Hemiplegia – after consulation

March 2022 – June 2022

Hours: 12

Patient decided to continue with rehabilitation and completed a further 12 hours at 2 x 45 minutes session per week.

Patient presentation:

  • 10 year old girl with right hemiplegia
  • She has a leg length discrepancy due to excessive tone in her calves which causes tip-toe walking.
  • Parents want to focus on stretching the calf complex, strengthening the right lower limb and increasing adherence to exercises.
  • The patient wants to improve core and upper limb strength.
  • Her right upper limb is weak – she has poor grip strength and inhibited motor skills
  • The upper limb in currently not a focus at the patient has had botox and all stakeholders want to capitalise on its effects. The upper limb in now something they wish to focus on.
  • After a meeting with their consultant they would like to be more ‘aggressive’ with exercising her affected side.

Reflection Model

  • Gibbs Reflective Cycle 1988

Exercise Prescription

What Happened?

  • After meeting with the patients consultant, I was asked by the parents to focus entirely on her right leg during training sessions.
  • The patient also wanted to improve her upper body strength so we incorporated that into her exercises of choice.
  • We continued to progress steps ups as highlighted before. We also incorporated balance work into step ups from time to time too.
  • Core work was added in the form of heel touches; however, we varied this and completed kneeling pallof presses, hanging knee/leg raises and partner assisted leg pushes.

 What were you thinking and feeling? 

  • Training just one side seemed to go against what I believed to be an important principle of rehab – treat both sides. However, in cases like this there is evidence that immobilising the more functional side of the body, thus forcing the affected side to work can have better outcomes for patients with hemiplegia. Further to this, we were actually able to get more done in the sessions as we were only focusing on one side.
  • I have started implementing external forces such as resistance bands to correct knee valgus during squats as I want to ensure that the movement is encouraging optimal biomechanics. We have also started to focus on foot placement of the affected side which is difficult for the patient; however, this is once again to encourage optimal alignment and movement patterns.

Analysis and Evaluation

  • The patient’s balance is consistently improving – she can now intermittently balance on her affect side when performing step ups. Both the patient and her parents were elated with this which was so lovely to see.
  • The patient is also starting to become more confident in the gym setting and less self-conscious of her affected side. Previously, she would always try to hide taking her splint on and off and she would also always choose to start exercises on her left. This could have potentially been out of habit but as time has progressed she knows that it is the right side she needs to use so she is picking up weights with that side more often now.
  • We have to change SL leg press as the patient really didn’t like the exercise. We substituted it for single leg supported half squats which she found much more manageable.

 Conclusion 

  • The patient has done well with the introduction on single leg work only and her strength has increased quite significantly in this block compared to the previous. This is likely due to the extra volume we can get through her affected side and shows that currently there are no adverse effects training in this way for her.
  • I am starting to run out of creative exercises for the patient and I am concerned she may get bored if we keep things the same for too long – equally this could result in a plateau so I need to look into developing the current exercises further whilst maintaining the patients enjoyment so she will continue with her training.

 

References

  • Baechle, T. R., Earle, R. W., & National Strength & Conditioning Association (U.S.). (2008). Essentials of strength training and conditioning. Champaign, IL: Human Kinetics
  • Das, S. P., & Ganesh, G. S. (2019). Evidence-based Approach to Physical Therapy in Cerebral Palsy. Indian journal of orthopaedics53(1), 20–34. https://doi.org/10.4103/ortho.IJOrtho_241_17
  • Gbonjubola YT, Muhammad DG, & Elisha AT. (2021). Physiotherapy management of children with cerebral palsy. Adesh Univ J Med Sci Res 3, 64-8.

Anterolateral knee p

Monday 13th June 2022

Hours: 3

Patient presentations:

  1. Anterolateral knee p

Reflection Focus

  • Anterolateral knee p

Reflection Model

  • Gibbs Reflective Cycle 1988

What Happened?

