May

05/05/2021 5

I was quite nervous for my first client as the notes for the remote consultation expressed that they were unsure of the clinical impression, and it was upper body. During the assessment, I originally thought that she patient has tendinitis of the supraspinatus. However, when the supervisor came in to double check everything, they found that it was instead a pectoralis tendinitis. My incorrect diagnosis made me feel nervous and incompetent. I had revised upper body injures before this session but still managed to misdiagnose. I will definitely do even more work to try and get my head around upper body injuries. We gave the patient some exercises which again, I wasn’t the most confident in. After the session, I wrote up the notes and created a plan for progressions and regressions for exercises.

Following this, I had an online appointment with a patient with decreased range of movement in external rotation of the shoulder. I felt confident in this online assessment, and I had a good idea of what the injury could be. This helped boost my confidence in my abilities following my previous client. After the appointment, I wrote up what assessments should be done in the next session.

After this, I had another online appointment with potential chronic ankle instability. I am very confident in treating ankles, so I found this appointment quite easy. After the appointment, I wrote down what assessments could be done and wrote down some potential exercises that could be given.

 

07/05/2021 3

My first patient was the client with the meniscus tear. This week, we progressed his exercises and got him on the anti-gravity treadmill. I forgot how to set the machine up so it was good to have a refresher. I felt very confident when treating this patient as I feel like its my most knowledgeable area. We had some issues setting up the anti-gravity treadmill at first but soon figured it out. I was getting confused about the maths in terms of what % of gravity we should be using for him, and what higher and lower gravity would feel like. This is usually something I would beat myself up about, but I have recently realised that I might have dyslexia or dyscalculia, and I have a screening booked in a few weeks. This made me not feel so bad about getting confused. Following the appointment, I wrote up the notes and created a plan for next week.

After this, we had a patient who has been referred from the osteopathy clinic. The patient was presenting with SIJ dysfunction. We prescribed him with some lower body exercises, targeting mainly where his pain was around the gluteus medius area. I felt quite confident in dealing with this client, even though before I was quite nervous due to them coming from an osteopath. After the session, I wrote up the notes and then wrote down some progressions or regressions for the exercises we prescribed for him.

14/05/2021 5

I felt confident going into clinic today, after having revised upper body injuries and having some good experiences with a multitude of different injuries lately.

My first patient with the patient with a meniscus tear. Today, we were able to get in the gym and run a session. I found this really enjoyable as we were able to do lots of functional and proprioceptive work. The patient also really enjoyed themselves and we both had a laugh which was really uplifting and nice. I think I managed to keep a good balance between professionalism and fun which I am really proud of myself for. The patient was really keen on his exercise progressions, so I am hoping this will help him adhere well at home. After the session, I wrote up the notes and then made a plan for next session.

The second patient was the patient from a couple of weeks ago who had pain in their metatarsal joint in the foot. She has progressed so much which was really lovely and confidence boosting to see. During the session, we were able to run through her exercise progressions with her which she really enjoyed. She admitted that whilst she had completed some of the exercises, she hadn’t completed all of them. So, in order to aid her adherence we let her take videos of us doing the exercises to help her remember then better. I felt this session feeling happy and confident. After the session, we wrote up the notes and wrote down some ideas for exercise progression.

After this, we had an online consultation with a patient who had knee pain. Our immediate clinical impression was either PFPS or meniscus damage. After the session, we wrote down ways to differentiate between each injury and thought of some potential exercises. This patient is very elderly so this is something we are going to have to take into account. At first we struggled with exercises that may be suitable for an elderly man for this injury, so this is something I am going to further look into in case he isn’t that mobile.

April

16/04/2021 5

Going into clinic today I was feeling super confident. I have learned a lot throughout this year at placement as well as during lectures.

My first client was an online consultation. I felt confident in conducting these now and I always took down detailed subjective notes. The patient was presenting with a very interesting pathology, to which she had pain in every movement of her neck and shoulder. She is classified as disabled and had a stoke a few years ago. I was unsure of a clinical impression at this point, but invited her in for a face to face to go through an objective assessment with her. Despite not being sure of the clinical impression, I still then planned for a variety of outcomes in terms of exercises and treatments.

Following this, we had a patient who had been diagnosed with an S1 disc herniation. She had been given exercise for this and now has no back pain. However, still gets a sharp nervy pain in her posterior thigh, down to her calf. For treatment, we put her on the traction machine. I wasn’t confident in using the machine, but the other student therapist was so I learned from them. This is something I want to work on outside of clinic, potentially by watching videos to get a better idea of how the machine can be used. Following the session, we wrote up the notes and made a long term plan for the patient including exercises they can do.

