May

05/05/2021 5

I was quite nervous for my first client as the notes for the remote consultation expressed that they were unsure of the clinical impression, and it was upper body. During the assessment, I originally thought that she patient has tendinitis of the supraspinatus. However, when the supervisor came in to double check everything, they found that it was instead a pectoralis tendinitis. My incorrect diagnosis made me feel nervous and incompetent. I had revised upper body injures before this session but still managed to misdiagnose. I will definitely do even more work to try and get my head around upper body injuries. We gave the patient some exercises which again, I wasn’t the most confident in. After the session, I wrote up the notes and created a plan for progressions and regressions for exercises.

Following this, I had an online appointment with a patient with decreased range of movement in external rotation of the shoulder. I felt confident in this online assessment, and I had a good idea of what the injury could be. This helped boost my confidence in my abilities following my previous client. After the appointment, I wrote up what assessments should be done in the next session.

After this, I had another online appointment with potential chronic ankle instability. I am very confident in treating ankles, so I found this appointment quite easy. After the appointment, I wrote down what assessments could be done and wrote down some potential exercises that could be given.

07/05/2021 3

My first patient was the client with the meniscus tear. This week, we progressed his exercises and got him on the anti-gravity treadmill. I forgot how to set the machine up so it was good to have a refresher. I felt very confident when treating this patient as I feel like its my most knowledgeable area. We had some issues setting up the anti-gravity treadmill at first but soon figured it out. I was getting confused about the maths in terms of what % of gravity we should be using for him, and what higher and lower gravity would feel like. This is usually something I would beat myself up about, but I have recently realised that I might have dyslexia or dyscalculia, and I have a screening booked in a few weeks. This made me not feel so bad about getting confused. Following the appointment, I wrote up the notes and created a plan for next week.

After this, we had a patient who has been referred from the osteopathy clinic. The patient was presenting with SIJ dysfunction. We prescribed him with some lower body exercises, targeting mainly where his pain was around the gluteus medius area. I felt quite confident in dealing with this client, even though before I was quite nervous due to them coming from an osteopath. After the session, I wrote up the notes and then wrote down some progressions or regressions for the exercises we prescribed for him.

14/05/2021 5

I felt confident going into clinic today, after having revised upper body injuries and having some good experiences with a multitude of different injuries lately.

My first patient with the patient with a meniscus tear. Today, we were able to get in the gym and run a session. I found this really enjoyable as we were able to do lots of functional and proprioceptive work. The patient also really enjoyed themselves and we both had a laugh which was really uplifting and nice. I think I managed to keep a good balance between professionalism and fun which I am really proud of myself for. The patient was really keen on his exercise progressions, so I am hoping this will help him adhere well at home. After the session, I wrote up the notes and then made a plan for next session.

The second patient was the patient from a couple of weeks ago who had pain in their metatarsal joint in the foot. She has progressed so much which was really lovely and confidence boosting to see. During the session, we were able to run through her exercise progressions with her which she really enjoyed. She admitted that whilst she had completed some of the exercises, she hadn’t completed all of them. So, in order to aid her adherence we let her take videos of us doing the exercises to help her remember then better. I felt this session feeling happy and confident. After the session, we wrote up the notes and wrote down some ideas for exercise progression.

After this, we had an online consultation with a patient who had knee pain. Our immediate clinical impression was either PFPS or meniscus damage. After the session, we wrote down ways to differentiate between each injury and thought of some potential exercises. This patient is very elderly so this is something we are going to have to take into account. At first we struggled with exercises that may be suitable for an elderly man for this injury, so this is something I am going to further look into in case he isn’t that mobile.

19/05/2021 3

My first patient was a patient who we had previously thought had a pectoralis tendonitis. Upon assessment of this patient previously, I thought the patient was presenting with a supraspinatus impingement or a cervical radiculopathy. However, when the intern came in to review what we had found, she informed us that she thought it was a pectoralis tendinopathy. During the session today, one of our supervisors came in to see how we were doing. After discussion, they informed us that they thought this patient was instead presenting with a cervical radiculopathy or a supraspinatus impingement. This was what I had originally thought the client was presenting with, so this restored my faith in my knowledge. After the first session we had we this client, I felt extremely unconfident in my abilities, seeing as I had completely misdiagnosed the injury. However, this event showed me to always question and to always trust myself as a therapist. We gave the patients new exercises, wrote up the notes and made a plan for the following week. After this, I planned for my next client.

