Running total of hours: 168.5

Patient 1 – Follow up for lower back STM, hip traction and piriformis release and patient 2 – Scheuermann’s kyphosis.
These sessions were follow ups for regular patients who simply requests the same treatment on a fortnightly basis. Although this does not provide me with the most optimal learning experience, as I am not able to build upon a progressive treatment plan, observe significant improvements or apply new techniques, it does give me the opportunity to practice my techniques for soft tissue massage and although I feel as though I am proficient in this aspect of my practice, I should always take the opportunity to improve upon my skills. I should ensure that I do not become complacent in my approach to treatment with these two individuals in particular; just because I see them on a regular basis for no more than maintenance, symptom relief and general wellbeing treatment, it does not mean that I should not reassess regularly or be vigilant in noticing changes in their functional ability and/or pain.
Also, it is important to regularly ensure than their status of health is the same each week, as any changes on medications should be noted and it should not be assumed that the patient will be notify me of any changes. Often with returning patients of this nature, I tend not to perform an assessment, but how would I be able to record or note any possible findings without a thorough assessment at the start and end of each treatment?
In order to fully maximise my time at the clinic, I would much rather see a more varied range of patients with a wide range of pathologies and injuries, however this is not necessarily realistic of a real live clinic scenario in the world of sports therapy and as such I should try to suggest that these particular patient consider reducing reliance on the clinic and better committing to an exercise based plan (as suggested) to increase time between sessions and eventually manage their symptoms themselves.

The second patient with Scheuermann’s kyphosis has adopted a more exercise based approach, which sometimes does see minimal improvements, however the treatment each session is very much the same.
In order to add a new dimension to my learning and to the treatment that I have been performing on this patient, I attempted to incorporate subscapular deep tissue massage as this had been previously administered to the patient with positive effects. I had never done this before, so with some guidance from the supervisor, I was able to have a go at this for the first time. I was not afraid to explain to the patient that this was my first attempt, but by being honest and up front, the patient was happy to give me feedback as to the sensation, pressure and effectiveness of the treatment. I used his past experience of this as a measure of my ability to correctly target the subscapularis.
I also practiced my technique at performing pectoralis MET exercises, as these have been found to improve forward shoulder posture by increasing pectoralis minor length and treating postural associated neck pain (Laudner, Wenig, Selkow, Williams and Post, 2015; Thomas, Cavallaro, Mani, Bianco and Palma, 2019).
While treating this patient, the supervisor came in to assist and noticed that due to the patient’s excessive hyper kyphosis, while lying prone, his shoulders rested in a rounded position, horizontally adducting bilaterally. It was advised that a towel be placed under the posterior shoulder joint to support this. Although it made sense to add the support due to the way the patient looked, however I wonder if this was the most appropriate intervention; the patient wasn’t asked if this was uncomfortable before adding the support and also as the aim of this particular element of treatment was to stretch the pectoralis muscles and open up the chest space, would having his shoulders in this position have served as a further means of doing so?

Extra Reflections –
Earlier in the term, I noted my desire to improve my note writing, specifically my ability to use abbreviations. I have found that over the last two months, not only has this improved significantly, I am now much quicker and more precise in doing so. This has a positive impact on my ability to move on to my subsequent clients.
In my experience, I am much more thorough and accurate when I write up my notes either during the appointment or soon after; if I am not able to do this, I tend to forget specific details. By being able to efficiently transcribe my notes during the session, I feel more able to manage my time better between patients and ending my clinic session at the end of the evening.
The following are the notes that I inputted into Cliniko and are more condensed and precise compared with earlier in the academic year. For example, in this case;

S
Previous treatment for subscaps – px during Rx, but felt better afterwards. Increased perceived ROM and mobility.

“X” thoracic ETT effective, has requested the same.

Not able to do exercises through holidays, twice max. No foam rolling. Sleeping on futon not normal bed. Px in upper traps and Cx (Lt).

Has been doing strengthening for external rotators and some Tx mobility last few days.

Not been on computer so Px less than before.

O
Full Passive, active and resisted ROM in cx. Slight bilat.restrictions in int. rotation, no Px, otherwise full active, passive, resisted ROM Of shoulders. Slightly restricted R Tx rotation while seated. Observations as before, no change.

A

As before has requested same Rx. Mobs of Tx and costovertebral jts, STM of sub scaps, thoracic mobility, postural taping

R/x
PA mobs 3×60 T4-T10, PA mobs 3×30 costovertebral Jts, passive thoracic mobility rotation, STM of sub scaps, STM of pectoralis major and minor, MET PIR of Pec Major. Have added sleeper stretch to enhance slight bilat.restrictions in shoulder int. rotation 20–30secs x3, 3xweek and thoracic mobility kneeling against wall and opening up chest hold for 20–30secs x 3, 3xweek. Have not progressed other exs as adherence poor over Christmas holidays.
postural “X” taping.

P

Review exs. If adherence good and progress maintained, adapt/progress exs. Particularly upper back strengthening.

Same Rx as today, mobs, METs, taping and passive mobility.

References –

Laudner, K. G., Wenig, M., Selkow, N. M., Williams, J., & Post, E. (2015). Forward shoulder posture in collegiate swimmers: A comparative analysis of muscle-energy techniques. Journal of Athletic Training, 50(11), 1133–1139. https://doi.org/10.4085/1062-6050-50.11.07

Thomas, E., Cavallaro, A. R., Mani, D., Bianco, A., & Palma, A. (2019). The efficacy of muscle energy techniques in symptomatic and asymptomatic subjects: a systematic review. Chiropractic & Manual Therapies, 27(1). https://doi.org/10.1186/s12998-019-0258-7