Subsequent to this, we had a client with a suspected disc herniation. During treatment, I knew that extension movements were good for treating disc problems, but I had never thought about how to actually complete these when not standing. When I thought about it in the session it became clear that being in some sort of cobra pose would be the best position. However, this was something I hadn’t thought about before so it was good to put it into practise. Dealing with patients in a great deal of pain often gives me anxiety as I am always afraid of hurting them more, despite being supervised in my decision making. Following this session, we wrote up the notes and then made a plan for what to do in the next session depending on whether the patient was to progress or regress.

 

23/04/2021 5

Again, today I felt quite confident coming into clinic. My first patient was with someone with reactive lateral epicondylitis. Due to this being one of the injuries in the rehabilitation exam, I felt confident giving this patient exercises. Following the session, we wrote up notes and made a plan for progressing the exercises, which I also felt very confident doing.

Following this, I had the patient that I had triaged last week. Usually in clinic I haven’t been able to see the same patient more than once or twice, so I have been unable to see their progressions. So, I have started to make sure that the patients I see are booked in with me so I can start seeing them start to finish. Upon assessment of this lady, it was clear that she had a lot of hypersensitivity as global muscle weakness, most seriously to her upper body. Due to her hypersensitivity, we requested to do a hydrotherapy session with her, as all land based movements were causing too much pain.  I hadn’t dealt with a patient who had some sort of psychological pain yet, so I found this patient very useful for my learning. Also, we hadn’t had the chance to do our hydrotherapy lesson due to COVID, so it will be really good to learn from the supervisors. After the session, I wrote up a plan of what we could do with her in the pool, which I created through online research and discussions with my supervisor.

After this patient, we had a patient with a foot injury. This was my first time dealing with a client with a foot injury so I found this very useful. The patient was a jive dancer who had pain in her metatarsal joint in her big toe. We couldn’t recreate the pain in any movement or during palpation. Due to this, we had to get advice from our supervisor, who also couldn’t recreate the pain. The only thing that was apparent during the assessment was the poor motor control of the arch complex, so we worked on this to see if this would help the pain. After this session it was evident that increasing arch height is definitely something I need to research further. Whilst I was good at proprioception exercises, I struggled thinking of exercises to increase arch height. Following the session, we wrote up the notes and created a plan for the next session with this client for both progressions and regressions.

 

28/04/2021 5

Since clinic has been on more consecutively, my confidence has grown massively.

My first patient was a post-natal lady who presented with extreme hamstring weakness, and weak abdominals. This is something I have always been good at treating, so giving exercises to her game very naturally. I had never dealt with a post-natal lady before, but after seeing her it made me think more about what I want in my career. I really enjoyed treating this lady, more-so than anyone else due to my interest in pre and post-natal exercise. This gave me a great idea of completing my Pilates qualification for pregnant women. This is something I have always been passionate about. As a child I always wanted to be a midwife, but when I grew up, I realised my heart truly wanted a career in exercise and rehabilitation. I figured that this way, I would gain a lot of pregnant clients, which is a demographic I would love to work with. After the appointment, I wrote up the notes and made a plan for progressions and regressions.

After this, we had a patient with pain around the distal lateral thigh. We were unsure of the clinical impression, but thought it could be bursitis, ITB, PFPS or hamstring weakness. Despite this, we were still able to give exercises targeted to his weaknesses to hopefully help reduce his pain. Again, lower body exercise prescription is something I am very confident in, so this was quite a nice client for me. After the session, we did some further research to try and find a more solid clinical impression, and then wrote a plan for next session.

Following this, I had an online consultation with a man who had medial knee pain. He had been to the doctors and they told him it was an MCL injury, however when I said this to my supervisor he reminded me to never take the word of another clinician and to instead decide on my own clinical impression. After this session, I went over what objective assessment I would do with him to differentiate between injuries and began to write down some potential exercise suggestions.

 

30/04/2021 5

My first patient was the patient I had for an online consultation on Wednesday. From my assessment, my clinical impression was that they had a meniscus tear in the knee. Lower body exercises are something I am very confident with, so prescribing him these was not stressful. During the assessment, I was unsure whether it was an MCL injury or a meniscus tear, as on the special tests the patient was positive for both. However, my supervisor then reminded me that in that case I need to go more off of the subjective assessment, to which I then realised the mechanism was more meniscus-tear-like. This is something I should have remembered to do myself, but now I have been told once I should be able to carry that approach through to the rest of my clients. I am feeling quite confident about this client and he is someone I am going to be seeing throughout so I am hoping it will be nice and confidence boosting to (hopefully) see his progressions throughout the weeks. After the session, I wrote up notes and made a plan for next session.

