01/10/2020 2
This session was a training session. During this session, we had to treat quite a few players. First of all, one player was complaining of pain in and around their calf. At first, myself and the other student sports therapist assessed it. We came to the conclusion that the issue may be to do with her peroneus longus muscle. However, when the supervisor then did her assessment, she then diagnosed it as shin splits. She explained that there are 4 different types of shin splints that we should look up, as it isn’t always as black and white the most commonly known type. Following this, the player who was complaining of shin pain on the weekend came over in pain again. Immediately upon assessment, we thought the problem was shin splints. However, considering she had said that she had seen a physiotherapist before and they said it was due to tight glutes and hamstrings, I didn’t contemplate this on the weekend. When the supervisor then did her assessment, she confirmed that she also thought it was shin splints. I feel like this was a good lesson learned; to not be afraid to put your opinion across, despite if a qualified professional has already given a diagnosis. Before hand, I simply didn’t say what I thought the issue was, because I automatically assumed that I was wrong over the professional. If the supervisor hadn’t reassessed, this injury could have been misdiagnosed, and the player wouldn’t of been given the therapy/rehabilitation needed to help her injury. So, upon reflection, it is definitely important to put your opinion across, despite your undergraduate title, even though a lot of the time it might be wrong. Next time, I won’t be afraid to conclude from my own findings.
04/10/2020 4
These 4 hours took place at a match. After having a very busy first match the previous week, I felt confident and ready to go when going to this one. Before the match began, a player came over complaining of pain in their shin, which increases when they run. They explained that they had been to a physiotherapist before, and they had said that it was because she had tight glutes and hamstrings. We palpated around the area and assessed range of movement and strength, to which it did certainly seem like the issue was muscle tightness. So, I passively stretched her glutes and hamstrings, as well as giving her some active stretches and then massaged her shin. Following this, I asked her to walk up and down the pitch, to see if her pain was any less than before, to which she said she couldn’t feel it. I then asked her to run at 50% pace, to which she again said she couldn’t feel it that much. I then asked her to run at 70% pace, to which she then said it hurt at around a 3. She said she was ok to play the match, so we said to her that as long as the pain doesn’t go above a 4, she can carry on playing.
During the match, it looked as though she was struggling a little. However, whenever she came off and we asked her what her pain was out of 10, she would always say a 2 or 3. Immediately, we realised that we shouldn’t of told the player the cut off number, as she was always going to down play her pain, as the obviously wanted to play. This was a lesson learned, and next time, we will decide on a pain score in private, without telling the player to ensure we are getting a true representation of her pain.
There were also a few other injuries during the match. One player went down with cramp, and another got hit in the face with a ball and had a nosebleed. With the player who had cramp, I felt confident in my treatment (stretching). However, the player how had a nosebleed was quite a difficult player to deal with. She was the kind who seemed like she didn’t really want our help. Regardless, we gave her a wipe for her face, and gave her a bandage the right size to fit in her nose. However, I do feel like dealing with difficult players is something I used to be quite good at, but I must have just been out of practise considering the majority of the team I work with are extremely friendly. So, this is something I am definitely going to reflect on more and think of good ways to communicate to these kinds of people. I think that because of the PPE that has to be worn, especially the masks, it makes it harder to create trust with a player I have never met before (she was on the other team). But, this is something I will have to learn to work around due to the current environment.
06/10/2020 2
In this training session, we continued to work on decreasing the swelling of the player who had the bad grade 2 ATFL sprain. In this session, we were expecting to see that her swelling had gone down a lot, so that we could start looking at repetitive range of movements and starting to aid gait. However, her ankle was still extremely bruised and swollen, and she mentioned that she couldn’t go into school today, as it hurts to much to walk around. So, instead of working on ROM, we flushed her ankle again, to help try and decrease her swelling. I chose this method to reduce swelling as after reading around the topic, it seemed that other methods used to decrease swelling such as compression and elevation will only have temporary effects, and once the foot is back into its normal position, the swelling will return (Fong, Chan, Mok, Yung & Chan, 2009). Also, during this session, there were a few injuries due to the girls falling over in the rain, meaning we did some first aid too. One player cut her arm and another player fell over and bruised her leg applying first aid is something I have definitely become more confident in, and this allowed me to practise the communication skills through the PPE needed on game days that I struggled with last week.
