Clinic Reflection 10

Date: 22/02/2021

What Happened?

This was an online follow up call with a previous patient presenting ankle injuries. This patient stood out to me because not only was he suffering with physical injuries, he was also really open with how he is struggling with his mental health. During the call, I could notice his hesitation to talk about how he is getting on with the exercises I prescribed him so I was making sure that I re-insured him that his quality of life should come before any exercises that I was giving him. I sat back during this call and let him take the session as it gave him an hour to talk to someone about whatever he wanted to really. I felt like this was the best way to approach the session as he may, like a lot of us, feel lonely and feel the need to talk to someone.

 

What did the experience mean?

The experience was different to what I generally experience with patient calls but this one was definitely one I could learn from. I was able to sympathize but also remain professional and it allowed me to re structure my plans to fit around his lifestyle. It has made me more aware of patient’s personal lives away from what I see in the clinic.

 

What are the next steps?

I am now going to put that into practice and make sure my rehab plans fit around my patient’s lifestyle’s. For this patient in particular, the main problem was that he cannot seem to get a good night’s sleep and he finds exercise sessions very tiring. Due to this, I have adjusted their program to fit their lifestyle and make it less strenuous and fatiguing. For example, I have taken away an ankle mobility exercise from the session and asked him to complete the sets whilst at his desk during the day when doing his university work. Another example is to stand on one leg when making his coffee’s during the day. This way we are still getting in the exercises with the aim of spreading it out across the day.

Clinic Reflection 9

Date: 14/01/2021

What Happened?

This was my first video consultation of the year and it was good to be back after the Christmas break. It was an unusual experience for me because this was my first time consulting a minor. My patient today was an 11 year old boy complaining of knee pain and all aspects of the assessment pointed fingers at Osgood Schlatter’s disease. At the beginning of the session, I was still communicating to him as I would with an older patient, after noticing myself do this, I had to alter my language and vocabulary to suit a younger patient.

 

What did the experience mean?

The experience allowed me to adapt in an unfamiliar environment and it pushed me to use my speaking skills to communicate with a younger patient. I also had to try and prescribe exercises that were not too difficult and were interesting so that the patient would adhere. I feel better and more confident in speaking to younger patients now.

 

What are the next steps?

Since the session took place and speaking to the patient’s father, he has let me know that the pain has reduced, and the patient is back playing surfing and partaking in the activities that he enjoys. The load has reduced but is slowly being increased to allow the patient to continue to partake in the activities that he likes whilst avoiding further pain.

Clinic Reflection 8

Date: 04/12/2020

What Happened?

Yesterday in clinic was our last time in before we break up for Christmas. Unlike previous weeks, this session only included one face to face and the other appointment was an online checkup. It was a relatively easy day; I did not feel rushed and I was well prepared as I prepped the sessions the night before. My online patient today was complaining of a really peculiar elbow pain which I was struggling to “diagnose” (I know we cannot really diagnose injuries). Previously we had been through exercises and tests face to face but unfortunately, he fell ill recently so was unable to complete the full treatment plan. I had thorough conversations with both Alex and Mike about the symptoms, onset, and aggravating factors etc. and we still were unsure. Together we roughly narrowed it down to about 3 or 4 different possibilities. Whilst I research more into this, I gave the patient a couple of easy exercises to complete.

What did the experience mean?

Comparing my abilities from back to my first clinic shift to now, I can see a massive improvement in aspects such as my confidence and excitement to learn alongside communication, practical and online skills. I know I bang on about how my confidence is always growing but, I would not be saying it without believing it. I have grown up with an external confidence and internal insecurities for most of my life but being in clinic and working towards something I genuinely am so passionate about is slowly but surely transitioning those insecurities from a negative to a positive state.

What are the next steps?

Returning back to the end of the first paragraph where I touched upon a patients unknown shoulder injury, I am hoping to research this over the course of the next couple days to see if I can figure out what it may be. The symptoms that the patient is receiving look like it could be a tendinopathy, plica or even as mike suggested, damage to the ligaments in the elbow. What I will be looking for in the research is finding different causes and alleviations of pain between these 3 injuries and I will be able to compare the findings with the patients assessment. I will return to this reflection with the reading once I have done it.

Clinic Reflection 8

Date: 04/12/2020

Hours completed: 6

What Happened?

