This week in open clinic, I had a client who was recovering from a football varsity match 3 days ago. He complained of tightness in his quadriceps, hamstrings and calves.
During the subjective assessment my client complained of a dull pain down the rectus femoris of the left quadricep, tightness in the right quadricep, both hamstrings and right calf. As part of the objective assessment I observed that my client had slightly everted feet and their knee crease was higher on the left side. When I palpated the rectus femoris the client stated that the pain was sharp and there was tightness down the lateral and medial side of the quads. When checking range of motion (ROM) I used the Thomas test to test for tightness of the rectus femoris and hip flexor muscles and Obers to check the tightness of the iliotibial band (IT band). My client was negative for Obers test but positive for the Thomas test as the hip angle was larger than normal (shows the hip flexor is tight) and when in knee flexion if you push the knee and it springs back it means the rectus femoris is tight. As part of my treatment I decided to do soft tissue massage on the quadriceps to release some of the tension and then used muscular energy techniques (METs) to stretch the tight muscles. As part of the massage I used effleurage and petrissage to achieve this by increasing blood circulation and lymphatic drainage. I then performed METs of the quadriceps by getting the client to lie in a prone position, flexing the knee and then resisting against my force. The last thing I did was give the client particular stretches that they can do at home to release some of the tightness in the quadriceps and hip flexors.
Areas for further improvement
My first area for improvement would be to continue to revise special tests so I know if the client is positive for a particular test. In today’s session I understood that my client had tight quadriceps, but my lecturer had to advise me on what tests I needed to use in order to see if it was actually the quadriceps or IT band that was causing the tightness. Another weakness of mine was that I ran out of time to do both quadriceps so I only did the one with tightness. This was because I had to check how to perform some of the special tests. Next time I need to do both sides of the body whether it is injured or not.
Things to remember