Wednesday 23^rd 3 hours.

The first 3 hours of the year came from an online session with Alex and Mike. The session included an in depth run down of how the clinic is going to be run in the current circumstances and getting our cliniko set up for the year. On reflection, I think it was a very helpful session in terms of getting important tasks done and feeling a lot clearer on what I am expected to do in the sessions whereas before, the thought of going into clinic felt very daunting. When Alex and Mike were helping everyone log into their cliniko accounts, some were taking longer than other through technical difficulties. In this time, I felt it would be good to look at the john’s reflective model, on reflection I feel as though this model would be good for me personally to start and have a go with as I feel like going through a set of questions would help me structure and think about my reflections more than some other models. Moving forward If I feel this model becomes too restrictive, I am very willing to try others to see which one works best for me personally.

Tuesday 29^th 2 hours.

This session was the first of the year that took place in university, it was strange to be back with all the new rules but was enjoyable none the less. The session was again run by Alex and mike and the main gist of it was to be completely prepared for having patients in the clinic and online sessions, making sure we all knew what to expect and how to deal with certain situations. Overall, the session was extremely helpful and informative and from who I spoke to after and during the session everyone felt the same way. On reflection, I would have liked to have asked a few more questions that I had in my head at the time, but at the same time I feel like I gave something to the session and kept focused throughout giving me confidence for next week’s session.

Tuesday 6^th 2 hours.

Today was my first experience of having a real-life patient in the clinic. Overall, I feel as though the session went well. I had an online consultation with a patient who was complaining of radiating pains down the back of both legs and had previously had a trapped nerve in their back. I went through the COVID-19 questions as required and then asked the patient the reason for their call. Looking back on the session I have come away feeling happy and somewhat confident before the session I was genuinely nervous. Something I would do differently next time is going through the objective assessment form in chronological order rather than doing this in an unorganised fashion, I feel this would help me gain a better understanding and also help me after the session when writing my notes up. Next time I have a patient on an online consultation I will like I say go through the assessments in more order and relax more before the session and try and talk more professionally to the patient. My second hour was spent writing up my clinical notes for the session. With the help of Mike and Alex the notes were done in good time and in good detail. I feel as though the notes are a good form of learning and I am excited for a time where I can write them up with no help and understanding everything I need to write down and with the correct detail.

Tuesday 13^th 4 hours.

Today I had my first face to face session with a patient. My patient was the same as the first week patient who I had an online consultation with, so this made me feel immediately more at ease than the first session. My feelings about the sessions are good, I feel as though I helped the patient and gave them specific exercises to do at home which I genuinely feel will help, and I am looking forward to seeing how the patient is after a week of doing the exercises. I learned different ways of dealing with patients who have specific needs. The patient struggles to go from sitting to standing so when I got them on the floor to show me how they had been doing their exercises I bought a chair over to make it easier for them to get back up. I also learned ways to incorporate exercises that would help the patient to exercises that they could do at home and gave them places they could potentially do them for example I gave them a prone extension exercise which I demonstrated on the couch that they could do on their bed at home. I would not change anything from this session. I also gave the patient a STM as they had a struggle performing cervical side flexion both sides, after the massage the patient’s cervical ROM was improved. I spent the hour after the session writing up notes which again helps reflection and knowledge. Unfortunately, my 5 o’clock appointment did not turn up, so I had a chat with Mike about what I am going to do next week. The session was particularly good for my confidence and knowledge, I am coming away feeling positive.

Tuesday 20^th 3 hours.

Today I only had one patient book in to see me, the patient was the same as last week and was coming in for more treatment. After the end of the last session, I wasn’t entirely sure how the STM treatment and the exercises I proscribed were going to work, when the patient came in and sat down in the waiting area, I could already tell that they were feeling better as their standing to sitting motion looked a lot smoother than previous. I spoke to the patient and they were feeling a lot better than the previous week which instantly made me feel good and improved my confidence tenfold. In this session I went back through ROM to see progressions/similarities from last time, went through the exercises they were doing at home to check technique and finally a lower back massage and a lower leg massage and this is what the patient said they felt would benefit them the most. I spent around 10 minutes talking, 10 minutes going through ROM, 5 minutes going through prescribed exercises and 30 minutes massages. This session taught me how to manage my time efficiently and I feel like this session was perfectly timed. The Next session is in two weeks’ time, I will assess how the patient is doing and asses their progress and see what they believe the best/most effective method was for their own benefit and carry it out.

Tuesday 3^rd 5 hours.

In order to better my reflections, I decided to investigate reflective models. The one that stood out to me was the Gibbs reflective model, some students applied Gibbs model in their research and the result showed that this model could cause awareness of the students and where their skills lie and where they need to improve (Adeani et al 2020).

