November

Sunday 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.

 

Tuesday 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.

October

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.

 

Sunday 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.

 

Wednesday 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.

 

Sunday 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

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.

September

22/09/2020 2 hours

Being my first session at Argyle Ladies when I arrived, I was nervous. I have minimal experience with football players and know only little about the sport. I was quite nervous about meeting the players, but not so nervous to meet the supervisor. Upon arrival, the supervisor ran through the general structure of the sessions and of match days and told me what she would ideally like me to commit to. During the training session, she showed me the medical bag to ensure I knew what to get when I buy mine. One player had an injury from the previous game (quad strain). So, it was insightful to listen to the supervisor’s rehabilitation, as they were quite different to what I was used to in basketball. To test my ability, the supervisor immediately asked me for a functional quadricep exercise. To which, I said Bulgarian split squats. Whilst she took my suggestion and the player performed these, afterwards, the supervisor took the player through some of her own functional quadricep exercises. During this, I realised that Bulgarian split squats are not a functional, and I quickly picked up on what sort of exercise I should have offered instead. For a first day, it went very well. The environment was very different to my previous placement, but it was enjoyable and professional. Already I feel as though I have taken a huge step in my personal development, and I am confident that I made a good first impression. The supervisor noted that she liked the amount of questions I asked in order to gain a good insight into what the role of a sports therapist in women’s football entails.

After the training session, I researched some exercises commonly used for lower body strengthening for a variety of different injuries in attempt to broaden my exercise knowledge (Eitzen, Moksnes, Snyder-Mackler, Risberg, 2010; Wilson, Kannan, Kopacko, Vyas, 2019; Hamstra-Wright et al, 2017).

 

References

Eitzen, I., Moksnes, H., Snyder-Mackler, L., Risberg, M. (2010). A Progressive 5-Week Exercise therapy Program Leads to Significant Improvement in Knee Function Early After Anterior Cruciate Ligament Injury. Journal of Orthopaedic and Sports Physical Therapy, (40)11, 704-721.

Wilson, K W., Kannan, A S., Kopacko, M., Vyas, D. (2019). Rehabilitation and Return to Sport After Hip Arthroscopy. Operative Techniques in Orthopaedics, 1048-6666.

Hamstra-Wright, K., Aydemir, B., Earl-Boehm, J, Bolga, L., Emery, C and Ferber, R. (2017). Lasting Improvement of Patient-Reported Outcomes 6 Months After Patellofemoral Pain Rehabilitation. Journal of Sport Rehabilitation, (26), 223-233.

 

23/09/2020 2

During this training session, I got to know the players on the 1st team, as the team I was working with yesterday was the development team. At the beginning of this session I asked the supervisor a lot of questions including how to know when to take a player off or to allow them to carry on playing, as I was aware that the protocol for every sport and team is different. Following this, we proceeded to treat the player who had a quad strain but this time through massage, considering she had already done her rehab earlier that day. This is something I had never really considered, however on this placement I am quickly learning that there isn’t many common football injuries that you can’t massage over, you just have to be sure on the pressure and the type of massage you are giving. Subsequent to this, a player who has chronic ankle instability went down on the pitch. The supervisor and I ran on to find that they had yet again sprained their ankle. We took the player off, assessed and iced the ankle. This was my first experience running onto the pitch, even though it was just a training session. From talking to the other sports therapists, it seems in football, sports therapists run on a lot more often than they do in basketball, which is something I am really excited to get more confident in as I feel like this part of my education was limited last year.

Ultimately, I am finding this placement extremely good for my confidence and self-development. I am getting involved in all of the assessments and treatments, with the supervisor allowing me to perform them as I would, with her to watch over me and correct if necessary. I’m finding myself feeling very comfortable at this placement, perhaps due to the fact that they are a women’s team, maybe, I’m feeling less intimidated. However, the progress in knowledge from 2nd year to 3rd year will also be playing a big role in this.

 

24/09/2020 2 hours

Within this training session I was working with the supervisor to decrease the amount of swelling in the ankle of the player who went to hospital with a grade 2/3 sprain on Sunday during the game. In order to do this, we iced her ankle for 3 minutes and then flushed her ankle with light effleurage for 10 minutes and repeated this 3 times. Following this, we gave her instructions as to attempt to partially weight bear sometimes, in order to try and retain some movement at the ankle joint. Whilst sat down, we instructed her to plantarflex her foot gently 10 times. I have never been involved in such a big injury before, so this was the first time I have applied my knowledge of big injuries to a real life setting. Following this, another player came over complaining of groin pain. The supervisor instructed me to assess the area to see what I thought the issue was, to which I came to the conclusion that it might be a minor groin strain. Before giving treatment, I asked my supervisor to confirm that I was correct, which I was. So, I massaged her groin and quadriceps, and then gave her some groin stretches to do at home.

