Reflection: 25/11/2020                                   Hours: 6

What happened:

Today I had four patients in clinic, one with calf pain, the second with lower back pain, the third with neck pain and the final with ankle pain.

The patient with ankle pain had previously sprained his ankle but had never performed rehabilitation, consequently he was left with reduced dorsiflexion range of movement and was having trouble running as a result. During the assessment he mentioned he had previously been suffering from a pain in his glutes and had had ultrasound on what he thought was a “knot”. On palpation I noticed it felt like a hard lump that was deep into the muscle tissue and was not moving with palpation. I asked my supervisor about it to be sure it was safe to perform treatment on it. She informed me that it was a calcification from prolonged steroid use. There is a reported link between calcification and prolonged steroid use or complications with steroid use (Park et al., 2019). This was really interesting as I have never seen/felt a calcification before and now in the future I will be aware of this and the potential causes.

What I was thinking and feeling and what was good or bad:

I felt like I learnt a lot today and it made me aware of other things to look out for aside from contraindications and flags (red, yellow and blue).

What else I could have done/areas for improvement:

Felt less embarrassed to talk about it with the patient, to ensure I made them feel more comfortable to discuss these things.

 Action plan:

Look more into the research behind calcification and steroid use and other common causes.

 References:

Park, H. ., Kam, M., & Gwark, J. Y. (2019). Association of steroid injection with soft-tissue calcification in lateral epicondylitis. Journal of Shoulder and Elbow Surgery, 28(2), 304–309.