09.05.19 Clinical Hours

Today’s clinic session began with shadowing a patient (57-year-old male, desk job) with left foot pain which got worse in the morning and after exercise but was reduced during exercise. Objective assessment found pain on palpation on the plantar aspect of the left foot and on the medial side of the calcaneus. Diagnosis was plantar fasciitis. Treatment included soft tissue massage to plantar aspect of foot, ultrasound, K-tape, strengthening exercises for toe flexors (toe pickups/curls), heel raises (gastrocnemius) and bent knee wall heel raises (soleus) and a towel stretch. As I was unsure about plantar fasciitis and its diagnosis, I did some reading during some free time between patients. A study by Petraglia, Ramazzina & Costantino (2017) confirms that plantar fasciitis has the following symptoms: Pain in the planta fascia which is worse in the morning and after long periods of rest. It develops on the insertion of the planta fascia and can be unilateral or bilateral. Pain is often localised in the origin of the planta fascia on the calcaneus.

After shadowing this patient, I had no one to shadow so instead I discussed how to apply posterior anterior glides (PA) on the spine with a colleague and a graduate sports therapist. I found out that you should apply PA for 3 sets of 60 seconds for each vertebrea for both unilateral (transverse processes) and bilateral (spinous process) PA. Furthermore, I found a good outcome measure called the LEFS (lower extremity functional scale) to help determine the progress of lower extremity injury rehabilitation.

After this discussion session, I was meant to shadow another patient but was then told to treat the patient myself. The patient (33-year-old female, yoga instructor/life coach) came in for a follow up with a stiff neck, pain on palpation of upper trapezius and left forearm extensors (extensor digitorum). Bilateral PA on C3, C4 and C5 spinous process showed slight pain and reduced movement. Treatment was soft tissue massage to trapezius, levator scapula, rhomboids, deltoids, extensor digitorum, Bilateral PA for C3, C4, C5 spinous processes for vertebrae mobility. Exercises included banded rows, L raises, shrugs and broomstick side-to sides. After this session, I spent the rest of my time in the clinic writing up the notes of this patient, which took a long time. This was because I’m still new to treating clients and because the patient had a long history of notes form prior sessions that I needed to look through and figure out what would be best to do in her next treatment session. For future clinic sessions I need to go over forearm and foot anatomy to help aid in diagnosing and treating clients.

After this session I did some reading on cervical spine assessment as my knowledge is not up to standard. Passive Accessory Intervertebral Mobilizations (PIVM) of the c-spine can be used to assess intervertebral mobility and pain provocation of each vertebral segment. Overall reliability was found to be poor but moderate reliability was found consistently for segment C1/C2 and C2/C3 (Van Trijffel, Anderegg, Bossuyt & Lucas, 2005). I did not know about these assessment techniques before and was surprised to find out about them. It seems that it will take some practice to become efficient in applying these techniques. For the future, will practice PIVMs of the c-spine in order to help my diagnosing skills and broaden my assessment tools. Below is a great video demonstrating PIVM to the upper cervical vertebrae segments.

Links:

Physiopedia LEFS: https://www.physio-pedia.com/Lower_Extremity_Functional_Scale_(LEFS)

LEFS Picture from: https://www.researchgate.net/figure/Source-originale-Binkley-JM-Stratford-PW-Lott-SA-Riddle-DL-The-Lower-Extremity_fig1_221874838

References:

Petraglia, F., Ramazzina, I., & Costantino, C. (2017). Plantar fasciitis in athletes: diagnostic and treatment strategies. A systematic review. Muscles, ligaments and tendons journal7(1), 107–118. doi:10.11138/mltj/2017.7.1.107

Van Trijffel, E., Anderegg, Q., Bossuyt, P., & Lucas, C. (2005). Inter-examiner reliability of passive assessment of intervertebral motion in the cervical and lumbar spine: A systematic review. Manual Therapy10(4), 256-269. doi: 10.1016/j.math.2005.04.008

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