Following this, we had an online consultation with a client with suspected upper cross syndrome. I am not as good with upper body injuries as I am usually dealing with lower body injuries. So, my skills and knowledge around this area needs to be improved. I am always fine with upper body assessment, but when it comes to clinical impressions I am never sure on what the problem could be. This is definitely something I am going to work on. After the session we wrote up the notes and created a plan of some potential exercises.

Subsequently, we had a patient with lower back pain who had been coming in for a while. All movements were pain free and strength was good, so it was been clear that the pain is psychological. Again, this is something I hadn’t dealt with a lot in terms of back pain. But after the session it became clear that treatment is almost the same in terms of the exercises you would prescribe. However, it just requires more psychological aid and enthusiasm to make them feel more confident in themselves. This is something I have practised quite a lot of Argyle so I found this quite easy to do.

March

12/03/2021 5

Going into this clinic session I was still feeling quite nervous. However, in clinic today we had a very interesting patient. They came to clinic following an operation to the neck to remove cancerous lymph nodes. Following this the patient had been cleared of any cancers. I found this case very interesting to deal with, despite not knowing what the best thing to do was. I knew the patient needed to gain strength in their neck muscles and upper trapezius, but due to the severity of the issue I had to ask my supervisor if the exercises we were thinking of were suitable. I found dealing with this patient a big learning curve in my journey as this is something I never would have though I would be dealing with. Now, I feel I will be more ready to work with clients who have had serious diseases. Following the appointment, we wrote up the notes and planned what we could do next session with the client if they responded well to the exercises given.

After this, we again ran through different case studies. We ran clinical assessments on each other and then created an exercise plan tailored to their needs. Again, I found this very useful; it was making me a lot more confident in clinic.

Following this, we did an online consultation with a client. It was hard to do observations over zoom, but the subjective assessment suggests that the injury is either disc, facet, SIJ or piriformis. After the session, we discussed what we could do to differentiate between each injury upon objective assessment. Due to the fact I had done lots of revision on clinical assessments, I felt quite confident during this discussion.

 

19/03/2021 5

After completing the diagnostic and rehabilitation module in February, I am feeling a lot more confident in giving exercise based rehabilitation. Going into clinic today, I was finally starting to feel more like a confident sports therapist who can effectively diagnose and treat injuries.

The first patient I had today was a very interesting one. I was informed before the appointment that she had been referred to the Marjon clinic to be put on the cervical traction machine, to create more space between the vertebrae. Due to the severity of the condition, I wasn’t able to go through an objective assessment over the phone, so instead I completed a very thorough subjective assessment. I felt very confident when taking this online triage, as I was making very detailed notes. The patient liked to chat a lot, so sometimes it was hard to get an answer to the questions I was asking. But, I managed to get the answered that I needed in the end. We invited her in for a face-to-face appointment to use the cervical traction machine which I am really keen to get involved in as it is something I haven’t used before. I always find it very useful to treat clients with more complex issues as it really pushes my learning.

Following this, we had a client for a follow up appointment for their peroneal/calf strain. The client had seen minimal improvement since their last appointment but admitted they hadn’t been completing their home based exercise program as often as they should have been. I felt quite confident giving this client exercises, as lower body rehabilitation exercises is definitely my strongest point due to doing lower body exercises often at the gym myself. My coaching has also definitely got a lot better since the beginning of this year, where my coaching tips were definitely lacking. I could always complete the exercise myself, but was bad at explaining how to do the exercise to other people. Now, I seem to have got the hang of it, which is really nice to see. Following this session, we wrote up the notes and then made a plan for next session including progressions and regressions depending on how they get on with their exercises throughout the week.

After this, we had a client with SIJ dysfunction and L4/5 stiffness. I hadn’t yet dealt with a patient who had SIJ dysfunction so this was really interesting. We gave SIJ mobilisations first as this was the root cause of the pain, and then gave some exercises. Admittedly, I didn’t have any ideas on the sort of exercises I could give this patient, so getting advice from my supervisor was really insightful. This is something I am going to research further as I would like to be more confident in this area. Subsequent to this, we wrote up the notes and created a plan for if the patient were to progress or regress.

