Non-weight bearing hydrotherapy

In order to understand the effectiveness of hydrotherapy in the rehabilitation of athletes, it is important to discuss the advantages and disadvantages, as well as critically evaluating the treatment method. “Hydrotherapy is the medical use of water for positive health benefits” (Bahadorfar, 2014). It provides an alternative to other post-exercise recovery treatments, such as massage and cryotherapy (Ślaga, et al., 2018). As technology continues to develop, exercise pools now have underwater treadmills, underwater video cameras and numerous aquatic exercise equipment pieces, which can be used and examined by highly skilled aquatic therapists (Reynolds, 2015).

It is vital to consider the advantages of using hydrotherapy in the care of high-level athletes, during their rehabilitation progress (Reynolds, 2015). A positive factor with regards to the use of aquatic exercises and therapy, is that following injury, treatment can begin earlier in the pool than on land (Skinner, 2009). This is as a result of the heat of the water and the weight relief from the property of buoyancy, which allows for pain reduction and decreases muscle spasm, therefore, facilitates movement, coordination and functional recovery (Skinner, 2009). In an investigation on “The effect of post-exercise hydrotherapy on subsequent exercise performance and heart rate variability”, the results confirmed that hydrotherapy restores cardiac autonomic nervous system (ANS) function that stimulates parasympathetic reactivation and improves recovery after intense exercise (Stanley, Buchheit, Peake, & Kondo, 2012). The balance of high to moderate quality evidence supported that hydrotherapy within rehabilitation can improve many factors, including muscular strength, range of movement (ROM), balance and joint mobility which will promote a return to normal function, while decreasing pain, muscular spasm and oedema (Waining, Young, & Williams, 2011). Another benefit of hydrotherapy is that it provides an effective environment for performance training, in order to get an athlete back to competition (Reynolds, 2015).

There are disadvantages to the majority of any technologies, hydrotherapy being one of them. The physiological and biomechanical mechanisms by which aquatic exercise and therapy benefits athletes are still unclear as there is limited research and evidence to support this (Stanley, Buchheit, Peake, & Kondo, 2012). There are a number of water-related factors which affect the body, not just temperature, but water pressure as well as active or passive behaviour during the bath (buoyancy, resistance) all needs to be considered when planning the use of hydrotherapy in post-exercise recovery (Ślaga, et al., 2018). This adds a large amount of time onto the process. A study conducted by Stanley et al. (2012) presented that the results provide new evidence that the body’s response to hydrotherapy does not enhance or impair subsequent exercise performance (when recovery between physical exercise was short). This research disagrees with one of the main advantages of hydrotherapy. A final disadvantage is that the cost benefit of hydrotherapy remains unanswered as it is a very expensive therapeutic tool, especially when evidence for this type of treatment is still limited (Geytenbeek, 2002).

To conclude the effectiveness of hydrotherapy needs to be questioned. The advantages suggest functionally the treatment is beneficial, but there is still limited evidence to support this. More research needs to be conducted to see if the effects of hydrotherapy on exercise performance and cardiac parasympathetic activity, can depends on the demands of exercise and the duration of recovery time between sessions (Stanley, Buchheit, Peake, & Kondo, 2012).

References

Bahadorfar, M. (2014). A Study of Hydrotherapy and Its Health Benefits. International Journal of Research, 1(8), 294-305.

Geytenbeek, J. (2002). Evidence for effective hydrotherapy. Physiotherapy, 88(9), 514-529.

Reynolds , J. (2015). The Use of Aquatics in Orthopaedic and Sports Medicine Rehabilitation and Physical Conditioning. Physical Therapy in Sport , 16(2), 204.

Skinner , A. (2009). A case for hydrotherapy in sport. SportEX Dynamics(20), 18-19.

Ślaga, J., Gizińska, M., Rutkowski, R., Rąglewska, P., Balkó, S., & Straburzyńska-Lupa, A. (2018). Using hydrotherapy at different temperatures for promoting recovery in professional athletes. Invited Review Trends in Sport Sciences, 57(25), 57-67.

Stanley, J., Buchheit, M., Peake, J. M., & Kondo, N. (2012). The effect of post-exercise hydrotherapy on subsequent exercise performance and heart rate variability. European Journal of Applied Physiology, 112(3), 951-961.

Waining, M., Young, I. S., & Williams, S. B. (2011). Evaluation of the status of canine hydrotherapy in the UK. Veterinary Record, 168(15), 407.

 

STYC01 Clinical Reflection 1/4/19 @ 10

In the second half of the open clinic session I treated a client who had postural issues, therefore experiences achiness in and around the shoulder area.