References
Fong, D., Chan, Y.Y., Mok, K.M., Yung, P.S & Chan, K.M. (2009). Understanding acute ankle ligamentous sprain injury in sports. BMC Sports Science, Medicine and Rehabilitation, 1 (14), 1-14.
07/10/2020 2
In this session we began by going through some late stage rehabilitation with the player who has the quad strain. We assessed the knee, the hip and the adductors before going ahead with the rehabilitation. Since last week, the player has made a drastic improvement that was really nice to see. However, considering she was doing all of the exercises, even lunges (which she couldn’t do last week) pain free, she was frustrated that she wasn’t training. I reminded her that if we let her play too early again, then we will only tear it more and it will become worse again, like last time. She agreed and then carried on with the rehabilitation. Having to practise my psychology skills last week with this player made me more confident and articulate in what I was saying this week, which was really useful considering the player is getting more and more frustrated. Furthermore, instead of giving me exercises for the core section of the rehabilitation, the supervisor allowed me to decide on them myself. I found this useful in developing my exercise knowledge, which is something I think I really need to work on. When pitch-side, I feel more confident in writing rehabilitation programs as we go away, write them and then send/give them to the player when we next see them, giving us time to research what exercises are best. But, it seems that when going into clinic we have to give the patient exercises on the spot, which is something I am definitely not confident in. However, we are starting modules next week which include the rehabilitation of each joint, so I think that as the year goes on I will feel more and more confident in this area. But at the minute, I’m finding it a bit of a struggle. From now onwards, I’m going to try to increase my exercise knowledge, so that I can be efficient with giving patients exercises on the spot.
08/10/2020 2
Within this training session, I was instructed to go through an assessment for a player’s hamstring injury. Upon clinical assessment, it seemed to be a proximal hamstring strain. When I was going through the assessment with the athlete, the supervisor afterwards noted what she would have done differently, which consisted of testing the hamstring strength at different angles of knee flexion to assess the different portions of the hamstring. This was something new and interesting that I hadn’t heard of before, but I will definitely include in my future clinical assessments, not only for the hamstring but for other major muscles such as the quadriceps too. Taking part in this placement is really teaching me the way that each individual therapist does things in a slightly different way. I am keen to develop my abilities to create my own individual way of doing things, that works best for myself throughout my time at Argyle. In my previous placement I felt as though there almost wasn’t room for me to do this, and I was instead learning their particular way of doing things rather than having some room for individualism. So, I am very grateful that I am afforded the opportunity to have personal freedom to find myself as a therapist here.
11/10/2020 4
During this game I felt quite confident again, after being ‘thrown in the deep end’ in the previous games. Again, I was feeling confident and efficient. During this game, one player got hit by an elbow of a player on the other team. The player became wobbly and looked to be dizzy whilst holding her head. She tried to continue playing and the referee didn’t stop the match. However, we quickly told the coach to get her off the pitch so we can do an assessment for a concussion. This was a very quick decision that had to be made, and it displayed the importance of always having your eyes on the game. If one of us therapists were to not see that, the player may have carried on playing and her concussion may have become more severe. When we took the player off, the supervisor asked if any of the students wanted to go through the concussion protocol with her, to which I said yes and went forth completing what I had been taught in my previous placement. I dealt with many concussions during my second year of placement, so this was something I felt I could do quite well. This again, boosted my confidence and made me feel like I was becoming a very competent therapist.
13/10/2020 2
In this training session, one player asked for an assessment of their knees due to pain they were experiencing during training. This player had previously had ACL surgery and many other issues with their knees. Due to this, the supervisor took the assessment, to allow us to learn through observation. Throughout the observation, when the player reported pain, our supervisor asked us if this is something we should be concerned about in terms of the present injury or whether this is something we would except due to their previous knee surgeries. Throughout, I found that I wasn’t as confident in this as I thought I would have been. So, throughout this assessment I learned a lot. This also guided me in the right direction in terms of my revision, as I feel as though I am often revising from scenarios that aren’t as complicated as this particular player. The supervisor did say that it is ok to not know everything, and that even after graduating she still has to research some things she feels as though she ‘should know’. She explained that even after University, everyday is a learning day. This made me feel a lot better about my uncertainty during the assessment. The clinical impression for the injury was general wear and tear of the meniscus, to which we prescribed some quad, hamstring, adductor, glute and calf exercises. I felt more confident prescribing exercises after looking at some websites my supervisor recommended. It made me realise that rehabilitation exercises aren’t as complicated as I once thought, in fact, they are actually very simple exercise I include in various forms throughout my work-outs at home or in the gym. After realising this, I decided to be more confident in suggesting exercises that I know at training sessions, without worrying if they’re ‘good enough’, as my knowledge of the best exercises will continue to develop throughout the year at placement, clinic and also through the third year modules.
14/10/2020 2
During this training session, I felt extremely tired but was trying to keep a positive and alert mind in case any injuries were to happen on the pitch. As training is quite late, and I’ve usually done a full day of work prior to this, I often do find myself more tired than I would like to be for these late night sessions. Once we are there and are involved in helping a player, I immediately wake up usually, but today I really struggled. Nonetheless, during the training session one player came off complaining calf pain. Upon assessment, it was apparent that the issue was simply severe muscle tightness. The other therapist and I massaged the player and then gave her some stretches. Due to my love for yoga, I find prescribing stretches the easiest part of exercise prescription. The other therapist noted that eccentric loading of the calf would also be beneficial which is something I hadn’t considered before. I left the training session feeling more awake then when I arrived.
Tonight, I reflected upon how far I have come since the beginning of Argyle. At the beginning I was extremely nervous about whether I would be good enough and if I would be liked. But now, I feel more confident than ever just being myself and trusting my knowledge, which is something I wasn’t used to do doing previously.
15/10/2020 2
In this session, I was asked to give some early stage rehabilitation exercises to the player with a hamstring strain. After reading papers on this (Asking, Tengvar & Thorstensson, 2013;Sherry & Best, 2004), I found that I had to prescribe eccentric exercises for the hamstring as well as trunk stabilisation exercises and agility. I felt quite confident in delivering these exercises, however again, I felt as though my verbal coaching ques were lacking so this is still something I need to work on throughout my time coaching exercises.
References
Askling, C.M., Tengvar, M. and Thorstensson, A. 2013. Acute hamstring injuries in Swedish elite football: a prospective randomised controlled clinical trial comparing two rehabilitation protocols. Br J Sports Med, 00:1–8.
Sherry, M A S & Best, T M. (2004). A comparison of 2 rehabilitation programs in the treatment of acute hamstring strains, Journal of Orthop Sports Phsyical Therapy, 34(3), 116-25.
18/10/2020 4
At the beginning of the game, we conducted a lot of pre-game massage, mainly for the calves. During the game, we had to keep an eye on the player who was complaining of calf pain on Thursday, as they said at the beginning of the game that they were still sore. She also explained that she hadn’t completed any of the stretches we gave her, so throughout the game I was thinking of ways to motivate her to adhere to her rehabilitation program. Around 30 minutes into the game, the player came off and I practised my psychology skills in attempt to motivate her to adhere to the stretches. Also during the game, one player went down due to being kicked in the ankle by another player. We ran on and assessed the severity, before helping her walk off to the side lines. The injury looked to just be bruising, so we gave her an ice pack whilst helping her with the shock of the injury. Before games, I always still feel slightly nervous about running onto the pitch, worrying that I am going to freeze when I do and not know what to do, even though this has been a focal point of my revision and I have done it many times before. But, every time I do, the adrenaline kicks in and I know exactly what to do. I need to start remembering that every situation is so unique that practising and revising at home can only go so far, as it is completely dependant on every tiny detail of the individual situation. After the game, we gave many post-game massages and helped some players with some lower body stretches. Again, this is something I often like to take the lead in due to my love for yoga, and the players seem to enjoy it.
