10.12.18 – Hour 20-21
Today my patient came to me complaining of pains that he has been experiencing since he strained his lower back in his warehouse job, where he over stretched for an item on the top shelf. There was no obvious issues upon observation however his left erector spinae did feel warm to touch and he was complaining of pain when I palpated the area – signs of a muscle strain.
I started the treatment by applying gentle effleurage to the patients erector spinae, on the right left side as this was where he was reporting pain. I also applied petrissage to the patients internal obliques. I repeated this treatment on the right side of the patients back to try and relieve any tension/pain that referred to the other side. I worked on each side for about 15 minutes each, and then applied some Kinesiology Tape to the patients lower back to try and offer him more flexibility and increase the blood flow to the area.
Overall, this massage was good, and was one of the first times I had a patient with a lower back issue. It was also the first time I taped independently as part of my own treatment. It was good for me to do this without lecturer supervision as I had to think for my self regarding the technique of applying the tape. If I was to do this again, I would try and make sure there are less creases in the tape, as this will reduce the likelihood the tape will get caught on clothes.
4.2.19 – Hour 21-22
Today was my first open clinic. My patient today was a footballer for the university. He came to complaining of general tightness in his legs, due to not stretching adequately before and after games. I performed 5 minutes of effleruage, petrissage and tapotement on each of the left and right hamstring, quadricep and gastrocnemius. Furthermore, I also performed some stretching in the form of STR and PIR with the patient.
Following the treatment, he said he felt considerably looser, and would be very interested in returning for more treatment. Overall, I think the treatment was successful as the patient left feeling an improvement. Furthermore, it was clear to myself I was becoming more confident when performing techniques such as STR and PRI, as I was able to talk the patient through the process a lot easier. To try and improve I will focus on learning my anatomy in more depth so I can go into greater detail when explaining the stretching to the patient.
4.2.19 – Hour 22-23
My second patient of today’s open clinic offered a new experience to me. It was the first time I had a patient in a clinic environment whom I knew nothing about prior to the session. It forced me to take a different, more professional approach to the treatment. The patient came complaining of lower back pain. She was a mum of two young children and we contributed the pain to carrying her young children, amongst other things. I checked for contraindications. Through speaking to the patient during the treatment, it turned out she was a second year student on my course, and therefore was able to provide me feedback through the treatment.
I performed effleurage mainly, as well as some petrissage to the patients lower back, working up to her upper back to try and relive any tension that could be contributing to her lower back pain. Throughout the treatment we was both communicating, and she was giving me advice on how to get deeper into the muscle tissue, such as using certain parts of my knuckle etc. Overall this was one of my most beneficial experiences so far as it put me out of my comfort zone and forced me to focus a lot more on what I was doing.
25.2.19 – Hour 23-24
Today was open clinic again. My first patient today was the warehouse worker who I have treated previously. In our previous session, he had strained his lower back when stretching for an item on a high up shelf. He returned today saying the treatment helped him significantly, but he was starting to feel general tightness in his back again. Similarly to the first treatment, I applied effleurage and petrissage to the patients lower back for the majority of the treatment, working up to his upper back as well as he was complaining of general tightness across his trapeziums.
The massage was okay, however I felt as though it became quite repetitive and therefore felt I wasn’t making much difference towards the end of the treatment. For next time, I will research different techniques/methods of massage I can try to apply so that my treatments do not become repetitive both for me, and my patient.
25.2.19 – Hour 24-25
My second patient of todays open clinic was a student from my university. She had seen the open clinic advertised and came due to pain she had been experiencing in her back. Through subjective assessment of the patient, I found out she was a third year and therefore had been spending long hours studying for her dissertation, which was causing the tightness in her back (did not play sport/exercise).
For about 30 minutes I performed effleurage on her back, both lower and upper, and petrissage on both her trapezius’ and internal obliques to try and get rid of any tightness she was experiencing. To finish the session off, I shown the patient how to perform some basic back stretches I had found when researching stretches due to pain I had been experiencing myself – https://www.youtube.com/watch?v=t_uR01Dx9Mk. In order to improve for next time, I will try and research some different stretches for the upper back so I can provide my patients with better aftercare advice.
4.3.19 – Hour 25-26
Today was open clinic again. My first patient today was a footballer who plays for my university football team. A few weeks ago, he strained his hamstring when stretching for a tackle, and with varsity fast approaching, he wanted to make sure he was fit to play. Due to playing for his team, I already knew his conditions, so I checked for contraindications etc before the treatment.
Due to the injury still being fairly recent, I applied a lot less pressure when first massaging the patients injured hamstring. I gradually built up the pressure of the effleurage to a level where I was deep enough into the muscle tissue without causing the patient to much discomfort. While I focused on his injured hamstring, I also applied effleurage and petrissage to the patients other hamstring, quadriceps and gastrocnemius’. To finish the treatment, I applied K-Tape onto the injured hamstring, as K-Tape aids blood flow to the area and aids flexibility.
4.3.19 – Hour 26-27
My second patient of today’s open clinic was actually another person on my course, who’s patient did not turn up. I jumped at this opportunity as it gave me the opportunity to get some feedback from someone with similar experience to myself, in a non-formal way. The patient did not have any particular areas of concern so I gave him a general massage consisting of the areas of the back, hamstrings and gastrocnemius’.
