Reflection: 24/2/2021

Reflection: 24/2/2021                       hours: 2

What happened:

Today I had a patient in clinic who has been suffering from shoulder pain which is aggravated by his poor posture when studying from home. The patient is currently taking his A-levels and is applying to med school, therefore he is very stressed and spending long hours sat at a desk, which he admits gives him bad posture. A cause of the shoulder pain has found to be coming from the thoracic spine which is stiff. Due to treating remotely currently, I am unable to perform mobilisations, therefore I have prescribed him thoracic stretching as part of a HBE programme. Due to being very busy, his adherence to the HBE is quite low, therefore I have modified it to ensure it only includes a few key exercises which he has time to perform daily.

One of the exercises prescribed was the “open book” thoracic stretch, which he was struggling with (he was able to thoracic rotate left but not right). We discussed this in todays appointment and believe a contributing factor to this, is that he used to play a lot of badminton, so potentially an adaptation in his biomechanics is causing this change in thoracic rotation. Previous studies on a range of sports have shown that bilateral asymmetry of trunk muscles occurs in athletes who frequently perform trunk rotation in one direction (Izumoto et al., 2019; Sanchis-Moysi et al., 2010, 2013).

I modified the ‘open the book’ exercise to a rhomboid stretch with rotation and advised he performs the ‘open the book’ exercise once each side, at the end of the exercises and uses this as an objective marker to monitor improvement in tx rot.

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

It was good practice to have to adapt exercises to meet the patients needs and abilities as not one exercise is suitable for all individuals. It was very interesting to find out more about the effect of certain sports on biomechanics and how this can cause issues around the kinetic chain.

What else I could have done/areas for improvement:

Checked the patient was able to perform the exercises by asking them to perform them on camera and watching their form/technique and asking for feedback on the exercises.

Action plan:

Research more into the effects of asymmetrical movement patterns during sport on biomechanics and in turn injury risk.


Izumoto, Y., Kurihara, T., Suga, T., & Isaka, T. (2019). Bilateral differences in the trunk muscle volume of skilled golfers. PLoS One, 14(4), 122–126.

Sanchis-Moysi, J., Idoate, F., Dorado, C., Alayón, S., & Calbet, J. A. (2010). Large asymmetric hypertrophy of rectus abdominis muscle in professional tennis players. PLoS One, 5(12).

Sanchis-Moysi, J., Idoate, F., Izquierdo, M., Calbet, J. ., & Dorado, C. (2013). The hypertrophy of the lateral abdominal wall and quadratus lumborum is sport-specific: an MRI segmental study in professional tennis and soccer players. Sports Biomechanics, 12(1), 54–67.

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