Essay about my internship at Health Works

1. Josiah English
Internship Experience
Internship Project Essay
My internship project is on total knee arthroplasty (TKA), also known as total knee
replacement. Total knee replacement is a surgical procedure to replace any part of the knee that
is weight-bearing on the knee joint, performed to relieve pain or disability. I chose to do my
project on total knee replacement because nearly every day I was assisting patients who were
rehabilitating from total knee replacement.
Rehabilitation for a total knee replacement is based on progression and how the patient’s
body is reacting to treatment or surgery, since every human body reacts differently. Knee
replacement progression usually lasts 3-6 months after surgery. Phase 1 of this progression lasts
a day or two after surgery to 2 weeks; phase 2 usually lasts 3-6 weeks after surgery; and phase 3
is usually 6-12 weeks after surgery. All 3 of these phases will always depend on the progression
of the patient. If the patient does not meet each of the criteria for a certain phase, the patient will
not advance to the next phase. Other factors that have an impact on the patient’s progression are
age, comorbidities, pre-surgical range of motion (ROM), health functional status, strength,
patient’s willingness to do rehabilitation, and learning barriers.
Patient A, an 85-year-old Caucasian female, has pervious medical history of osteoporosis,
stroke, and high blood pressure (HBP). Patient A had total knee replacement on her right knee.
Patient A’s surgery was on 8/5/2021. Patient A completed a month of physical therapy before the
surgery. That previous month of physical therapy turned out to be extremely beneficial to patient
A. My site supervisor said, “ Patient A did much better than other patients after her knee
replacement because she had a month of physical therapy before surgery, giving her the

2. advantage of being stronger, more flexible, and having improved blood flow to the area (from
exercising) which allowed for improved healing time” (PTA, Diane). After surgery, patient A’s
range of motion was 0-120. The 0-120 range of motion is termed within functional limits (WFL).
Phase 1
High pain levels will be at a 7-10; low pain levels will be a 1-3 on the scale. Active
normal range of motion (AROM) will be 0-130. Passive range of motion (PROM) will be 0-130.
Strength at a normal range will be considered 5/5.
The start date of patient A’s physical therapy for her knee replacement was on 8/23/2021
with the following assessment:
- Pain level 4/10; AROM 0-87; PROM 0-94; Strength 2+/5
Patient A started phase 1 by coming into Health Works physical therapy clinic 2-3 times a
week every Monday, Wednesday, and Friday starting 2 ½ weeks after surgery.
Rehab Goals
The physical therapy clinic set up goals for patient A including: restoring range of
motion, active extension of leg without a lag, ROM returning to prior level, safety
transferring, progressing towards ½ of mile walk. Each patient is encouraged and pushed to
exceed more ROM then they have previously, heel striking, and use of available knee flexion
during gait. After the goals were set for patient A, she was ready to begin physical
therapy.Every day that Patient A came into the clinic we would ask her how she was doing
today, how did she feel after the last physical therapy session, and what was the pain like
today.

3. Modalities
The next part was to get the patient set up for modalities, also called electrical stimulation
(E-stim), Electrical stimulation was to help with poor quad contraction and pain. This is the
first step to physical therapy for Patient A, 20-25 minutes of E-stim with lumbar and cervical
hot packs placed on patient’s quad/knee.
Therapeutic exercises
Patient A began her therapeutic exercises right after E-stim. We would have the patient
get on the stationary bike with no resistance for 15-20 minutes or until patient feels pain.
After the stationary bike, the patient would do exercises such as quadriceps set, straight leg
raises, prone hamstring curls, supine heel slides, supine heel down wall slides, leg extensions,
and sit to stand squats on a chair. Patient A did all exercises 3 sets of 10 repetitions, unless
pain started or said otherwise. All of these exercises were given with just body weight. NO
ADDED WEIGHT for phase 1.
Manual therapy
After patient A finished her exercises she received manual stretching or a soft tissue
massage from the physical therapist or the physical therapist assistant. Flexibility is extremely
key after a knee replacement. At the completion of manual therapy we would have patient A use
ice packs on the knee for 10-20 minutes. This concluded the physical therapy treatment that day.
Precautions
Some precautions that I was told to look out for while in Phase 1 physical therapy were to