After the game, I researched how to encourage patients to adhere to their rehabilitation and found many things that I will put into practise throughout the rest of my career. Wesch et al (2012) used self-efficacy interventions, for example, teaching positive self-talk, and imagery use, such as visions of returning to sport, to improve adherence to rehabilitation. Nava-Bringas et al (2016) ensured to give patients lots of information about their injury and exercise plan, ensured patients achievements of goals were recognised, as well as ensuring that patients felt well understood throughout their rehabilitation process. Before the next training session I will think of ways to implement these findings specifically to the injured player.
References
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.
Tuesday 20/10/2020 2
At this training session I went through rehabilitation with the player who has a hamstring injury. I found that after practising at home, my coaching tips were a lot smoother than usual and I was beginning to sound more professional. In attempt to encourage this player to adhere to their rehabilitation program I gave them lots of insight as to why they were completing each and every exercise (Nava-Bringas et al 2016). The player was very interested and ended up asking many questions, so it seemed to be having a positive effect on the player. Considering last week I was unsure how to encourage a player to adhere, I am very happy that I was able to do this competently this week. This was my first time applying the research I read up on last week when I was struggling with how to encourage another player to adhere to a rehabilitation program, and I feel as though I did so quite well. Next time, I will try to add in other methods such as imagery and positive self-talk (Wesch et al, 2012). Also during this training session we had to keep an eye on the player who had recently returned to play from a quadricep injury. This player is known for being very reluctant to come off the pitch when they are injured, so my supervisor told me to keep a close eye on her so we can bring her off to ease her in slowly. After around an hour of training, I could see her apprehension when kicking the ball, so we brought her off and massaged her quads, and then explained to her the reasons why its best to ease herself back in to avoid re-injury. I feel as though I am getting better at talking to players who uphold a lot of frustration with their injury since doing this placement, as this time, unlike many other times, the player was more cooperative.
References
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.
Wednesday 21/10/2020 2
At the beginning of this training session, I had to go through some groin and adductor stretches for a player who was complaining of tightness. I was unsure of how to target the groin in particular, so I had to ask my supervisor for advise of how to target quite proximally. Following this, I had to run onto the training pitch after a player twisted their ankle. As I was giving stretches during this time I didn’t have my eyes on the pitch at all times so I missed the mechanism of injury, this is definitely something I am going to work on – trying to pay attention to 2 things at once for effectively. The player described the mechanism and it looked to be an ATFL sprain upon observation. As I had dealt with a very severe ATFL sprain at the begging of the season I felt quite confident in giving advise to and treating this player.
Thursday 22/10/2020 2
During this training session, the player complaining of groin tightness came over again, complaining of pain. This time, I assessed her myself (she was assessed by a different therapist beforehand) and found that she might have a groin strain. I asked my supervisor for a second opinion and she agreed. This made me feel like a very competent therapist. Following this, we gave her some isometric exercises to get her started on her rehabilitation program. I again, used the methods I have recently learned to encourage the player to adhere to their rehabilitation program. I used positive self-talk and imagery quite a lot for this player, as they were quite upset with their injury as they really wanted to play. After speaking to her, she seemed a lot more positive about the recovery process for her injury. We allowed her to play so long as it wasn’t hurting too much, but after 10 minutes of playing she quickly came back off. When she came off, she walked off and looked to be crying, so I went over and had a heart-to-heart with her about how she was feeling. I consider myself a very empathetic person who is very good with people, so this came quite naturally to me. When I came back, another therapist said they wouldn’t of known what to say in that situation, so that again, made me realise I was more competent then I think I am.
This training session reminded me of the psychological affects injuries have on athletes, and how import it is a practitioner to show empathy to players and to be a part of their support system during their recovery process.
