On the 10thJanuary, I started my clinical placement at Plympton Chiropractic, where I got the chance to shadow a qualified sports therapist. It helped me to increase my knowledge on different treatment techniques, so I could begin to understand when it is appropriate to use a specific method, in order to get the best outcome for the patient.
The first patient had sciatica and experienced symptoms down one side of the body. The cause of the pathology could be the piriformis muscle compressing on the nerve, as the client had a tight piriformis. The sciatica could also be caused by a herniated disc as the client has this and gets lower back pain. The therapist decreased the tightness of the piriformis using soft tissue massage (STM) and soft tissue release (STR). They also used massage on the client’s lower back to help decrease the pain. The client had a separate pain area (dull ache) around the superior angle of the scapula, possibly from their job. This was also loosened off using STM.
The second client was a male, who had lost up to six stone since going from doing no exercise, to training in the gym seven times a week. As there had been such an increase in the amount of activity the client had been participating in, they were experiencing extreme tightness in both the hamstrings and the quadriceps. STM was used, as well as STR of the hamstrings to decrease the hypersensitivity, therefore allowing the muscles to relax (Keperawatan, Petpichetchian, & Chongchareon, 2013).
The final client was a 17- year old boy who had Osgood Schlatter on the right knee. Osgood Schlatter is a traction apophystis of the tibial tuberosity, where there is bony prominence (Nakase et al., 2015). On palpation, the therapist identified that there is thickening of the patella tendon, which could cause patella tendinopathy. Also, 2/3 years ago the client experienced a lateral meniscus tear and had an operation on it, although no physio was offered after. Both of these injuries cause the client to experience constant knee pain and tightness in the quadriceps and hamstrings, due to weakness at the knees. The therapist used STM on the quadriceps, hamstrings and calves, in order to induce relaxation by decreasing tension and reducing abnormal muscle contraction (Keperawatan, Petpichetchian, & Chongchareon, 2013). Accessory mobilisations were used on the patella including lateral and medial glides, as well as caudad and cephalad which increased the pain. Mobilisations are used to decrease both pain and stiffness (Merlin, McEwan & Thom, 2005). On palpation, the therapist also found that the thoracic spine was tense, possibly because the client has lordosis. Mobilisations were also used on the thoracic spine to decrease stiffness. In the last session the client was unable to perform a deep squat, without the feet going into dorsiflexion. This implied that the mobility of the ankle needed to be improved. Physiological mobilisations of ankle dorsiflexion were used to increase range of movement in order to decrease stiffness. Finally, an exercise prescription was given to the client with a variety of activities. The therapist noticed that the client had inadequate firing of the glutes, so the hamstring and lower back compensated because of this. For the glutes, resistance bands can be used and exercises include an easier version of sumo squat incorporating a simple squat rather than a deep squat. Flexibility of the calves can also be increased by standing on the edge of a step and dorsiflexing the toe. Finally, for the clients lordosis, the pelvic tilt can be used either against the wall or floor, to correct the arch of there back.
Areas for further improvement:
My first area for further improvement would be to continue to revise the different pathologies at each joint, so I am able to identify what it could be from the mechanism of injury, subjective assessment and objective assessment. This will allow me to select the most appropriate treatment method for the injury. I also need to take time to practice mobilisations as they are a great replacement for massage, as the same aims can be achieved in a much shorter time. My final area for improvement would be to research and look at the literature surrounding different treatment techniques. This will allow me to start to understand which methods are more effective, so I can incorporate these into treatment if they are suitable for the pathology, ensuring to consider contraindications at all times.
Things to Remember: