accomplish that. I received many positive comments regarding the benefit the students pulled from being able to practice the special tests that we covered and being able to take the information from the presentation and apply it to patient cases. I was glad that the additional lab time and time spent on the cases was appreciated and helpful. I certainly have some things to work on, in terms of presenting, but much of the feedback I received let me know that I was on the right track. The time spent on this project also provided me with a much needed review as well. I found it very beneficial to review special tests and delve back into the similarities and differences that can be found between patients with low back pain and patients with hip pain. The time spent on this project is certainly going to have an effect on how I structure my examinations going forward for these patients

 

Acknowledgments

Firstly, I would like to thank my primary advisor, Jeff O’Laughlin, for his feedback and guidance throughout the past four months. He is a great wealth of knowledge and proved to be invaluable to the process of putting this Capstone together. Jeff has been a great help to me in more ways than one and I greatly appreciate his time and effort.

Next, I would like to thank Rani Helvey-Byers, who is a current orthopedic residency student at UNC and was my instructor during my Integrated Clinical Experience. Rani served as one of my committee members and helped me a great deal by providing on-going feedback and by meeting with me to assist in creating the patient cases.

Lastly, I would like to thank Sarah McAuliffe, who is an Orthopedic Clinical Specialist and Fellowship trained. Sarah was able to provide valuable on-going feedback for my presentation and other products that may have otherwise been missed had she not been a part of my committee.

Jeff, Rani, and Sarah – You three helped me so extensively on bringing my Capstone to fruition and I am incredibly grateful for your help. It was a joy putting this project together and it was a joy having you all be a part of it.

To my UNC DPT ’23 classmates – I am incredibly proud of the work you have all put into these projects, this academic year, and the almost three years of PT school that are soon coming to a close. You have all made a great impact on my time here in this program and I am forever grateful for you all.