What happened and what were you thinking/feeling?
Today I had a patient who was suffering from pain in his hamstring. I was really anxious as I thought the appointment was an online triage but realised last minute that it was face to face, so felt very unprepared. A fellow final year student had completed the online triage with the patient two weeks prior so I reviewed his exercises, did special tests and tested his range of motion (active, passive and resisted). The student had written that she thought he was suffering from a hamstring strain, however following the subjective assessment, I thought it was more likely to be a reactive hamstring tendinopathy. Cook and Purdam (2009), suggested that a tendinopathy occurs across three phases which are a continuum rather than separate phases. The reactive phase (which is the first phase) occurs after overload of the tendon and can be treated by unloading the tendon and performing isometric exercises to ease pain and strengthen the muscle without compressing the tendon (Naugle et al., 2012). Consequently I reviewed the patients exercises and the concentric and eccentric exercises provided which were aggravating his symptoms, I replaced with isometric exercises and discussed load management with him. We agreed that he stops playing football for a few weeks to avoid placing further compression on the tendon which could cause it to progress onto the next phase of the continuum – tendon disrepair (Cook, 2009).
Evaluation: What was good and bad?
I felt confident on the tendinopathy continuum theory so I feel like my rehabilitation was suitable and effective for the pathology. It is important that the diagnosis is correct as incorrect diagnosis can lead to ineffective rehabilitation exercises, delaying recovery.
Analysis: What else can you make of the situation? & Conclusion: What else could you have done?
I still need to broaden my exercise knowledge and increase my bank of exercises, as a single one does not work for everyone. I also need to practice explaining exercises and correcting patients technique, as incorrect technique can lead to injury.
Action plan: If it rose again what would you do?
- Broaden my knowledge on exercise prescription by finding more exercises for each pathology.
- Revise tissue healing in each phase (what state the tissue is in during reactive tendinopathy)
- Practice talking patients through exercises and correcting technique
Cook, J. ., & Purdam, C. . (2009). Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. British Journal of Sports Medicine, 43(6), 409–416.
Naugle, K. ., Fillingim, R. ., & Riley, J. . (2012). A meta-analytic review of the hypoalgesic effects of exercise. Journal Pain, 13(12), 1139–1150.