My next client was someone I had been seeing regularly who had global muscle weakness and chroic pain. When she came in today, I gave her progressions on her exercises and massages her upper fibres of trapezius. I am really glad I’ve had the opportunity to treat a client with chronic pain, as it is really good experience for the future. I had planned a light yoga session to complete with her, but at the session she stated that she instead just wanted a massage. After the session, we wrote up the notes and planned how to progress her exercises for the next session.

21/05/2021 5

My first patient in clinic was an online consultation with someone who had anterior knee pain. The consultation went well and I am very used to writing up notes and delivering the subjective assessment virtually now. Knee pain is something I had seen a lot of in clinic, so this was quite easy to see what the potential problems could be for this client. After the appointment, I wrote up the notes and made a potential plan for a session for when they come in.

Following this, I had a face-to-face appointment with someone with patella femoral pain syndrome. Again, this is something I have dealt with a lot in clinic so I felt super confident delivering the assessment and giving the player exercises. After this, I wrote up the notes and made a plan for the following session.

After this, I had a patient with a facet joint dysfunction. This is one of the injuries I have dealt with the least in clinic and at my other placement. However, I still felt confident delivering the assessment and giving the client exercises. Sometimes with back pain I struggle with knowing what level of exercise to give each patient but recently I have got a lot better at deciphering what is appropriate. After the session, I wrote up the notes and made a plan for next session.

25/05/2021 1

For this session, I was with a client I treat quite regularly. Last week, I planned a yoga session for her to complete with me, but instead she only wanted a massage. This week, the same thing happened. Although this week, she mentioned that she had some lower back pain so I assessed her lower back. Upon the assessment there was a lot of bruising on her lower back, so I asked her if she had a fall however, she couldn’t recall. Because of this, I instead massages above the bruising after getting confirmation from my supervisor. This is something we are going to keep an eye on and re-assess next week, especially if the bruising is still there. This was something new that I hadn’t dealt with before, but I felt quite confident in my abilities.

28/05/2021 3

My first patient was someone I had been working with for a while. He had torn his meniscus in his medial knee. This week, instead of taking him into the gym I had to regress his exercises as he said that his pain had got worse. This is one of the first times I had to regress exercise as usually the patients I had dealt with had actually improved. But, I felt very competent to do so. Also during this session I gave him ultrasound, which is something I hadn’t done in a while. I had to refresh my memory of the settings but as soon as I did, I felt confident in delivering it. After the session, I wrote up the notes and then made a plan for progressions and regressions next session.

After this, I had an online consultation with a client who seemed to be presenting with golfer’s elbow. The appointment ran smoothly, and I was glad to have a client with an upper body injury as I am usually dealing with lower body injuries. After the appointment, I wrote up the notes and made a potential plan for the session.

Following this, I had a face-to-face client with a patient who had patellofemoral pain syndrome. In this session, we went into the gym and I progressed their exercises further. Again, the knee is the most common body part I’ve had to treat so I felt confident in doing so. Going in the gym was enjoyable and we managed to get the client doing lots of things they hadn’t done before. After this, I wrote up the notes and made a plan for next session.

April

16/04/2021 5

Going into clinic today I was feeling super confident. I have learned a lot throughout this year at placement as well as during lectures.

My first client was an online consultation. I felt confident in conducting these now and I always took down detailed subjective notes. The patient was presenting with a very interesting pathology, to which she had pain in every movement of her neck and shoulder. She is classified as disabled and had a stoke a few years ago. I was unsure of a clinical impression at this point, but invited her in for a face to face to go through an objective assessment with her. Despite not being sure of the clinical impression, I still then planned for a variety of outcomes in terms of exercises and treatments.

Following this, we had a patient who had been diagnosed with an S1 disc herniation. She had been given exercise for this and now has no back pain. However, still gets a sharp nervy pain in her posterior thigh, down to her calf. For treatment, we put her on the traction machine. I wasn’t confident in using the machine, but the other student therapist was so I learned from them. This is something I want to work on outside of clinic, potentially by watching videos to get a better idea of how the machine can be used. Following the session, we wrote up the notes and made a long term plan for the patient including exercises they can do.

Subsequent to this, we had a client with a suspected disc herniation. During treatment, I knew that extension movements were good for treating disc problems, but I had never thought about how to actually complete these when not standing. When I thought about it in the session it became clear that being in some sort of cobra pose would be the best position. However, this was something I hadn’t thought about before so it was good to put it into practise. Dealing with patients in a great deal of pain often gives me anxiety as I am always afraid of hurting them more, despite being supervised in my decision making. Following this session, we wrote up the notes and then made a plan for what to do in the next session depending on whether the patient was to progress or regress.

