Clinical Placement – 23rd January 2020 for 5 hours

This week, I shadowed treatment and rehabilitation for four different clients. Some of the pathologies included a possible sub acromial impingement, rotator cuff (RC) impingement or biceps tendinopathy, suspected medial meniscal damage which had progressed to an inflamed quadricep tendon and general tightness in hamstrings, glutes and shoulders.

Reflective Summary

The first client of the day was a long-distance runner who presented with a lot of tightness in their lower back, glutes, hamstrings, quadriceps and calves. My supervisor chose to use soft tissue massage (STM) on all these areas, to increase drainage of waste products, as well as reducing abnormal muscle contractions, allowing the muscles to relax (Keperawatan, Petpichetchian, & Chongchareon, 2013).

The next client was experiencing shoulder pain from lifting tyres repetitively at work. He has a kyphotic posture, rounded shoulders and a protruded head. The frequency of the pain had decreased; however, the intensity remains the same, possibly because he had fallen over on the ice and put his hands out. The therapist suspects that the pathology could be either a sub-acromial impingement, RC impingement or biceps tendinopathy. The most likely injury is biceps tendinopathy, as there was a lot of tenderness in the bicipital groove. Before treatment began, range of motion (ROM) was tested, specifically medial and lateral rotation of the shoulder, by bringing the arm back and then up into a triceps stretch. It was good to use this as an objective measure, as it allows you to see an improvement in ROM and shows the effectiveness of techniques used. The aims for treatment are to reduce pain, increase ROM then strengthen the area. Due to the client having rounded shoulders, they had a lot of stiffness in the thoracic spine, so STM was used to reduce this as well as mobilisations of the spine at a grade 3. STM was also used on the shoulders and so was mobilisations; this includes anterior posterior (AP) of the glenohumeral joint, as well as mobilisations with movement, where a belt is put around the top of the arm by the therapist who pulls back and down, while the client performs shoulder flexion. An exercise prescription was given to the client and included single arm rows, bent over rows with a band, external rotation (ER) of the shoulder with a band and finally with the shoulder at 90 degrees, holding a band and bringing the arms out to the side.

The third client was an 18-year-old boy who in previous years had suspected medial meniscus damage. He also experienced a valgus force to the lateral side of the knee, so causes it to give away medially. His symptoms were improving and his glute and hamstring strength had started to increase however, he had recently cut his hand open so had to have surgery, therefore was resting a lot and not using his knee (including doing his prescribed exercises). We also noticed increased swelling on the right knee which could be from inflammation of the quadricep tendon. As he had regressed, the main aim was to release tightness in the hamstrings and quadriceps using STM. As his glutes had weakened again, he was given glute bridges, wall sits at 45 degrees and sumo walks with a resistance band to aid glute activation.

The finally client was a physiotherapy student who had areas of hypersensitivity in the shoulders and further up into the neck. This could be because she is a climber and also had rounded shoulders. STM was used to try to combat the tightness.

Areas for further improvement 

My first area for further improvement would be to practice mobilisations with movements, so I become more confident on how to use them effectively and when it is suitable to use them in treatment. I also need to revise the anatomy and movements of the shoulder (which the muscles are responsible for), as it could help me to understand the signs and symptoms of different pathologies, so I am beginning to link all the taught modules together. Finally, my last area for improvement is related to the prescription of different exercises. It is important to consider the clients age, ability, injury etc as the exercise may need to be adapted to suit their needs to allow optimal recovery.

Things to Remember:

  1. If any symptoms present as possible red flags, REFER!
  2. Use both treatment and rehabilitation in order to manage an injury
  3. With any clients it is important to address pain first, then ROM and finally strength

References 

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.

 

 

 

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