Walklin Clinic Reflections 3RD of May to 31ST of May 2021 – 40 HOURS – Emily Rockey – Approval of hours
MONDAY 3RD & WEDNESDAY 5TH MAY 2021 10 HOURS
3RD of May 2021 5 HOURS
This was my first clinic shift within the Walklin clinic within the new Body world Gym. I am a team member at Body World gym, and had previously met Brooke the owner of Walklin clinic so was feeling excited to get started. Within the first two hours, she firstly took me around the gym, showing me the type of equipment she uses within her rehabilitation plans, and the sort of exercises she includes. We went through some simple shoulder rehabilitation exercises with Thera-bands looking at rotator cuff muscle strengthening. I had previously made a video on these exercises so I felt pretty confident about them. However we also went through how to properly stabilise the shoulders looking at shoulder instability too. Joen & Choy (2018) study suggests that GSE positively affects shoulder stability and pain control in patients with shoulder pain, through a centralisation effect on the shoulder mechanism. Within the next 2 hour we spent some time going through her rehabilitation plans, how she writes them and how they are laid out. She lays them out extremely neatly to ensure all ages are able to read and interpret them. Within the last hour she had a client in for a requested STM. STM has been shown to increase fibroblast activity after soft tissue massage, resulting in an improvement in the formation and maturation of collagen. This suggests there may be an effect of massage on the collagen found in the fascia of involved muscles and tendons (Moodley, 2019).
5TH of May 2021 5 HOURS
During these sessions, Brooke had a client within the clinic complaining of knee px when squatting. We did this assessment together and went through all AROM, PROM and RROM along with functional movements. This px found it painful when performing IR & EXT rotation along with FLX, this px also couldn’t perform a simple WB squat without any px or a lunge finding it difficult coming out of these movements. This pt also had a positive Apley’s grind and McMurray’s tests. We diagnosed this pt with a Lateral meniscus tear with a D/d as PFPS. Treatment for this pt included STM for the hamstrings. Sharp twists performed by unbalanced load (torsional loading) or a high compressive force between femoral and tibial articular heads (axial loading) often cause meniscus damage. Moreover, physical therapy and rehabilitation is a central aspect of conservative treatment, with exercises focused on maintaining range of motion (ROM), improving hip and hamstring flexibility, increasing quadriceps and hip strength, and retaining knee proprioception (Howell, Kumar, Patel Tom, 2014). Additionally, a home exercise prescription programme was emailed to this client. We additionally, went through these exercises with them before to ensure their technique and positioning was correct. Some exercises we included within his rehab programme can be seen within this video – https://www.youtube.com/watch?v=yLB4ktZFMJE. Within the next 2 hours, Brooke spent some time going through a forough spine assessment with me. Reducing the number of nonsurgical consultations in a surgeon’s caseload can help to reduce consultation wait times for surgical patients who may benefit from spinal surgery and potentially redirect nonsurgical candidates for more appropriate treatment earlier (Bath & Pahwa, 2012). Having the best knowledge and understanding about the process in diagnosing patients with spinal conditions, can allow for a faster rehabilitation approach as well as proper diagnosis. Within the last hour we spent some time going over massage treatment techniques along with cupping therapy. I had never had the opportunity to see how cupping therapy works and its effects. Cupping therapy is an ancient technique of healing. Cupping is performed by applying cups to selected skin points and creating a subatmospheric pressure, either by heat or by suction. Reported effects of cupping therapy include promotion of the skin’s blood flow, changing of the skin’s biomechanical properties, increasing pain thresholds, improving local anaerobic metabolism, reducing inflammation, and modulation of the cellular immune system (Aboushanab & AlSanad, 2018)
Returning to this reflection using Gibbs reflective model, I felt excited when starting this clinical experience, due to the rapport I already had with Brooke. Brooke’s knowledge and understanding is outstanding, and when explaining, she explains her knowledge clearly so it’s really easy to interpret and understand. Although in some situations our knowledge varies, I am therefore able to gain greater variations of exercises and protocols. When treating clients, I have learnt more efficient ways in diagnosing these, and in future I can
MONDAY 10TH OF MAY AND WEDNESDAY 12TH OF MAY 2021 10 HOURS
10TH of May 2021 5 HOURS
During these 5 hours within the Walklin clinic, I spent some time researching common injuries within a gym environment, due to this also being my place of work. As suggested, physical exercise is one of the most essential activities people can do to improve their overall health, and exercise is necessary for the healthy aging process of humans that aids in reducing risk factors of chronic diseases, and possibly prevent early death. Although with this comes over-exercising and this may lead to an increase in the range of acute and overuse musculoskeletal injuries (Alwabli, Al Ruwaili, Alghadoni & Alsaleh, 2019). The possibly higher rate of knee injuries for weightlifters compared with other weight-training sports may reflect differences in the manner in which the squat is performed. For example, weightlifters perform the clean and jerk, snatch, front squat, and high-bar back squats through a full range of motion whereby the gluteals may come to rest on the calf musculature at the bottom of the lift. Such a range of motion and the bar position requires the weightlifter to maintain a vertical trunk position and utilize large degrees of dorsiflexion and anterior knee translation (Keogh & Winwood, 2017). Rebuilding Milo (Horschig, 2021) suggests that minimal power is generated at the spine during a normal tempo air squat, however, as soon as you add a barbell. If an individual has a butt wink and this carries on with load added, the power generated at the spine increases at one or two specific joints of the lumbar spine. With this stress concentration power at these lumbar joints comes injury risk increases. Moreover, having greater understanding about common injuries that occur within the gym, can enable me to better diagnose these injured clients.