After the session I reviewed some papers on ankle rehabilitation to get some guidance for the stages of rehabilitation following an ATFL sprain, in order to help me with offering suggestions of progressions throughout the process (Mattacola & Dwyer, 2002).

This placement has given me a huge confidence boost that I’ve really needed. Being trusted to assess a player alone and make decisions displays the supervisor’s confidence in my knowledge as a therapist, which only motivates me to be even better. I’ve always thought that I was someone who responses well to criticism; in that I thought it only motivated me to want to do better. So, I would vocalise this to those teaching me, telling them not to be shy in telling me I’m wrong quite bluntly. However, starting this placement has made me realise that I respond better to enthusiasm and positivity even more so. My desire to learn this year is so much more than it was last year, which I didn’t think was possible. Upon reflection, it seems that last year my desire to learn more wasn’t necessarily for myself, but for my peers to see I am doing well, as opposed to me actually enjoying and loving the process of learning. This is a trait that I had massively in my 1st year of University but was sadly lost in my 2nd year. However, I’m really happy to see this version of myself return.

 

References

Mattacola, C, G & Dwyer, M, K. (2002). Rehabilitation of the Ankle After Acute Sprain or Chronic Instability. Journal of Athletic Training, 37 (4), 413-429.

 

Sunday 27/09/2020 4

This session was my first game with Argyle Ladies. To say I was nervous would be an understatement. We were the sports therapists for the development team’s game, and I had heard from a therapist who did this placement last year that this team goes down on the pitch quite a lot. Usually this would mean that he would have to run onto the pitch at least 3 times a game. Considering this was something I wasn’t used to, it made me quite anxious that I would freeze when it actually came to it. However, at the game, we had a total of 5 players go down injured on the pitch. As there were 3 sports therapists, we took it in turns running on in pairs, and therefore I ended up running on 3 times. Throughout the game, we dealt with 4 ankle injuries and 1 concussion. Three of the ankle injuries were quite minor, and just required icing. However, one girl heard a loud pop, her ankle immediately swelled up and bruised. We immediately carried her off of the pitch and iced her ankle. The pain was becoming increasingly worse, so we decided it was best that she went to A&E to get it checked out. Luckily, her Dad was watching her, so he was able to take her. This was the most important decision I’ve had to make during my time as a sports therapist, but it has been confirmed by the supervisor that it was the right thing to do, as the hospital diagnosed it has a partial, potentially full tear.

Very quickly I became aware that I was a lot more confident then I thought, and my skills and knowledge were definitely up to scratch. I got praise from the other therapists for my initial response to injury skills regarding shock. I feel like I am now back in the flow of my role, and I will be a lot more confident throughout the rest of the season.

 

29/09/2020 2

In this session, I was working with a who had almost recovered from her quad strain, but then over did it upon her return to training and tore it even more. I was given a list of exercises to go through with the player and asked to assess her progress. The player was very reluctant to go through the exercises, and just wanted to play. But I managed to get her on board by explaining that the reason she is back in this position she is, is because of the fact she over did it.

When going through the exercises, we didn’t manage to finish the cardio at the very end of the work out, due to her pain becoming too much. This clarified that I made the right decision in not allowing her to train. So, instead of the cardio I went through some stretching and core work with her, performing all of the exercises and stretches with her to keep her motivated.

This session truly tested my athlete psychology, something that I have had a lot of practise in but am out of practise with. However, I feel as though I did a good job, considering she completed the entire work out with a smile on her face, and eventually stopped asking to play.

 

30/09/2020 2

These hours took place at a training session. During this session, I had to assist in coaching a player through their exercises of their rehabilitation program for an adductor strain. Due to the fact I have an adductor strain myself and have been rehabbing it, I found this task quite easy. We are not that far into the module looking into rehabilitation exercises, so I found it quite lucky that I had experience with this injury. Whilst I had completed the exercises I was coaching many times before, I found that I struggled to find the right words and phrases to use when describing how to complete the exercise. I found it easier to demonstrate the exercises, and then to subsequently give corrections if their technique was slightly off, rather than being able to give the coaching points at the beginning of the exercise. This is something I am definitely going to work on as I think its important in terms of professionalism as well as for injury prevention.