  • Patient presented with anterolateral knee p after walking 14 miles
  • Has had a previous injury on this knee but cannot remember what it was or how it was resolved
  • Subjected and objective did not reveal anything that would fit a specific pathology

 What were you thinking and feeling? 

  • I had a another student in observing me so it was good to have someone to bounce some ideas off.
  • Neither of us could ascertain what was the root of the problem and after discussing the assessment with the clinic supervisor I was confident that I hadn’t missed anything significant.
  • It was frustrating not to have a clear clinical impression for the patient; however, we were able to identify certain areas to work on that could improve knee health and alleviate his p. He was starting to feel better at the end of the assessment so he was happy and confident with his treatment plan which in turn made me feel happy and confident.

Analysis and Evaluation

  • Not all patients are going to fit nicely into a box when it comes to presentation of symptoms which could make ascertaining a clear clinical impression difficult.
  • In this situation, rather than panicking like I have done in the past, I stayed calm, cleared red flags and treated how the patient presented. Isometrics were prescribed for knee p, glute strengthening was prescribed due to glute weakness on ipsilateral side and proper heel-to-toe walking was encouraged.

 Conclusion 

  • I have found that I am becoming much more confident in my clinical practice and I am okay with not knowing the answer to something. Not knowing a clinical impression doesn’t necessarily mean you can’t help a patient; however, by being honest about not knowing what was going on and how I was going to proceed, I was able to gain the patients trust and buy-in.

Revisiting Reflection

 

 

References

L1 Burst Fracture

February 14th February 2022 – March 7th March 2022

Hours: 12 (12 x 1 hour sessions over 4 weeks – 3 sessions per week)

Patient presentations:

  • Traumatic L1 burst fracture 2021 after a motorcross accident – conservatively managed.
  • Patient complaining of stiffness in the back and a pins and needle type discomfort from lower back into glutes which he calls sciatica.

  • Patient was no longer under the care of the hospital and his physio was happy for him to resume gym-based exercise.
  • The patient does not seem to have any movement restrictions except for extension of the thoracic spine. I don’t know what his ROM was previously; however, the patient has limited thoracic extension. In addition to this there is a lot of apprehension with certain movements, e.g. RDL’s.
  • Patient reports being around 80% back to normal and would like a gym programme to help him get as close to 100% as normal. Main concern he would like to address = lower back stiffness & reduce pins and needles sensation.

Reflection Model

  • Gibbs Reflective Cycle 1988

Exercise Prescription

3 supervised sessions a week – the patient does not complete any unsupervised sessions in the gym or at home.

 

What Happened?

  • Half of the 1 hour sessions were dedicated to mobility and the rest consisted of S&C and/or cardiovascular training. Resistance training and mobility focused on the lower limb and back.
  • Upper body mobility – Back extensions/Cobras were a replacement for cat camels as this patient could not perform this movement.
  • It proved very difficult to activate the patients glutes – banded glute bridges, single leg glute bridges, banded lateral walks and clam shells all failed to generate any glute activation. In the end, a hip abduction machine provided some glute med activation so this replaced banded glute bridges; however, sometimes the patient would feel his legs working rather than his glutes on the hip abduction machine.
  • There are a lot of exercises that I had to encourage the participant to complete due to apprehension. For example, when instructed on how to use the back extension machine his initial response was, ‘ I can’t do that – no way.’ After spending time explaining the benefits of the movement for lower back strength and that he can cease the exercise if he feels uncomfortable he was then happy to proceed.
  • By the end of the 12 sessions, the patient was reporting reduced stiffness in his back but it was short lived, i.e., if he didn’t have a session for 3-4 days he would feel like he starts to stiffen up again. His pins and needles had reduced in intensity and frequency; however rotational movements still seem to be an aggravating factor for this symptom.

 What were you thinking and feeling? 