12TH of May 2021 5 HOURS
During this day with Brooke, we went through a mobility programme that will be added to a class within the gym, as well as looking at a full body assessment with an individual revising for my final exam, as well as treating a LBP pt. Mobility can be one of the biggest training methods in the reduction of injury. While working within the gym, the most important factor is form. Furthermore, mobility training can benefit form. When muscles and joints are more movable and increased range of motion is seen. This can allow for better technique and correct posture when squatting. Moreover, planning for a mobility session can in some ways be hard, as the individuals taking part in the class may all be at very different levels of flexibility and range. However researching to better my understanding of the various adaptable mobility exercises has enabled me to use these within my own mobility routines. Additionally, I brought in a pt who was experiencing slight LBP and felt they were not reaching their potential when squatting. Moreover when doing a spinal assessment on this PT and looking at their squatting mechanics, they had a slight butt wink, with a limited range in dorsiflexion. This meant their squatting depth could not be reached without their heels coming off the floor. We looked at doing self ankle mobilisations for this pt, having them perform them before all squatting movements. Moreover, the next pts appointment consisted of STM for the lower back, with additional spinal rotations and QL stretching.
Returning to this reflection and using Gibb’s reflective cycle, I am able to use the knowledge and understanding gained from researching, along with the adaptable mobility exercises I have learnt with my personal pts, to give better treatment techniques, allowing for the best possible rehabilitation journeys for them.
MONDAY 17TH OF MAY AND WEDNESDAY 19TH OF MAY 2021 10 HOURS
17TH of May 2021 5 HOURS
During this session with Brooke, we went through a full run through of the mobility class she would be taking on the following Wednesday. Within the gym, classes are now back up and running from the 17th. As seen in the picture below is the full mobility routine Brooke runs within the mobility class, within the gym. Moreover, we also went through more additional cupping therapy techniques looking at gliding and friction, using these techniques on each other. With little knowledge about cupping therapy, I was unsure of its effects on the body. The most common, most practical and safe method of cupping is the vacuuming technique using plastic pumps, with little cost with the advantage of greater sterilisation. However in some cases, using the glass cuppings have greater effects on the body. Moreover effects of cupping therapy are as follows:
- Increasing blood flow and tissue oxygenation at the applicable site
- Increasing lactate level and lactate/pyruvate ratio
- Increasing in pressure pain threshold
- Reducing proinflammatory lipids, increasing anti-inflammatory lipids
- Increasing microvascular function
- Significant reduction of tissue stiffness and maxim tensile strength
- Increasing vascular density, hemoglobin concentration and oxygen saturation
19TH OF MAY 2021 5 HOURS
During this session Brooke had her first mobility class. Three members of the gym joined in with this class. I also took part to shadow Brooke, if Brooke is ever not able to make it. I will take the class myself. This class was very effective and all members found this helpful. With all members booking in for the next available class too. Moreover, I also spent some time researching the best most beneficial tools to use when completing mobility routines. Resistance bands, as well as poles and barbells are a great way to increase the mobility deficits that bodyweight stretching cannot achieve. Moreover a pt was treated with a STM on the thoracic area, due to limited range and stiffness within this area. Additionally thoracic exercises were given to further increase their range, including thoracic spine windmills and threading the needles.
Returning to this reflection using Gibbs reflective cycle. I felt a little apprehensive using cupping therapy due to having little knowledge of it. Therefore I am looking at booking in for a cupping therapy course, enabling me to gain my qualifications and enabling me to use various treatment methods on my clients. I am also now able to further use poles and barbells in a safe and effective way to greaten a pts mobility.
