24.10.18 – Hour 10-11
Today for the first hour, I massaged a friend of my parents who is a keen runner, and often competes in various races/marathons. He came to the clinic complaining of experiencing very tight gastrocnemius’ following runs over the past few weeks. Upon palpation it was evident his gastric and soleus were very tight and had multiple adhesion, which would explain the pain he had been experiencing.
I proceeded to apply effleurage and petrissage to the patient’s gastrocnemius to try and reduce the tightness and aid circulation to the area. Throughout the treatment I could feel the muscle gradually becoming less tight and by pushing the adhesion’s towards the heart, these also diminished. The patient said he could immediately feel the benefits following the massage.
Overall, I believe this was my best massage to date, as I was very thorough regarding my pre-treatment observations (e.g. palpation and observation of the muscle). Furthermore, I was able to discuss the treatment I was providing the patient throughout, due to me having a good knowledge regarding the structure and make up of the gastrocnemius. If I was to massage this patient again I would do some tests before and after the treatment to get a more objective measure about how effective the treatment was.
24.10.18 – Hour 11-12
For the second hour of today’s session, I massaged a footballer who plays for my university team. Roughly a month before treatment he had pulled his right hamstring and was close to returning to play. Upon observation, the area did not seem to have any bruising or swelling, however when palpated did feel quite tight, and was mildly uncomfortable for the patient.
I began to apply effleurage and petrissage to the hamstring, but only applying a light pressure to start with to avoid injuring the patient again. Due to it being uncomfortable for the patient, I ensured I remained in constant communication, making sure I wasn’t applying too much pressure on to the injured area.
The patient said he felt comfortable throughout, despite the injury being uncomfortable. It was my first time massaging a patient with a somewhat acute injury and forced me to be a lot more careful regarding the muscles I massaged and the pressure I applied. If I was to massage someone with a similar injury in the future, I would ask more questions regarding how the injury occurred to try and gain a better understanding of the structures that may have been affected, rather than assuming it to be the whole muscle body.
30.10.18 – Hour 12-13
Today was my first ‘follow-up’ appointment, as my patient was someone who I had previously massaged. Last time he came to me, he was complaining of tightness in his hamstrings, predominantly his right. Since our first appointment, he reported a significant improvement, however now, roughly two weeks since his first treatment, he is reporting feeling the tightness again. Similarly, to the first treatment, this was confirmed upon palpation and observation.
I again applied the same methods I applied previously, as this had proven to be effective last time, however applied more pressure to try and get deeper into the muscle tissue in hope that the effects of the treatment may last a while longer. Furthermore, at the end of the massage I advised the patient to perform some stretches in his free time so that the muscles do not seize up when he is not playing.
Today’s session was good as I had already treated this patient before, and therefore I was able to spend more time observing, palpating, and treating the patient, and was just getting updates on his condition. Furthermore, I began to apply techniques In different ways such as the use of my knuckles and elbow in order to get deep into the muscle tissue. In order to improve next time I will aim to use the tapotement technique in my treatment, as the hamstring is a good area for tapotement to be applied.
30.10.18 – Hour 13-14 – Massage Case Study
My second patient today was a friend of mine who is an office worker. He came to me complaining of tightness across his upper back, due to working long hours (4-6 hours) sat at a computer desk. I had previously treated another office worker about a week prior, and therefore had a good idea of the symptoms this patient would present, and how to treat them effectively. Upon observation, it was clear there was elevation in his right trapezium, and that his shoulders were protracting. When I palpated the patient, the tightness in his trapeziums’, particularly the right side, was very evident.
For this treatment I primarily used effleurage for the patients upper back and used petrissage on his trapezius’. I did not think the area that I was treating was appropriate to use tapotement so did not incorporate this into the treatment. Towards the end, I also used petrissage on his shoulders and deltoids, to try and relieve any tightness around these areas which could have been contributing to the overall pain the patient was experiencing.
I used these techniques as the patient was only complaining of general tightness in a large area rather than a specific part of the body. These techniques allowed me to cover large areas and therefore effect large areas of muscle. The use of effleurage was important as the back is a large area to cover, I was able to use my forearm to cover more muscle at once, and alternatively use my knuckles to get deep into muscles such as the erector spinae. The use of petrissage was effective on the patient’s trapezius’ as the wringing action involved in the technique allowed me to get deep into the muscle and relieve the tension.
Following the massage, the patient said he felt much looser in his upper back, and then messaged me a few days later saying he felt much more comfortable when at work. Due to it being his upper back, it was difficult to test an accurate and consistent range of motion (ROM), however, upon observation following the massage, it was clear to see the patients shoulders were not protracting as much, meaning that tension had clearly been relieved in his upper back. Also, the elevation in his right trapezium had significantly decreased, however, was still slightly evident. This means that further treatment will be needed in the future if the patient wants to relieve all tension on his upper back.