Reflective Summary 

In the subjective assessment of the form the client explained that they had a dull ache underneath the medial border and around the superior angle of the scapula. On the VAS pain scale, they scored the right side a 5 and the left a 3. The objective assessment is made up of 3 components. During observation I noticed the client had rounded shoulders and the head was tilted slightly forward which suggested they had poor posture. When I palpated the medial border more trigger points were present on the right side. I also palpated the inferior angles of the scapula and the right side was higher up. I finally tested range of movement (ROM) of the lumbar spine by using flexion (which was limited), extension and side flexion and the cervical spine by using side rotation. From this I decided to use soft tissue massage of the trapezius and rotator cuff muscles to increase blood flow, decreasing tension. I also used soft tissue release to separate fibres in order to lengthen the shorter ones.

Areas for further improvement 

In this session I believe I wasted time as I took too long to fill out the clinical consultation form. I need to improve this as it meant I did not have the time to k tape my clients back in order to adjust their posture. For next time I could save time by using more abbreviations on the form. I also could have advised the client on home exercises/stretches.

Things to remember 

  1. Use abbreviations as much as possible to speed up the process of filling in the clinical consultation form
  2. Soft tissue massage is not used all the time
  3. When performing an objective assessment of the back ensure the client has their top off

 

 

 

 

 

 

STYC01 Clinical Reflection 1/04/19 @9

In my last open clinic session my client complained of a dull ache in the Quadricep muscles.

Reflective Summary

In the subjective assessment my client complained of a dull ache in both quadriceps, but felt more tightness on the right side, possibly due to them being right leg dominant. As part of the objective assessment I observed an increased amount of muscle bulk on the left side (I thought this may have been because in the past medical history (PMH) section the client explain that they had a previous  injury to the right ankle so was using/putting more pressure on the left side of the body). However, on palpation there was more tightness on the left side of the body, especially the groin area. The final thing I tested was range of movement (ROM) by using the Thomas test. This tests tightness of the hip flexors and rectus femoris. The client was negative for the hip flexors but positive for the rectus femoris. I decided from this that I would do soft tissue massage of the quadriceps. I used various techniques including effleurage, petrissage and tapotement to increase the blood circulation and neuromuscular technique on the areas of the hypersensitivity.

Areas fur further improvement

I think the first improvement that I need to make would be to revise the special tests that are part of the objective assessment. This is important to do as it will allow me to confidently recall which test should be used to test a specific joint, muscle, nerve or ligament. In this particular treatment I could have applied more pressure as the client was only a 5 on the VAS pain scale. In order to do this, I may have needed to alter the height of the bed so I could have applied pressure using my whole-body weight. The final thing I needed to remember to do was to repeat the Thomas test at the end of the of the massage so I could see if the treatment performed was beneficial. You would hope to see an improvement in ROM if the treatment was effective.

Things to remember 

  1. Give clear instructions to the client so they understand what you are asking them to do
  2. Ensure the whole muscle can be accessed so the treatment affects the entire area
  3. Re test the muscle/muscles that have been treated at the end so you can see if the soft tissue massage was effective

STYCO1 Clinical Reflection 25/03/19 @ 9

In the first hour of open clinic I treated a client who had delayed onset muscles soreness (DOMs) from physical activity 3 days ago. They were out of the acute stages therefore I was able to treat using soft tissue massage.

Reflective Summary 

As part of the subjective assessment the client could tell me that they felt achiness in both calf muscles, especially the right one. I then went on to complete the objective assessment where I observed more muscle bulk on the right side of the body, the feet were everted and they had slight Varus knees. During palpation I noticed more hypersensitiveness in the right leg, which is probably due to them being right leg dominant (which I found out from the subjective assessment). The final thing I tested was range of motion (ROM) at the ankle using plantarflexion and dorsiflexion and there did not appear to be any limitations. I then decided on a treatment plan and used soft tissue massage and Muscular Energy Techniques (METs) on the gastrocnemius. I used effleurage to create heat and to feel for any potential abnormalities where as the aim of petrissage is to increase blood circulation and lymphatic drainage to remove toxins. I used post isometric relaxation (PIR) which is a type of MET that contracts the target muscle. I used this technique as it strengthens weak muscles and stretches tight muscles therefore improving flexibility. I tested ROM at the end of the massage to see if there had been any improvement.

Areas for further improvement 

My first area for improvement would be to give my client stretches or exercises to do at home, so they can try to release/prevent tightness in the future. If you do give them activities to perform make sure you demonstrate how to do it to ensure that they have the correct technique and form, preventing possible injury. I could do research to consider other special tests or movements that could test ROM of the gastrocnemius and soleus. In the session I only tested plantarflexion and dorsiflexion of the ankle but other movements should have been tested if I was more knowledgeable on what to test.

