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.