Sunday 25/10/2020 4
At the begging of the game, we had to talk to the coach about who was allowed to play. The coach really wanted the player who had a groin injury to play, however we had to explain that this wouldn’t be good for her, however he wasn’t too happy with that. Whilst I have dealt with unhappy players, I hadn’t really dealt with unhappy coaches before, so this was a new experience that I think will be important for my career. I found myself feeling quite awkward when talking to him, due to the fact he was quite unhappy with our decision. So, this is something I need to work on. I need to be able to say things confidently to coaches without looking/feeling awkward to allow them to have trust in my decision making. Also, before the game, we completed a number of pre-event massages to players with tight calf muscles. During the game, we had to deal with a few first-aid needing injuries. One player fell and cut their leg during a tackle with another player, to which we had to run on and clean the wound and apply a bandage to protect it. Another player went down due to being winded by another player. We ran on and helped her with the shock of the injury and gave her some water, as well as asking if she had any pain in her ribs. Another player got physically attacked by a player on the other team. She tackled the ball quite late leading to both players falling over. The player from the other team got up quickly and began kicking her in the ribs whilst she was on the ground. I was the closest authoritative figure to the players, so I had to run on and stop the player from attacking. By this point, the referee has sent the other player off so I could attend to the injured one. At first, I checked for bleeding and then asked her where she was in pain. She said she was fine and was just in shock, so we took her off of the pitch and helped her calm down, and then assessed the site of the injury. Everything looked to be fine so we gave her some ice and continued to emotionally support her.
This was a situation I never even considered. However, another therapist who was very into football said that this sort of stuff is actually quite common, I just hadn’t yet experienced it at placement. This was a completely new experience for me, but I feel as though I responded to it quite well. When I was on the pitch, I was trying to remember the acronyms for responding to emergency trauma, however I couldn’t quite remember all of them. So, this is something I need to brush up on to ensure I am being as safe as I need to be.
Tuesday 27/10/2020 2
At this training session, we progressed the exercises for the player with the groin strain, as well as for the player with the ATFL sprain. I found that I was more confident in progressing the exercises for the groin strain than I was for the ATFL sprain. Serious injuries often make me nervous that I am doing the wrong thing, despite how much I revise them. The supervisor mainly took charge of the player with the ATFL sprain due to its severity, however she would instruct us of what to do rather than her doing it personally. I have found this a really good way to learn. I haven’t dealt with many severe injures from early stages to return to play, so I am excited to be able to see an entire recovery process, as this really puts my knowledge into practise. As well as this, we also conducted a whole lower body stretching session at the end of training for players who were complaining they were stiff. This is something I really enjoy, so it made me think that I should look into group exercise instructing alongside sports therapy.
Wednesday 28/10/2020 2
At the beginning of the training session I gave a massage to the player with tight calves. During this, I spoke to her about her adherence to her rehabilitation as there hadn’t seemed to be much improvement since I last massaged her. She said that she had been stretching but not as much as I asked. So I used the techniques that I researched earlier in the season such as giving her plenty of information as well as imagery work in attempt to motivate her to adhere more. It seems like she is the type of player who enjoys getting massages rather then stretching, so I spoke to her about how massages are good, but only for short term benefits for her particular injury and how stretching is what will actually ensure recovery long-term. After this, I did flushing of the ankle for the player who had an ATFL injury, as I was shown at the beginning of the season. I found this quite useful for seeing my development as a therapist, as this is something I would of considered doing if I hadn’t come to this placement.
Thursday 29/10/2020 2
Within this training session, we went through some late stage ACL rehabilitation with a player who had an ACL injury last season. I hadn’t yet dealt with someone who had an ACL injury and this player hadn’t been coming to training sessions that often to do their rehabilitation. We did lots of agility and plyometric training which I found extremely useful for my exercise knowledge. I have recently realised that I am a lot more confident on end stage rehabilitation then I am early stage rehabilitation, especially for lower body injuries. Often, end stage rehabilitation for lower body injuries overlap do I now find this quite easy. However, I need to work on my knowledge of early stage rehabilitation for big injuries, as this is something I haven’t had to deal with that often.