  • The patient was relatively sedentary outside of his gym session so I was concerned about how much impact the sessions would make. He stated that he doesn’t have time to come into the gym by himself and would rather have someone help and support him when he is in training. I think this may be way the reduction in his back stiffness is short lived as he wasn’t completing any additional mobility exercises at home (although he was encouraged to do so) and remaining sat down for a significant period of time each day.
  • Initially, I was unsure on what the conservative management would be for this type of injury and did some research of physical therapy management. However, my reading highlighted that exercises such as bridging, back extensions and bird dog are all suitable for strengthening and stabilising the lumbar spine – an important area to address in this type of injury (find evidence)
  • I felt quite frustrated that I could not successfully or consistently get the patients glutes to activate. I tried all the exercises I could think of but it is still something we are struggling to get right.

Analysis & Evaluation

  • Evidence suggests that thoracolumbar burst fractures without neurological deficits can be successfully treated through a non-surgical approach. (Pehlivanoglu, et al., 2020; Sahoo, et al. 2022). Therefore, I was confident that this patient was suitable in addition to both their doctor and physiotherapist approving an exercise training programme.
  • I found it really challenging to find research that provides an evidence base approach to end-stage rehabilitation of a traumatic thoracolumbar burst fracture. Therefore, I treated how the patient presented and what I knew would need to be addressed. For example, a fracture will impact stability of the spinal column; therefore, it was really important for me to work on stability of the lumbar spine with exercises such as back extensions and side planks.
  • The patients apprehension to complete certain exercises was concerning and may indicate a psychological barrier to rehabilitation success. However, it is good that he trusts me enough to try the exercises before completely ruling them out. So, I am hopeful over time he will become increasingly confident and take on more complex movement patterns or tasks with less hesitation.
  • Being unable to activate the glutes means that cannot be effectively strengthened.
    • The ability to actively control the muscles of the hip plays an important part in lumbar segmental stability. As a function of the gluteus maximus muscle, the sacroiliac joint delivers loads from the trunk to the lower limb, and if this joint moves excessively, it results in pressure on the joints and disks between the L5–S1 vertebral body, sacroiliac joint, and pubic symphysis, which leads to functional failure of the sacroiliac joint and low back pain. (Jeong, et al. p.3814 2015)

    • I need to investigate further into why this patient cannot activate his glutes. Jeong, et al, 2015, found that glute strengthening alongside lumbar stabilisation exercises improved lower back pain. Therefore, proper strengthening of the glutes may be key for long-term back health in my patient.
      • He does have difficultly crossing his leg over when performing glute foam rolling and cannot cross his legs in general. He reports a sensation of restriction whilst pointing to his TFL (sometimes his ITB) and this could be inhibiting the glutes from firing correctly.
  • Despite, encouragement the patient doesn’t appear to be intrinsically motivated as he will not perform any exercises on his own or at home. I will need to see if this is something we can work on as he is sedentary and movement could help reduce the sensation of stiffness. He also reports that when he sits for too long that he experiences a pins and needle sensation like sciatica from his back to his glutes; therefore, there could potentially be a disc bulge irritating the nerves. Completing a small amount of exercise at home or even taken active breaks from sitting may help speed up his recovery but also reduce discomfort.

 Conclusion 

  • Next phase needs to incorporate strengthening in rotational movement patterns. The patient reports that when he twists he experiences the pins and needles sensation. This programme has very little rotational movement patterns so incorporating this into the programme may help to strengthen this movement pattern and reduce symptoms
  • I also need to address inhibition of the gluteals – being sat down for significant portions of the day is not going to be helpful so in addition to finding more exercises to help target the glutes, I need to consider how to reduce TFL activation and encourage the participant to move more outside of his sessions.