January

15/01/2021 3

Going into this clinic session I was still feeling quite nervous. The clinic has been quite quiet recently due to COVID so I haven’t been exposed to a lot of different injuries yet. However, in clinic today we had a very interesting patient. They came to clinic following an operation to the neck to remove cancerous lymph nodes. Following this the patient had been cleared of any cancers. I found this case very interesting to deal with, despite not knowing what the best thing to do was. I knew the patient needed to gain strength in their neck muscles and upper trapezius, but due to the severity of the issue I had to ask my supervisor if the exercises we were thinking of were suitable. I found dealing with this patient a big learning curve in my journey as this is something I never would have though I would be dealing with. Now, I feel I will be more ready to work with clients who have had serious diseases. Following the appointment, we wrote up the notes and planned what we could do next session with the client if they responded well to the exercises given.

After this, we again ran through different case studies. We ran clinical assessments on each other and then created an exercise plan tailored to their needs. Again, I found this very useful; it was making me a lot more confident in clinic.

November

06/11/2020 3

After missing as session of clinic last week due to family reasons, I was really super nervous about clinic today. My last patient last week was very complicated and I didn’t feel competent. Since then, I have gone over common pathologies, however I am still feeling nervous. The patient I saw was with another sports therapist, so this made me feel more at ease. After assessment, it was clear that the patient had a strain to the supraspinatus. Upper body exercises are not usually something I would consider myself as confident in prescribing, however due to my good knowledge of anatomy, exercise ideas came naturally. This made me feel more competent and slightly less anxious about clinic. Following this, we wrote up the notes and planned the patients next session.

After this, the clinic was extremely quiet, so the supervisor gave me a case study to go through, create a clinical impression and then write an exercise program for. I found this extremely useful as it allowed me to ask as many questions as I want without a patient there, and I was able to google search as and when I needed to in order to get the best possible exercises. We have begun our rehabilitation module at Uni which I think is going to help with exercise prescription a lot in clinic. So, as we get later on into the year I think I will start to feel more confident and knowledgeable in exercise prescription.

 

13/11/2020 3

Coming to clinic today I felt slightly more confident than before. First, I had my first online triage appointment. So far, I’ve ended up with all face-to-face clients after their triage, but I was yet to complete one. I was less nervous about thus then I was about meeting someone face-to-face. But, was still worried I was going to get things wrong. I am usually a very confident person when it comes to speaking to people, but for some reason lately in clinic I have been getting very nervous around clients. I am wondering if the lack of socialising during lockdowns has given me slight social anxiety.

During the face to face, everything ran quite smoothly. The layout was clear and easy to follow and I didn’t miss any steps. My clinical impression was either a lower gastrocnemius strain, aponeurosis of the soleus or gastrocnemius complex or an Achilles tendinopathy. Following the session, I planned out how I would differentiate each condition upon assessment.

Following this, we again ran through induvial, quite complex, case studies including creating a clinical impression and then creating a plan. Again, I found this very useful as we had the support of the clinic supervisors and we were able to discuss ideas as a group.

October

23/10/2020 3

This was my first face-to-face clinic session, so I was quite nervous about what it was going to be like. I had done a lot of revision over the summer of clinical assessments and common pathologies to prepare myself, but I was still feeling very nervous.

The first patient I saw was someone who has a grade 1 hamstring strain, and they were at the end stage of their rehabilitation wanting to return to football. For my first client, I think this was quite a nice and easy one to do. The patient is going to personal training sessions 3 times a week now, so I gave him some exercises to incorporate into his personal training sessions. For my first session in clinic, I felt quite confident. It was nice to start with an easy injury that required end stage rehabilitation exercises, as this was what I was most confident in. Following his session, I learnt how to write up notes correctly, and got advice and feedback from the clinic supervisors about the session. I then planned a next session for if he were to come in again.

After this, I had a patient who had very complex signs and symptoms, making it very hard to get a clinical impression. With the help of my supervisor, we found that it may be Achilles tenosynovitis, due to weak plantarflexion muscles and an over pronated foot. For this, I gave the patient eccentric calf exercises. This patient presenting with complex signs and symptoms made me feel quite anxious about my time in clinic. I felt as though I wasn’t as competent as I thought I was. Whilst I got through the session with the help of the clinic supervisor, I still felt like I needed to do better. So,  before next week I am going to do more work into common pathologies. Following this session, I wrote up the notes and then created a plan for the patients next session.

September

23/09/2020 CLINIC 1 

This session was an induction session for the clinic. We went through housekeeping, data protection, guidelines, first aid, accidents and near misses, and waste disposal including PPE. We went through how to keep take our clinic notes and keep a record for each patient who comes into clinic, and the processes of how the clinic will be run due to Covid-19 to minimise risks. Following this, we then set up our Cliniko accounts, and worked out how to use it. Before this session, I was extremely nervous to go into clinic, I felt like I had no idea how to do anything (not sports rehabilitation related, but all of the other things). But, this session soothed my nerves massively, and I feel like I am very ready to begin. Being an organised person, I think the lack of knowledge on note taking and how the clinic was run etc stressed me out a lot, as I simply couldn’t picture what the experience was going to be like. This session answered all of my questions and more, and made me confident to start working.