1. Description
2. Feelings
3. Evaluation
4. Conclusions
5. Actions

Today was the longest session I have ever had in clinic, alongside it being the longest it was also the one in which I had the most patients. My first hour was an online consultation with a patient complaining of lateral right knee pain that was worst when they were walking downstairs or running, from this information I was instantly thinking of PFPS and when Mike came in to see if everything was ok he also thought that the same. This made me feel confident in my knowledge which in my opinion is a big part of being a goof therapist, the session ended by the patient wanting a F2F appointment with me next week which again Is always nice to hear. My second hour was spent preparing for a session in the next hour. I found this stressful as I was given the patient just after my first patient so was a rush to get all the information and quickly come up with a plan as the patient had already been in clinic twice before for rehabilitation sessions. Overall, the hour with the patient went well all things considered. My fourth hour was spent writing up notes for my first two patients, notes are very important to me I find them hard to do but they do make me think about the injuries and patients and keeps my knowledge fresh. My final hour was with another patient who came in purely for a massage. The patient had a condition which I had never heard of before but Mike gave me a brief overview so I knew what I was doing regarding the massage, I started by asking standard questions I always ask and then I tested lumbar and cervical ROM so that after the massage I could re-test. I massaged the patient for 30 minutes, after this I re-tested and their ROM had massively improved, and they told me they felt better already which is always great to hear from a patient. Overall, this session was stressful but good for me in the sense of having to think fast and use all my knowledge. the only thing I would change from this session is that I knew the patient so on reflection some professionalism was lost on my behalf and we were talking about things completely unrelated to their injury.

Tuesday 10^th November 5 hours.

Today’s session was my most enjoyable session so far. I think the reason for this is because all the patients I saw were follow ups and I had seen them all before and so I had a plan for them and knew in my head how I wanted the sessions to go. The first hour today was spent going back through my plan for each patient. My first patient was a follow up who had a week 6 meniscus tear so was getting back to full fitness so me and Mike decided it would be best if I took them on the AstroTurf to do some match specific drills to see where the patient was at in regard to their recovery. Overall, I was impressed by what they patient could do and how they felt doing the exercises I had set up for them e.g., bounding and one footed land on the injured side. I genuinely cannot think of anything I would have done differently if I were to do it again and I think this set the tone for the rest of my patients. Straight after I had done with this patient, I had another. This patient is suffering from PFPS, so I had given them some stretches to do at home, and they said these helped and they felt better in everyday life which is always great. I had planned for this session to go back over the stretches in the rehab area and give the patient some strengthening exercises to take home and talk through what we would do next week if the exercises helped. This session was good and if I could change anything it would have been to book the gym out so I could have tried some cardio with the patient, but time was running short anyway and I still felt good about what I had prescribed. After this I had 30 minutes before my final patient, I spent this time writing my notes for the previous patients. My final patient only wanted a massage as they have medical conditions that cause them to be stiff and occasional cause pain and they feel massages make their condition improve. However, in current circumstances we are only aloud to massage for 25 minutes so I thought showing the patient some exercises and stretches would benefit them. I have since sent them the exercises in an email and I am excited to see how they feel next week. Today’s session made me realise that planning sessions make them easier for me and more beneficial for a patient so this is defiantly something I will take into the future with me.

Tuesday 17^th November 5 hours.

Today’s session was like last weeks as I had the same number of patients booked in and, they exact same patients as last week. Personally, I like having repeat patients as I believe it improves me as a therapist because it is more realistic to what it will be like when I have graduated. Building a relationship with patients is important and I feel as though these three patients I have been working with for a few weeks have trust in me and I am helping them which is great for both me and them. My first hour was spent in the gym going through band work and lower limb strengthening exercises for a patient with a meniscus tear. The patient is gradually improving however, they are quite impatient and keep trying things outside of the clinic that they should not be doing so I make sure I tell them every session to try there best to limit that. This session taught me that you can only do so much in the way of telling a patient what to do when they leave the clinic, so I believe having a balance of making sure they understand what you are saying and not make it out as though you are telling them off. The only thing I would change from this session is the fact my planning for this patient was not as thorough as for others and I am happy to admit that so I can change this next week. My second patient and third hour this session was successful, and I put this down the fact I planned this session from start to finish so I knew exactly what I was doing. This is the first time in clinic that I had to be told I was running out of time and I had not even noticed the time, which is my eyes is a good thing as it shows I was enjoying myself. This session was again in the gym, I started by warming the patient up on the cross-trainer then we got into some band work as the patient specifically asked what they could do at home with a band as they had one and never used it. After this we went through some strengthening exercises as the patient has PFPS, so strengthening was always going to be my main aim of every session, “Strategies to address maltracking include quadriceps strengthening and improved flexibility of regional soft tissues” (Dutton et al. 2014). When this patient first came into clinic running of any sort was agony, over the past few weeks of doing proscribed exercises at home the patient was saying how much better they were feeling and so I thought it best to try a run on the treadmill. The patient plays tennis and tell me every week how much they miss it so I knew they would do anything to get back into quicker. The run on the treadmill was good, they ran for 7 minutes at a reasonable pace with no pain, for the last minute I asked if the patient felt comfortable with gradually increasing the speed until they felt pain. They felt pain at 7kmh, so I told them to stop, the patient came off the treadmill happy saying they felt good, this was great to hear and gives me motivation. I really do not believe there is anything I would change from this session. Unfortunately, my final patient could not come in due to illness, so I spent the remainder of my time in the clinic writing up my notes and helping clean and close the clinic. I will take away from today the fact that I must put as much effort into every planning of patients because they are feeling of having a solid plan makes it not only easier and more professional from me but gives the patient a better chance of improving.