4. watch incisions for signs of infection or separation, pain or soreness after physical therapy
should not stay longer than 24 hours, and providing the patient education on “hurt vs. harm”.
Patient A did physical therapy treatment in phase 1 for 2 ½ weeks. We saw improvement
of ROM, muscle function was increased , and increased gait. The patient was ready to begin
phase 2.
Phase 2
Patient A started phase 2 on 9/10/2021 with the following assessment:
- Pain 4/10; AROM 0-105; PROM 0-113; Strength 4+/5
For phase 2, patient A still came into Health Works 2-3 times a week for appointments.
Patient A did a tremendous job in phase 1. We were extremely happy for patient A.
Rehab Goals
The new goals set for patient A were to try to get ROM 0-125, increased quadricep
strength during leg raises, progression of strength towards more than just body weights,
functional and normal gait, and using the right knee (affected knee) for equal weight bearing
with sit to stand transfers.
Modalities
Patient A’s treatment began with E-stim for pain and soreness and to help with quad
contraction. Lumbar and cervical hot packs were placed on right quad/knee for 15-20 minutes.
Therapeutic Exercise
After finishing modalities, patient A rode the stationary bike for 15-20 minutes. This was
followed with strengthening exercises such as leg press, sit and stand squats, single leg balance,

5. gastrocnemius strengthening, step ups, lunges partial range, standing knee extensions with
theraband, hip strengthening, core strengthening, and equalizing weight bearing during different
functions. Patient A did 3 sets of 10 repetitions unless exercises are timed or unless knee became
irritated. After finishing exercises, patient A had manual therapy from PT or PTA. This involved
stretching and icing for 20 minutes every therapy session.
Precautions
One of the precautions was that she was not ready to run or jog yet.
Patient A spent 4 weeks in phase 2. We saw continuous improvement in ROM, increased
gait, quadricep function improved greatly, and patient A’s activity tolerance also improved.
Phase 3
Patient A was progressing well with physical therapy at Health Works and with her at-
home exercises. During phase 3 patient A came into therapy 2-3 times a week. Patient A started
phase 3 on 10/7/2021 with the following assessment:
- Pain 0/4; AROM 0-120; PROM 0-120; Strength 5/5
Rehab Goals
Goals set for patient A were ROM 0-125, no lag doing right leg extension, normal gait,
being able to do stairs without handrails, independent transfers, and independent functions.
Modalities
Patient A started phase 3 physical therapy with modalities 1-2 times a week, consisting of
ultrasound for 15 minutes. When patient came into the clinic sore, E-stim and heat were
performed on patient A.

6. Therapeutic Exercise
After patient A was finished with modalities she would ride the stationary bike with some
resistance for about 15 minutes. Next, patient A worked on lateral and multidirectional
movements and continued functions from sit to stand. She also did exercises from phase 2.
Manual stretching performed by the PT or PTA were performed on patient A after therapeutic
exercises were completed.
Precautions
Patient A was advised to not lift over 50 lbs, staying in the 20-45 lb range, and was told
to keep working on flexibility.
Patient A achieved all goals on 10/22/21, completing physical therapy at Health Works.
The month of physical therapy before surgery was so beneficial for patient A that my site
supervisor said, “ I’m pushing for orthopedists to start making it standard protocol to prescribe
physical therapy before surgery because the outcomes are much better” (PTA, Diane). This was a
very successful internship experience especially at the end of Patient A’s therapy. One of the
challenges was getting patient A motivated to do her exercises occasionally, but most days she
was willing to work to get back to full recovery. One of my strengths during this internship
experience was when patient A was not motivated to do therapy, I pushed and motivated her to
exercise. Another strength was my increased knowledge of anatomy during this experience. I am
very thankful for my site supervisor for making me a better student and learning to help patients
recover through physical therapy.