External Placement Exmoor Osteopaths Thursday 24th Oct 2019 – 4hours (09:00-13:00): 67 total

Running total of hours: 67

During this week’s session, I had the opportunity to carry out diagnostic assessments with minimal input from my supervisor.
I have now carried out a number of joint assessments and therefore I have been able to really practice my organisation of procedures. Early on in my clinical experience, I found it difficult to conduct a flowing routine of tests, which resulted in my patient having to move around and continuously change positions. This was apparent with all of my joint testing, however, I am now starting to develop a more efficient method by aiming to test everything in each position. This is especially important with the hip and back, as this requires the patient to perform tests while standing, sitting, walking, lying prone, supine or on either side. As my routine develops through experience, this should hopefully help me to manage my time more efficiently and allow for a more comfortable assessment process for my patients.

For a patient visiting today, I conducted a treatment for chronic neck pain and stiffness which included soft tissue massage and mobilisations (Riaz, Haider, Qamar, Basharat, Manzoor, Rasul, 2018; Yildirim et al., 2016), with additional manipulations being performed by my supervisor (Grade V manipulations are beyond the scope of my practice).
Many of the patients who come into the clinic are receiving treatment for neck and/or back pain and with many of these patients, joint stiffness has been identified. This is especially apparent in the cervical spine, with research reporting the correlative association between pain and stiffness (Ingram, Rivett and Snodgrass, 2015).

In a self-review of my ongoing progress, I looked back at the goals I set myself at the start of my placement.
Goal 1 was to gain experience in identifying joint movements and end feels as well as improving my understanding of capsular patterns. Over the past 4 weeks, I have been able to assess joints with a known pathology, as opposed to asymptomatic joints of my fellow students, which has proved incredibly valuable in my learning. I have been given the task of identifying areas of stiffness and then having this confirmed by my supervisor and I have become more proficient at identifying contralateral differences, but most notably intervertebral joint stiffness specifically in the cervical spine as this is a common issue seen in the many patients attending this clinic. I still have much to learn when identifying exactly what the end feel is indicative of and why, but I will aim to develop this over time. As a first step, I am pleased with my better ability to identify a joint abnormality through movement and touch alone.

My second goal was to improve my technique when manual handling my patients so that I can minimise the risk of injury to myself and allow for a more efficient treatment. At present, I am still finding it hard to perform certain mobilisation or soft tissue techniques as I find the patient to heavy to move around. I am assured by Katrina that she is putting in very little effort when performing the same maneuverers and that I must use my whole body in sync with the patient’s movements, almost as though we are “dancing”. Patient feedback has revealed that I am not able to apply the same pressure or the same type of motion at the moment and therefore I am aware that I still have much room for improvement. I do, however, feel that I am improving with some techniques, such as combined shoulder soft tissue massage with mobilisations and lumbar spine anteroposterior mobilisations and this may be down to the recurring need for this treatment.

My Final goal (3) at the start of my experience at this clinic was to build a good relationship with the clinic osteopaths, Katrina and Ed Stenner. One of the ways in which I feel this could be achieved is through building a good rapport with their patients. I have been able to develop good patient/therapist relationships with the patients and the atmosphere throughout the sessions have been both relaxed and professional. I have felt comfortable asking questions throughout the session, which portrays my enthusiasm to learn and ability to be honest when I am not sure about something. Katrina has been very accommodating and has been able to help with any questions I have had and has been explaining her rationale of treatment to me and has ensured that I remain hands on throughout the sessions.

I am really happy with my progress in this placement and feel that this is a very good opportunity to put everything that I learn in the Marjon Sports clinic into practice. I have also found that this reflective aspect of my placement is a good medium to review my more physical skills as a therapist, as opposed to my knowledge and understanding of treatment rationale, as reviewed in my Marjon clinic reflections.

References –

Ingram, L. A., Rivett, D. A., & Snodgrass, S. J. (2015). Comparison of cervical spine stiffness in individuals with chronic nonspecific neck pain and asymptomatic individuals. Journal of Orthopaedic and Sports Physical Therapy, 45(3), 162–169. https://doi.org/10.2519/jospt.2015.5711

Riaz F, Haider R, Qamar MM, Basharat A, Manzoor A, Rasul A, et al. Effects of static stretching in comparison with Kaltenborn mobilization technique in nonspecific neck pain. BLDE Univ J Health Sci 2018;3:85-8.

Yıldırım, A., Akbaş, A., Dost Sürücü, G., Karabiber, M., Eken Gedik, D., & Aktürk, S. (2016). Miyofasiyal ağrı sendromuna bağlı boyun ağrılı hastalarda mobilizasyon uygulamalarının etkinliği: Randomize bir klinik çalışma. Turkiye Fiziksel Tip ve Rehabilitasyon Dergisi, 62(4), 337–345. https://doi.org/10.5606/tftrd.2016.95777

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