Revisiting Reflection

 

 

References

  • Jeong, U. C., Sim, J. H., Kim, C. Y., Hwang-Bo, G., & Nam, C. W. (2015). The effects of gluteus muscle strengthening exercise and lumbar stabilization exercise on lumbar muscle strength and balance in chronic low back pain patients. Journal of physical therapy science27(12), 3813–3816. https://doi.org/10.1589/jpts.27.3813
  • Pehlivanoglu, T., Akgul, T., Bayram, S., Meric, E., Ozdemir, M., Korkmaz, M., & Sar, C. (2020). Conservative Versus Operative Treatment of Stable Thoracolumbar Burst Fractures in Neurologically Intact Patients: Is There Any Difference Regarding the Clinical and Radiographic Outcomes?. Spine45(7), 452–458. https://doi.org/10.1097/BRS.0000000000003295
  • Sahoo, M., Ray, S., Mahato, P.,  & Sahoo, U., &  Panigrahi, T. (2020). Outcome of nonoperative management of thoracolumbar burst fractures without neurological deficits – An analysis. Journal of Orthopedics, Traumatology and Rehabilitation. 12. 79. 10.4103/jotr.jotr_2_20.

Suspected Biceps Tendinopathy & RC Weakness

Monday 9th May 2022

Hours: 3

Patient presentations:

  1. Knee and hip Pain
  2. Suspected Biceps Tendinopathy & RC Weakness

Reflection Focus

  • Suspected Biceps Tendinopathy & RC Weakness

Reflection Model

  • Gibbs Reflective Cycle 1988

What Happened?

  • Patient presented with a 3 month history of R side shoulder pain and was concerned it may be frozen shoulder.
  • Painful Arc +ve, Resisted Bicep Test +ve, Lift Off Test +ve
  • PoP bicipital groove and ToP across deltoid

 What were you thinking and feeling? 

  • I had prepped for presentation and treatment of frozen shoulder; however, the patients signs and symptoms did not fit the presentation.
  • I was quite nervous during this assessment as I still don’t feel 100% confident with shoulder pathologies.
  • I treated with an exercise prescription to activate and strengthen the RC muscles. I also prescribed AROM exercises to maintain shoulder ROM. I did not provide anything for IR as this was too painful to complete.

Analysis and Evaluation

  • I think my assessment was much better than previous shoulder assessments and my prior reading meant I could rule out frozen shoulder. After clinic, I did wonder if this was a common presentation and found that bicep tendinopathy is often secondary to rotator cuff problems, particularly subscapularis (Raney, et al. 2017).
  • However, I have been so focused on improving assessment and identifying shoulder pathology that I have failed to give enough attention to the rehabilitation component.

 Conclusion 

  • I need to focus my final bout of revision for the shoulder on appropriate rehabilitation strategies as this was what let me down today. I didn’t offer any exercise for the bicep tendinopathy which was a mistake and this should be incorporated on the patients next visit.

Revisiting Reflection

 

 

References

  • Raney, E. B., Thankam, F. G., Dilisio, M. F., & Agrawal, D. K. (2017). Pain and the pathogenesis of biceps tendinopathy. American journal of translational research9(6), 2668–2683.

Week 12 – Next Steps & Self Talk

11th April 2022

  • Hours: 2

Participants

  • 10

Education 

  • Next steps
    • Reviewing goals and implementing longer term goals
  • Self-Talk
    • Positive self talk – saying you are useless doesn’t make you useless, it impedes your emotional wellbeing.
    • Try and catch those moments where you aren’t being kind to yourself – ask yourself, ‘is this true?’ or ‘what could I say about myself instead

Exercise Class – CV circuits & Strength Training

CV Circuit

  • Warm Up – 3 x 30s each exercise
    • Marching on the spot
    • Half Squats
    • Arm Circles
    • Chest Swings
    • Torso Rotations
  • Main Session 60 secs on, 30 secs rest x 3
    • Body Weight Squat Thrusters into calf raise
    • Walking with knee drive
    • Side Step with Knee Lift
    • Toe Taps
    • Hands to toes > hands to sky with stability ball
  • Warm Down – Static Stretches, 30 secs per muscle group
    • Glutes
    • Hamstrings
    • Back
    • Chest
    • Shoulders

Strength Training

  • Warm Up – CV of choice
  • Main Session 3 sets of 8 reps
    • Leg Exercise
    • Leg Exercise
    • Chest Exercise
    • Back Exercise
    • Back Exercise
    • Core Exercise
    • Optional: Arm/Shoulder Exercise
  • Warm Down – Static Stretches, 30 secs per muscle group
    • Glutes
    •  Hamstrings
    •  Back
    •  Chest
    • Shoulders

Analysis & Evaluation 

  • Participants were given a rough structure to their workout and I was on the gym floor to provide help if they needed it. I was pleasantly surprised that most of the participants were content with the programme structure and could follow it easily. There were a few things I needed to help with, e.g. adjusting suspension straps, however, they all selected the appropriate exercises for each body part. All reported feeling confident that they could do that on their own again without help or support which highlights that they are ready to independently continue their journey.