Yesterday in clinic was our last time in before we break up for Christmas. Unlike previous weeks, this session only included one face to face and the other appointment was an online checkup. It was a relatively easy day; I did not feel rushed and I was well prepared as I prepped the sessions the night before. My online patient today was complaining of a really peculiar elbow pain which I was struggling to “diagnose” (I know we cannot really diagnose injuries). Previously we had been through exercises and tests face to face but unfortunately, he fell ill recently so was unable to complete the full treatment plan. I had thorough conversations with both Alex and Mike about the symptoms, onset, and aggravating factors etc. and we still were unsure. Together we roughly narrowed it down to about 3 or 4 different possibilities. Whilst I research more into this, I gave the patient a couple of easy exercises to complete.

What did the experience mean?

Comparing my abilities from back to my first clinic shift to now, I can see a massive improvement in aspects such as my confidence and excitement to learn alongside communication, practical and online skills. I know I bang on about how my confidence is always growing but, I would not be saying it without believing it. I have grown up with an external confidence and internal insecurities for most of my life but being in clinic and working towards something I genuinely am so passionate about is slowly but surely transitioning those insecurities from a negative to a positive state.

What are the next steps?

Returning back to the end of the first paragraph where I touched upon a patients unknown shoulder injury, I am hoping to research this over the course of the next couple days to see if I can figure out what it may be. The symptoms that the patient is receiving look like it could be a tendinopathy, plica or even as mike suggested, damage to the ligaments in the elbow. What I will be looking for in the research is finding different causes and alleviations of pain between these 3 injuries and I will be able to compare the findings with the patients assessment. I will return to this reflection with the reading once I have done it.

Patello Femoral Pain Syndrome (PFPS)

Patellofemoral Pain Syndrome (PFPS) nicknamed “runners’ knee” is the one of the most common cause of knee pain in sport, especially in runners, hence the nickname (Thomeé, 1999). It can be caused by imbalances in the forces controlling patellar tracking during knee flexion and extension and particularly when the joint is being overloaded (Dixit, 2007). It is also widely accepted that it is caused by an increased patellofemoral joint stress and the wearing down of articular cartilage (Collado, 2010). It is commonly found that patients with PFPS have a distinct lack in knee extensor strength (Thomeé, 1999). There is also belief of a pattern of weaknesses in eccentric muscle strength within the quadriceps muscles (Thomeé, 1999). One study found that correct sport specific biomechanics may decrease the risks of injury (Weiss & Chris Whatman, 2015). By learning to move properly makes it more efficient for the body which in theory should reduce the chances of injury. My aim with this information is to create an exercise program which will in theory, decrease the chances of athletes developing patellofemoral pain syndrome. Although it is near impossible to completely prevent an injury, I as a practitioner can prescribe prehabillitation program’s in attempt to reduce the risk of these injuries occurring (Heidt, 2000). Physical rehabilitation programs to treat anterior knee pain have proven to be a highly effective non-operative option (Waryasz, 2008).
Patellofemoral pain syndrome gets the nickname runners knee because it is a common injury to receive in runners. Out of all the injuries runners get, it is said that at least 25% of those injuries are PFPS (Dixit, 2007). Although it is a common running injury, people who partake in all sports are at risk of developing it. Basketball players, gymnasts, any sport that contains lots of running and jumping along with every day people are at risk of developing PFPS.

When creating a prehabilitation (prehab) program, all risk factors should be accounted for. PFPS specific risk factors that will be encountered when creating this program will predominantly include the risk of overloading the joint, anatomic anomalies (hypoplasia of the medial patellar facet), altered biomechanics, muscle dysfunction and taking into consideration for any possible previous injuries/surgeries. Overloading the knee joint will cause unnecessary stress on the quadriceps, patella, ligaments, and other surrounding anatomical structures. The prehabilitation program is designed to strengthen these areas and prevent injury, not weaken and cause further injury. Previous injuries from the hip downwards will influence the program design for these athletes due to some structures already being weakened. For example, if the athlete has had previous knee pain, the practitioner needs to find and understand the cause of this pain before pursuing the program. Another common risk factor that should not be forgotten about is the risk of developing patellofemoral osteoarthritis. This disease occurs due to the loss of cartilage within the patella (Kim, 2012). Kim et al, reported that valgus knee alignment has been proven to increase the risk of developing patellofemoral osteoarthritis and the direction or force of the quadriceps femoris can also be of influence to the progression of the disease (Kim, 2012). Knowledge of these risk factors will allow me to create a program around these concerns in aim of providing exercises with the most beneficial, low risk outcome.