 

23/04/2021 5

Again, today I felt quite confident coming into clinic. My first patient was with someone with reactive lateral epicondylitis. Due to this being one of the injuries in the rehabilitation exam, I felt confident giving this patient exercises. Following the session, we wrote up notes and made a plan for progressing the exercises, which I also felt very confident doing.

Following this, I had the patient that I had triaged last week. Usually in clinic I haven’t been able to see the same patient more than once or twice, so I have been unable to see their progressions. So, I have started to make sure that the patients I see are booked in with me so I can start seeing them start to finish. Upon assessment of this lady, it was clear that she had a lot of hypersensitivity as global muscle weakness, most seriously to her upper body. Due to her hypersensitivity, we requested to do a hydrotherapy session with her, as all land based movements were causing too much pain.  I hadn’t dealt with a patient who had some sort of psychological pain yet, so I found this patient very useful for my learning. Also, we hadn’t had the chance to do our hydrotherapy lesson due to COVID, so it will be really good to learn from the supervisors. After the session, I wrote up a plan of what we could do with her in the pool, which I created through online research and discussions with my supervisor.

After this patient, we had a patient with a foot injury. This was my first time dealing with a client with a foot injury so I found this very useful. The patient was a jive dancer who had pain in her metatarsal joint in her big toe. We couldn’t recreate the pain in any movement or during palpation. Due to this, we had to get advice from our supervisor, who also couldn’t recreate the pain. The only thing that was apparent during the assessment was the poor motor control of the arch complex, so we worked on this to see if this would help the pain. After this session it was evident that increasing arch height is definitely something I need to research further. Whilst I was good at proprioception exercises, I struggled thinking of exercises to increase arch height. Following the session, we wrote up the notes and created a plan for the next session with this client for both progressions and regressions.

 

28/04/2021 5

Since clinic has been on more consecutively, my confidence has grown massively.

My first patient was a post-natal lady who presented with extreme hamstring weakness, and weak abdominals. This is something I have always been good at treating, so giving exercises to her game very naturally. I had never dealt with a post-natal lady before, but after seeing her it made me think more about what I want in my career. I really enjoyed treating this lady, more-so than anyone else due to my interest in pre and post-natal exercise. This gave me a great idea of completing my Pilates qualification for pregnant women. This is something I have always been passionate about. As a child I always wanted to be a midwife, but when I grew up, I realised my heart truly wanted a career in exercise and rehabilitation. I figured that this way, I would gain a lot of pregnant clients, which is a demographic I would love to work with. After the appointment, I wrote up the notes and made a plan for progressions and regressions.

After this, we had a patient with pain around the distal lateral thigh. We were unsure of the clinical impression, but thought it could be bursitis, ITB, PFPS or hamstring weakness. Despite this, we were still able to give exercises targeted to his weaknesses to hopefully help reduce his pain. Again, lower body exercise prescription is something I am very confident in, so this was quite a nice client for me. After the session, we did some further research to try and find a more solid clinical impression, and then wrote a plan for next session.

Following this, I had an online consultation with a man who had medial knee pain. He had been to the doctors and they told him it was an MCL injury, however when I said this to my supervisor he reminded me to never take the word of another clinician and to instead decide on my own clinical impression. After this session, I went over what objective assessment I would do with him to differentiate between injuries and began to write down some potential exercise suggestions.

 

30/04/2021 5

My first patient was the patient I had for an online consultation on Wednesday. From my assessment, my clinical impression was that they had a meniscus tear in the knee. Lower body exercises are something I am very confident with, so prescribing him these was not stressful. During the assessment, I was unsure whether it was an MCL injury or a meniscus tear, as on the special tests the patient was positive for both. However, my supervisor then reminded me that in that case I need to go more off of the subjective assessment, to which I then realised the mechanism was more meniscus-tear-like. This is something I should have remembered to do myself, but now I have been told once I should be able to carry that approach through to the rest of my clients. I am feeling quite confident about this client and he is someone I am going to be seeing throughout so I am hoping it will be nice and confidence boosting to (hopefully) see his progressions throughout the weeks. After the session, I wrote up notes and made a plan for next session.

Following this, we had an online consultation with a client with suspected upper cross syndrome. I am not as good with upper body injuries as I am usually dealing with lower body injuries. So, my skills and knowledge around this area needs to be improved. I am always fine with upper body assessment, but when it comes to clinical impressions I am never sure on what the problem could be. This is definitely something I am going to work on. After the session we wrote up the notes and created a plan of some potential exercises.