Following the session, I was advised to look up the Aspetar program in order to advice the player on more agility based exercises in their next rehabilitation program with us. The paper made me realise that adductor injuries require a lot more agility based rehabilitation then I would have ever thought. I found this paper extremely useful as the exercises are very transferrable to other lower body injures, particularly in the late stages of rehabilitation.

Formative & Summative Assessment

 

Formative & Summative Assessment Plymouth Raiders

Formative Assessment Plymouth Raiders

Summative Assessment Plymouth Raiders

 

Formative & Summative Assessment Marjon Basketball

Formative:
What are the students Strengths?
Communication: Amber has demonstrated a good ability to be able to effectively communicate, utilising written, verbal and other alternatives to these previous two types to ensure that information is relayed to relevant individuals, whether this be staff, coaches or players.
Enthusiasm: Amber has certainly been one of the more enthusiastic therapists this year, highlighting her passion for basketball and really getting to grips with the game, forming a strong rapport with many players in the team whilst also maintaining professionalism.
What would you like to see the student concentrate on, or develop, in the remainder of their time on placement?
Increase Attendance for Support Sessions: I would really like Amber to complete more additional support sessions on a Wednesday morning, these prove to be immensely helpful for other students as the class sizes are quite small and it includes a lot of peer learning, as well as a good mixture of anecdotal and evidence based practice and advice.
Working Independently: What I’d like to see Amber do would be to work more independently, perhaps just on her own when she feels confident enough to do this, so her judgement is not always questioned and she understands what it is like to have to work independently. Identifying the challenges this presents of having to utilise resources and the significance of preparing well for a game to ensure that if anything does happen she is adequately prepared.
Other Comments?
 
Summative:
What are the students Strengths?
Knowledge: Amber has shown a great thirst to continually strive for learning and engaging with learning, as has been evident clinically. I have had the opportunity to be able to supervise and observe Amber’s clinical ability more so than pitch side. Her competency and level of clinical judgement is very impressive and I have been pleasantly surprised when having critical discussions with her regarding individual players.
Professionalism & Punctuality: Amber is always early to training and game sessions than the required meet time, ensuring she is adequately prepared, respectful, well dressed and otherwise professional. It has really impressed me how Amber has conducted herself this year and I think spending time with a professional basketball team, has only benefited her practice and professionalism when working with the BUCS Basketball teams.
What area(s) of professional development would you suggest that the student focuses on in the next 12months?
Confidence: Albeit I eluded to Amber’s knowledge being excellent, she sometimes lacks the conviction to follow through with what she thinks to be right, when she is often right. I’d really like to create an environment where amber might be able to succeed and be given praise more often instead of more challenging situations she often finds herself in during her other placement. Trying to build on the foundation knowledge she already has and cultivating her ability and allowing her more freedom and flexibility to do with players what she wishes to, to try and improve her confidence.
Utilising Pocket Tools, Support Sessions and CPD: I’d really like for Amber to utilise more advice through me and her other clinical and placement supervisor’s to try and extract a mixture of anecdotal and evidence based information that will help her throughout her career. The completion of CPD to gain further specific knowledge so she can make better informed decisions professionally about modalities, how to treat professional players and engage with them psychologically as well as utilising pocket tools that can benefit clinical decision making in a pitch side environment or in high pressure situations that help to take the pressure of her by prompting of following a protocol.
Working Towards RFU PHICIS: I would eventually like for amber to have completed the Emergency Trauma (Pre Hospital) RFU course by September of next year, I feel she is currently working towards achieving this but feels she would benefit from some further 1:1 sessions, observations and feedback on her performance that perhaps is not appropriate for here.
Other Comments?
Kind Regards,
Mike Prynn Bsc (Hons)

Graduate Intern; Clinic Supervisor 

Marjon Sport & Health Clinic

Faculty of Sport, Health; Wellbeing 

Plymouth Marjon University

Derriford Road, Plymouth, PL6 8BH

United Kingdom

Risk factors contributing to shoulder dislocations.