May

04/05/2021 2

During this training session, we progressed the exercises for the player who had the minor meniscus tear. The player had made big improvements last week. This was nice to see as it shows me that I am going the treatment right, and gives me more confidence in dealing with acute injuries. I learned some exercises that I hadn’t seen before which was really interesting and useful. Following this, gave more treatment to the player with the back injury. Upon assessment, our clinical impression has shifted from disc to facet joint. We gave her light mobilisations and light exercises to help with lumbar flexion. Again, back injuries are something I haven’t dealt with a lot, so this was extremely useful. After this, we had to give this player the bad news that she wasn’t allowed to come to the game on Sunday as it was a 4 hour bus drive away, which will cause her to be in a lot of pain. The player didn’t respond to this very well. She has ADHD so we had to let her calm down in her own way, and offer her alternative activities should could do on Sunday. She wasn’t responding well to the alternatives, and got quite upset. The lead sports therapist was dealing with this situation mainly, however I would like to go away and research the best ways to help people with ADHD. Whilst I know it will be quite subjective to each person, I might find some good tips that might make the player feel better if she were to get upset again.

 

11/05/2021 2

At this training session, I was asked to assess a players knee who has had an injury for a while. This was to get opinion on the injury as despite scans, physiotherapists and the lead sports therapist assessing it, the injury is yet to be diagnosed. Being asked to articulate my own clinical impression made me feel super confident in my abilities, and it felt as though I was trusted as a therapist which made me extremely happy. Upon assessment, I found a multitude of different thing but thought that the injury was either tendinitis of the hamstring, meniscus damage or an MCL injury. The findings were very inconclusive. After telling the main sports therapist my clinical impression, she agreed that these were the three she had thought as well. Despite doing rehabilitation, the player was still complaining of very complex symptoms. Due to this, the main sports therapist instructed me to do some desensitisation work around the area. When doing this, it made me think that the injury was more of a tendinitis. I found assessing and treating this injury very useful, as having inconclusive results is something that comes up quite often. Whilst this case was the most complex I had ever seen , it was good for practising my differential diagnosis skills.

April

01/04/2021 2

This was the first training session back after lockdown and I was feeling quite rusty on my pitch-side skills. I had done a lot of rehabilitation revision over the lockdown as this was something my exams focused on, so I was feeling super confident in that area, but I was definitely feeling less confident about emergency trauma injuries. At the beginning of the session I treated the player with tight calves by giving her a massage as she requested. When doing so, I noticed how much better they felt so I was able to give her lots of praise and recognise her achievements as she had adhering to her rehabilitation throughout lockdown. It felt nice to see a player improve so much with me being her primary therapist for her injury. As I have said previously, I haven’t had much experience rehabilitating injuries from start to finish, and although this was only muscle tightness, it was still confidence boosting to see improvements. It made me realise how important it is to encourage players to adhere to their rehabilitation programs, as this player wasn’t seeing any improvements until I implemented some strategies suggested by Welsh et al (2012) and Nava-Bringas et al (2016). Following this, we spoke to the player who had the groin injury. She had adhered well to her rehabilitation program throughout lockdown and said that she has been pain-free for a while. This was the same for the player who had an ATFL injury. So, together, we ran some return to sport drills to assess their ability to play. Upon assessment, the player with the groin injury stopped running and began crying, not because she was in any pain but because she was afraid of injuring it again. To this, I offered as much support as I could, however I had to let the lead therapist take over as I was unsure of the best ways to improve confidence after an injury, this is definitely something I will be working on. The player with the ATFL injury, however, was safe to return to sport and so took part in the training session for the first time in a while, which she was very happy with.

 

Nava-Bringas, T I., Desatnik, A R., Arellano-Hernandez, A & Cruz-Medina, E. (2016). Adherence to a stability exercise programme in patients with chronic low back pain, Cirugia y Cirujanos, 84(5), 384-391.

Wesch, N., Hall, C., Papavessis, H., Bassett, S., Foley, L., Brooks, S., & Fowell, L. (2012). Self-efficacy, imagery use, and adherence during injury rehabilitation. Scandinavian Journal of Medicine and Science in Sports, 22(5), 965-703.

