24.10.19 – Hours 1-3

Today was my first day of placement at Pure Gym. I was with David for 3 hours today, seeing 3 different clients in this time. The first client we saw was a young lady who plays netball for Plymouth University. The previous year she had tore ligaments in her ankle during a game, and despite the injury being fully healed, she was still very cautious about her ankle. The aims of her session with David were to increase confidence and stability with her ankle, and improve strength and power in her legs. The session started with some exercises to work on stability in her ankle, such as single leg squats and wall sits. Following these we then moved onto more compound exercises such as deadlifts and squats. To promote explosive power in her legs, David implemented a tempo of 3:1 (3 seconds concentric, 1 second eccentric). The session was finished with a cool down including walking lunges, specific muscle stretches and ankle mobility work. From this session I gained a good insight into how a therapist may structure their session around the clients needs.

The second patient today was a gentleman in his 40’s. He was a power lifter for many years and still goes gym 4-5 times a week. He explained how in the last year he has been experiencing more muscle pain following training and has been coming to David for nearly 3 months now to help with pain management. The treatment consisted of effleurage, petrissage and tapotement, focusing on the legs and back. One thing that I noticed with David’s massage technique is how he manipulated his techniques so that he was going along the grain of the muscle. He said this allows him to get deeper into the muscle tissue, with less effort. Through conversation with the client it arose that he also used to be a sports massage therapist, and he told me about his experience in the industry, the best ways to network, amongst other things. As well as massage techniques, this client gave me a lot of knowledge about the field of work its self and gave me advice that will be invaluable in the future.

The third and final patient today was a runner in his 20’s who had been diagnosed with a build up of collagen in his right hamstring, particularly along the semimembranosus. He had been working with David for about 4 weeks and noted already seeing considerable improvement. The session consisted of fewer exercises, but with each exercises eccentric phase being performed at a really slow tempo. The first exercise was hamstring curls. He explained by putting the muscle under stress for an increased period, we are realigning the collagen fibres so they are in line with the body’s natural muscle fibres. Other exercises include Bulgarian split squats, and Romanian deadlifts. David explained how for the next session, they would look at a more standard leg workout to try and retain/improve strength in the legs. The session with this client was very useful as it was a case I had not heard of before, and allowed me to expand my knowledge so that if I have a client with a similar issue, I will be able to treat them appropriately.

25-10-19 – Hours 4-6

The first client today was a female basketball player for the Plymouth Raiders, who was recovering from a knee injury the previous season. The session consisted largely around the concentric phase of exercises, such as squats, deadlifts, hamstring curls and leg extensions. Each exercise was performed at a tempo of 3:1, meaning that the client slowed down the concentric phase of the movement to make it last 3 seconds, improving form and increasing time under tension. To finish the session David implemented some more functional movements such as box jumping as this is a movement she will use a lot in basketball. From this session I learnt the importance of isolating phases of a movement to optimise results in a patients recovery.

The second client today was a PT who David diagnosed with having a quadricep tendinopathy, following an intense 6 week squat programme when he did not allow a de-loading period inbetween the end of this programme and starting a new one. This was only the clients second session with David, so the session focused largely on unilateral movements, and in particular the concentric part of the movement. The aim of this is to put maximal load through the quadricep during these movements with the hope that soon he can perform these movements with no pain. The exercises included wall sits, single leg squats, leg extensions and box jumps.

The third client today came in for a massage. The individual is a police officer who spends long hours sat down in the car, while also training heavily 4-5 times a week. This has led to tightness in the glutes region, transmitting down into the hamstring. During this treatment, David used a mixture of effleurage, petrissage and tapotement in order to relieve tension in this region. While the majority of the treatment was done on the lower extremity of the client, with being a regular gym user, David also applied treatment to the upper body, focusing mainly on the shoulders and chest. While this session was quite basic in the treatment applied, it gave me a good opportunity to discuss with David and his client the various forms of treatment he offers, and how this clients experiences with David differs to those of other therapists he has seen.

1-11-19 – Hour 6-7

The client I observed today was the the runner who had been diagnosed with a build up of collagen in his right hamstring. This session differed to the first one in the fact that it was a more standard leg workout session, with less emphasis on the eccentric phase of movement, and just focusing on functional movements such as squats, deadlifts etc. Towards the end of the session the client did perform some more eccentric focused exercises in the form of hamstring curls, to relieve any tension built up as a result of the session. This session demonstrated how rehab sessions can be simplified, just focusing on fundamental movements and ideas while still getting optimal results.

4-11-19 – Hours 7-9

The first client I saw today was the female basketball player who I had previously seen with David. Todays session was a development of the last session, with the exercises included being the exact same (squats, deadlifts, hamstring curls and leg extensions). Similarly again, the exercises were performed at a tempo of 3:1 to promote time under tension, and put the previously injured knee through the maximum amount of controlled stress as possible. Davids main goals for this session was to implement progressive overload in to the session, by gradually increasing the weight used during all the exercises, with the aim that eventually the knee will be able to perform all these movements functionally with no pain.

The second client today was the same netball player who I met with in the first session, who was looking to improve stability and strength in her ankle following a torn ligament last year. The session started again with some unilateral exercises in the form of single leg wall sits and single leg squats. However, the session progressed into working on core stability, as David explained this would help increase the clients overall balance and stability, decreasing the likelihood of the injury reoccurring. This then progressed onto proprioception training, which included the use of balance boards to add an unstable base to the exercises, forcing the client to balance. This session demonstrated to me how effective utilising different pieces of equipment such as medicine balls and balance boards can be in a rehab programme. Furthermore, it also showed how training other parts of the body can have a positive effect on other parts e.g. core stability and ankle stability.

8-11-19 – Hour 9-10

Todays session was another therapy session which involved a sports massage. The client was a PT who also works at pure gym, but had never experienced a sports massage before. Due to this, there was no real focus of the massage, and instead just aimed to relieve general tension in his muscles. While the treatment was basic, it allowed me to have a good discussion with both David and the client about their experiences of being self-employed, which gave me a good insight into how to conduct myself when I graduate, and from then onwards.