Date: 23.01.2020
Duration: 1300-1600
Individual with whom I worked with: Mick Smirthwaite
Before my placement:
Aims from today’s placement:
Mick suggested that I come along on a Thursday afternoon this week because he had more appointments booked in. However when I arrived the situation had changed because a couple of clients had cancelled. This is the reality of working as a private practitioner and circumstances change. One of the clients had Scoliosis so I was hoping that the therapy applied would be very interesting and certainly something that I had not personally observed or seen before.
During my placement:
My role today was purely observational, but that does not mean that I wasn’t involved. I was very much involved in that I asked questions when I wanted to understand more about why a treatment was applied during a client’s therapy. I watch and listen intently throughout each therapy session. Today was particularly interesting because Mick applied techniques to areas of the body that until today, I believed could not be treated by a sports therapy practitioner.
After my placement:
I listened to each client’s discussion with Mick regarding the areas of the body that they wanted him to treat and the Musculoskeletal issues that they were experiencing. I observed Mick during the treatment applied on each client during their therapy session.
Client 1 – The first client was a male, long distance runner in his mid-forties. He mentioned that he had pain in his hip and stiffness in the lumbar region. He also mentioned that his Achilles were tight. Upon examination it was clear to see that the client had limited ROM in ER in both his right and left hip and that he was very tight in his lower back. STM was applied to the glute medius, quadratus lumborum and the erector spinae on both right and left side of the body. STR was applied to the right and left Gluteus Medius and NMT to the Quadratus Lumborum. Mick also applied mobilisations on the hip and lower back.
Tightness in both left and right hamstrings, calves and Achilles was eased with STM and STR. Mick placed the ankle in dorsiflexion when massaging the Achilles and applying STR He also demonstrated to the client how to stretch the hip with the FABER stretch and the hamstrings with the SLR.
Client 2 – This client used to play netball competitively years ago and was very active. She developed Scoliosis and no longer plays netball but she does go to the gym and keep active in order to manage her condition. She also sees Mick for therapy to help loosen tight muscles which have adapted to moving in a different way because of the limitations of the Scoliosis. She said that she was struggling with her ribs and intercostal muscles – movement was become more restricted.
It was very interesting to observe Mick apply STM and slow tissue release (STR) of the intercostal muscles. During the application of the technique the client was prompted to inhale and exhale deeply as Mick applied gentle pressure to each affected muscle. The rationale for applying the technique was to lengthen shortened muscle fibres to improve functional movement of the ribs. Mick also applied STM to the gluteus medius, the quadratus lumborum and mobilised the hip. STM was applied to the erector spinae and rhomboid muscles on the left side of the upper back.
When the client turned over into the supine position Mick applied a muscle energy technique on the diaphragm and intercostal muscles using the clients own energy during deep breathing. Whilst applying the technique Mick showed me where to place my fingers to palpate the intercostal muscles when the client was inhaling and exhaling. The rationale for applying this technique was to improve the strength of the intercostal muscles which have been weakened as a result of the condition. He also worked out a trigger point at the point of the 1st rib in the shoulder and applied mobilisation and traction of the neck.
I found the therapy very interesting and will read more on the condition and the application of treatment for this case.
Client 3 – is a young competitive weightlifter. She reported that her legs needed some attention, her right glute and ITB felt tight and her left shoulder was aching through the Levator Scapulae and Trapezius muscles. She just wanted Mick to loosen up the tight muscles. Mick always checks the areas of the body where the client reports aches and pains and MSK issues by palpating the tissue and the bony points. STM and STR was applied to the left and right quads and NMT was applied to work out trigger points in the adductors in the left thigh. The client had trigger points in the upper fibres of the Trapezius and Levator Scapulae and Mick used an NMT to work them out. He applied mobilisation to the scapula and GHJ in the left shoulder.
STM and STR was applied to the left and right hamstrings and the left ITB was also massaged. Mick checked the alignment and ROM of the lower back and hips but there was no restricted ROM. He also massaged the forearms and the biceps in both arms which were tender after the client’s training session the previous day.
Evaluate today’s placement activity:
I found today’s placement very interesting and useful. It certainly helps to observe treatment of real cases, how pathological conditions change the way the body moves and the effectiveness of sports therapy techniques in improving functional movement. I realise that I am still at the beginning of my learning and that my skills will improve with more experience. I am still very much a novice.
A deeper, analytical and critical approach to today’s experiences:
I found the therapy applied to relieve the MSK issues experienced by the client with Scoliosis very interesting. I saw techniques applied that I have never seen or heard described before. I will read more about the condition of Scoliosis and how it is treated. I will also investigate whether there is any research available regarding the treatment of the condition, whether massage is effective in improving a client’s functional movement with this condition.
Draw conclusions – what have I learned from today’s activities and my reflections:
I am beginning to see more visual evidence of the effect that soft tissue massage and sports therapy techniques have on improving the functional movement of clients with different pathologies. I would never have the opportunity to experience real-life cases, first hand in our practical lectures at University. I may get to experience different cases in the Sports Therapy Clinic but I am finding this experience very beneficial and enlightening.
Action plan – how will I apply what I have learned from today’s activities & my future professional and personal development:
I will do some reading to help my understanding of Scoliosis and the treatments currently used in treatment of this condition.
Have any questions arisen from today’s placement that I need to discuss with my Placement Tutor or University Placement Tutor:
I had no questions at the end of today’s placement.
Returning to my reflections:
I did a bit of reading online to find out more about scoliosis (Mayo Clinic, 2019), I learned that Scoliosis is an abnormal curvature of the spine, in the coronal plane, and is usually an ‘S’ or ‘C’ shape. There are different types of Scoliosis and in the majority of cases the cause is unknown. It thought that the condition may be caused by birth defects, neurological abnormalities or genetic conditions.
After reading the research literature it appears that the condition is generally managed conservatively using a combination of therapies (Lotan & Kalichman, 2019; Morningstar, Woggon, & Lawrence, 2004; Villafañe, Silva, & Dughera, 2012) as there is insufficient evidence of the efficacy of any specific treatment (Everett & Patel, 2007).
References:
Lotan, S., & Kalichman, L. (2019). Manual therapy treatment for adolescent idiopathic scoliosis. Journal of Bodywork and Movement Therapies, 23(1), 189–193.
Mayo Clinic. (2019). Scoliosis. Retrieved May 28, 2020, from https://www.mayoclinic.org/diseases-conditions/scoliosis/symptoms-causes/syc-20350716
Morningstar, M. W., Woggon, D., & Lawrence, G. (2004). Scoliosis treatment using a combination of manipulative and rehabilitative therapy: A retrospective case series. BMC Musculoskeletal Disorders, 5, 1–10.
Villafañe, J. H., Silva, G. B., & Dughera, A. (2012). Manipulative and rehabilitative therapy as a treatment of idiopathic scoliosis without psychological sequelae: A case report. Journal of Chiropractic Medicine, 11(2), 109–114.