I believe I dealt with this patient very well, both before and during the treatment. This was my first client who was not a sports player, and therefore I had to treat him slightly different in how I approached the treatment e.g. asking different questions regarding his condition. During the massage, I believe I treated the patient very well using a variety of techniques to my advantage. Furthermore, I began to apply the techniques in slightly different way, for example using a combination of my forearm and my knuckles to perform effleurage on the back in order to cover a larger surface area, which proved to be very effective and time efficient. I communicated with the patient throughout, ensuring he was comfortable with the treatment while also making sure he would feel the benefits. In order to improve next time, I will try and do some ROM tests with the patient, so I can obtain some objective measures regarding the effectiveness of the treatment, rather than relying on subjective feedback.
1.11.18 – Hour 14-15 – Formative Assessment
Today was my first formative assessment, in which I got assessed by a second year sports therapist. This was a good experience for me as i was able to receive feedback from someone who had a years worth more experience than myself. Furthermore, he is also the therapist for the university’s mens football first team, meaning he had experience treating patients who play at a high level. He came presenting no real complaints issues, which allowed me to massage him in various places and apply various techniques.
Throughout the treatment, I massaged primarily his legs and back, while also massaging his shoulders and neck to try and receive as much feedback as possible. I most often applied effluerage and petrissage to the areas, as well as tapotement where I deemed it applicable. Finally, I also incorporated a muscular energy technique (MET) in the form of post-isometric relaxation (PIR) at the end of the treatment.
After the massage, the patient completed a formative assessment form, and fed back his thoughts to me. He said that my depth of massage was good throughout, and he could feel that I was getting deep into the muscle tissue, relieving any tension which may be present. He noted that while my knowledge of the various techniques was good, my application could be better, particularly for tapotement and METs. Finally, he said that before the treatment, I missed a few important contraindications, which could have drastic outcomes. Overall, he said the treatment was good, and a lot of things will be improved with more experience.
12.11.18 – Hour 15-16
Today I massaged for the first time in just over a week, due to having a cold/flu in the previous week. This highlighted the importance of cleanliness and good hygiene in the clinic. Prior to the treatment, I washed my hands and arm up to my elbow thoroughly. My patient today was a tennis player who plays for a local club. He plays 2-3 times a week dependant on competitions at the time. He came to me complaining of pain in his right forearm and shoulder.
I applied mainly effleurage to his forearm, with only a slight use of petrissage due to it not being a large muscle body. I mainly applied petrissage to his shoulder, primarily aiming for the 3 heads of the deltoid muscle. I did not deem tapotement applicable to the area I was massaging. For the first time, I also applied soft tissue release (STR) in this treatment. STR involves pressure being placed onto a muscle, at the same time as the muscle being stretched. This re-aligns adhesions and lengthens the muscle.
Overall this treatment today was very good, and allowed me to massage parts of the body and apply techniques I had not done previously. I felt as though the massage depth was good throughout, and particularly for the STR, my communication with the patient was very good. One main area I can improve on is revising my anatomy of different structures such as the forearm so I can be more precise when explaining the treatment I am providing to patients.
30.11.18 – Hour 16-17
Today I had a netball player who I had previously massaged. She came complaining of general tightness in her gastrocnemius’ and hamstrings. This was the same as when I had previously treated her and therefore had a good understanding of how to treat the patient. She also added that she had been experiencing some pain in her lower back, which I contributed to the tightness in her hamstrings.
Similarly to the last treatment, I applied effleurage and petrissage to the muscle bodies to try and relieve any tension and remove any adhesion’s. Furthermore, I also applied tapotement to her gastrocnemius’ and hamstrings, as well as using petrissage on her internal obliques. Following the treatment, I advised the patient to perform some extra stretches in her own time to try and maintain the effects of the treatment.
Overall, I believe the massage was very successful as when palpated, the muscle felt significantly less tight when palpated in comparison to before the massage. The patient also stated she felt a lot better after the treatment. This massage was also good as I began to apply more techniques such as petrissage of the internal obliques which I would not have done previously. In order to improve in the future, I must stay aware of how much massage medium I am applying, particularly when massaging girls who often shave their legs and therefore have less hair to absorb the medium.
30.11.18 – Hour 17-18
The second patient I saw today was a rugby player for both Marjon university and a local team, playing between 3 and 5 times a week. Again, I had previously massaged him and wanted more treatment to see him through to the Christmas break. When he came in initially, he explained he had a previous injury in his right quadricep, however it had been healed for a long time and therefore was not a cause for concern. I checked for updates on the patients condition e.g. whether he had suffered any injuries since or he has been experiencing unexplained pain but this was all negative.
