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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.