Subsequently, we had a patient with lower back pain who had been coming in for a while. All movements were pain free and strength was good, so it was been clear that the pain is psychological. Again, this is something I hadn’t dealt with a lot in terms of back pain. But after the session it became clear that treatment is almost the same in terms of the exercises you would prescribe. However, it just requires more psychological aid and enthusiasm to make them feel more confident in themselves. This is something I have practised quite a lot of Argyle so I found this quite easy to do.

March

12/03/2021 5

Going into this clinic session I was still feeling quite nervous. However, in clinic today we had a very interesting patient. They came to clinic following an operation to the neck to remove cancerous lymph nodes. Following this the patient had been cleared of any cancers. I found this case very interesting to deal with, despite not knowing what the best thing to do was. I knew the patient needed to gain strength in their neck muscles and upper trapezius, but due to the severity of the issue I had to ask my supervisor if the exercises we were thinking of were suitable. I found dealing with this patient a big learning curve in my journey as this is something I never would have though I would be dealing with. Now, I feel I will be more ready to work with clients who have had serious diseases. Following the appointment, we wrote up the notes and planned what we could do next session with the client if they responded well to the exercises given.

After this, we again ran through different case studies. We ran clinical assessments on each other and then created an exercise plan tailored to their needs. Again, I found this very useful; it was making me a lot more confident in clinic.

Following this, we did an online consultation with a client. It was hard to do observations over zoom, but the subjective assessment suggests that the injury is either disc, facet, SIJ or piriformis. After the session, we discussed what we could do to differentiate between each injury upon objective assessment. Due to the fact I had done lots of revision on clinical assessments, I felt quite confident during this discussion.

 

19/03/2021 5

After completing the diagnostic and rehabilitation module in February, I am feeling a lot more confident in giving exercise based rehabilitation. Going into clinic today, I was finally starting to feel more like a confident sports therapist who can effectively diagnose and treat injuries.

The first patient I had today was a very interesting one. I was informed before the appointment that she had been referred to the Marjon clinic to be put on the cervical traction machine, to create more space between the vertebrae. Due to the severity of the condition, I wasn’t able to go through an objective assessment over the phone, so instead I completed a very thorough subjective assessment. I felt very confident when taking this online triage, as I was making very detailed notes. The patient liked to chat a lot, so sometimes it was hard to get an answer to the questions I was asking. But, I managed to get the answered that I needed in the end. We invited her in for a face-to-face appointment to use the cervical traction machine which I am really keen to get involved in as it is something I haven’t used before. I always find it very useful to treat clients with more complex issues as it really pushes my learning.

Following this, we had a client for a follow up appointment for their peroneal/calf strain. The client had seen minimal improvement since their last appointment but admitted they hadn’t been completing their home based exercise program as often as they should have been. I felt quite confident giving this client exercises, as lower body rehabilitation exercises is definitely my strongest point due to doing lower body exercises often at the gym myself. My coaching has also definitely got a lot better since the beginning of this year, where my coaching tips were definitely lacking. I could always complete the exercise myself, but was bad at explaining how to do the exercise to other people. Now, I seem to have got the hang of it, which is really nice to see. Following this session, we wrote up the notes and then made a plan for next session including progressions and regressions depending on how they get on with their exercises throughout the week.

After this, we had a client with SIJ dysfunction and L4/5 stiffness. I hadn’t yet dealt with a patient who had SIJ dysfunction so this was really interesting. We gave SIJ mobilisations first as this was the root cause of the pain, and then gave some exercises. Admittedly, I didn’t have any ideas on the sort of exercises I could give this patient, so getting advice from my supervisor was really insightful. This is something I am going to research further as I would like to be more confident in this area. Subsequent to this, we wrote up the notes and created a plan for if the patient were to progress or regress.

January

15/01/2021 3

Going into this clinic session I was still feeling quite nervous. The clinic has been quite quiet recently due to COVID so I haven’t been exposed to a lot of different injuries yet. However, in clinic today we had a very interesting patient. They came to clinic following an operation to the neck to remove cancerous lymph nodes. Following this the patient had been cleared of any cancers. I found this case very interesting to deal with, despite not knowing what the best thing to do was. I knew the patient needed to gain strength in their neck muscles and upper trapezius, but due to the severity of the issue I had to ask my supervisor if the exercises we were thinking of were suitable. I found dealing with this patient a big learning curve in my journey as this is something I never would have though I would be dealing with. Now, I feel I will be more ready to work with clients who have had serious diseases. Following the appointment, we wrote up the notes and planned what we could do next session with the client if they responded well to the exercises given.

