Clinical Placement – 12th March 2020 for 5 hours

During the 5 hours, the therapist treated a possible rotator cuff tendinopathy or subacromial impingement, shin pain and tight calves, as well as a client who requested a 30-minute massage of the back and neck.

Reflective Summary 

The first client that came into the clinic was experiencing a dull ache in the anterior part of the shoulder. When testing range of movement (ROM), the client felt increased pain during IR and ER, which is usually suspected with a rotator cuff tendinopathy, although the shoulder is complex, so it is hard to say exactly what the pathology is. However, as the session progressed it became apparent that it could more likely be a sub- acromial impingement, as the left shoulder was rounded, particularly as they were stressed, so could impinge on the joint space. Also, when people are stressed, it causes elevated shoulders that tightens the upper fibres of the trapezius (UFT) and pectorals major. A functional movement that increased the pain and was uncomfortable was putting on a bra. The client also had neck pain and felt a twang during cervical flexion. We did not think it was related to the shoulder pain, but it could be due to tightness of the levator scapulae which could be causing headaches, although work and stress could also cause headaches. The treatment began with soft tissue massage (STM) on the UFT, rhomboids, subscapularis, serratus anterior and anterior deltoid. The therapist then massaged the pectorals as the shoulders usually become elevated when people are stressed so causes tightness here. Finally, soft tissue release (STR) was used on the pectorals, so tenderness was found and the shoulder was moved into ER, which was the most painful movement. Various rehabilitation exercises were prescribed including double chin exercises to encourage the spine to be more neutral, ER of the shoulder (weight can be added at a later stage in order to help strengthen the shoulder) and finally palpating the shoulder and feel it move down and back in order to help correct posture.

The next client was a previous patient who had been experiencing shin pain and calf tightness since beginning running. They have been unable to run for a while and were not allowed to after the last session because they still felt a slight pain when walking. When arriving to the session they were pleased to inform us that they had not had any pain when walking. This meant that we were able to assess her running gait. We noticed that she had knocked knees (valgus) and her left foot went inwards when the foot was planted, even though they had a high arch. This seemed to be happening because her running trainers were  giving her very little support, therefore it was recommended that the client buys new trainers that are more supportive. The treatment provided was STM of the calves in order to increase blood flow allowing the transportation of more oxygen and nutrients to the tissues and the removal of waste products, therefore promoting an efficient system (Findlay, 2018). Accessory mobilisations that mimic plantarflexion were used for her ankle stability as it was poor. Exercises were given to improve balance including standing on one leg with the eyes open and then progressing it to performing the action with the eyes closed. Exercises were also prescribed for strengthening the gluteus medius such as squats and walkouts, in order to prevent the knocked knees.

The last client visits the clinic regularly and receives treatment from both the sports therapist and the chiropractor. They have general shoulder pain, specifically tension in the levator scapulae. They also have lower back pain. Therefore, STM was used on the lower back, trapezius (upper and lower fibres), rhomboid and levator scapulae.

Areas for further improvement 

My first area for further improvement would be to begin to make a document of all the different rehabilitation exercises for a variety of pathologies and muscles that may need strengthening. It is also essential to understand how each exercise can be progressed or regressed as they may vary depending on the age, ability etc of the client. I also need to continue to practice STR of different muscles and mobilisations at different joints, so I am confident wth using alternative techniques, other than massage.

Thing to Remember

  1. The subscapularis muscle can be accessed by massaging just below the armpit
  2. In order to be an effective sport therapist, it is important to use a combination of treatment and rehabilitation
  3. Explain to the client why you are giving them specific exercises to do, so they can understand the benefits of completing them
  4. With any new client, explain to them what pain threshold you work at (example 8/10) and if it is too high to inform you
  5. Always ask about the frequency and the intensity of the pain

References 

Findlay, S. (2018). Sports massage. Champaign:Human kinetics

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