In this session, I shadowed my placement supervisor, who treated two different clients; the first had osteoarthritis (OA) in both knees and the right ankle, while the other client had torn their calf and had been experiencing pain. I also got the chance to practice peripheral mobilisations on a qualified sports therapist, so they could help me to refine my previously learnt skills and techniques.
The first client that came into the clinic, had OA in both knees and in the right ankle from playing rugby for years. He is due to have surgery for the OA in the left knee in the next few months. Due to his OA, he has shortened ligaments in the ankle as well as tight calf muscles, specifically tibilalis anterior and posterior. The client was also experiencing pain and stiffness in the lower back and glutes, which could be from the OA that is present in the knees. Soft tissue therapy was used on the lower back and the top of the glutes to decrease tension, allowing the muscles to relax (Keperawatan, Petpichetchian, & Chongchareon, 2013).Massage was also used on the calf muscles and around the structures of the ankle, including the ligaments and achilles tendon. Soft tissue massage increases blood flow allowing the transportation of nutrients to the tissues and the removal of waste products, allowing for an efficient system (Findlay, 2018). A distraction (caudad) technique was used on the right ankle so that the talocrural joint was separated to help alleviate pain.
The second client experienced a medial calf tear (right) a few months ago, where the pain has been improving. However, a few weeks ago the client had a fall resulting in pain on the lateral peroneal side. The pain had now stopped as they have been resting and not been doing much exercise. To begin the session, the therapist got the client to run outside so they could see if any pain occurred and it did not. This meant that they would be able to get back to running but start the training off gradually by doing 15-20 mins steady running. Massage was used on the right calf so that any tightness could be released. The client was instructed to continue with their exercise prescription. This included single leg raises and drops, ensuring pain was not produced.
I also got to practice both physiological and accessory mobilisations on a variety of joints includes the ankle, knee, hip and shoulder. The fact that I got to perform this movements on a sports therapist meant that they could give me feedback on client position, my position and the force of application.
Areas for further improvement
My first area for further improvement would be to practice and perfect peripheral mobilisations. This will help me for my practical exam and future treatments, as it will allow me to use a variety of techniques that are effective according to the literature. With the application of mobilisations, I need to ensure the correct positioning of the client so they are relaxed and comfortable. I also need to ensure that I am in the correct position, in order to perform an effective mobilisation. My final area for improvement would be to ensure the forces applied with mobilisations are firm, by making sure I have a strong grip, with one hand stabilising while the other hand moves. With an accessory mobilisation of the tibiofemoral joint (AP and PA), the stationary hand needs to be straight, so the bed needs to be adjusted accordingly.
Things to remember specifically relating to peripheral mobilisations:
Findlay, S. (2018). Sports massage. Champaign:Human kinetics
Keperawatan, C., Petpichetchian, W., & Chongchareon, W. (2013). Does Foot Massage Relieve Acute Postoperative Pain? A Literature Review. Nurse Media Journal of Nursing, 3(1), 483-497.