I applied effleurage, petrissage and tapotement to his quadriceps as this was his main area of discomfort. I also applied PIR to the area to, as this technique is known to increase ROM. The patient experienced some discomfort when I was applying PIR, so therefore I reduced the amount of pressure I was applying and the extent of which I was stretching the muscle.
This treatment was good in some areas but definitely has room for improvement. The main area for improvement I observed was when applying stretching techniques such as PIR, I should start lighter and gradually increase how much pressure I apply/how far I stretch the muscle, so that I do not cause the patient to much discomfort. Besides this, the treatment was overall very good and it is clear that I am improving through experience.
4.12.18 – Hour 18-19 – Stretching Case Study
Today I saw a patient for the third time. The patient is a semi-professional footballer who has been experiencing tightness in his hamstrings, particularly on the right side. In his previous sessions, I had applied soft tissue therapy to his legs in order to relieve any tension in these areas. For today’s session, me and the patient agreed we would focus on stretching rather than massage, so that he has a better knowledge of how to perform certain stretches at home;
The patient is a footballer who plays for a local semi professional football team. He plays a minimum of twice a week at a very high intensity. In his previous game he was experiencing tight hamstrings, particularly on the right side. I observed the hamstrings of the patients and could not see any bruising or swelling but could see some muscle bulking in his right hamstring. This suggests there is some muscle tightness rather than an acute injury.
The technique I used on the patient was muscular energy techniques, primarily Post-Isometric Relaxation (PRI). This technique involves a primary force of the patient being gently counteracted by the therapist. It uses intrinsic power of muscles to achieve a variety of effects including isometric and isotonic contractions. Following an isotonic contraction, there is believed to be a moment of complete muscle relaxation. It is in this time that the therapist can push the muscle beyond the bind and increase the range of movement.
I chose the use of MET’s as this technique strengthens weak muscles, while relaxing overactive muscles. It also stretches tight muscles and increases range of movement (ROM) while increasing circulation to the targeted area. As well as this, this technique also targets specific muscle problems such as releasing trigger points and adhesions. I also chose this stretching technique as it is quite easy to do, and as this was the patients first stretching session, it allowed for him to grasp a basic understanding of what we do, and then we can progress onto more complicated techniques in the future sessions.
I started by testing the patient’s ROM in his hamstrings by getting him to completely extend his leg and directing him how to flex his hip as much as possible. His ROM in his right hamstring was initially 79 degrees, measured using a goniometer. I then applied 15 minutes of PIR to his hamstrings, quadriceps and glutes, as these areas can all effect each other if they are injured/tight, while also stretching his lower back to account for any tightness there that could have been there and accounted for the pain in his hamstring. Following the treatment, I re-tested his ROM and it measured in at 84 degrees, showing an improvement of 5 degrees. This means that in just a short time I managed to increase his range of motion by a good amount.
My patient reported back to me that his right hamstring felt a lot better straight after the treatment, and he felt the treatment was conducted very easily and professionally. Personally, I feel the treatment went very well and the results reflect this. The patient is approximately 6 foot 2 and therefore had long limbs which made it difficult sometimes to get control of the limb when pushing it to bind and counteracting the patient’s pressure. In order to improve I believe I must work on my hand positioning in order to make providing the treatment easier and more comfortable for myself, while still achieving maximum results.
4.12.18 – Hour 19-20
Today I massaged a patient who plays football locally, 1-2 times a week. He had never had a sports massage before and therefore did not know what to expect. He came to saying he often felt pain after his games, predominantly in his hamstrings and quadriceps.
As this was quite a straightforward treatment, which involved basic effleurage and petrissage of the various muscles, I used this as a chance to work on various things that I’ve noted needed improving in previous treatments. Firstly, I ensured I remained in communication with the patient regarding the treatment and whether he was comfortable with the amount of pressure I was providing. Secondly, I applied less massage medium in the first instance and applied more as and when it was needed. This allowed me to get it to a point where I had enough medium that It was smooth on the patients leg, while still allowing me to get a good grip. I advised the patient to start doing some basic stretches after his games to reduce his DOMS.
Todays treatment was a very straightforward session, however was very effective for me as it allowed me to go over a lot of little things that I need to improve on. I will gradually try and implement these into all my treatments. Also, following the massage, I made sure to leave my bed in an exemplary manor, as the person in the bed before me today did not wipe down the bed or fold their towels, which meant I had to do this and therefore shortened the time I had with my patient.