The knee joint is a complex configuration of muscles, joints, ligaments, tendons, and cartilage. The main knee extensors are a group of muscles called the quadriceps. This group is made up from the vastus medialis (medial side), Vastus lateralis (Lateral side), Vastus intermedius (middle portion) and the rectus femoris (largest quadriceps muscle). On the posterior side of the thigh, you have the hamstrings which are the primary flexors for the knee joint. The hamstrings consist of 3 muscles, the semitendinosus (medial side), the semimembranosus (medial side) and the bicep femoris (largest and most lateral). With this information and the findings of Thomee et al, the program can begin to look at focusing on stabilising the muscles and tendons that surround the patella and knee joint. Thomee et al found a common trend that people with PFPS were likely to be lacking strength from their quadriceps muscles. By progressively building strength in this area, especially in the eccentric phase of the quadriceps muscle, we should be able to begin to reduce the risk of developing PFPS.
Isotonic eccentric training of quadriceps muscles have been found to be effective in decreasing pain and increasing functional performance of patients with patellofemoral pain syndrome and is a suggested method of treatment (Eapen, 2011). The program must also work behind the law of progressive overload to create muscular hypertrophy safely without causing unnecessary loading on the joint which could have a detrimental effect (Kim, 2012). Alongside strengthening the quadriceps (knee extensors) we need to strengthen the hamstrings (knee flexors). Research suggests that there is a common trend that patents with PFPS have tight hamstrings (Kwon, 2014). With this information, the program can include stretches and strengthening exercises for the hamstrings. Having properly functioning muscle groups around the knee joint will influence correct biomechanics of the knee and as we already discussed, this is helping to reduce the risk of developing PFPS.
So, to develop a good injury prevention/ prehabilitation exercise program, the therapist needs to analyse the patient’s performance goals and work around their lifestyle. Whether this be an add on to their current exercise routine or for this to be the main focus. The prehab exercise program needs to be focusing on growing and strengthening the muscles and structures surrounding the knee in order to reduce the risk of developing Patellofemoral pain syndrome.

10 Links and 5 Blogs That Helped Me This Year

10 Links That Helped Me

https://www.studiosity.com/
https://www.marjon.ac.uk/student-life/marjon-futures/
https://www.screencastify.com/
https://www.marjon.ac.uk/margen/
https://scholar.google.co.uk/
https://www.nhs.uk/

Are Ice Baths Overkill?


https://www.auckland.ac.nz/en/about/news-events-and-notices/news/news-2017/02/ice-baths-no-good-for-muscle-recovery.html
https://www.youtube.com/
https://breakingmuscle.com/fitness/the-critical-art-of-recovery-for-crossfitters
5 Blogs That Helped Me
https://www.revolutionsportsinjuries.co.uk/blog
http://www.performancesportstherapy.net/blog/

Front Page


https://www.bettermovement.org/
https://bodyinmind.org/

3 Courses Alongside My Degree

3 Courses Alongside Sports Therapy

The first course that I would choose to go on to aid my sports therapy practice would be to complete a crossfit level 1 coaching course. The reason behind this choice is because I myself enjoy the sport and take part in it 4 to 5 days a week. Being able to combine my sports therapy knowledge with crossfit will enable me to use different rehabilitation techniques with my patients. It will also allow me to branch out into the crossfit community therefore being able to treat patients in an environment that already suits my passion for the sport. Combining the 2 will create more enjoyment in my work and push me to work harder in my practice.

The second and third course that I would choose to take part in would be an acupuncture course alongside being trained in edge mobility and suction cupping. Having a wider range of qualifications within sports therapy will enable me to give my patients the most effective treatment I can. Without additional courses alongside sports therapy my scope of practice would be relatively narrow. With the more courses and qualifications that I have, it will create more opportunities for me to learn as a therapist.

Placement Page

Placement Page

Living an hour away from the closest city its harder for me to plan my travel ahead with factors such as traffic, accidents, regular road closures and such. So for my placement I would prefer it to be within a 10 mile radius. Tavistock is my nearest town and its only 5 minutes away. The reason behind this is because I want to be on time every morning and I don’t want to let my team down by being late for work. Time management is a huge responsibility in which I take pride in having. For my placement I would love to work in a relatively small environment which provides quality over quantity. There are a few sports clinics around the tavistock area that I am going to look at and if I feel like I could see myself working their after my course then I will enquire about placements. Personally, I don’t think there is any point in spending a years placement in an environment which you wouldn’t see yourself working in in the future. I am going to be looking for a clinic which provides a wide range of treatment so that I can learn as much as I can throughout the placement year. I am really looking to gain as much learning experience as I can to help me really push towards my end goal of becoming a qualified sports therapist.