Saturday 27^th/Sunday 28^th March Hours 48-62 (Continued Professional Development)

This weekend I participated in a continued professional development course (CPD). The course was for sports trauma management and covered a variety of subject areas regarding acute injuries and how to deal with them. While I already have a first aid certificate, I thought this would be a great opportunity for me to further my knowledge, and subsequently feel prepared in any situation that may present itself. The course was 2 days with each day being 7 hours long (09:00-16:00); due to the COVID-19 Pandemic, there was minimal practical practice or application, and further emphasis was put on the teaching of the theory of the information. Over the course, we covered injury assessment, the use of oxygen and Entonox, spinal board extraction, orophalangeal use, c-spine immobilisation, fracture and wound management, and general injury assessment. The usual practical, hands on method of teaching that would be utilised with this course made it strange that it was predominantly theory based and took some getting used to. While the course leader provided demonstrations at each stage it was still more difficult to understand exactly how to put it into practice. While it was not ordinary, I believe it made me focus more on what I was being told as there was little practical to reinforce what I was hearing, however this ended up not being an issue. Over the duration of the 2 day course, I had different emotions as we were shown and told stories of how these skills may need to be put into use; the seriousness of some of the situations made me feel quite anxious in case I was not prepared to deal with something similar, however after some conversation with the course leader he re-assured me that when in the situation my instinct would take over. Following my comment, he decided to provide us with some practical scenarios which included immobilising the C-spine and moving them on to a spinal board using the log roll technique. When in the situation, I felt a lot more comfortable in dealing with the patient as I was able to consider all variables of the situation and take control. While this does not replicate a real-life situation, it made me feel more confident leaving the course that I would be able to apply this in a situation. Upon completion of the course, I was presented with a certificate to confirm my completion which I will attach below.

Tuesday 30^th March Hours 62-67

Today’s first client was someone who I had not spoken to previously but was seeing for a face-to-face appointment; using my previous experience I pre-emptively read around the area that the clients notes’ suggested was his injury. His online consultation concluded that he had peroneals weakness which was causing him pain when rock-climbing.  Schöffl et al., (2016) highlighted the risk for peroneal injuries in rock climbing due to the excessive pressure on the lower limb extremity. As I had never dealt with a rock-climber before, I also made an effort to read around the physiological demands of the lower extremity in the sport, so that not only could I apply functional exercises into his rehabilitation plan, but also engage in conversation with client and therefore making him feel more comfortable. Previous experiences with clients have made it clear that good conversation not only makes them feel more comfortable in what could be an anxious situation, but also makes it easier for myself to obtain information. The session consisted of objective assessment of the ankle joint, and exercise prescription focusing on strengthening of the peroneals which included exercises such as isometric wall presses, calf raises and drop jumps. While the routine of assessing the joint and providing exercise prescription was not any different, the clients sport provided a new challenge in the form of aiming to make the session functional to his needs. While difficult, it was very beneficial and left me feeling confident in dealing with climbers in the future. The rest of todays’ session involved me ensuring todays note, and previous notes were to a good standard. I then shadowed an online consultation of another student, to help with note taking and ensure no information was missed. While typically ordinary, the client presented with an extensive medical history and subsequent medication list. This was interesting to shadow as after the session I had to research each individual medication named to see their effects, and whether they could have a baring on the clients’ condition. While in this instance there seemed to be no correlation, it was good experience to do so and will make me more mindful in the future in ensuring that all of this information is covered.

Tuesday 13^th April Hours 67-71

In todays clinic session I unfortunately had no clients of my own – while this wasn’t ideal as I would like to see as many clients as possible, it gave me time to reflect on my previous sessions so far. Thinking back, and from my previous reflection points, I used my time today to create an action plan as to how I could improve as a therapist and provide better treatment for my clients. I spent time researching each of the points I highlighted to ensure I understood how I could progress;

• Use of clinical measures: While using subjective measures to obtain the progress of clients isn’t a bad thing, it can be massively beneficial to use clinical measures to highlight their progress. An example of this could be measuring a patients’ ROM pre and post treatment and then comparing the difference. Not only will this provide me as a therapist with more measurable, objective figures to present as data, but it will also motivate the client and maintain their adherence to the rehabilitation plan.
• Psychosocial Factors: A main criticism of myself so far is that I often fail to consider other factors that may be effecting the clients injury. Sleeping patterns, eating, stress levels etc. are all known to have effects on the body and can sometimes highlight potential causes for injury. When working with clients I will aim to consider these factors more in an attempt to help the injury short-term, and prevent it re-occurring.
• Confidence: While being confident in both talking to clients and my general ability to treat them, the presence of the clinic supervisors makes it very easy to rely on asking them for help with diagnosis, or treatment methods. Once graduated, I will not have the opportunity to do this so it is important I become more self-dependant and confident in my own ability.