Conclusion 

  • I have offered a final check-in for those who want additional help or a new programme to follow in the gym to ensure that they have an opportunity to ask any questions they may not have been comfortable addressing to the group.

Revisiting Reflection

References

Week 11 – Planning for Success & Worry

4th April 2022

  • Hours: 2

Participants

  • 10

Education 

  • Planning for success
    • As the programme is coming to a close we created an action plan for the week, e.g. what days to exercise, what days to rest, what type of exercise, etc.
  • Worry less
    • The difference between a practical worry and a hypothetical worry.
    • Hypothetical worries can be addressed during a dedicated time and place so not to intrude on your day.
    • Practical worries can be resolved through problem solving.

Exercise Class – CV circuits & Stability

CV Circuit

  • Warm Up – 3 x 30s each exercise
    • Marching on the spot
    • Half Squats
    • Arm Circles
    • Chest Swings
    • Torso Rotations
  • Main Session 60 secs on, 30 secs rest x 3
    • Body Weight Squat Thrusters into calf raise
    • Walking with knee drive
    • Side Step with Knee Lift
    • Toe Taps
    • Hands to toes > hands to sky with stability ball
  • Warm Down – Static Stretches, 30 secs per muscle group
    • Glutes
    • Hamstrings
    • Back
    • Chest
    • Shoulders

Functional Stability

  • Warm Up – 3 x 30s each exercise
    • Marching on the spot
    • Half Squats
    • Arm Circles
    • Chest Swings
    • Torso Rotation
  • Main Session 40 secs on, 20 secs rest x 3
    • BOSU Balance
    • Stability Ball Leg Extension
    • Stability Ball Torso Rotations
    • Stability Ball Arm Circles
    • Wall Supported Plank
  • Warm Down – Static Stretches, 30 secs per muscle group
    • Glutes
    •  Hamstrings
    •  Back
    •  Chest
    • Shoulders

Analysis & Evaluation 

  • To increase confidence further from the last two weeks, we completed the stability session in the gym. Participants really enjoyed the change of scenery but also reported that the gym didn’t seem as intimidating as they had once thought. Some had been using the gym in the own time since having the gym induction; however, those who hadn’t now seemed more inclined to come in.
  • Participants are reporting increased fitness with many recovery faster in between sets of exercises. This is solidifying that 2 x 30 min sessions a week has been enough to make a meaningful impact and should hopefully encourage individuals to keep their activity levels up.

Conclusion 

  • I think next weeks session should involve more gym equipment to give that last little bit of confidence for participants to continue their journey independently. As the classes will cease, they will need to ensure that they have an appropriate replacement ready. Equally, this will allow those who are improving in their CV fitness to challenge themselves as the work will be individual.

Revisiting Reflection

 

References

Week 10 – Recovery & Sleeping Better

28th March 2022

  • Hours: 2

Participants

  • 10

Education 

  • Sleep, rest and recovery
    • Incorporating low impact activity when in pain
    • Knowing when exercise is not the best choice
    • Quality of sleep is linked to perception of pain
  • Sleeping better
    • Developing a healthy sleep routine
    • Discussion around sleep hygiene – leaving phones out of the bedroom, no caffeine close to bed time, etc.