24^th November 5 hours.

In today’s session I had two patients who I have previously seen so this made it easy for me to get prepared for the session as I knew what the patients needed and how I had in my head they would progress. The first hour was spent finishing off the plan for my PFPS patient, because PFPS is normally due to weakness of the muscles surrounding the knee joint, hamstring gastric, quads (Waryasz, & McDermott 2008) so the session was aimed at giving the patient lower limb strength-based exercises such as step ups and RDL’s. ROM was tested and compared to the week before and there was shown to be an improvement which was great to see. I would change the way I did things in this session regarding the order, I started with the gym session and came back in and tested ROM which is not how I would normally work as the ROM could have been changed due to the gym session before. This was probably due to the fact I was ready and prepared for the gym session so wanted to get it done, on reflection next time I need to keep my head and remember the basics first and not get ahead of myself. My third hour was spent with a patient suffering from a torn meniscus. This patient was a footballer who was still struggling with kicking a stationary football, every other movement was ok for this patient. Muscle strengthening, proprioceptive and balance exercises Frizziero et al (2012) were all in the rehabilitation programme for this patient in a gym-based session whilst also re-testing ROM of the patient and going through a stretching session. This session went well however on reflection, I feel as though the session was very similar to one or two before this one, In the next session I will make sure to change more of the session to made sure the patient does not get bored. The last 2 hours were spent really trying to get my notes done properly so that Alex and Mike could scan through them and check them off quickly.

1^st December 5 hours

In today’s session, I had one of my very good friends come in for treatment, he is a semi-professional footballer who just wanted a general lower limb massage, the patient enjoyed the massage a lot and on reflection I am happy with my time management as I managed to give equal time on each muscle I wanted to and never felt like I was rushing which was great. One thing I would change next time is my professionalism levels could have potentially dropped because I was treating one of my friends and there are defiantly some things I would not have done if I did not know the patient. Saying this it is always hard to stay professional when you personally know a patient. My second hour of this session was a mixture of writing up the notes from the previous hour and going over the session I had planned for the next patient. This I the same patient from my last session in November who is suffering from a torn meniscus, I was quite surprised to see the patients name on my timetable as the last session we were really getting somewhere, and I had proscribed the exercises and stretches that I believed would help get this patient back to full fitness. I found out within the first few minutes that the patient had returned to sport to prematurely and re-done the same injury, the greatest risk of injury is re-injury and this can result in worse performances and in some cases it can turn chronic and leave an athlete with no option but to retire (Whittaker et al, 2015) I felt a tiny bit upset that the patient did not listen to me but of course did not let this show at all, and it felt as though we had to go back to square one. The last hour was spent how it usually is, making sure my notes were good, I feel as though my notes are improving, and this is showing my Alex and Mike barely having to make any changes to them anymore which is great. I am happy with how I reacted to feeling disappointed in this session by keeping a level head and not showing the patient how I felt whatsoever.

8^th December 5 hours.

In this 5-hour session I had two patients, the first was a patient I had seen a few times with a knee problem, and the second was someone who had previously been to the clinic however this was their first session with me. The first hour was spent planning what the sessions would include and how I would manage my time to optimise the sessions, as I did this last week and it helped me as a therapist and made the session more beneficial for the patient. The first session was spent in the gym after completing active range of movement with overpressure and passive ROM to test the ligament laxity. I based the session around lower limb strengthening, the majority of the exercises were banded for activation and slowly building up strength. The session went well, and I felt as though I took hold of it and told the patient everything, I felt was necessary. The second hour was spent typing up notes to try and get ahead of the game and looking at the notes for my next patient and figuring out with the help of Mike and Alex what to do. The hour with my second patient simply came in and requested a STM as they had tight erector spines that were tender on palpation and complained of tightness in the traps. The main goals are to control the pain and inflammation (Brindle et al. 2001). The patient suffers with fibromyalgia and therefore certain considerations needed to be considered with this patient and this was beneficial for me as a therapist to have to think differently. On reflection, the session went well overall however I would like to have learned more about fibromyalgia before the session so I could have moulded my session around this.