Things to remember 

  1. It may not be suitable to treat using soft tissue massage if the athlete is in the acute stages of injury
  2. If there are any areas of aggravation ensure you are careful so you do not make it any worse
  3. Warm the massage medium up before putting it onto the client

 

STYC01 Clinical Reflection 25/03/19 @10

This week in open clinic, I had a client who was recovering from a football varsity match 3 days ago. He complained of tightness in his quadriceps, hamstrings and calves.

Reflective Summary 

During the subjective assessment my client complained of a dull pain down the rectus femoris of the left quadricep, tightness in the right quadricep, both hamstrings and right calf. As part of the objective assessment I observed that my client had slightly everted feet and their knee crease was higher on the left side. When I palpated the rectus femoris the client stated that the pain was sharp and there was tightness down the lateral and medial side of the quads. When checking range of motion (ROM) I used the Thomas test to test for tightness of the rectus femoris and hip flexor muscles and Obers to check the tightness of the iliotibial band (IT band). My client was negative for Obers test but positive for the Thomas test as the hip angle was larger than normal (shows the hip flexor is tight) and when in knee flexion if you push the knee and it springs back it means the rectus femoris is tight. As part of my treatment I decided to do soft tissue massage on the quadriceps to release some of the tension and then used muscular energy techniques (METs) to stretch the tight muscles. As part of the massage I used effleurage and petrissage to achieve this by increasing blood circulation and lymphatic drainage.  I then performed METs of the quadriceps by getting the client to lie in a prone position, flexing the knee and then resisting against my force. The last thing I did was give the client particular stretches that they can do at home to release some of the tightness in the quadriceps and hip flexors.

Areas for further improvement 

My first area for improvement would be to continue to revise special tests so I know if the client is positive for a particular test. In today’s session I understood that my client had tight quadriceps, but my lecturer had to advise me on what tests I needed to use in order to see if it was actually the quadriceps or IT band that was causing the tightness. Another weakness of mine was that I ran out of time to do both quadriceps so I only did the one with tightness. This was because I had to check how to perform some of the special tests. Next time I need to do both sides of the body whether it is injured or not.

Things to remember 

  1. If the client has very tight quadriceps it may be better to test knee flexion in a prone position as there would not be as much strain on the muscles
  2. Ensure you test the uninjured side first
  3. You may have to ask leading questions to find out more information about aggravating factors

 

 

STYC01 Clinical Reflection Tamar 10K 24/03/19

On the 24thMarch I performed pre and post event massage on runners who were participating in the Tamar Bridge 10k.

Reflective Summary 

This was the second running event that I have treated at using both pre and post event massage. At this event I had my own massage bed, so on arrival I set up the couch ensuring the working environment was safe. As there were more therapists than beds we paired up so we could massage one side of the body each to save time, in order to get through more athletes. We started pre-event massage at around 8 and finished at 8.30.  Pre-event is important as it can decrease muscle tension, possibly decreasing the risk of injury, enhance range of motion (ROM) as well as reducing general anxiety. When applying pre-event massage my hands moved faster and would not go deep to avoid pain for the client. I used effleurage, petrissage and in an ideal world would have used stretching but not to replace the warm up. Post event massage is different as I used slow, deeper rhythmical movements in order to reduce delayed onset muscle soreness (DOMS), disperse any lactic acid and return main muscles to normal resting length.

Areas for further improvement 

When I am next treating at any sporting event an improvement would be for me to ask the client if they have had any previous injuries. This is important to do as it may mean that for certain areas of the body you may have to be more cautious as there could be areas of weakness. In the future, if I was applying post event massage I would want the treatment to last longer. Because we were so busy, we were only massaging clients for approximately 3 minutes each however, in an ideal world it should last 15-20 minutes.

Things to remember 

  1. Ask the client if they have had any previous injuries as it may alter the way you treat
  2. You may need a different amount of massage medium depending on the build of the client
  3. Pre-event massage is used to increase the temperature of the muscles whereas post event massage is a lot deeper to help remove toxins

STYC01 Clinical Reflection 22/03/19

For this hour I treated a power lifter who complained of achiness in their groin area.

Reflective Summary 

In this session I treated a client who complained of a dull ache in the groin area. When I did the objective assessment, I did not notice any abnormal characteristics with posture, muscle bulk etc however, on palpation there was tightness in the upper groin. When testing range of movement (ROM) of the hip, the client only got pain in the groin during adduction. A functional movement that they also struggled with was a deep squat. In the execution phase when the knee was in maximum flexion they experienced a sharp pain in the area causing aggravation. I then got the client in a supine position sat up and started the treatment using soft tissue massage. I used effleurage and petrissage to release some of the tension by increasing the blood circulation. My client’s feedback about the massage was very positive as they stated that “it felt so much better after the massage”.