I highlighted these as 3 key action points to work on which will allow me to progress as a therapist. When working with clients in the future I will aim to think about these and ensure I meet the action points. I will then revisit them in a few weeks and judge whether I have met them or not.

Tuesday 20^th April Hours 71-75

Today another student and myself worked together in seeing a face-to-face client whom we had an online consultation with a few weeks previous but due to time constraints was only just able to meet. In the time between our online consultation and today the client had been diagnosed with a herniated disc at level S1, which explained why he had been experiencing sciatic symptoms. This was beneficial for us as it took the diagnosis progress out of the picture and it allowed us to focus solely on assessing the clients’ ROM and gaining objective measures which we could compare in the future after a number of sessions. We then took the client through some exercise prescription that we had pre-planned. However, we underestimated quite how severe the clients’ movement and pain was. It was very difficult for him to get on and off the floor which made some of the exercises near on impossible to demonstrate for him. This was a difficult situation to be in as our planned exercise session was no longer viable, and we had to think on the spot regarding appropriate adaptations that can be made which will be achievable for him. While this was stressful at the time, upon reflection it was good practice going forward as in a real clinical environment these are the types of situation that I could be faced with every day; furthermore, I was forced to rely on my own knowledge which is something I previously highlighted in my action plan. For the rest of the session, I used my time to ensure the clients notes were to a good standard and contained all relevant information and began to look forward to future sessions. I have decided I will aim to use a new reflective model in the form of Johns (1994) 5-point method. Combining this with my previously made action plan should hopefully see me improving on areas I had previously identified as weaknesses, and subsequently improving as a therapist.

Tuesday 27^th April Hours 75-80

As previously mentioned, for future reflections I will be using Johns (1994) reflective model for each session to try and pinpoint good and bad things for each session and highlight how I can learn from these. The first stage of the model consists of highlighting influencing factors. Todays’ client was an online consultation who was presenting with shoulder pain. The use of online consultations can always present with problems, in particularly internet connection with this session which made it difficult to see the client at times. Another issue with online consultations is that it is not possible to do things such as palpation and observations, and even observing movements can become difficult. The second part of Johns reflective model is considering whether I could have dealt with the situation better; in this instance, I believe I reacted to the technical difficulties very well and ensured that while the visual aspect of the call wasn’t perfect, I maintained good levels of audible communication which allowed for the call to still flow freely and reach its desired outcome of booking a face-to-face session. Step 3 of the model is learning from experience; something I will take away from this session is the skill of not relying on the observation of the injury. From having to focus more on what the client was telling me I was still able to come to a rationalised diagnosis which was then confirmed by my supervisor. This is something I will look into trying more in the future, as the amount of information I was able to gather was surprising rather than moving straight to objective assessments. Lastly, Johns stated it is beneficial to reflect on the experience as a whole, describing how you felt; initially, when I realised there was some connection issues I felt stressed as I thought I wouldn’t be able to complete a good consultation with the client, however as the time went on I became more and more confident in going through the assessment without the visual aspect. Although it is something that will rarely happen again, it gave me a vote of confidence that I am able to use the information provided to come to a diagnosis. Overall, the client session was very beneficial and improved my confidence going forward. I had a second client booked for the end of the evening however they did not arrive. While this was annoying, it gave me time to check over all my client notes from the previous weeks and get them signed off.

