Clinical Placement – 30th January 2020 for 5 hours

During the 5 hours, 3 clients were treated with different pathologies and problems. This included an elderly man with Parkinson’s disease, a lady who experiences migraines from tension in the neck and a man who has a possible rotator cuff (RC) impingement.

Reflective Summary 

The first client was an elderly main who has Parkinson’s disease (PD). It is the second most common neurodegenerative illness and progressively decreases quality of life, self-image and the ability to be independent (Besbris et al., 2020). With PD common signs include a shuffling walk with very small steps, as well as stiffness and tightness in the muscles, which is what the client wanted treatment for (NHS, 2019). Our client also had a kyphotic posture. He had tightness in the lower back, glutes, hamstrings and calves which was addressed using soft tissue massage (STM). The glutes were particular tender, specifically the gluteus medius, so soft tissue release (STR) was used here on any trigger points. STR is used as it helps to alleviate musculoskeletal pain and improve range of motion (ROM) (Doley, Warikoo, & Arunmozhi, 2013).

This was the first time I saw the same client again, so enabled me to see if the treatment was effective and if the pain was becoming less frequent, during his active daily living (ADLs). It was important to test ROM again of the neck and the shoulder, specifically ER and IR of the shoulder because previously, this is where ROM had regressed the most. We also found that they experienced pain during the painful arc and couldn’t get to full ROM. The client still had stiffness in the thoracic spine, which was increased by tightness of the muscles surrounding it, including erector spinae, trapezius, rhomboids and quadratus lumborum. To treat the tension in the muscles, STM was used with mobilisations of the thoracic, at a grade 3, to help decrease stiffness. Next, the therapist released off through the pectorals major and biceps brachii, as there was tenderness due to the client having rounded shoulders. A distraction technique was used on the shoulder to help with any compression that may be around the joint. Similar to last week, anterior posterior (AP) mobilisation of the glenohumeral joint was used. STR was used around the shoulder to try to improve ROM during abduction. This technique was also used on the neck, where the therapist pushed on a trigger point then instructed the client to put their head down and away from the site, which was repeated a few times. The client was told to continue with the previous exercises given and to begin to incorporate strength work so the shoulder can become stronger.

The final client was a lady who experiences migraines on a regular basis, which is caused by tension in the neck and the top of the shoulders, on the right side. Currently, she gets corticosteroid injections that relieve inflamed muscles, that could help our client by preventing headaches. In the session she was given STM on the neck, getting right into the levator scapulae as well as the trapezius. STR was also used on the upper fibres of the trapezius to decrease pain as well as ROM.

Areas for further improvement 

My first area for further improvement would be to practice STR, revising the application of it. If I am confident on the general technique, I should be able to apply it to any area. The idea of this method is to apply pressure to a muscle, while the muscle is being stretched at the same time: the muscle is shorted and a lock is applied towards the origin. Next, slowly lengthen the insertion away from the lock/origin. Another improvement that I need to begin to make is starting to consider the clinical reasoning behind the choice of techniques used in treatment and rehabilitation. This will allow me to be an efficient and effective sports therapist.

Things to Remember: 

  1. At the beginning of the session, explain to the client the aims of the treatment that is going to be provided
  2. Lower back pain is usually because of stiffness in the thoracic spine
  3. Before mobilisations, it makes sense to use STM around the area, because if the muscles are already tight it can increase the stiffness of joints/vertebrae
  4. A distraction mobilisation is also known as caudad, as you pull towards the feet
  5. When massaging near to the spine, try and get as close to it as possible   

References 

Besbris, J. M., Vaughan, C. L., Kluger, B., Long, J., Johnson, A., & Sumrall, M. (2020). Parkinson’s Disease Personified : Patient and Caregiver Perspectives on Palliative Care Needs. Journal of Pain and Symptom Management, 59(2), 465–466. https://doi.org/10.1016/j.jpainsymman.2019.12.147

Doley, M., Warikoo, D., & Arunmozhi, R. (2013). Effect of Positional Release Therapy and Deep Transverse Friction Massage on Gluteus Medius Trigger Point – A Comparative Study. Journal of Exercise Science and Physiotherapy, 9(1), 40–45.

NHS. (2019, April 30). Parkinson’s disease – Symptoms. Retrieved January 31, 2019 from https://www.nhs.uk/conditions/parkinsons-disease/symptoms/

 

 

 

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