Areas for further improvement 

My first area for improvement is to make better use of the bolster in order to get the client in a good position so you can access the particular area. For example, to start with I could not access all of the groin area. This meant that half way though the treatment I had to adapt my towelling technique in order to access the whole area, especially where the patient complained of pain. I also need to place the bolster underneath the leg I am massaging so the client can be as comfortable as possible. The final thing that I forgot to check was to ensure that the patient did not have any contraindications (cancer, inadequate circulation, open wounds) or allergies to the massage mediums.

Things to remember

  1. Get the client in the most suitable position depending on the area you want to treat
  2. As men tend to have harrier legs you will more than likely need to apply more massage medium
  3. For larger clients you may have to adapt the techniques in order to achieve the same thing

STYC01 Clinical Reflection 21/03/19 @ 10

In the second hour of open clinic I massaged a member of the varsity squad from the Men’s 5th football team who was complaining of lower back pain.

Reflective Summary 

Before beginning the treatment, during the objective assessment I did not observe anything unusual, but on palpation I noticed tightness in the middle of the lower back on both sides. There was more hypersensitivity on the right side probably because this is my client’s dominant side. I then tested range of movement (ROM) of the hip by performing active flexion, extension, abduction, adduction, internal rotation and external rotation. During abduction my client experienced some pain in the hip, which made me think that they could have weak hip flexors and glutes. From this I decided to massage both sides of the clients back for a total of 30 minutes. I initially used effleurage to identify any potential signs of injury and to create heat. On the back I mostly use petrissage to increase the blood flow which can be seen when there is erythema (redness on the surface of the skin). On the areas of hypersensitivity, I used neuromuscular technique (NMT) by reducing the blood flow to that area, then increasing it to release tension.

Areas for further improvement 

I think that my main weakness was that I applied too little pressure. As long as you communicate effectively with the client you will be able to understand what they consider to be a good amount. To do this you can use the VAS pain scale by rating the pain: 1 being minimal pain and 10 being maximal. Another area that I could improve on would be to use other techniques beside soft tissue massage. In this case if I had more time I could have recommended particular stretches or exercises that they could do to help strengthen the hip flexors and glutes. However, I need to do more research into this to ensure the exercises are effective in improving the particular problem.

Things to remember

  1. Test ROM of all the possible movements available at the particular joint you are assessing
  2. Always give clear simple instructions to the client so they know what to do
  3. Check to see if they have any allergies to the massage mediums before you begin the treatment, so you can choose the appropriate medium

 

STYC01 Clinical Reflection 21/03/10 @ 9

In this open clinic session, I continued to treat a client from previous weeks to get his left knee fully recovered before varsity. 

Reflective Summary 

Once my client arrived, as part of the subjective assessment, I found out that they had been experiencing clicking of the knee the day before. When I tested range of movement (ROM) there was no pain during knee extension, but a slight dull pain during active flexion. From this I decided on a suitable treatment based on his previous injury (twisted knee) and to alleviate pain during flexion. In previous massages I treated the Quadriceps in order to improve lymphatic drainage where the swelling/bruising had been around the knee. The client gave positive feedback to this treatment as they said that the injury had improved since soft tissue massage had been performed on this area. Therefore, in this session I treated the Quads again by initially using effleurage to create heat and to identify any potential painful areas. I used mostly petrissage so I could get deeper into the muscle tissues. This was achieved by not only using my fingers but my knuckles, palms and forearm as well as it allows me to apply more pressure.

Areas for further improvement 

The first improvement I think I need to make is to ensure I use appropriate towelling techniques so I can access the whole of the Quadriceps muscles. This is because the rectus femoris originates from the AIIS, which is quite high up around the hip area, so I need to be able to move the towel effectively to protect the client’s modesty while being able to access the whole muscle. Another slight improvement that needs to be adjusted is making sure I always remember to adjust the bed height before beginning the treatment. This is important to do so my back is protected and it can allow me to apply as much pressure that is needed. The finally improvement that I need to do, as part of the objective assessment is to test ROM of all movements possible at the particular joint. As an example, I only tested flexion and extension of the knee joint but I should have tested internal and external rotation as well.

Things to remember:

  1. When massaging the Quadriceps ensure a bolster is put underneath the knee joint
  2. Ensure you have plenty of towels in order to protect the client’s modesty
  3. Do not be afraid to reveal the whole area of the muscle even if it is awkward to access