Before the girl’s match, I treated three of the players which included massage, stretching and taping. The first girl had tight hamstrings so wanted a pre-event massage to help the muscles to relax. I also used muscular energy technique (METs) of the hamstrings using post isometric relaxation (PIR), in order to increase range of movement (ROM) where I tested it before and after treatment, to see if it was effective. The next player that came in had been diagnosed with a disc herniation around the lumbar/sacrum height and had bilateral sciatica down to the middle of the quads. Previously, they had also had symptoms of cauda equina. To begin the treatment, I massaged the lower back in order to reduce tightness. As extension eased the pain I treated using McKenzie repeated movement for extension, again checking ROM before and after. I repeated extension 5-10 times statically as this movement was still quite painful for the client. I also taped there lower back using k tape to try and psychologically ease the pain. The final player wanted their ankle taped using rigid tape and their knee with k tape. I used the figure of 8 for the ankle and patellofemoral pain syndrome taping for the knee.

In the first hockey game, no first aid was required during the game. The only incident that I observed was a girl got hit with the ball in the head, but she seemed fine and was happy to carry on. No treatment was given.

For the men’s game no first aid was needed for the home team. One of the players wanted to stretch their glutes so we demonstrated the seated glute stretch (figure of 4). Although, one of the boys from the opposition was experiencing neuropathic pain in the calf, indicating it was compartment syndrome. We tested ROM of the ankle using singular movements and combined movements. We also gave him some ice to try and ease the pain.

After the game, the player with back pain came down to clinic so that we could fully assess her doing a subjective and objective assessment. This included active ROM with overpressure, dermatomes (for sensation), myotomes (muscle strength), upper motor neuron lesion (UMNL) tests including babinski and clonus, as well as neurodynamic testing using straight leg raise (SLR), which did reproduce the pain therefore was positive. With dermatomes there was altered sensation in the right leg and for myotomes they had weaknesses in both legs, but more so in the right leg with the strength being 2/5. As they had a slipped disc, the traction bed was used to help with the pain. This therapy involves stretching the clients back by placing the individual into a harness, then strapping the harness at 4 different locations (Winternheimer & Gray, 2015).

Areas for further improvement 

My first area for further improvement would be to revise what movements of the spine are related to certain spinal pathologies. For example, if the client experiences pain in flexion it usually indicates a disc problem, whereas pain in extension can be related to the facet joints. Therefore, if you suspect it to be a disc problem the treatment will incorporate extension, by using repeated movements. In some spinal cases it is not always this generic, however it is just a basis to go off of. Another thing that I need to improve on is to revise the subjective and objective assessment as part of the clinical consultation form. This is because in 3^rd year, as part of my clinical hours I will need to do this every time I see a client. In order to do this, I can go into the clinic and shadow some of the 3rd years so I will be confident on what I have to do.

Things to Remember

1. With ROM only go to the range that is not too painful for the client
2. With myotomes, use the oxford scale to test the strength of the muscles
3. With cauda equina expect saddle anaesthesia, as well as bowel and bladder dysfunction
4. Ask the client why they want taped, is if there is a weakness in the area?
5. With disc problems DO NOT use joint mobilisations, use McKenzie’s repeated movements
6. With babinskis UMNL test either draw a C or an L on the bottom of the foot

References 

Winternheimer, J., & Gray, C. R. (2015). U.S. Patent No. 9,114,051. Washington, DC: U.S. Patent and Trademark Office.