08.04.19 Clinical Hours

I spent three hours in the Marjon injury clinic as part of my first officially scheduled clinic session. I shadowed a graduate therapist who was assessing a 33-year-old female who had constant Achilles tendon pain on her right leg. She injured her Achilles 6/52 ago, with initial severe swelling, during running which she does 2/7. Objective found pop on right Achilles, tibialis anterior and pain when doing eccentric part of heel raise. Diagnosis was Achilles tendinopathy with tight right & left tib ant. Treatment was concentric calve raises, training volume reduction and toe scrunches. During the session the therapist mentioned different phases of Achilles tendinopathy and thus I did some research on this after the session. Cook & Purdam (2008) suggest that tendinopathies follow the following continuum of stages: Reactive (Tendon thickening), tendon disrepair (Failed tissue healing) and degenerative (Pain, swelling, nodules, rupture) stage.

After the shadowing session was completed a graduate therapist and some of my fellow colleagues discussed treatment for disk herniations as we were unclear on this. She suggested the use of the McKenzie exercises (repeated movements opposite to the movements that cause pain) with the aim of centralising pain to diagnose the problem. Then once the painful movements have been found appropriate exercises are used as treatment with the aim of centralising and reducing pain. The McKenzie method has been shown to provide positive changes in spinal disk i.e. resolved herniation in patients with disk herniations (Takasaki, May, Fazey, & Hall, 2010).

Then we discussed the difference between HIIT (High intensity interval training) and HIFT (High intensity functional training) as the clinic were introducing a HIFT training programme for police officers that come into the clinic over the summer (reference below). The key differences are that unlike HIIT training, HIFT training elicits additional improvements in muscular endurance and strength. The main components of the exercise programme focus on strength exercises (compound exercises), accessory movement (isolation exercises) and a metabolic component (CV work to raise HR).

Overall this clinic session was a little disappointing as I was meant to be there for 5 hours but ended up only getting 3 hours of experience. Positives of this session were that I learned a useful tool to help diagnose and treat disk herniations via the McKenzie method and learn about the different tendinopathy stages and benefits of HIFT training. For the next clinic session, I will revise leg anatomy to refamiliarise myself with the muscle origin and insertions.

Links:

McKenzie Method: https://www.physio-pedia.com/Mckenzie_Method

Police HIFT programme: https://create.piktochart.com/output/35828801-response-unit-photo-version

References:

Cook, J., & Purdam, C. (2008). Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. British Journal Of Sports Medicine43(6), 409-416. doi: 10.1136/bjsm.2008.051193

Takasaki, H., May, S., Fazey, P. J., & Hall, T. (2010). Nucleus pulposus deformation following application of mechanical diagnosis and therapy: a single case report with magnetic resonance imaging. The Journal of manual & manipulative therapy18(3), 153–158. doi:10.1179/106698110X12640740712455

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