13-11-19 – Hours 11-12

The first client today was a runner who came to David following pain in his achilles. David diagnosed him with an achilles tendonopothy. David explained how the main treatment for this disorder is calf raises as it is the main movement which isolates the achilles tendon. The client performed these movements in a slow controlled tempo of 3:1 focusing on time under tension. As the client is a runner and cannot recall any trauma to the area, we can assume the injury is a chronic disorder. Due to this, rehab of the injury will primarily involve strengthening and stretching. The remainder of this session consisted of strength work of the lower limb, using exercises like squats, leg extensions and weighted lunges.

In the second session today the client has been coming to David for sometime now following a torn pectoral muscle. As he is at the end of his rehab, the last few sessions have been focused on building the strength in the chest and surrounding structures. David started the session with a compound movement in the form of the bench press, and then incorporated more isolated exercises such as the incline and decline chest press, lateral raises and shoulder press. Previous sessions had restored full functional range of motion in the shoulder joint, and allowed the client to perform the movement without pain. This session was beneficial as it showed me how rehab sessions look towards the end of the programme.

14-11-19 – Hours 13-15

The first hour of todays session was with the client who was diagnosed with a quadricep tendinopathy. The last session consisted of working on the eccentric phase of functional movements; this session David decided to work on strengthening the lower limb, particularly targeting the quadricep muscle. He did this by prescribing exercises such as leg extensions, Bulgarian split squats and walking lunges, all at a tempo of 3:1 to maximise time under tension. This session highlighted to me the importance of maintaining strength within an injured structure in order to optimise recovery results and time.

The second hour was spent with the same client, observing a sports massage to the quadricep and surrounding structures to relieve any tightness that could of been caused as a result of the injury. This time gave me the chance to research more in-depth information regarding the pathology, allowing me to understand the treatment being provided better.

The final hour today, I again saw the client who had been diagnosed with a build-up of collagen in his right hamstring. As the last session was a strength based session, the onus again returned to focusing on the concentric phases of movements such as leg curls, performed at a very slow tempo to maximise time under tension. David explained by doing this, you are promoting for the collagen to realign itself back into its normal alignment due to high levels of stress on the area. The main outcome of the session was implementing progressive overload by increasing the weight used in the concentric phase of movements.

18-11-19 – Hours 16-17

The first client today was a new case, which presented in the form of a herniated disc in the lumbar spine. While the pathology had been present for a long time, it started causing the client more issues recently so she seeked help from David. Due to the nature of the pathology, the main course of action is stretching and strengthening of the surrounding structure. In this session, David put a large focus on efficient stretching to relieve tightness and to begin to ease pain, using stretches such as the cat-camel stretch. The session then progressed onto working the key muscles in the back such as the laterals and latissimus dorsi. This session highlighted the effects that stretching can have, and their importance in some treatment plans.

The second client today came to David for a massage on his legs. The client explained he is a semi-professional footballer and comes to David regularly for treatment to aid recovery between training and games. While the massage application was standard with the use of effleurage, petrissage and tapotement, David also applied K-Tape to the client which was my first time observing this. David Applied tape from the sole of the foot, over the heel and up the back of the leg. This is due to the client often experiencing tightness in his achilles tendon and his calf. It was beneficial to observe this as it revised my knowledge as to how tape can be manipulated, in this case to cover both the gastrocnemius and the soleus.

20-11-19 – Hour 18

Today, we once again saw the female basketball player. Due to the intense nature of professional sport, she is coming to see David very often so that she can optimise her recovery time. David remained to focus on progressive overload, maximising the amount of weight performed in each exercise. David also began to implement progressive overload into more sports specific functional movements such as box jumps. He did this by implementing weighted vests with the aim that when the vest is removed, she will be able to jump with more power. This session again demonstrated how different pieces of equipment can be used in rehab.

22-11-19 – Hours 19-20

Today, I spent 2 hours with the client who came to David recently complaining of more severe pain following a herniated disc in the lumbar spine. The first hour consisted of a standard session, with an onus on stretching and strengthening of the surrounding structures. This was done by again having an extended warm-up, focusing on reaching a maximum stretch. The session then moved onto strengthening exercises such as deadlifts, and rows.

The second hour of this clients treatment consisted of a massage on the back, with an onus on the lower back. David explained how massage, and myofacial release is a good way to manage pain in patients with herniated discs. He remained in constant contact when massaging near the effected area to ensure she was not in any discomfort. This demonstrated the importance of effective communication within therapy, especially when dealing with specific injured structures.