12^th January 3 hours

After a long break due to COVID-19 restrictions, it was nice finally get back into the clinic and get back learning. The session was online which is always challenging and frustrating as I feel I could not get as much out of the session as I personally wanted to. My areas for improvement from this session would be to go away and think about how I can utilise an online session better and get all the information that I need from a patient in the allocated time. Another thing I would improve upon is taking control of the session more and becoming more confident in my own ability because 9 times out of 10 I know the correct thing to say. I will achieve this by firstly, thinking about ways in which I can utilise the sessions e.g., correct ways of asking a patient something in simpler terms and using my words to get what I want. I will also speak up more in the sessions and back my knowledge. The patient was still struggling with a meniscus problem and a rehab programme will be written up by me to help aid the patient’s rehab. Rehabilitation treatment provides knee stability, muscle strength and no-load restrictions (Frizziero et al. 2012). The session was spent on a video call with both Alex and Mike explaining what is going to happen now with the lockdown and, we were allocated tasks to do whilst at home.

3 hours 19^th January

This session was a very frustrating one as I only had one patient booked in, and as it will be for the foreseeable future sessions will be online triages from home as we are in a national lockdown and this will make it hard for not only me but the patients as well. The patient did not turn up for the session today which is annoying however I used this time to my advantage which on reflection I am happy I did as it would have been very easy to leave it there and do nothing. Luckily, I had Mike on the call with me and we went through some of the cases I have had throughout the year and basically had a big reflection on what I learned from them and how I would change the sessions if I were to have that injury again. This widened my knowledge and gave me confidence that 90% of the exercises I prescribed would be beneficial to the patients. The last hour and a half were spent going through draft notes that had not been checked by Mike or Alex yet, so this was good to keep everything in order and maintained. I also planned next week’s online triage, so I felt prepared and gave myself the best opportunity to do well as possible.

3 hours 2^nd February

As said in my last reflection, I only had one client today and again it was online which always makes things more difficult, but I tried to make the best out of the situation and make it as worth while for me and the patient as possible. The first hour was making sure my laptop was working and getting the notes up and connecting the call with Mike who was there throughout to make sure everything was ok. The second hour was with the patient which was good however on reflection I feel as though for the first time maybe I put too much time and effort into the planning of a session as all the patient needed really was a general catch up and a few new exercises for the progress they were making. Saying this, it was good to see the patient happy and excited about their potential return to play as they said they could see light at the tunnel and the exercise I prescribed were helping. Like last week, the final hour was spent with Mike completing my notes and talking through how I felt the session went and how it could have improved next time. I mentioned the fact I probably put too much time into the planning of an online triage, and he agreed with me, but also said it is better to be over prepared than underprepared which I agree with and I would always rather do that than nothing and be panicking 5 minutes before the session.

5 hours 16^th march

After a week off clinic, we were still meeting you online triage’s due to the COVID-19 situation on this week as last week only had one patient. As it was still lockdown it made it very easy spend a lot of time thinking about what to do with the session and making it as beneficial as possible. The patient provided a few notes and key details about the injury which I researched and made a suitable plan for online triage with this patient. Calf pain occurs for numerous reasons, including vascular, skeletal, and muscular sources. Calf pain in runners usually results from muscle issues, with the gastrocnemius among the most common of all muscle injuries (Fields & Rigby 2016). Unfortunately, without reason patient did not turn up for the 530 appointment which of course was very frustrating for me and Mike. Even though there is nothing you can do in the circumstances it was still frustrating as I had put time and effort into the session, however I still gain knowledge around the injury that I would previously have done if the patient did not book in, in the first place. In the first hour I was again making sure my laptop was set up for the session and reading through previous notes from other therapists as the patient had been in clinic before. As me and the other therapists did not have any other clients this day, we all joined a call with Mike and Alex and all reflected on how he had been so far what we aim to achieve and what we would do differently in the coming weeks, also making sure we were all up to date with my notes from previous sessions.

29^th March 5 hours

This session was booked out so that we could have a gait analysis session that Mike and Alex that took 3 hours and was very beneficial. The session started with an overview of what that aims of gait analysis are, the basics of how to start a gait analysis with a patient and when you may use the analysis. Gait analysis is the study of how a person walks or runs (Whittle, 2014), which can be used for a multitude of different potential injuries in a clinic environment and is a vital skill to have as a therapist. After the 3-hour session of Alex and Mike talking us through the ins and outs of a gait analysis, me and two of my peers thought it would be a good idea to stay behind and go through a gait analysis session on each other so we would feel more confident and comfortable when it came to doing one on a live patient. For the last hour I thought it would be most constructive to stay in the clinic and start to plan for next week’s session to try and get ahead, I now feel prepared and confident for my next week’s sessions and learned so much from the gait analysis session with Mike and Alex.

13^th April 5 hours

In this 5-hour session I had my two patients I was meant to see both cancel on the day which as always, is very frustrating but the work I put in to sorting out their sessions is just turned into good revision so in that respect I do not mind too much. I always want to make the most of a clinic session as I give myself the 5 hours off every week to get work done and learn so this week, I joined up with some of my peers to help/watch them with a patient to see how they may do things differently to me and of course learn and take some ideas off them if I think they do well in a certain scenario. The first patient came in with anterior knee pain and we took him on the anti-gravity treadmill which was good to see how someone else sets it up and it was great to sit back and observe to see what I may do differently in the future. To make myself helpful in the both the sessions I observed I was writing the client notes out as they were saying things to save time for my peers and improve my abbreviation skills as I was typing as the patient was speaking. Next time I would like to have inputted more on the sessions as there was times where I felt like I could have said something to improve the session. On reflection, learning from others is a method I have never really thought about, but I really did learn a lot from this experience, and I think/hope they gained something from me being there with them sharing my thoughts even though I feel as though I could have done more of this.

20^th April 5 hours

In today’s session I did not have anyone booked in to see me which is very rare and strange but also quite nice in the fact that I could make sure all my notes were up to date and like last week’s session, go in with my peers and shadow their sessions. After last week telling myself I would have been more vocal if the chance I felt this was a great opportunity to get this right and improve myself and achieve a short-term goal. The first patient came in with a new shoulder issue that the person I was shadowing did not know about so it was good to pick each other’s brain during and after the session discussing what and why might be going on and what would be most beneficial for this patient. The session went well, and I got my points across ore vocally and it defiantly feel as though it helped everyone involved. The second and final shadow of the session was less enjoyable as I was just watching a massage, even though it was not the most enjoyable session I had done I really tried to engage and focus which again is another one of my short term aims. On reflection I am happy with how the session with the first patient went and I have come away feeling good that I spoke up more and had the confidence to do so. One thing I would change about this session Is I feel as though it would have been far more beneficial and saved some time if I were writing up notes whilst watching the massage for me and my peers rather than spending another hour all together at the end typing them all up. Overall happy with how today went and happy with what I have taken from the session once again.

27^th April 5 hours

This session was a very busy one for me as I had 3 Patients to see in 5 hours. Every one of these patients was an online triage which was slightly annoying however this of course is better than having no patients to see. It was also the first time I had seen any of the patients and they did not leave any notes for me to read so there was no preparation I could do for which I suppose on reflection helped me as I had situations in which I had to process information quickly and come up with answers on the spot and think about what I wanted them to do there and then. The first patient was complaining of localised lower back pain that has been occurring for 4 months, as the pain was localised my initial though was a facet joint issue and so I made her do some movement from home which I demonstrated for them, but I found out how hard it is to tell if their technique is right and if they are gaging the pain correctly. The call was rather short and ended in me booking the patient in for a F2F appointment next week to further investigate what is going on. I had a half an hour break before my next client which was spent doing my clinic notes for the session, as it was less time consuming to write out as there was no touching or face to face contact, this was of course the same for my next two patients later in the session. My next client was a child who had to be accompanied by an adult which Was a first me, as much as it took some getting used to with trying to work out who to direct conversation at, by the end I think I had a better balance of talking to both the child and adult when it concerned them. On reflection, I will next time make sure to not just focus on the adult who was talking and make a conscious effort to make sure the child is always aware of what is going on as they were the one with the injury, like the last patient I booked the patient in for a F2F session next week to get a better understanding of what was going on. After finishing off the notes for this patient, it was time for my final appointment. Unfortunately, the patient did not turn up to the session which was really frustrating for me as I felt confident going into it however it did give me a change catch up on some work and start planning the sessions for the two patients I had booked for next week. On reflection I feel as though it would have been easy for me to just go home after the patient didn’t turn up but I’m happy I stayed and have come away feel constructive and ready for next week’s session.