 

04/04/2021 4

Before the game, we again gave many pre-event massages to the players. We spoke to the injured players to see who able to play in the match, and told the coach how long they should be allowed to play for before coming off to rest to ensure they don’t overdo it. This time speaking to the coach a felt a lot more confident. Since my exam in January, I have felt a lot more competent as a therapist as it was heavily rehabilitation based, so this has, in general, made me more confident. I was expecting there to be a lot of injures at this game, due to the fact their bodies won’t be as ready as they usually would be for a game considering they have hardly trained. However, there wasn’t as many injuries as I would have thought. Almost all of the players who were injured in November has almost recovered, which was really confidence boosting. However, the player who had the groin injury came off the pitch around 30 minutes into the game complaining of mild pain. We massaged the area and I went through some more stretches with her, then told her that on Tuesday we will give her some more exercises to continue doing. I was unsure exactly what to do in this situation, I felt quite bad for the player, as she was so excited to be able to go on and play. The supervisor said that with groin injuries due to their sharp nature afterwards there is often psychological blocks that can cause ‘pain’ due to their anxiety. We said that we would re-assess and give her further exercises on Tuesday but I still felt like we at almost failed at her recovery, which was quite disheartening. I wondered if when we did her return to play, when she cried, if she was actually crying due to pain rather than due to anxiety. I thought that there might have been a potential that she could of lied in order to get onto the pitch and is now experiencing the consequences. This was one of the first times I haven’t seen regular progress in injury recovery, so I found it quite disheartening.

Also, during the game, there was a few injuries that required first aid such as cuts and head collisions. Considering this was the first game back and I was quite anxious to do pitch-side work again, it actually went very smoothly.

 

06/04/2021 2

During this training session we re-assessed the player with the groin injury and gave her some further exercises. She seemed to be in a more positive headspace about it today which was nice to see. However, we still ensured to speak positively about her progress to keep her motivated to carry on with her rehabilitation. Also, during this session, I was asked to look at a player’s ankle who we think has chronic ankle instability. Upon assessment, I noted that the player had very lower arches in their feet, which is something that could disrupt the entire biomechanical pattern of gait which may pre-dispose them to ankle sprains. I asked my supervisor for confirmation and she agreed and gave me a lot of praise for realising which felt good. When it came to thinking of exercises to increase arch height, I found myself quite stuck, so had to ask my supervisor. This is something I am going to look in to, as my supervisor said that it is a very common cause of injury for many.

 

08/04/2021 2

At this training session, I looked at a player’s lumber spine after they were complaining of pain and stiffness. The spine is something I have always revised a lot, however I haven’t actually had that much experience dealing with these injuries in a real life setting. I found the assessment easier than I thought I would, and found that the issue was imply muscle tightness. So, I gave the player a massage and then game them some stretches to do at home to ease their pain. This is the same player who has ACL surgery and an ATFL sprain, so I wondered if the reason their back was to tense was because of compensation during movements for so long. Being able to complete the lumbar assessment made me feel good about myself, but reminded me that I need to go over the upper motor neuron lesion tests. Whilst they weren’t a part of this assessment, it still reminded me that they were something I needed to brush up on as I haven’t had to use them with a player or client in clinic yet. Also during this session I massaged the player with tight claves and took her through some passive stretches. I have really built up a good rapport with this player which is something I have been trying to do both in clinic and at Argyle. However, at Argyle, as there are so many different therapists tending to the players it is sometimes hard to continue building a rapport. But, it is something I am continuing to try and do throughout my time at Argyle.

 

11/04/2021 4

At the beginning of this game, we gave players pre-event massages. During the game, we dealt with a nosebleed, a twisted ankle, and a player who wanted to come off due to starting their period. With the nosebleed and twisted ankle, I felt very confident dealing with the emergency trauma care. When the third player went down, we were unsure what the problem was as we didn’t see a mechanism of injury even though we were watching the game. When we got over there and she told us that she thinks she may have just started her period, we immediately brought her off of the pitch. This is something I had never really considered in women’s sport, but I was glad I had encountered it now so I can be prepared for the future. From now on, I am going to carry emergency sanitary products for the girls, in case something like this were to happen again. I felt quite unprepared for this situation but I’m glad it was something I hadn’t dealt with before and that it was outside the box, as every different situation I am in allows me to become more and more prepared for various situations. At the end of the game, we gave some post-event massages and went through some stretches.

