CLINICAL REFLECTION – 4/3/19

 

Date Location Total Amount of Hours Overview of Session
4/3/19 Open Clinic 2 hours First client – LBP, performed MET to improve ROM during IR.

Second client – Tight quadriceps, performed NMT, STR and STM.

Reflective Summary Areas for further Improvement plus action plan
Client suffering with lower back pain (around L3-L5) and has been having two soft tissue massages a week on their lower back but has seen no improvement to the pain.

 

I checked contraindications and tested the client’s ROM in the lumbar spine (Flex, Ext and side Flex) all of which was good. Due to the client being a golfer I decided to test his hip ROM as research (Murray, Birley, Twycross-Lewis, & Morrissey, 2009), suggests that poor internal rotation of the hips can lead to lower back pain in golfers, due to putting excess strain on their lumbar spine to compensate. Upon testing ROM I noticed that his ROM for external rotation was good and equal on both sides, however he had very limited internal ROM. I used MET (PIR) to stretch the medial rotators (gluteus medius, gluteus minimis, TFL and the adductors). I then re-tested ROM and noticed an improvement in range. I gave the client an exercise to do (sitting on the floor with his hip and knee flexed, while lifting the lower leg up from the ground). I advised he do this for 5 minutes in the morning and 5 minutes in the evening, every day for a week until he came for the next session (then I will retest his ROM and see if the stretching has been effective).

 

The second client had tight quadriceps, so I checked contraindications and palpated the entire muscle to identify any adhesions and trigger points. I then used STR  to break down the adhesions, NMT to deactivate myofascial trigger points and finished with STM to relax the muscles.

 

 

–       Assess the joints above and below as the problem may not always be caused by the joint that the pain occurs at.

 

–       Ask client for feedback on treatments so that it can be identified if a particular treatment isn’t being effective (e.g. if STM alone isn’t helping the problem).

 

–       For next session: Check client has done their exercises (if not, why not? If have, has it been effective? Re-test ROM. If ROM improved, continue with the exercises, if hasn’t improved, find new exercises to do)

Returning to reflections at a later date
The stretching improved the client’s ROM and I have advised he continues this for the next few weeks to aim for a normal ROM of between 30-40 degrees (Quinn, 2019). It was really interesting to put a plan in place and record its effectiveness. I will do this with clients in future to improve their ROM. I understand that not all clients will follow the rehabilitation plans that therapists set for them and therefore I will ensure I monitor their adherence to assess the effectiveness of the exercises I recommend.

Murray, E., Birley, E., Twycross-Lewis, R., & Morrissey, D. (2009). The relationship between hip rotation range of movement and low back pain prevalence in amateur golfers: An observational study. Physical Therapy in Sport, 10, 131–135.

Quinn, E. (2019). See the Generally Accepted Values for Normal Range of Motion (ROM). Retrieved from      https://www.verywellhealth.com/what-is-normal-range-of-motion-in-a-joint-3120361

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