Author: wstuart

Today I had a follow-up appointment with the client id seen the previous week. It was the first follow-up appointment that id had in a while. It was good to be able to see the development that the client had experienced during the two weeks that we had not spoken. I was confident in the further advice I was able to give to the client in the aspect of adding extra sets to exercises and using an RPE scale in regard to walking to ensure that the client was not going to far too soon and increasing the risk of reinjury. Due to lockdown restrictions being eased I was able to book the client in to a F2F appointment in the next two weeks and this excites me as I will be able to go back to giving out proper exercise prescription in a clinical environment and this is where I feel I can really make the best progress with my clients.

Today I had my first online triage of the semester. I was nervous as I thought I would be rusty. This was not the case. As soon as I got into the call I was confident in my questioning of the client and my overall diagnosis. I approached this triage differently as opposed to offering any treatment on the call I opted to develop a full treatment plan for the client post call and emailed it on the same day. This gave me more time to think through the rehab and I feel like it worked well for me as although I had a good idea of what I wanted to do for the rehab even on the call, it gave me an opportunity to better articulate and explain things as to not confuse the client. Ive inserted the treatment plan below.

 

Rehab plan-

To be completed every day if possible, working within RPE 13-16 – see BORG scale attached.

You may experience some swelling etc after conducting these exercises. I recommend that you Ice your ankle if you are experiencing discomfort after the exercises for 15-20 minutes.

Exercise	Description	Sets and reps	Video link
Ankle ROMS	Take you ankle to the end range of movement for each exercise shown. End range is the point where you can’t move your ankle any further. Hold at end range for 6-10 seconds depending on tolerance.	3 sets of 10 reps of all movements shown in the video.   6-10 second hold at end range.	https://youtu.be/ViRsbvnL6uQ
Ankle ROMS with Towel	This exercise should help with dorsiflexion which you were saying you struggled with. Take the ankle to end range with the towel. Should see gradual increase in ROM throughout sets.	10 sets of 3 reps.   6-10 second hold at end range.	https://youtu.be/Zz30hjRKgqk
Marching/ Weight shifting	Weight transfers will help develop stability surrounding the ankle joint.	3 sets of 10 weight transfers.   Once weight is transferred hold weight on foot for 5 seconds- increase time held depending on RPE tolerance.	https://youtu.be/uvcJOSnivpw
Jockeys	One thing to take note of is foot and ankle placement at each stage. This will work on correct stance and movement in sit to stands .	3 sets 10 reps   6 second hold at top of movement.	https://youtu.be/NhZGW_zAPhc
Stork stands	This will really develop proprioception in your ankle and increase overall stability.   To begin with don’t worry if you cant come onto the ball of your foot but gradually incorporate this.   Make sure you’re working both legs	5 sets of max time holds- relevant to RPE.	https://youtu.be/atDzc08CW54

 

Today in clinic I had another online consultation. It was very challenging due to Wifi connection issues. It was a struggle to hear what the client was saying so I tried to direct the questions to be as easy as possible to reply to and for the client to also understand. With regards to the pathology, it was tricky to get a complete clinical impression due to the nature of the online consultation and not being able tom get hands on. However, I was able to use functional movements such as the stork stand, the sit to stand and repeated abduction. The onset of repeated movements seemed to aggravate the pathology. Following the appointment, I designed a flexibility, mobility and strengthening programme for the hip slowly factoring in walk-run for the client as they were training for a half marathon prior to injury. To improve this session next time I could go through all the some exercises with the client whilst o the call, to do this in will need to improve my knowledge of Hip mobility exercises that I would know off the top of my head.

Today I had another online triage. The patient had not made any prior notes so therefore I went into the triage not knowing anything about what I was going to be dealing with. This would have phased me before but now I feel so much more confident in my clinical skills I was unphased. I feel I handled the call well even with the client presenting with lower back pain. Even though it was online I still managed to go through some active ROMs in the Lumbar and thoracic spine just to aid with clinical impression. Although it is hard to be 100% certain about a diagnosis over the phone the AROM helped narrow my thoughts and findings. My impression was a disc compression in the lumbar spine. For this I prescribed some stretches that aim to relive pain such as the cobra and knee hugs. This is an aim to get the client moving more and I have scheduled a other appointment in a 2 weeks time to check on progress.