 

13/04/2021 2

At the beginning of this training session, I K-taped the ankle of the player who has chronic ankle instability. I hadn’t taped in a long time, but the player knew exactly what they wanted, so that is what I did. This is something I need to brush up on as I haven’t been doing much taping during this season. During training, we went through some more late stage rehabilitation with the player with an ACL injury. I found that this time round, as it was after my exam, I found this a lot easier to think of end stage rehabilitation drills. Since that exam, I have really felt like a more competent therapist and it required us to create rehabilitation plans for a range of different injuries. Before this, we had mainly focused on treatments such as stretching, massage, taping ultrasound etc. However, I knew that this was the type of therapist that I wanted to be. At the end of second year, I came to the realisation that I wanted to become an exercise focused therapist, and I now feel like I have all the tools and knowledge to do so which is really exciting.

 

15/04/2021 2

At this training session, we assessed a player for a hamstring injury. I hadn’t dealt with many hamstring injuries at this point, but was feeling quite confident with the assessment and the rehabilitation from my exam. I’ve found that during my clinical assessment, I always forget to test adduction, so this is something I need to make a note of and remember to do. Upon assessment, we clarified that it was a hamstring strain, and we proceeded to give rehabilitation exercises. I felt confident in delivering these, unlike at the beginning of the season, where I felt as though my coaching points weren’t as good as they could be. Also, during this session, we did some passive stretching with a few players who had a lot of lower body tightness. I also hadn’t done this in a while, but it at this point in my sports rehabilitation journey knowledge is sticking in my mind more due to repetition. It made me feel good that I was still competent in completing something that I hadn’t done in a while, as it showed me that I really am becoming a good sports rehabilitator.

 

18/04/2021 4

Before the game began, we gave some players some pre-event massages and taped a player’s knee. During the game, two players fell to the ground in a tackle, the player who landed on the ground first ended up with the other players studs of their shoes on their cheek. Whilst I had dealt with many head injuries in terms of concussion previously, I hadn’t dealt with any where there has been wounds to the face as well as this. The player was sat up and the cervical spine was fine, so I assessed them neurologically by asking Maddocks questions. I had recently been revising for the RFU course, so I felt as though my first aid knowledge was expanding quite quicky. The other player got back up very quickly and ran away, and the one we were dealing with had some grazes on their cheek. Despite not dealing with facial wounds before, because of my RFU revision I felt quite confident on treating and dealing with them. The player didn’t seem to be concussed following the pocket SCAT assessment, but we kept her off due to the risk of symptoms developing later considering she did have a direct blow to the head. At the end of the game, we gave some post event massages and stretches to some of the players. Before next time, I need to get more bandages and dressings, as my medial bag is currently running low. This meant that if the injury was worse, I wouldn’t of been able to treat the wound as I would have liked to. So, before the next game I am going to do a re-stock of my medial bag.

Looking back on my time doing this placement, my development in knowledge and skills has been extremely drastic. This year, I feel as though I was really able to get stuck in. I was confident in my knowledge and with the help of the rehabilitation modules, the RFU revision and learning lots in the clinic, I can clearly see my development as a therapist.

 

20/04/2021 2

At this training session, a player asked for advice following their knee swelling up after the game on Sunday. This player had previously had an ACL surgery so upon assessment I was very aware of this. The swelling was at the left, top of the knee above the patella. The player hadn’t played properly in years, and reported no pain when walking, running or playing football. The initial thought the other therapist and I had was that this was a protection mechanism in her body to protect her knee after the shock of playing football again. Upon assessment, no pain was reported on any movement, and her strength was good throughout. In the assessment, the lead sports therapist taught me how to test for adductor strength in 3 different adductor muscles; with legs and hips at 90/90, with legs bent and with legs straight. This is something I hadn’t yet come across but found it very useful. Following this, we took her through some sprints to see if there was any recreation of pain, to which there wasn’t. Following the assessment, I advised the player to not play for the rest of the training session, to see how her knee reacts to the sprinting drills she had just done.

I felt quite confident in the assessment of this athlete, but was unsure if swelling years after ACL surgeries was something to expect or not. So, I am going to research what to expect from athletes knees in the years following ACL injury to ensure I am giving the athlete the correct instructions before letting them back on the pitch.

 

22/04/2021 2

At the beginning of this training session, before the main sports therapist arrived, a player arrived hardly being able to walk due to severe back pain. She stated that her pain increased when she stands up after prolonged sitting, and when bending forward. Immediately, I thought she had a problem with her disc. I got the player down to the ground and lightly palpated her spine, to which there was a lot of pain. During this assessment the main sports therapist showed up and took over. She agreed that she thinks it must be a disc problem. This made me feel really competent, especially considering I haven’t had to deal with a patient with a disc injury yet, I was very happy my clinical impression was the same as my supervisors. In such an acute stage of injury, I was unsure what to give the client. It seemed everything would be too painful, so I learned a lot by watching and asking questions at this training sessions. My supervisor began by giving a massage to the lower back muscles which had seized up to attempt to guard the injury. Following this she got the player onto the floor and went through a number of light lumbar stretches and showed the player the best way to fall asleep. Before this training session, this is something I wouldn’t of known to do, to I have definitely learned a lot and I need to do some further research into what sports therapists can do to help severe back pain including disc problems.