On all areas, I used effleurage and petrissage, and on the lower limb muscles, I incorporated the use of tapotement. Despite not having any areas he believed were bad, the patient had a number of adhesions in his lower limb muscles. This gave me a good opportunity to practice my neuromuscular release (NMR) techniques, while receiving educated feedback from my peer. Following the treatment, my patient commented that the massage depth was good and he could tell from my communication I had a good knowledge regarding anatomy. He said to improve, I could communicate better when using NMR, rather than waiting for the patient to tell me he is in to much pain.
11.3.19 – Hour 27-28 – Taping Case Study
Todays patient was a netball player who I have previously massaged. She came wanting a general massage to get rid of any tightness in her legs before her big match on the weekend. I performed general effleurage and petrissage on the patients legs for roughly 30-45 mins, and in the last part of the treatment, she asked me to tape her ankle, as she keeps rolling it since an injury she had a long time ago;
The patient has previously injured her lateral ankle ligaments (Posterior Talofibular Ligament, Anterior Talofibular Ligament, Calcaneofibular Ligament) and since has had a weakness in this area. This has resulted in her often rolling her ankle when she plays netball. She wanted me to tape her ankle in an attempt to stop her ankle rolling when she plays. The type of taping I chose was rigid taping, as this would add stability to her ankle, while still allowing her to perform optimally.
Before me taping her, the patient decided to shave her leg as I previously advised her the tape may go up to her shin and therefore be painful to take off. Furthermore, I also applied a base layer of under wrap to try and make this more comfortable when both applying and removing the tape.
The equipment I used was a non-adhesive under wrap, and zinc oxide tape. I used Zinc Oxide tape as its properties will provide the patient with increased ankle stability, while still being able to move her ankle adequately and perform to her optimal level.
First, I cleaned the area to ensure a clean smooth surface, then dried the area so the tape would stick to the patient. Secondly, I applied an under wrap onto the patient’s ankle to limit the amount of tape that is in direct contact with the skin. I used the ‘figure of 8 technique’, starting behind the patient’s ankle around the proximal end of the Achilles tendon, and bringing the wrap over the cuboid, across the medial cuneiform, back under the calcaneus, and finally over the navicular where the wrap meets again at the start point.
Next, I began to apply the zinc oxide tape over the wrap, aiming to follow the same line I had covered previously. I tried to remain in constant communication with the patient to ensure the tape was tight enough to add stability to her ankle, but not so tight that it was restricting normal movements and was uncomfortable. I did this by asking questions such as ‘How does that feel’ as it will provide me with more subjective answers from the patient.
Then, I tried to smooth out any creases or bubbles in the tape, as this will both make the tape more effective, and stop the tape from catching on the patients clothing and ripping off. Finally, I put the patient through some basic ankle movement tests to ensure she could still reach her maximum ROM with the tape on.
Overall, I thought the application of the tape was good, and this was backed up by client’s feedback at the end. She said the tape felt comfortable, while still stabilizing her ankle. One main criticism of my taping is that the tape is not completely smooth and has various creases. This makes the tape prone to catching on clothes and ripping off when the patient is playing. This could be because I was rushing the taping. In the future, I will take more time when applying the tape to avoid creasing the tape.
Click below link to see photos:
11.3.19 – Hour 28-29
Todays second patient was a county standard sprinter. I arranged to treat this patient, as her mum is a sports therapist in the local area, and has worked at various clinics and leisure centres around the city, therefore the patient would be able to give me feedback in comparison to massages she has had from her mum. The patient as complaining of lower back pain, which in turn was putting added strain on to her glutes and hamstrings.
I primarily focused on her lower back, as this seemed to be the source of the pain. I mainly applied effleurage both vertically and horizontally, to stretch the muscle as much as possible. Furthermore, I proceeded to apply effleurage, petrissage and tapotement to the patients hamstrings, up to her glutes, as although the lower back seemed to be causing referral pain, the hamstrings and glutes were still quite tight.
Overall I found the massage to be very good, and the experience was very helpful as throughout the treatment we was discussing her mothers role as a sports therapist, which gave me a good insight into the job role I am aiming to get into. The patient commented that the massage was of a good quality, but in some places I was going to fast rather than getting deep into the muscle. From now on I will focus on trying to balance getting good massage depth, while massaging at a good speed.
21.3.19 – Hour 29-30
My first patient today was a power lifter, who’s main lifts are the bench press, squat and dead-lift. He came to me complaining of pain in his chest when lifting, which I narrowed down to his pectoral major. He lifts heavy weight on bench press 2-3 times a week depending on his training split at the time. He is currently in preparation for Uni Worlds Championship and therefore wants to try and remove any pains/problems as soon as they present themselves.
I applied effleurage to the patients chest, working into effleruage of the trapezius and deltoid, to account for any tightness in the general area, which may have been contributing to his pain. Furthermore, with him doing so much squatting and dead-lifting, I also performed effleruage and petrissage on the patients hamstrings and quadriceps, where I found a number of adhesion’s, which I was able to remove using NMT.
Overall the massage was a good experience as it was the first time I had massaged a patients chest, and as the patient was a high standard power lifter, he had a good knowledge regarding stretching and how his muscles should feel. He commented after that his chest felt looser and offered greater flexibility, and his legs also felt tighter despite not feeling any problems with them before the treatment.