4tn May 5 hours

This session was potentially the best/most enjoyable session I have ever take part in, I had 2 patients this week, both face to face which made it much more enjoyable and good for my learning that an online triage. Today I had a client in my first hour so unlike most sessions I was planning at home before, which on reflection probably made me more prepared and deliver the session far better than if I was rushing around in the hour before. The session was with someone I had seen before lockdown who suffers with a diagnosed disc herniation, unfortunately the patient was in more pain and unable to do as much as before so we were back to square one. For this patient, the main goal is to bring back functional skills and getting them doing more activity, so I prescribed exercises such as sit and stands and cat camels in the hope to get the patient feeling more mobile. I started the session by testing ROM as a gage for the coming weeks for the patient to look back and realise the progress they are making, after testing rom it was a case of regressing some exercises so they could do them and giving them examples of where might be best to do them. For example, knee rolls were one of the prescribed exercises for this patient and they have trouble getting on the floor, so I suggested doing them before they go to bed at night, so they are already laying down. I sent the patient all the exercises I had prescribed over email, so they did not forget. Overall, this session went well, the patient went away happy with what they were given, and I felt as though this session would improve their condition. The second and third hours of this session were spent firstly, writing up my notes from the previous patient whilst thinking up somewhat of a plan for the next session with them as they booked in for 2 weeks’ time again with me and secondly, planning for my next patient. This was a challenging one as I had only seen this patient online so was hard to grasp exactly what the problem was, so I was excited to try and diagnose the problem myself by testing movements and having a more in-depth chat. The session went well, however there was time in which I was confused as after the ROM testing the patient appeared to be ok and experienced no pain whatsoever. The main thing I am taking from the session is the way I handled the initial confusion and really had to think about what to do next which in the end I managed to do with the help of Mike and felt reassured in my decision making. As always, the last hour was spent writing up notes and making sure they were a good standard.

11^th May 5 hours

In this five-hour session, the first two hours was spent in the biomechanics lab with my peers and lecturers just touching up on our force plates knowledge and finding literature to back up our initial thoughts. These first two hours were hugely beneficial to us to solidify the knowledge we already had and of course expand on it. As good as the session was on reflection I feel as though two hours in there could have been spent doing more than we did and it is possible we could have used our time more wisely and got more work done, however saying this we did get everything we wanted to do done and it is always nice to have a bit of fun whilst you are working. This is perhaps the only thing I would change about these first two hours but overall, I am happy with how much work was done and the knowledge I gained. After this session, I had two clients to see in the clinic. The first being an online triage and the second being in person. I experienced a first today, with my first client calling me from Derriford hospital explaining that his injury had worsened and was going for an ultrasound at the hospital and of course could not make the session and wanted to book in next week, I could tell the client was in a rush and didn’t want to keep them too long so the call literally lasted two minutes. Luckily before the session this client wrote down notes of the injury which happens rarely, and I had gone over with Mike in the daytime what would be beneficial and how to go about this session and again put time and effort into it however they are coming back in next week so I can use this plan again. My second patient was face-to-face and one I have seen before. The patient requested soft tissue massage on the lower back area where the pain is occurring and did not really seem interested in anything else which of course is fine, I say this as last week I prescriptive the patient exercises to be doing at home and they came in and bluntly told me that they had not been doing the exercises, but they will try this week. The massage went well however something I will change next time is the fact that I was only massaging a small part of the lower back where the patient felt the massage is most beneficial, next week I would like to potentially get into the glutes and upper back a little bit more to check for any other potential injuries or discomforts. By the time I had finished the massage and prescript a few more stretches for the patient I only had one hour left in the clinic to write up both my notes. It was strange writing up the notes for the first patient who rang me to tell me they were in hospital as of course is the first time this has happened however saying that it is good to know what I do in this circumstance if it ever happens again. And the second patient was straightforward as I wrote down the prescriptive exercises how she had been feeling the previous week and explained the soft tissue massage I gave them; Mike was happy with both the notes and I have got them signed off. The massage patient booked in again next week and it is my plan to start work in the glutes and upper back as well as the lower back and go through the session I had planned with the patient who was in hospital. Today was very beneficial for me and I have come away feeling as though I have been very constructive.

Reference list

Adeani, I. S., Febriani, R. B., & Syafryadin, S. (2020). USING GIBBS’REFLECTIVE CYCLE IN MAKING REFLECTIONS OF LITERARY ANALYSIS. Indonesian EFL Journal, 6(2), 139-148.

Brindle, T., Nyland, J., & Johnson, D. L. (2001). The meniscus: review of basic principles with application to surgery and rehabilitation. Journal of athletic training, 36(2), 160.

Collins, S. H., Adamczyk, P. G., Ferris, D. P., & Kuo, A. D. (2009). A simple method for calibrating force plates and force treadmills using an instrumented pole. Gait & posture, 29(1), 59-64.

Dutton, R. A., Khadavi, M. J., & Fredericson, M. (2014). Update on rehabilitation of patellofemoral pain. Current sports medicine reports, 13(3), 172-178.

Fields, K. B., & Rigby, M. D. (2016). Muscular calf injuries in runners. Current sports medicine reports, 15(5), 320-324.

Frizziero, A., Ferrari, R., Giannotti, E., Ferroni, C., Poli, P., & Masiero, S. (2012). The meniscus tear: state of the art of rehabilitation protocols related to surgical procedures. Muscles, Ligaments and Tendons Journal, 2(4), 295.

