Number of hours: 6
Location: Essential Chiropractic Torquay
The first patient came to the clinic after suffering from neck pain following a football match last week. He said that during the game he headed the ball more than usual and on one of the occasions stretched his head too far and felt a sharp pain in his neck which has since turned into a dull ache. He hasn’t used any ice or heat to treat this.
Upon palpation I felt his levator scapulae and sternocleidomastoid was very tight and he had very reduced ROM of the cervical spine.
I performed STM and NMT of the levator scapulae, sternocleidomastoid, UFT, rhomboids and posterior deltoids to reduce muscle guarding and muscle spasm. I then performed MET in all the movements of the cervical spine to increase ROM. I advised that the patient uses heat to reduce any muscle spasms if they experience them and ice to reduce any pain for the next 72 hour. I showed them some MET to do on themselves at home to further increase ROM.
The second patient has been receiving chiropractic treatment for a lumbar discogenic problem, he was advised by the chiropractor to have a STM due to muscle guarding and tightness in his latissimus dorsi, QL, erector spinae and glutes which was affecting his gait due to muscle shortening.
I performed STM of the latissimus dorsi, QL, erector spinae and NMT of the glutes and latissimus dorsi to reduce muscle spasm. I then performed STR of the QL to realign and lengthen muscle fibres. At the end of the treatment I shadowed the chiropractor while she readjusted his spine and pelvis him using manipulation. She then prescribed him QL, glute and piriformis stretches to do in order to keep his muscles lengthened, reduce muscle spasm to alleviate pressure on the discogenic problem.
The third patient has been suffering from a left shoulder impingement for 9/12 which caused guarding on her left side and therefore a lot of muscle tightness in her rhomboids, UFT and levator scapulae.
I performed STM and NMT of these three muscles and MET of rhomboids and levator scapulae to lengthen the muscle fibres. I learnt a lot during this hour as she was a difficult patient and at the end of her appointment said she had been suffering from biceps tendinopathy and asked me to treat this as well, I briefly looked at her ROM and palpated the area and performed STM of the bicep brachii which was tight due to the presence of the biceps tendinopathy. Once I finished STM, she then asked me to tape the area and got very annoyed when I said that unfortunately we had already run over the appointment time and therefore I wouldn’t have time to. My placement supervisor helped me speak to her and explain to her that we based our treatment on the objective and subjective assessment at the start of the appointment and during this time she never mentioned the biceps tendinopathy, so we didn’t factor this into our treatment plan. This was a good learning curve for me as it taught me how important communication skills are when dealing with patients and that it is good to clearly ask the patient if they have multiple injuries, which their priority is and therefore would like me to treat first.
I now clearly ask:
- what is their aim for treatment
- which injury is most problematic, and would they like me to treat first
- would they like me to spend the entire treatment time in this one area or would they like me to divide the time up – I then advise them if I believe one area needs longer for effective treatment and then let them make the decision.
For the rest of the day at placement I discussed different communication techniques with my placement supervisor and together we created the list above to make sure the patient clearly understands the plan for treatment. We also discussed different scenarios, for example if a patient asks for services which I am not qualified in and how to explain this to them and how to speak to a patient who is being inappropriate. I now feel a lot more confident in how to approach these difficult scenarios.