In this online triage I really took the time to talk to the client about the history of her conditions. She has been struggling with pain for a long time and it was clearly having an impact on her mental health. This client reaffirmed to me why I wanted to get into the field of sports rehabilitation, to help people who are seeing things as hopeless and giving them hope for pain free activity and movement. We had a long chat about lifestyle and training and following the call I spent a long time developing a gym plan and suggesting changes to lifestyle that can help the client to have the best and quickest recovery possible.

joint dysfunction

Today in clinic I signed off my first client. This was a big deal for me as it reaffirmed my self-belief that I am a competent practitioner. Before seeing my client I finished off the gym plan that I’ve written for them. The programme follows a needs analysis for the clients wants for example the client is planning to join the marines, so I added cardio into the programme along with weight training to continue to strengthen up his core and back to stabilise his lower back and try and stop an onset of pain. I went through the programme with the client and got his thoughts and feelings on it which were all very positive. We did alter a few things but I would rather alter some things and the clients happy opposed to them not being entirely on board with the plan and me wasting my time. Additionally, we went through all the movements on the programme together to ensure he was moving correctly and there were a few tweaks that I made to his form on some exercises such as using the imaging of ‘screwing feet into the floor’ in order to  prime the glutes before the lift.

Today in clinic I treated just the one client. My client is one I have treated previously with a reactive Achilles tendinopathy. For the session I looked at AROM, PROM and resisted ROM in both ankles before going through a gym session. The gym session consisted of functional movements such as squats and calf raise with isometric holds. Comparing the client to the previous session the pathology appears to be easing which supports the subjective reassessment, the client seems to be progressing well and I feel like face to face appointments are not appropriate with the reopening of gyms, I could easily write this client a gym programme that he would adhere to in order to further strengthen the Achilles tendon and reduce the risk of reinjury.  Throughout the session I felt very comfortable and confident with both my practice and use of physical therapy as a treatment modality. For the remainder of my time in clinic, after I had finished writing up my notes, we looked at CPD presentations about selected pathologies looking at special populations and gender differences. This was a good task as it allowed me to focus on one pathology and expand my knowledge. I found the other presentations very useful as it gave me an insight to other pathologies but the main reason why the session was good as it reinforced the need to take into considerations in gender differences.

Today in clinic I treated two clients. The first once was a face to face gym appointment with a client displaying a reactive Achilles tendinopathy. Prior to going into the gym, I performed an objective assessment. Upon completing  the objective assessment my clinical impression remained the same, so I followed through with the planned gym session. The Session involved a lots of isometric calf work with the aim to put load through the tendon without much concentric movement which will mean the muscle will not be repeatedly put on and off stretch. (Mantovani, L., Maestroni, L., Bettariga, F., Gobbo, M., Lopomo, N. F., & McLean, S. (2020). Does isometric exercise improve leg stiffness and hop pain in subjects with Achilles tendinopathy? A feasibility study. Physical Therapy in Sport, 46, 234-242.). For the hour between my two clients I wrote up my notes from my first client and ensured that my plan for my 11oclock client. For my final client I was again in the gym. The client is recovering from a facet joint dysfunction so for the session I used RPE in a gym session to see if a heavier load affected the onset of pain. The session did not cause an onset of pain which is really good, especially considering the movements involved such as stiff legged deadlift. Going forward with this client I will be giving him a gym plan for when gyms reopen after lockdown for him to stick to and follow which should be loaded appropriately while working within RPE that will give him the best progress.

Today in clinic I started off with an online triage call with a new client. The pathology appears to be a reactive achilies tendinopathy in the left leg. I felt confident about this diagnosis as the pain was onset with activity and the client was overtraining themselves in the gym. This led to me making the decision to see the client in the clinic next week. This is not only to reaffirm my clinical impression but also to be able to explain some rehab to the client by taking them through a gym session and to give some brief observations about the clients lifestyle that could help aid recovery. These observations can include volume of training, nutrition, hydration, and sleep. Helping clients to make informed choices in their daily lives can help to improve the body’s healing process. For example, getting higher quality sleep improves the amount of REM sleep you get which is when the body recovers and repairs the most. After this call I finalised the notes from the call and prepares the session for the following week. This is important for me to do as it means that I can programme it when the client is still fresh in my head and I can recall all the information needed to create an impressive individualised session. Following this before my other client I looked at a case study of concussion and the steps as a sports rehabilitator I should take to ensure players are safe to return to play following a concussion. For the rehab plan I based it from the RFU return to play regulations. Although the return to play is for rugby players it can be easily adjusted for all sports through the integration of sports specific drills. It is important for me as a practitioner to keep going over key pathologies so I can use the latest programmes designed to get clients back playing sport as quickly and safely as possible. For my final client I took him through a gym session for a facet joint dysfunction. While working with this client for the last three weeks I have seen great progress and pain go from being limiting in everyday life to non-existent. For this I have simply looked at exercise prescription and some lumbar mobility. The client has adhered very well to the plan and the progress is clear for both him and me to see. Going forward I am looking to use the gym aware kit to predict his 1rms in order to programme him a 6 week gym plan for after the second lockdown in order to continue to develop his stability in lower back, continue to improve his glute firing and ensure symmetry in his quads and hamstrings to prevent a pelvic tilt from developing.