Exercise Class – 2 x CV

CV Circuit

  • Warm Up – 3 x 30s each exercise
    • Marching on the spot
    • Half Squats
    • Arm Circles
    • Chest Swings
    • Torso Rotations
  • Main Session 60 secs on, 30 secs rest x 3
    • Body Weight Squat Thrusters into calf raise
    • Walking with knee drive
    • Side Step with Knee Lift
    • Toe Taps
    • Hands to toes > hands to sky with stability ball
  • Warm Down – Static Stretches, 30 secs per muscle group
    • Glutes
    • Hamstrings
    • Back
    • Chest
    • Shoulders

Cardio Class

Chair based cardio by external instructor

Analysis & Evaluation 

  • Participants really enjoyed another class taught by an external instructor and it has the desired effect of cementing their confidence. many participants picked up class timetables when leaving this session which indicates they are very much interested in continue classes once the programme ends.
  • Sleep hygiene was a difficult discussion as many stated they know what to do they just don’t do it. Many of the participants stated that there is so much to do to get good sleep that it is almost impossible to get the perfect routine. I encouraged participants to look at it from the perspective that, ‘some change is better than no change.’ Rather than doing everything all at once they should look to change just one thing and see how they get on with that. I also encouraged them to reflect on what they learned about sleep last week which should encourage and motivate them to improve their sleep hygiene.

Conclusion 

  • Trying to make positive changes can seem daunting when there are multiple components to try and stick to. However, small changes can be meaningful over time and it is important that people recognise that not being able to do something ‘perfectly’ doesn’t mean we shouldn’t do it at all.
  • I will need to ensure I have a discussion with participants about appropriate class they could attend as not all will be suitable.

Revisiting Reflection

 

References

Week 9 – Weight Management & Your Mood

21st March 2022

  • Hours: 2

Participants

  • 10

Education 

  • Weight management
    • The impact of obesity on load bearing joints such as the knees and hips.
    • Fat creates and releases chemicals that promote inflammation which can exacerbate or speed up the onset of OA.
    • Discussion on ways to manage weight, e.g. exercise and a diet focused on whole foods.
  • Accept your mood
    • Take notice of your feelings, especially if you feel your mood is low.
    • Acknowledge the emotion you are feeling and allow it to pass naturally.

Exercise Class – CV circuits & Functional Mobility

CV Circuit

  • Warm Up – 3 x 30s each exercise
    • Marching on the spot
    • Half Squats
    • Arm Circles
    • Chest Swings
    • Torso Rotations
  • Main Session 60 secs on, 30 secs rest x 3
    • Body Weight Squat Thrusters
    • Walking
    • Side Step with Knee Lift
    • Seated Running
    • Hands to toes > hands to sky with stability ball
  • Warm Down – Static Stretches, 30 secs per muscle group
    • Glutes
    • Hamstrings
    • Back
    • Chest
    • Shoulders

Functional Mobility 

Yoga session taught by an external instructor

Chair based options provided for those with poor mobility

Analysis & Evaluation 

  • Many of the participants report that weight management is something they struggle with. They also feel that they haven’t been given the correct support to help them achieve a healthier weight. During the discussion, I made sure to iterate that if anyone felt they did not have control over their eating or that there is an emotional component to their eating, to speak to their GP about further support. After mentioning this, one participant opened up about living with an eating disorder and how knowing she needs to lose weight is triggering for unhealthy habits of restriction which leads to binging.
  • I thanked the participant for sharing and at the end of the session I signposted her to BEAT which is a UK charity for people who need help regarding an eating disorder. I am glad that I was aware of BEAT, as if I wasn’t I would have worried about what further help and support I could give to the participant beyond visiting her GP.
  • Participants really enjoyed having an external instructor in and it made them feel as though they would be able to do a class once the programme ends. I have planned another session with an external instructor so this can cement their confidence in their abilities even further.

Conclusion 

  • This situation has highlighted the importance of networking and signposting. Rehabilitation of any kind needs to centre around the whole person and sometimes you may develop relationships where they share personal information that requires you to either onward refer or provide appropriate signposting. I am going to spend some time creating a document of resources which cover a variety of areas a person may need further help and support on. E.g. BEAT, Alcohol change UK, Gamcare, etc. This will ensure that I can offer immediate signposting.