Shoulder dislocations are a common injury, especially among young athletes (Ahmed, 2019). It is stated to be the most frequently dislocated joint large joint in the human body (Mackenzie, 2013). Many consider this to be due to the anatomical structure, suggesting that the difference between the small glenoid cavity and the large humeral head makes this joint extremely susceptible to dislocation (Gaballah, Zeyada, Elgeidi, & Bressel, 2017). Shoulder dislocations can occur anteriorly, posteriorly and inferiorly, however anterior shoulder dislocations are by far the most common (Jones et al, 2019; Ahmed, 2019; Gaballah et al 2017). Inferior glenohumeral dislocations only account for approximately 0.5% of all shoulder dislocations (Plaga, Looby, Feldhaus, Kreutzmann & Babb, 2010). Posterior glenohumeral dislocations account for approximately 3% of all shoulder dislocations (Mackenzie, 2013). Whereas anterior glenohumeral dislocations account for approximately 95% of all shoulder dislocations (Olds, Ellis, Donaldson, Parmer & Kersten, 2015).

Primarily, one of the biggest risk factors for anterior, posterior and inferior shoulder dislocations is previous shoulder dislocations. Previous shoulder dislocations cause microtrauma to the structures within the glenohumeral joint. This can lead to a tear or erosion in the glenoid labrum during the force of the movement of the humeral head. This weakens the glenoid labrum and therefore weakens its attachment to the humeral head (Olds et al, 2015; Mackenzie, 2013; Plaga et al 2010; Eshoj et al 2020; Gallabah et al 2017).

Anterior (1), inferior (2) and posterior (3) dislocations.

 

Previous shoulder dislocations can also lead to muscle weakness and ligament laxity. Muscle weakness can occur due to a lack of exercise, and as recovering from a shoulder dislocation requires a significant period of rest, this can be expected following a shoulder dislocation. Yes, you would also be performing rehabilitation exercises. However, ultimately, to get your muscles back to significant strength, this can take a long time. Especially, when you are at extreme risk of re-dislocating your shoulder whilst your muscles are still weak, causing another long rest period, and in turn, even weaker muscles. Ligament laxity can occur following a shoulder dislocation due to overstretching during the forceful movement of the humeral head anteriorly, posteriorly or inferiorly (Olds et al, 2015; Mackenzie, 2013; Plaga et al 2010; Eshoj et al 2020; Gallabah et al 2017). Muscles and ligaments of the glenohumeral joint play a huge role in the support and function of the shoulder. This includes: deltoids, pectoralis major and minor, biceps brachii, triceps brachii, coracobrachialis, latissimus dorsi, teres major and minor, supraspinatus, infraspinatus, and subscapularis, the capsular ligament and the glenohumeral ligaments (Biel, 2014). When these structures are weak or lax, it is harder for humeral head to sit in the joint, especially when subject to trauma (Olds et al, 2015; Mackenzie, 2013; Plaga et al 2010; Eshoj et al 2020; Gallabah et al 2017). This is especially supported for anterior shoulder dislocations as Eshoj et al (2020) and Gaballah et al (2017) both state the high risk of recurrent shoulder dislocations following their primary dislocation.

One of the greatest risk factors for inferior, posterior and anterior shoulder dislocations is collision sports. For instance, rugby and American football as well as combat sports, such as boxing, judo and karate (Jones et al 2019; Ahmed 2019). For anterior shoulder dislocations, collision or positions in these sports can force the humeral head to separate from the glenohumeral joint, rupturing its attachment to the glenoid fossa. Often this will occur when the collision or position forces too much extension, abduction or external rotation of the shoulder beyond its physiological limits (Olds et al, 2015; Ahmed 2019). For posterior shoulder dislocations, collision or positioning in these sports can force the humeral head to dislocate towards the back of the body. Often this will occur when the collision or position forces too much internal rotation with adduction beyond its physiological limits (Mackenzie, 2013; Ahmed 2019). For inferior shoulder dislocations, collision or positioning in these sports cause the humeral head against the acromion. Often this will occur when the collision or position forces too much abduction beyond its physiological limit (Plaga et al 2010; Ahmed 2019).

Racket based sports are a risk factor for anterior and posterior shoulder dislocations. For instance, badminton, squash and tennis (Jones et al 2019; Ahmed 2019). Racket based sports can result in your shoulder over stretching in a variety of movements beyond its physiological limits, particularly external rotation (creating a risk for anterior shoulder dislocations) as well as internal rotation with adduction (creating a risk for posterior shoulder dislocations) (Olds et al 2015; Mackenzie 2013; Ahmed 2019).

Board based sports such as surfing and snowboarding, equestrian sports such as jumping and polo, and extreme sports such as rock climbing and skydiving are all risk factors for anterior, posterior and inferior shoulder dislocations (Jones et al 2019; Ahmed 2019). For instance, falling off of these boards into a position of shoulder extension, abduction or external rotation beyond its physiological limits creates a risk of anterior shoulder dislocations (Olds et al 2015; Ahmed 2019). Falling off in a position of shoulder internal rotation and adduction beyond its physiological limits creates risk of posterior shoulder dislocations (Mackenzie 2013; Ahmed 2019). Or, falling off in a position of shoulder abduction beyond its physiological limits creates a risk of inferior shoulder dislocations (Plaga et al 2010; Ahmed 2019).

Another risk factor for anterior and posterior shoulder dislocations is seizures and electric shocks (Olds et al, 2015; Mackenzie, 2013). During this, tiny muscle contractions can cause the humeral head to pull away from the glenohumeral joint, whether its anteriorly or posteriorly. Anterior shoulder dislocations are more likely to occur than posterior shoulder dislocations during a seizure or electric shock. However, without significant trauma, it is unlikely that a posterior shoulder dislocation will occur (Olds et al, 2015; Mackenzie, 2013).

Age and sex has been depicted by Olds et al (2015) to be a risk factor for anterior shoulder dislocations. This research suggests that people between the ages of 15-40 are at a higher risk of shoulder dislocations than those who are 40 and above, and that men are at a higher risk than women of shoulder dislocations.

Ultimately, research suggests that there are a multitude of different risk factors that can contribute to anterior, posterior and inferior shoulder dislocations. Previous shoulder dislocations, collision sports, combat sports, racket sports, board based sports, seizures, electric shocks, age and sex are all significant factors to be considered when determining risk factors for shoulder dislocations.

 

 

References

Gaballah, A., Zeyada, M., Elgeidi, A., & Bressel, E. (2017). Six-week physical rehabilitation protocol for anterior shoulder dislocation in athletes. Journal of Exercise Rehabilitation, 13(3), 353-358.

Ahmed, H. (2019). A Rehabilitation Protocol For Athletes Diagnosed With Shoulder Dislocation. Physical Education, Sport and Kinetotherapy Journal, 56 (2), 32-37.

Jones, G., Wilson, E., Hardy, M., Summers, D., Edwards, J., & Munro, M. (2019). BMA Guide to Sport Injuries: The Essential Step-by-Step Guide to Prevention, Diagnosis and Treatment. London: Dorling Kindersley Limited.

Plaga, B., Looby, P., Fledhaus, S., Kreutzmann, K & Babb, A. (2010). Axillary Artery Injury Secondary to Inferior Shoulder Dislocation. The Journal of Emergency Medicine, (39) 5, 599-601.

Olds, M., Ellis, R., Donaldson, K., Parmar, P & Kersten, P. (2015). Risk factors which predispose first-time traumatic anterior shoulder dislocations to recurrent instability in adults: a systematic review and meta-analysis. Br J Sports Med, (49), 913-923.

Mackenzie, D. (2013). Point-of-care Ultrasound Facilitates Diagnosing a Posterior Shoulder Dislocation. The Journal of Emergency Medicine, (44) 5, 976-978.

Biel, A. (2014). Trail Guide to the Body: a hands on guide to locating muscles, bones and more. USA: Books of Discovery.

Eshoj, H., Rasmussen, S., Frich, L., Hvass, I., Christensen, R., & Boyle, E. et al. (2020). Neuromuscular Exercises Improve Shoulder Function More Than Standard Care Exercises in Patients With a Traumatic Anterior Shoulder Dislocation: A Randomized Controlled Trial. Orthopaedic Journal Of Sports Medicine8(1), 1-12.

11/03/2020 2 hours

This session took place in the Sports Therapy and Rehabilitation clinic.

In this session, I gave one player a lower back massage and a soft tissue release on their glutes to help decrease their pain whilst they continue to strengthen their glute maximus and glute medius. It is a real confidence boost to see some big improvements in this player. In the next session, I gave another player mobilisations on their spine for their ongoing back pain whilst under supervision by the clinic supervisor. This time, the supervisor didn’t have to show me what to do first, I felt confident going ahead straight away. This time, I was still using my thumbs instead of the side of my hands, but the clinic supervisor said that this will come with time.

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