Tuesday 4^th May Hours 80-84

Todays’ clinic session consisted of seeing 2 clients, both with drastically differing problems. The first client I saw today presented with anterior hip pain following kicking a rugby ball. While seemingly normal, the client was only 15 years of age. While this is not an issue, I had to be more aware in how I dealt with the client, both from a professional and treatment perspective. I wasn’t unsettled by the clients age as I was still able to discuss the issue with him and made sure he was comfortable at all times. Through subjective and objective assessment, I was able to distinguish that it seemed he suffered a minor rectus femoris strain when kicking a ball, which has since not healed properly and therefore become weak. Some studies have highlighted that younger age can be attributed to higher risk of muscle strain (Freckleton et al., 2013). I then took the client into the gym area to prescribe and demonstrate some home-based exercises which he can do in order to strengthen the structure. While this session was quite simple, it was good practice for dealing with adolescents as they can sometimes become shy and difficult to extract information out of. The second client of the day was the individual who I had connection issues with during the online consultation. While already having a rationalised diagnosis through subjective assessment, it was good to be able to measure the individuals’ ROM at the shoulder joint which is something I am aiming to do more often. Furthermore, as we had previously identified that the injury was muscular based, I also tested his strength through resisted movements, which shown a distinct lack of strength in his perceived stronger side. Throughout the session I felt comfortable as I had a good grasp of the injury at hand and was confident in the exercise prescription aspect of the treatment. We went onto discuss other lifestyle factors such as how the client is trying to improve their diet in order to look after his body, so we discussed his dietry choices and gave advice on little things he could change. The client reported feeling at ease knowing he was getting treated and this could mark the start of his lifestyle transformation – this gave me a sense of pride as it reminded me how what I’m doing is very important to some individuals, and gave me the further incentive to ensure I provide the best treatment possible. During this session I learned the importance of changing how you deal with clients depending on who they are e.g. younger or older client. Furthermore, I began to implement some aspects of my action plan in relation to using objective clinical measures, and also considering the psychosocial aspects of the clients.

Tuesday 11^th May Hours 84-89

In todays’ session I had a last-minute cancellation of my first client. As I was already there, I used the time to do some research towards my next client. It was the client who I had seen the past 2 weeks due to a shoulder injury and who also wanted to start a healthier lifestyle. As discussed in our last session, today was a gym-based session in which I would take him through some strengthening exercises that he can then take into future sessions in his own time. Throughout the session myself and the client remained in conversation regarding his condition, his lifestyle and what changes he would like to make. In terms of my action plan, this was a great session to have as I was constantly considering psychosocial factors and how they may subsequently affect his condition. Alvarez et al., (2013) describes how stressful stimuli can lead to chronic widespread pain in adults, which we also discussed how to manage his stress levels. The session was good and allowed me to put into practice the management of psychosocial factors. Due to a lack of clients, I spent the rest of the clinic session going over some techniques with the supervisor in-regards-to different myofascial release, In particularly of the glutes. The techniques shown will allow me to perform release on these muscles that may otherwise be quite invasive for some clients. I also spent time reading around the effect of stress on muscular issues in adults, amongst other factors discussed in the session with the client today.

Tuesday 18th May Hours 89-94

In todays clinic session I saw 3 patients all with different injuries. The first client had pain in the posterior aspect of the shoulder which we judged to be caused by tension in the trapezius. This was fixed through massage. My other 2 clients were individuals I had seen for a few sessions now and consisted of re-assessing their conditions and progressing and regressing there HBE accordingly.

Thursday 19th May – Saturday 21st May Hours 94-100

In order to gain more experience in a different field, I have undertaken an external placement with a local football team. This will be providing pre and post game treatment and pitchside care under the supervision of their manager who has had vast experience of doing this work for multiple years. The first week consisted of a training session on the thursday where I gave a few massages and helped deal with any knocks picked up. On the saturday there was a game which meant I was totally pitchside. Throughout the game I dealt with a knock to the head, and a twisted ankle. Both were dealt with quickly and efficiently.

Tuesday 25th May Hours 100-104

Today in clinic i saw 2 patients – the first was a young lad who had been experiencing knee pain after a long season of football. Through assessment I managed to confirm it was patellarfemoral pain syndrome. I gave him some exercises to do and we will re-assess in 2 weeks. The second client was a re-ocurring client with shoulder pain. We managed to get him pain free and we are now working on strengthening the structure so today was a gym session.

Tuesday 25th May – Saturday 29th May Hours 104-112

With the football team this week I had 2 training sessions and a game. Both training sessions consisted again of me providing massages to loosen any tense muscles. During one session someone took a kick to the foot which I had to deal with. I provided ice and observed for the rest of the session to ensure they did not get any worse. When bruising appeared I advised him to stop playing. The game on the saturday had me working pitchside again but was uneventful and I was not needed for the duration of the game.

 References

Freckleton, G., & Pizzari, T. (2013). Risk factors for hamstring muscle strain injury in sport: a systematic review and meta-analysis. British journal of sports medicine, 47(6), 351-358.

Johns, C. (1994). Nuances of reflection. Journal of clinical nursing, 3(2), 71-74.

Schöffl, V., Lutter, C., & Popp, D. (2016). The “Heel Hook”—a climbing-specific technique to injure the leg. Wilderness & environmental medicine, 27(2), 294-301.