After this, we again ran through different case studies. We ran clinical assessments on each other and then created an exercise plan tailored to their needs. Again, I found this very useful; it was making me a lot more confident in clinic.

November

06/11/2020 3

After missing as session of clinic last week due to family reasons, I was really super nervous about clinic today. My last patient last week was very complicated and I didn’t feel competent. Since then, I have gone over common pathologies, however I am still feeling nervous. The patient I saw was with another sports therapist, so this made me feel more at ease. After assessment, it was clear that the patient had a strain to the supraspinatus. Upper body exercises are not usually something I would consider myself as confident in prescribing, however due to my good knowledge of anatomy, exercise ideas came naturally. This made me feel more competent and slightly less anxious about clinic. Following this, we wrote up the notes and planned the patients next session.

After this, the clinic was extremely quiet, so the supervisor gave me a case study to go through, create a clinical impression and then write an exercise program for. I found this extremely useful as it allowed me to ask as many questions as I want without a patient there, and I was able to google search as and when I needed to in order to get the best possible exercises. We have begun our rehabilitation module at Uni which I think is going to help with exercise prescription a lot in clinic. So, as we get later on into the year I think I will start to feel more confident and knowledgeable in exercise prescription.

 

13/11/2020 3

Coming to clinic today I felt slightly more confident than before. First, I had my first online triage appointment. So far, I’ve ended up with all face-to-face clients after their triage, but I was yet to complete one. I was less nervous about thus then I was about meeting someone face-to-face. But, was still worried I was going to get things wrong. I am usually a very confident person when it comes to speaking to people, but for some reason lately in clinic I have been getting very nervous around clients. I am wondering if the lack of socialising during lockdowns has given me slight social anxiety.

During the face to face, everything ran quite smoothly. The layout was clear and easy to follow and I didn’t miss any steps. My clinical impression was either a lower gastrocnemius strain, aponeurosis of the soleus or gastrocnemius complex or an Achilles tendinopathy. Following the session, I planned out how I would differentiate each condition upon assessment.

Following this, we again ran through induvial, quite complex, case studies including creating a clinical impression and then creating a plan. Again, I found this very useful as we had the support of the clinic supervisors and we were able to discuss ideas as a group.

October

23/10/2020 3

This was my first face-to-face clinic session, so I was quite nervous about what it was going to be like. I had done a lot of revision over the summer of clinical assessments and common pathologies to prepare myself, but I was still feeling very nervous.

The first patient I saw was someone who has a grade 1 hamstring strain, and they were at the end stage of their rehabilitation wanting to return to football. For my first client, I think this was quite a nice and easy one to do. The patient is going to personal training sessions 3 times a week now, so I gave him some exercises to incorporate into his personal training sessions. For my first session in clinic, I felt quite confident. It was nice to start with an easy injury that required end stage rehabilitation exercises, as this was what I was most confident in. Following his session, I learnt how to write up notes correctly, and got advice and feedback from the clinic supervisors about the session. I then planned a next session for if he were to come in again.

After this, I had a patient who had very complex signs and symptoms, making it very hard to get a clinical impression. With the help of my supervisor, we found that it may be Achilles tenosynovitis, due to weak plantarflexion muscles and an over pronated foot. For this, I gave the patient eccentric calf exercises. This patient presenting with complex signs and symptoms made me feel quite anxious about my time in clinic. I felt as though I wasn’t as competent as I thought I was. Whilst I got through the session with the help of the clinic supervisor, I still felt like I needed to do better. So,  before next week I am going to do more work into common pathologies. Following this session, I wrote up the notes and then created a plan for the patients next session.

September

23/09/2020 CLINIC 1 

This session was an induction session for the clinic. We went through housekeeping, data protection, guidelines, first aid, accidents and near misses, and waste disposal including PPE. We went through how to keep take our clinic notes and keep a record for each patient who comes into clinic, and the processes of how the clinic will be run due to Covid-19 to minimise risks. Following this, we then set up our Cliniko accounts, and worked out how to use it. Before this session, I was extremely nervous to go into clinic, I felt like I had no idea how to do anything (not sports rehabilitation related, but all of the other things). But, this session soothed my nerves massively, and I feel like I am very ready to begin. Being an organised person, I think the lack of knowledge on note taking and how the clinic was run etc stressed me out a lot, as I simply couldn’t picture what the experience was going to be like. This session answered all of my questions and more, and made me confident to start working.

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