Date: 09/11/2020 Number of hours: 4
First 2 hours:
In today’s session, I saw a ten-year-old boy who was suffering from heel pain which increased when he exercised, leading to him walking on his tip toes for comfort. He had previously gone through a growth spurt and due to his age and symptoms, I suspected Sever disease. This condition affects children ages 8-15, however it can also affect children younger and older depending on the time of their growth spurt (James, Williams, Haines, 2016).
In the hour leading up to the session I researched Sever disease in more detail using the website Medscape to make sure I was clear on the symptoms, diagnosis and treatment. I complied my notes onto a word document so that I have these notes for future cases.
What were you feeling?
I was feeling very motivated and interested in this session, as I have not treated a younger patient before and this was a condition, I did not know a lot about and hadn’t seen before. I really enjoyed learning more about the condition and felt like I was working towards having a large folder of notes to help me in future appointments, especially when I graduate.
What was good and bad?
During the online triage, I learnt a lot about the patient which made me confident that it was Sever disease, I asked a lot of questions in the subjective assessment, where I found out that he was the tallest in his class, he had a growth spurt about eighteen months ago (and his pain began soon after) and he has previously been to the doctors who told him it was growing pains and advised him not to play any sport. The subjective assessment is important because it allows therapists to get background information on how the condition began, developed and how the patient is currently managing it, in order to offer support and advice on how to move forward (Simmonds, 2010).
I struggled with the objective assessment as the patient was sat at a table, so it was hard for them to perform active range of motion (AROM) and functional tests. This is important to check as limitations in range of motion at the ankle, can lead to problems further up the kinetic chain.
What else can you make of the situation?
I was very interested to see how the patient walking on his tip toes to ease the pain (a learnt response) could lead to the patient walking on his toes the majority of the time, leading to alterations in his gait pattern (Weir & Chockalingam, 2013). The patient had pain and reduced ROM in dorsiflexion (DF). Walking has been shown to require about 10 degrees of dorsiflexion, however research by Weir and Chockalingam, (2013) has reported up to 20 degrees of dorsi flexion has been shown in subjects during gait analysis. Movements such as the squat require even more DF ROM. Maximal squat depth to just pass parallel requires almost 35 degrees of dorsiflexion. The ankle influences the knee position in functional tasks (Dill et al., 2014), if ankle DF is limited, the knees and other areas of the kinetic chain will have to compensate, leading to decreased stability and problems further up the chain.
What else could you have done? In future if it rose again what would you do?
In the future, I would ask the patient to find a space to perform the online triage from the start, so that during the whole session they had enough space to perform all movements for me to see, allowing me to check their AROM, joints above and below and functional movements for a more thorough and clear objective assessment. This would also allow me to potentially continue online treatments, rather than face to face, which is more suitable during lockdown.
Second 2 hours:
Today I had a patient who had had a previous online triage with another student and booked into see me face to face. The patient had a hamstring injury which the student believed to be hamstring tendinopathy.
What were you feeling?
I was feeling really anxious as I had not completed the online triage myself and was concerned that judging from the patient’s history, I believed it may be a hamstring strain rather than a tendinopathy, as the injury occurred during football training, when the patient was. Tendinopathies are usually associated with gradual onset from overuse (Chu & Rho, 2017).
What was good and bad?
I reviewed the patients exercises and progressed some of them, it is important that as therapists we are able to progress and regress exercises to make them suitable for all patients. This was very interesting as I have not had much practice in this area, so it was good to get experience of this.
It is important that patients perform suitable rehabilitation as there is a strong reoccurrence rate following a hamstring strain, studies have reported that almost 1 in 3 hamstring strains will recur, and many happen within the first 2 weeks of return to sport (Chu & Rho, 2017). Suitable rehabilitation can reduce the risk factors associated with reoccurrence rates.