This was my first session in clinic working with members of the public who require treatment, rehabilitation and management.

Reflective Summary 

The first client requested a soft tissue massage, however a triage process is now in place before anyone can have a face to face appointment.The effects of massage can be both physiological and psychological (Findlay, 2018).There are various established massage techniques such as effleurage, petrissage, tapotement, frictions and vibrations (Ogai, Yamane, Matsumoto, & Kosaka, 2008). Effleurage stimulates the flow of lymph fluid that leads to increased drainage of waste products, as well as inducing relaxation and reducing abnormal muscle contraction (Keperawatan, Petpichetchian, & Chongchareon, 2013). Keperawatan et al (2013) also stated that “all petrissage movements enhance blood flow”. Increasing blood flow transports more oxygen and nutrients to the tissues and removes waste products, promoting an efficient system (Findlay, 2018). Furthermore, the compression and release on the muscles stimulate the venous blood flow in certain tissues and muscles that results in decreased amount of blood in peripheral vessels and increased drainage of lymph (Keperawatan, Petpichetchian, & Chongchareon, 2013). Tapotement can also be used to induce muscle relaxation by releasing soft tissue tension, initiates digestive movement through peristalsis, by stimulating the parasympathetic nervous system and again increases lymphatic return thus assisting with the elimination of toxins (Findlay, 2018). Despite this, many researchers have found limited evidence for the effectiveness of massage, therefore it may not be my first choice of treatment as it can be hard to rationalise (Calleja-González, et al., 2016). Subsequently, I will educate my client on other treatment that may be more beneficial such as foam rolling, especially as this can be done at home. The effects of foam rolling are similar to massage and include enhancing recovery, reducing muscle tension and pain and breaking down scar tissue (Škarabot, Beardsley and Štirn, 2015). I advised my client to perform foal rolling before coming into clinic 1-2 times a day for 1-3 minutes on the specified structure (Kalichman and David, 2017).

My first area for improvement would be to ensure I set out the HPC using OLDCARTS so I know I have covered everything that needs to be included. I also forgot to use the VAS pain scale to compare the pain in certain positions etc. I will be sure to implement this into the next appointment as it can help to understand the patients pain pattern.

We believe that the second client had a possible MCL rupture and medial meniscus tear that they sustained 8/52. This occurred during a football match where the client went in for tackle with a straight leg – as there was impact with the other player it forced the clients leg into ER. They were NWB for 2/52 so on crutches. Had an x-ray 5/52 and only showed swelling of the knee so they got referred to a doctor. 1/7 went to Nuffield where an MRI has been booked for a few weeks time and they referred him to the acute knee clinic. Still has swelling so suspected ligament problem where we will treat it as this until MRI suggests otherwise. Atrophy in right quad and sharp pain on medial side. Pain during active ROM expect IR. During flexion clicking behind knee and for extension stabbing in medial side. Also have ache in the hamstring.

The aims for treatment are to focus on reducing pain, swelling, maintaining ROM and strength of the muscles around the knee. The game ready machine can be used to decrease swelling, therefore improve range of motion at the knee (Murgier and Cassard, 2014). In order to maintain strength, muscle stimulation can be used as well as the isokinetic dynamometer. I am not very confident with using the isokinetic machine so have booked myself in with the lab supervisor, in order to improve my knowledge and skills on this piece of equipment.

Closing the Loop

Since writing this reflection, I now utilise the acronym OLDCARTS to ensure the HPC section has been completed thoroughly and the VAS/NRS to access the patients pain pattern to not only compare different movements but to see progress between sessions.

References

Calleja-González, J., Terrados, N., Mielgo-Ayuso, J., Delextrat, A., Jukic, I., Vaquera, A., … & Ostojic, S. M. (2016). Evidence-based post-exercise recovery strategies in basketball. The Physician and sportsmedicine, 44(1), 74-78.

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

Kalichman, L., & David, C. B. (2017). Effect of self-myofascial release on myofascial pain, muscle flexibility, and strength: a narrative review. Journal of bodywork and movement therapies, 21(2), 446-451.

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.

Murgier, J., & Cassard, X. (2014). Cryotherapy with dynamic intermittent compression for analgesia after anterior cruciate ligament reconstruction. Preliminary study. Orthopaedics & Traumatology: Surgery & Research, 100(3), 309-312.

Ogai, R., Yamane, M., Matsumoto, T., & Kosaka, M. (2008). Effects of petrissage massage on fatigue and exercise performance following intensive cycle pedalling. British Journal of Sports Medicine, 42(10), 534-538.

Škarabot, J., Beardsley, C., & Štirn, I. (2015). Comparing the effects of self‐myofascial release with static stretching on ankle range‐of‐motion in adolescent athletes. International journal of sports physical therapy, 10(2), 203.