Date: 13.02.2020

Duration: 1300-1700

Individual with whom I worked with: Mick Smirthwaite

Before my placement:

Aims from today’s placement:

Ensuring that I am looking after clients when they arrive and during their treatments such as providing support for the client’s neck when they are in supine position on the couch.  Ensuring clients are comfortable.

During each treatment, thinking about the phase of tissue healing of the injury being treated.

Understand why specific treatments and modalities are used in treatment of the injury.

Observing and understanding new cases that I haven’t seen before and asking questions when I don’t understand why Mick is applying a specific treatment or using a technique I haven’t seen before.

During my placement:

My role the majority of the time is observational, with the occasional invitation to palpate soft tissue and apply soft tissue massage.  I also meet and greet clients and ensure that they are comfortable and relaxed.

I feel very honoured when clients are happy for me to be present during their treatment.  I feel more confident in my communication with clients, sensing when they want to talk and when they just want peace and quiet during their treatment.  I enjoy helping clients and talking to them.  Nothing happened today, that made me want to change what I had planned to do.  Each week I don’t always see the same clients, as they change their appointments depending upon what is happening in their lives.  I do often ask Mick how those clients are progressing, however, as I am interested in their progress.  I have never found myself in a situation that I felt the need to intervene or change.  Each week there is always a new client with an injury that I have not seen before.  It makes each placement visit very interesting.

After my placement:

Describe the activities you undertook whilst on placement today:

During this afternoon’s placement I listened to each client’s description of the MSK dysfunction that they were experiencing that required treatment and I observed each treatment applied.  I asked questions when I did not understand why Mick chose to apply a specific soft tissue technique or to confirm that my understanding was correct.

Client 1 – The first client of the afternoon is a retired dentist.  He is a very active man e.g. plays golf regularly, runs and hikes and snowboards.  He asked for a soft tissue massage today to ease tension in upper and lower back and hamstrings.  With the client in prone position, Mick palpated the spinous processes and transverse processes in the lower and thoracic spine.  He also palpated the muscles checking for tension.  Soft tissue massage was applied to the erector spinae, rhomboids, upper fibres of the trapezius both on the right and left side of the upper back.  Mick applied NMT to ease trigger points in the upper fibres of the trapezius.  He applied mobilisations to the hips and lumbar spine.  At the time I made a mental note to ask Mick whether the mobilisations were a modification of the McKenzie Technique. He moved to the hamstrings and calves applying soft tissue massage on both the left and right legs to just ease muscle tension.  There were no MSK issues.

In supine position STM was applied to the quads and NMT and STR was applied to the left quad to ease out a trigger point.  Mick also massaged the client’s neck and shoulders clearing trigger points in the first rib of the neck.  He completed the treatment applying a traction stretch on the neck.

Client 2 – was a female who was training for her first marathon.  She sees Mick regularly during her training to ease tension in the leg muscles during her training.  Due to the recent stormy weather and family commitments she has had to change the timing of her scheduled runs this week and has run on four consecutive days.  Soft tissue massage and deep tissue massage was applied to the hamstrings and calf muscles on both the left and right legs.  The soleus muscle and Achilles were tight on both legs.  Soft tissue massage was also applied to the quads on the left and right legs.  NMT was applied to the rectus femorus, on the left leg to ease out a trigger point.  The massage was standard treatment for tight muscles.

Client 3 – was an elite, competitive power lifter and a regular client.  During the subjective assessment the client asked Mick to massage her upper back and both shoulders.  On the left side a rotator cuff muscle was a bit niggly and her left shoulder, forearm and triceps were also tight.  Also her right hamstring and adductor muscles were tight.  I observed Mick as he applied STM and STR to the right hamstrings and gluteus maximus muscle.  Mick worked deep into the tendons of the semitendinosus and semimembranosus both at the insertion and attachment sites.  On the Left side, Mick applied NMT and STR to the gluteus maximus and STR to the gluteus medius. He palpated the lumbar spinous processes and applied mobilisation to the SIJ on both the left and right side of the body.

STM was applied to the left upper back and NMT to the trigger point in the Rhomboid muscle close to the medial border of the scapular.  Mick also stretched the shoulder and mobilised the scapular.  PA was applied to the upper thoracic vertebrae T2-T3.  Deep tissue massage of Teres Minor.  Mick gently massaged the right upper back but there were no issues.  Mick did mobilise the right Glenohumeral joint and applied STR to the triceps.  The client was turned on the couch into supine position so that Mick could work on her right arm.  STM and STR was applied to the Extensor Carpi Radialus and biceps muscles.  Mobilisations were carried out on the wrist.  The treatment concluded with a traction stretch of the neck.

Client 4 – is a regular client and has treatment to manage the muscle spasms and cramping which are symptoms of Parkinson’s disease.  He sees Mick for massage to help manage his condition.  He also switched to a Keto diet as part of that management after researching the condition.  He recently buried his mother so there were additional factors regarding his psychological well-being as well as the symptoms of Parkinson’s.  Mick applied soft tissue massage to the hamstrings and calves on both legs.  Although the client is an older gentlemen his skin seemed unusually dry probably due to not drinking enough water.  Mick used a massage cream rather than massage oil on this occasion.

Document how you felt through-out your placement today:

I enjoyed this afternoon’s placement experience particularly talking to clients.  I would like to think talking and looking after them enhanced their experience.

Evaluate today’s placement activity:

The treatments today were management of tense musculature with the application of soft tissue massage.  There were no MSK injuries.  I felt relaxed and enjoyed helping and talking with the clients, some of whom I have seen before.  I feel more comfortable assisting Mick with his clients.

A deeper, analytical and critical approach to today’s experiences:

After Client 4’s previous visit, I did read up about Parkinson’s disease and the symptoms to inform myself as I really didn’t know very much about it.  I also searched the research literature to find out if there was evidence of the benefits of soft tissue massage in managing the condition.

Draw conclusions – what have I learned from today’s activities and my reflections:

My thoughts about today’s placement are:

How important it is to establish a good relationship with our clients, making them feel comfortable and providing a positive experience.

Action plan – how will I apply what I have learned from today’s activities & my future professional and personal development:

I plan to read more material regarding the management of the symptoms of Parkinson’s disease.

Have any questions arisen from today’s placement that I need to discuss with my Placement Tutor or University Placement Tutor:

I asked Mick whether the mobilisations applied to client 1’s hips were a modification of the McKenzie Technique.  He said that he wasn’t sure whether it was specifically a McKenzie Technique.  He had seen it used during a training course and thought it would be an effective and appropriate technique to use when working on an imbalance in the symmetry of the hips and to ease tension in the muscles of the lumbar region due to the imbalance.

I asked Mick about the progress of a couple of his clients that I had seen him treat in previous weeks and he provided an update.

We discussed the importance of professional appearance and maintaining hygiene in our practice especially when working outside.  For example – pre and post event massage at an off-road running race.

Returning to my reflections: