04/05/2021 2

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

11/05/2021 2

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

18/05/2021 2

At this training session, two players banged heads during a tackle. I felt very confident when dealing with this injury after completing the RFU course. Both the players had a suspected concussion, so we took them off the field of play. I ensured we kept re-assessing the players to watch for any deterioration. Also, during this training session, I gave some more rehabilitation exercises to the player with the knee injury. Again, considering I am now at the end of my degree, I feel as though my bank of exercises has really developed so I felt very confident selecting appropriate exercises.

Sunday 23/05/2021 4

At the beginning of this match, we gave a few of the players pre-event massages and taped one of the players who has shin splints. During the game, one player went down with an ankle injury. This is something I had dealt with a lot before so again, I was confident in dealing with this. After this, another player fell to the floor and hit their head. After completing my RFU course, I have found my knowledge of this type of injury has expanded extremely. I immediately thought of what I would do if the injury was a cervical spine injury. However, luckily, the player was up before I got over to them on the pitch. they did appear to potentially have a concussion, so we took them off the field of play. At the end of the match, we gave some post-event massages and stretched some of the players. I felt overall very confident during this whole game. The RFU course has given me a great deal of knowledge and skills that makes me feel like an extremely competent therapist.

Tuesday 25/05/2021 2

During this training session, we re-assessed the player with the facet joint injury and gave some further exercises. I have recently dealt with quite a few patients in clinic who have back pain so I felt quite knowledgeable during the assessment. I also felt quite confident when giving this player exercises, however it seemed as though the lead sports therapist had a lot of different ideas regarding exercises than myself and the other sports therapists. So, it was really good to get an insight into other exercises we can use for these kinds of clients.

Sunday 30/05/2021 4

At the beginning of the match, we gave some of the players pre-event massages and taped the player who has shin splints. During the match, one player came off complaining of tightness and pain in their calves. We gave the player soft tissue release but they were still complaining of pain and tightness, so we gave the player some stretches to complete at home. Also during the match we also had one player go down with pain in their knee and another player go down with a potential hamstring strain. Again, I feel like my skills and knowledge have developed to the point that now with the majority of scenarios, I feel equipped to identify, treat and give rehabilitation.

01/04/2021 2

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

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

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

04/04/2021 4

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

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

06/04/2021 2

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

08/04/2021 2

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

11/04/2021 4

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

13/04/2021 2

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

15/04/2021 2

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

18/04/2021 4

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

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

20/04/2021 2

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

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

22/04/2021 2

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

 25/04/2021 4

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

27/04/2021 2

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

01/11/2020 4

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

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

03/11/2020 2

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

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

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.

22/09/2020 2 

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 1^st 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 2^nd year to 3^rd year will also be playing a big role in this.

24/09/2020 2 

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 1^st year of University but was sadly lost in my 2^nd 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

 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 Plymouth Raiders

Formative Assessment Plymouth Raiders

Summative Assessment Plymouth Raiders

Formative & Summative Assessment Marjon Basketball

Checklist A & B – Marjon Basketball

Checklist A & B – Plymouth Raiders

PDF: A Reeves Clinic Total 19_20