Waryasz, G. R., & McDermott, A. Y. (2008). Patellofemoral pain syndrome (PFPS): a systematic review of anatomy and potential risk factors. Dynamic medicine, 7(1), 1-14.

Whittaker, J. L., Small, C., Maffey, L., & Emery, C. A. (2015). Risk factors for groin injury in sport: an updated systematic review. British journal of sports medicine, 49(12), 803-809.

Whittle, M. W. (2014). Gait analysis: an introduction. Butterworth-Heinemann.

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This link is for Part B, PFPS power point presentation.

Below is a video of me going through one of my sessions from my 4 week plan with my client. I had trouble doing any sort of editing on this video as I didn’t have any sort of software. If i did i would have added a little video at the start of me explaining everything and i would have also made a few edits.

Patellofemoral pain syndrome blog post 

In the main, patellofemoral pain syndrome (PFPS) is hard to define, the reason for this is that patients experience a variety of symptoms from the patellofemoral joint with varying levels of discomfort. The patellofemoral joint consists of the patella, both distal and anterior parts of the femur, articular surfaces and other surrounding structures (Thomeé et al., 1999). For this blog post I will be discussing the techniques that can be used to lower the risk of PFPS and also the risk factors for developing PFPS. 

Despite its high prevalence, little is known regarding the risk factors which predispose individuals to developing PFPS (Boling et al., 2009) (PFPS) is the most commonly diagnosed condition in people younger than 50  with knee pain. While the general practitioner sees an average of 5 or 6 new patients with PFPS per year, the amount of PFPS cases within the general population is still unknown. Women have higher risk of developing PFPS than men (Lankhorst et al., 2012). A study conducted by Boling et al., (2009) took 1,597 midshipmen from the United States Naval Academy who felt no pain when taking part in a jump-landing test or lower leg strength tests. The results of this test showed that “A total of 40 (females=24, males=16) participants with complete baseline testing and no history of PFPS developed PFPS during the follow-up period and met the inclusion criteria for the injured group. The non-injured group included 1279 (females=489, males=790) participants. The overall risk of PFPS was 3% in this population”.Waryasz and McDermott (2008) suggest that the positive potential risk factors for developing PFPS included: weakness in the following muscles; gastrocnemius, hamstring, quadriceps or iliotibial band tightness; ligamentous laxity; hip weakness; an excessive quadriceps angle and patellar compression. Being overweight is also a risk factor for developing PFPS. As well as intrinsic factors that may cause PFPS there are also Extrinsic factors that need to be considered such as training errors, incorrect footwear/poor surfaces and also psychosocial factors have all been shown to be extrinsic factors for PFPS (Van Tiggelen., et al 2008).

A sport in which PFPS is prevalent is weightlifting, especially in adolescents. The reason for this is because of the excessive weight the athlete is lifting, if any part of their technique isn’t flawless then a lot of stress will be transferred through the patella and in turn causes a high risk in obtaining PFPS. Gharote et al., (2016) conducted a study In which 50 players (44 male and 6 female) aged 15-30 years, the players all underwent a patella grinding test which if found positive would then undergo an X-Ray. The results show that 80% of three players with any anterior knee pain tested positive on the patella grinding test and then 62.5% of those tested positive for PFPS after an X-Ray.

There are always ways to reduce the risk of developing an injury. In the case of PFPS the preventative measures are still somewhat unknown however there are still a few things to do in the hope of reducing them . The first method in reducing the rate of this injury is to do with the quadriceps muscle. The reason for this is because it plays a key role in the pathology of PFPS. The preventative measure simply should be acting on as many modifiable risk factors as possible, for example working on the strength of the muscles and structures around the area and wearing correct footwear when partaking in activity. Stretching however has not been proven to be an effective method in the prevention of PFPS . In contrast, patellofemoral taping has proven to be an effective method for preventing PFPS (Van Tiggelen., et al 2008). A study that backs this statement up is one by Dutton et al., (2014) that states that taping of the area around the patella can reduce PFPS pain by producing a wider distribution of forces around the patella and also relieving pain by taking away contact in painful areas. A study that shows different preventive measures is one by Witvrouw et al., (2011) that say there are 4 main risk factors in the development of PFPS and these factors are also the way to treat/prevent the injury from occurring. The four risk factors are decreased flexibility of the Quadriceps; decreased explosive strength of the Quadriceps; altered neuromuscular coordination between VMO and VL; and a hypermobility of the patella. They say that the main focus needs to be on examination and treatment protocol on these four important parameters.