MONDAY 24TH OF MAY AND WEDNESDAY 26TH OF MAY 2021 8 HOURS
MONDAY 24TH of May 2021 4 HOURS
In this session, we treated three clients overall. Two of these clients had symptoms of back pain, while the other came into the clinic concerning pain in their shoulder. For the first two clients, we went through full spinal assessments to establish their conditions. With the first client we established limited movement within the lumbar spine and therefore gave treatment for this. Treatment included STM along with spinal rotations and QL release. Moreover, we gave this client additional lumbar mobility exercises to take home. The second client presented with a ‘butt wink’, in which we established the client had weakness within the glute med. We then treated this client with lumbar rotations with glute med strengthening exercises, including, for example, sideline abductions, CLAMS, and the use of core stability exercises such as ‘dead bugs’. Client 3 presented shoulder pain and stiffness, as a result of weightlifting exercises. Following an assessment of the shoulder, an imbalance in ROM was identified, which research has often linked to intrinsic risk factors such as joint and muscle imbalances and extrinsic risk factors, namely, that of improper attention to exercise technique (Kolber, Beekhuizen, Cheng, & Hellman, 2010). The client was sent away with a programme of shoulder strengthening and ROM exercises, to reduce the imbalance.
WEDNESDAY 26TH of May 2021 4 HOURS
On Wednesday, I had my final live patient exam before I spent some time in the clinic with Brooke. I went through what I did in my exam with the live patient, and received important feedback from her on what assessment and treatment she would’ve used for this specific client. This was to help me evaluate my performance in this exam, allowing me to self-reflect and gain a different perspective of how best to treat this individual client’s injury. After this, we had a client who required a full-body massage, with a full duration of 1 hour and 30 minutes. This client is preparing for a future body physique competition in the coming months, so had been training intensely, meaning that they had significant muscular fatigue and soreness.
Returning to this weekly reflection, and with reference to Gibbs Reflective Cycle (1988), I recognised that I had unconsciously incorporated aspects of the reflective cycle into my own work as a practitioner, particularly on Wednesday 26th of May after my live patient exam. Having completed my exam and reflecting on my assessments and treatment prescription while reviewing this with another qualified sports therapist in Brooke, it helped me to create my own ‘action plan’ to gain more knowledge in the subject area of the specific injury, to establish what I would’ve done had the circumstances arose again.
SATURDAY 29TH OF MAY 2021 2 HOURS
This session also included running a Mobility class and shadowing Brooke. More and more members are getting involved within these mobility classes which is really really good to see. Various members are also bringing other friends and family, which is amazing to see the group size grow. This mobility session included very similar exercises to previous classes, giving the clients full body mobility enhancements. With University coming to an end, and last assignments being handed in, and with this my last session being with Brooke. Brooke also had no clients booked in, so we had the chance to have a fun session, completing extra mobility exercises including spinal rotations along with massage. This session was really relaxing and I felt it very beneficial to be able to feel the full effects of STM.
REFERENCES
Aboushanab, T. S., & AlSanad, S. (2018). Cupping therapy: an overview from a modern medicine perspective. Journal of acupuncture and meridian studies, 11(3), 83-87.
Alwabli, Y., Al Ruwaili, K., Alghadoni, M., & Alsaleh, L. Exercise-related injuries among female gym members in Qassim 2019.
Bath, B., & Pahwa, P. (2012). A physiotherapy triage assessment service for people with low back disorders: evaluation of short-term outcomes. Patient related outcome measures, 3, 9.
Horschig, A. (2021). Rebuilding Milo: The Lifter’s Guide to Fixing Common Injuries and Building a Strong Foundation for Enhancing Performance. Victory Belt Publishing.
Howell, R., Kumar, N. S., Patel, N., & Tom, J. (2014). Degenerative meniscus: Pathogenesis, diagnosis, and treatment options. World journal of orthopedics, 5(5), 597.
Jeon, N. Y., & Chon, S. C. (2018). Effect of glenohumeral stabilization exercises combined with scapular stabilization on shoulder function in patients with shoulder pain: A randomized controlled experimenter-blinded study. Journal of back and musculoskeletal rehabilitation, 31(2), 259-265.
Keogh, J. W., & Winwood, P. W. (2017). The epidemiology of injuries across the weight-training sports. Sports medicine, 47(3), 479-501.
Kolber, M. J., Beekhuizen, K. S., Cheng, M. S. S., & Hellman, M. A. (2010). Shoulder injuries attributed to resistance training: a brief review. The Journal of Strength & Conditioning Research, 24(6), 1696-1704.
Moodley, D. (2019). The effect of soft tissue sports massage versus foam rolling in the treatment of myofascial trigger points in the hamstrings.