Revisiting Reflection

 

References

Week 8 – Pain Management & Happiness

14th March 2022

  • Hours: 2

Participants

  • 10

Education 

  • Pain Management
    • What have you found helps pain?
    • What do you find exacerbates pain?
  • Be happy that you are happy
    • Importance of self care and its link to our happiness
    • Are there any things that make you happy you haven’t done because of your joint pain? Can you see a way of trying to reincorporate it, or something similar, back into your life?

Exercise Class – CV circuits & Functional Strength

CV Circuit

  • Warm Up – 3 x 30s each exercise
    • Marching on the spot
    • Half Squats
    • Arm Circles
    • Chest Swings
    • Torso Rotations
  • Main Session 60 secs on, 30 secs rest x 3
    • Body Weight Squat Thrusters
    • Walking
    • Side Step with Knee Lift
    • Seated Running
    • Hands to toes > hands to sky with stability ball
  • Warm Down – Static Stretches, 30 secs per muscle group
    • Glutes
    • Hamstrings
    • Back
    • Chest
    • Shoulders

Functional Strength

  • Warm Up – 3 x 30s each exercise
    • Marching on the spot
    • Half Squats
    • Arm Circles
    • Chest Swings
    • Torso Rotation
  • Main Session 60 secs on, 30 secs rest x 3
    • Tempo Squats
    • Wall Push Off combine with Shoulder Taps
    • Leg Extensions
    • Stability Ball Chest Press > Shoulder Press
    • Hamstring/Glute Kick Back
    • Banded Row
  • Warm Down – Static Stretches, 30 secs per muscle group
    • Glutes
    •  Hamstrings
    •  Back
    •  Chest
    • Shoulders

Analysis & Evaluation 

  • Discussion around pain management highlighted how stress, poor diet, etc. can influence pain. This highlighted that the group are in tune with other factors beyond physical can influence how they feel. Some even shared dropping the dosage on their pain medication or removing them entirely which shows that the blended programme has really helped individuals with pain management.
  • Participants are becoming fitter and stronger – I can see form improving on exercises such as squats and the group tend to recover from each set slightly better than in the initial weeks. Many take pictures of the class session and then replicate it at home so we celebrated how doing just a little bit extra can make a big difference.

Conclusion 

  • To see participants engage with more activity outside of the programme hours instills a confidence that they are taking ownership over their joint pain management. This is hopefully the start of them being able to continue the healthy practices they have incorporated into their life beyond the 12 week programme.

Revisiting Reflection

 

References

STM for maintenance/self-care

Monday 26th April 2022

Hours: 3

Patient presentations:

  1. STM for maintenance of lower back ‘stiffness’ – patient also had an injured arm but was not looking for treatment of this.
  2. STM for maintenance of lower back ‘stiffness’ – patient also had an injured shoulder but was not looking for treatment of this.

Reflection Focus

  • STM for perceived lower back stiffness.

Reflection Model

  • Gibbs Reflective Cycle 1988

What Happened?

  • 2 patients both requested STM for the lower back.
  • No particular concern or injury, both used the phrase, ‘too keep on top of it’ regarding stiffness.

 What were you thinking and feeling? 

  • I remember not really looking forward to two hours of massage, particularly when I learned that there was no injury or complaint to treat.

Analysis and Evaluation

  • I failed to complete any outcome measures for both these patients which was not correct practice. Even though they had no specific complaint, I still could have assessed ROM.
  • I used a few STM techniques (efffluerage, petrissage, and TrPs’); however, I could have used mobilisations (PA) as they were both reporting stiffness.
  • I also failed to consider any psychosocial factors underpinning their desire for STM treatment.
  • Overall, I think my disappointment of not having a pathology or injury to work with resulted in my lack of thorough assessment and investigations.

 Conclusion 

  • The next STM I have in clinic, I will remember to complete an appropriate outcome measure and consider psychosocial factors during assessment and/or treatment.

Revisiting Reflection

 

 

References