 

 25/04/2021 4

At the beginning of this game, I taped the ankle of a player with chronic ankle instability. I hadn’t taped an ankle using rigid tape in a while, but it stayed on the whole game and the player was comfortable I was clearly still competent. At the beginning of the season we weren’t using tape much as this was something the lead sports therapist didn’t use often. However, now towards the end of the season the lead sports therapist is asking us to use it more. At first, I felt like I had almost forgot how to tape properly, however as soon as I was presented with the injury I did in fact know how to do so. This is definitely another one of those things where I second guess myself and feel as though I’m not as competent as I think I am. Using tape more often now has helped with this confidence. During the game, one player went down due to a suspected meniscus tear in the knee. We did an on field assessment which I felt confident doing, and decided to bring the player off the pitch. The player was in quite a lot of pain so we gave them ice for pain relief. Another player went down due to a direct blow to the quadricep. We brought the player off and again, gave them ice for pain relief after assessment. Whilst the first aid needed for injuries at Argyle Ladies is often very minor, we always ensure we are prepared for the worst. After my RFU course, I am going to purchase different airways to add to my medical bag as I will be qualified to use them after the course. The only thing I felt I could have done better today is be more alert. I had a bad nights sleep so found myself very tired. For the player who went down with a meniscus injury, I missed the mechanism and instead had to get the player to tell me. Next time, I am going to try my best to be more alert to not miss any mechanism of injury.

 

27/04/2021 2

At this training session, we assessed the player who went down with a potential meniscus tear, and found this to be our final clinical impression. It felt good to have had the right idea in the first instance as to what it is, my knowledge and skills are definitely expanding. The player was weight bearing quite well so we were able to give some exercises straight away. When injuries are in the acute stage, I always feel nervous giving players treatment and exercises, as I feel as though I am going to injure them further. Whilst I am going by what the lead sports therapists agrees with and by what I’ve been taught at University, it still gives me anxiety. This is something I’d like to get more confident in. After this, we did some passive stretches and massages with a few of the players.

November

01/11/2020 4

Before the game, we gave a few players a pre-event massage. During the game, one player went down after getting hit in the face. We ran on and after assessing that everything was ok, we walked her off the pitch. As we were walking off her nose began to bleed heavily. We wrapped up a bandage for her to put up her nose and helped clean her up. When we got her off the pitch, we did a mini concussion assessment to check she didn’t have any symptoms, to which she was fine. I feel quite confident in dealing with head injuries after dealing with so many last year. Also during the game, 2 players had a collision and one player went down. We had to run onto the pitch and assess the severity of the situation, to which we agreed it was bruising to the thigh. We took the player off and gave them ice. After the game, we went through the assessments of some injuries for players who got injured during the match but didn’t come off. We kept the assessments simple as we had to wait 24 hours for a proper assessment so we told them we would do this on Tuesday. But we gave the advice of PEACE and LOVE until then.

Throughout the season I can feel myself becoming more and more confident with pitch-side work. Although, a lot of the emergency trauma we have to tend to are often very acute, so it would be interesting to see how I would be in a more severe situation. Obviously, they are very rare, but I am still going to revise what to do in the most severe cases for in case one was to come about, as I feel like I am lacking practise in this area.

 

03/11/2020 2

At this training session, we went through a few different rehabilitation programs with a few different players. To begin, we went through some more late stage ACL exercises. I was asked to come up with some sport specific drills which is something I thought I would usually struggle with however I got some good feedback which made me feel good. As football is such a huge sport and so many people so know much about it, I sometimes feel like if I suggest any sport specific drills they wont be suitable. However, it was proven today that my knowledge is adequate and that you don’t have to know the sport inside-out to be able to prescribe sport specific drills. For sports less popular, I don’t usually have this anxiety, it was only during Football. This showed me that this anxiety was irrational and that I again, need to trust myself more. After this, we went through some agility based rehabilitation for the player with an adductor strain. I suggested we use some of the exercises from the Aspetar program I had learned about earlier in the year.

Considering the team have been having many of the same type of injuries, I have become very confident at dealing with quads, hamstrings, adductors and calves. However, I definitely need to brush up on my knowledge of upper body injuries and rehabilitation for them, as this is something I don’t encounter much at Argyle or in clinic.

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