In conclusion, PFPS will always be a common injury that will affect a lot of people, especially those who put a lot of stress through their knee joints. There are a lot of risk factors in the development of PFPS including, the main risk factors being to do with muscles and structures with strength and flexibility deficiencies around the patella and knee joint in general. Another main risk factor in developing PFPS are extrinsic factors such as training on unsuitable surfaces putting added stress through the patella. Also things like unsuitable footwear and poor technique when lifting heavy objects hence the reason this injury is very prevalent in weightlifters. There is a lot of research that states taping will help in reducing the risk of obtaining PFPS, the reason for this is because the tape spreads the distribution loss of the knee joint so less stress is meant to go through the patella itself, and also the tape is supposedly meant to reduce to the contact with painful sensitive areas. In terms of prehabilitation, strengthening the muscles around the patella, e.g quadricep in particular the VMO, and other structures around the area is shown to decrease the risk in obtaining PFPS.

Reference List

Thomeé, R., Augustsson, J., & Karlsson, J. (1999). Patellofemoral pain syndrome. Sports medicine, 28(4), 245-262.

Lankhorst, N. E., Bierma-Zeinstra, S. M., & van Middelkoop, M. (2012). Risk factors for patellofemoral pain syndrome: a systematic review. journal of orthopaedic & sports physical therapy, 42(2), 81-94.

Boling, M. C., Padua, D. A., Marshall, S. W., Guskiewicz, K., Pyne, S., & Beutler, A. (2009). A prospective investigation of biomechanical risk factors for patellofemoral pain syndrome: the Joint Undertaking to Monitor and Prevent ACL Injury (JUMP-ACL) cohort. The American journal of sports medicine, 37(11), 2108-2116.

Waryasz, G. R., & McDermott, A. Y. (2008). Patellofemoral pain syndrome (PFPS): a systematic review of anatomy and potential risk factors. Dynamic medicine, 7(1), 9.

Gharote, G. M., Shah, S. M., Yeole, U. L., Gawali, P. P., & Adkitte, R. G. (2016). Evaluation of patellofemoral pain syndrome in national level weight lifters with anterior knee pain. Saudi Journal of Sports Medicine, 16(3), 192.

Dutton, R. A., Khadavi, M. J., & Fredericson, M. (2014). Update on rehabilitation of patellofemoral pain. Current sports medicine reports, 13(3), 172-178.

Witvrouw, E. R. I. K., van Tiggelen, D. A. M. I. E. N., & Thijs, Y. O. U. R. I. (2011). Intrinsic risk factors for patellofemoral pain syndrome: Implications for prevention and treatment. Journal of Science and Medicine in Sport, 14, e118.

Van Tiggelen, D., Wickes, S., Stevens, V., Roosen, P., & Witvrouw, E. (2008). Effective prevention of sports injuries: a model integrating efficacy, efficiency, compliance and risk-taking behaviour. British Journal of Sports Medicine, 42(8), 648-652.

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Many people have questions as to why athletes foam roll pre event, there are reasons behind this technique. Foam rolling is a simple therapy technique often used to improve flexibility, recovery, and performance. A foam roller is essentially a more affordable way to give yourself a deep tissue massage. By slowly rolling over specific areas of your body, It will help break up adhesions and scar tissue. With everything, there are advantages and disadvantages of foam rolling, an advantage of foam rolling can is that it can increase blood flow and break down scar tissue. Also it can aid the maintenance of normal muscle length, reduce pain and soreness, increase range of motion, and aid in recovery. “Similar to massage, foam rolling before a workout has been said to help restore muscle length–tension relationships and allow for better warm-up (Healy, et el, 2014). Another aim of foam rolling is to relieve trigger points before exercise. “Releasing trigger points helps to re-establish proper movement patterns and pain free movement, and ultimately, to enhance performance” (The Athlete’s Guide to Foam Rolling, 2017) A reason that foam rollers have been so popular on the market is because just stretching isn’t always enough to loosen muscles, however foam rollers are.

However with everything there are down sides to foam rolling.  “In terms of the foam rollers potential negative effects on muscles, it is very similar. Certain muscles will tighten up to protect other parts of your body. This is common in the back, where certain muscles will tighten up to prevent the spine from suffering injury. So foam rolling to loosen up any and every muscle can potentially lead to more serious injury” (The Pros and Cons of Foam Rolling). In my opinion Foam rolling is defiantly beneficial to do pre exercise and in my personal experience made me feel looser before playing football matches and it was something I made sure I did before every game. I believe that foam rolling is effective and that it improved my performance. However I am not sure weather I was because it genuinely loosened me up and worked my muscles or it was just a placebo, but whatever it was it made me feel more game ready and feel more prepared to partake in exercise. In conclusion I believe that foam rolling is a technique that everyone should try and I do believe in it’s benefits.

The Athlete’s Guide to Foam Rolling

The Pros and Cons of Foam Rolling