Reflection: 7/12/2020 Hours: 4
Description: Describe what happened:
Today in clinic I had two face to face appointments. The first was a 50 year old male who I had previous had an online triage with 6 weeks ago, who was suffering from shoulder pain which we suspected to be biceps tendinopathy. It appeared that the pain was caused by incorrect technique or overtraining at the gym due to creating his own training programme. Following the online triage, I sent him a list of exercises to complete to improve his range of motion, rebuild strength and reduce pain. All strength exercises were isometric based as research has found that isometric exercise causes a pain inhibitory response, resulting in exercise induced hypoalgesia (Naugle et al., 2012). I instructed the patient to perform each exercise for at least 60 seconds with a contraction intensity of 40-50% of maximal voluntary contraction as this leads to optimal pain relief (Naugle et al., 2012).
In today’s face to face session the pain had dispersed and was no longer isolated to the bicipital groove, due to the location of the pain and the patients pain during active, passive and resisted ROM, we were unsure whether he was suffering from biceps tendinopathy or rotator cuff tendinopathy.
I watched the patient perform a dumbbell fly and a dumbbell chest press, for his usual sets and reps of 4 sets of 10 reps, to check his form, as well as his choice of reps, sets and weight. A few corrections on form were made. We also discussed activity modification and the importance of adjusting gym training load on days of decorating, as decorating has been an aggravating factor. Over training can increase the risk of injury. It is important he considers the time he spend on decorating and factors in rest time as he is working harder during decorating than he would if he was at the gym, therefore risking overload.
Feelings: What were you thinking and feeling?
I felt like my confidence has improved as I usually feel very nervous correcting peoples form as I don’t feel like this is my strong point.
Evaluation: What was good and bad?
It was good to be pushed out of my comfort zone and practice things I struggle with such as exercise correction.
Analysis: What else can you make of the situation?
It is important not to limit treatment to aspects I am comfortable with and I must consider the most effective treatment for that patient, rather than doing what I feel most comfortable with.
Conclusion: What else could you have done?
If I had had more time I would have reviewed more exercises and watched him perform a full gym session but this is the aim for our next appointment.
Action plan: If it rose again what would you do?
Be more confident and push myself out of my comfort zone more.