My first appointment was with a previous client who was coming into clinic, so I could perform an objective assessment in order to get a more in depth impression of the problem. For my second client I took them on the isokinetic dynamometer to understand the ratio of quadriceps to hamstring strength.
To begin with I completed a thorough objective examination where my key focus was on the movements at the hip, special tests and functional tests. From previous information, Femoroacetabular Impingement (FAI) seemed the most likely clinical impression; my findings clarified this as FADIRs test was positive. I also recognised that there was a lot of tightness within the hip flexors using Thomas test, rectus femoris by performing Elys test (Peeler and Anderson, 2008) and the bicep femoris during palpations.
The objective assessment should help to form a clinical impression which can help decide the appropriate management of the problem, however I believe I need to become more confident with rationalising treatment techniques for different pathologies (Akhtar, Bradley, Quinton and Burke, 2005). This will enable me to select the most effective treatment, hopefully resulting in an earlier return to work, sport or functional purposes etc.
Another area that I need to improve on is to check lifestyle factors as this may have an affect on the pathology. Several studies have found mortality rates are positively associated with cigarette smoking and physical inactivity (Merrill, 2019). Despite this being related to deaths, a similar concept can be applied to injuries as these factors can have a negative affect on recovery of injury. Not only do I need to check smoking and physical inactivity, sleep, diet and alcohol consumption should be established as well.
For the second client we had access to the Isokinetic Dynamometer in the sports lab. This machine has shown to both reliable and valid in assessing muscle function including concentric, eccentric and isometric strength and is referred to as to the “gold standard” when compared to other pieces of equipment that test strength (Toonstra & Mattacola, 2013). It is specific to my client as it can measure the strength of knee extensors (quadriceps) and flexor (hamstrings) muscles. It can also be used to analyse unilateral and bilateral strength imbalances (de Carvalho Froufe, Caserotti, de Carvalho, de Azevedo Abade, & da Eira Sampaio, 2013). From my clients results it indicated that he needs to improve hamstring strength, specifically for the right leg as the % difference between the quadriceps and hamstrings was 29%. Therefore, I prescribed exercises for both concentric and eccentric hamstring strength. I selected the nordic hamstring curl as it has been shown to decrease injury risk for this muscle by increasing eccentric hamstring strength (Al Attar, Soomro, Sinclair, Pappas & Sanders, 2017).
Closing the Loop
Since reflecting on these hours, I am more confident when rationalising treatment as I have be able to see what works for my clients and the techniques that have been less effective. Similarly, as I have become more familiar with the subjective assessment I remember to ask about lifestyle factors, considering how they may affect the clients problem.
Akhtar, S., Bradley, M. J., Quinton, D. N., & Burke, F. D. (2005). Management and referral for trigger finger/thumb. British Medical Journal, 331(7507), 30-33.
Al Attar, W. S. A., Soomro, N., Sinclair, P. J., Pappas, E., & Sanders, R. H. (2017). Effect of injury prevention programs that include the nordic hamstring exercise on hamstring injury rates in soccer players: a systematic review and meta-analysis. Sports medicine, 47(5), 907-916.
de Carvalho Froufe, A. C. P., Caserotti, P., de Carvalho, C. M. P., de Azevedo Abade, E. A., & da Eira Sampaio, A. J. (2013). Reliability of concentric, eccentric and isometric knee extension and flexion when using the REV9000 isokinetic dynamometer. Journal of Human Kinetics, 37(1), 47-53.
Merrill, R. M. (2019). Injury-related deaths according to environmental, demographic, and lifestyle factors. Journal of environmental and public health, 2019(1), 1-12.
Peeler, J., & Anderson, J. E. (2008). Reliability of the Ely’s test for assessing rectus femoris muscle flexibility and joint range of motion. Journal of Orthopaedic Research, 26(6), 793-799.
Toonstra, J., & Mattacola, C. G. (2013). Test – Retest Reliability and Validity of Isometric Knee-Flexion and -Extension Measurement Using 3 Methods of Assessing Muscle Strength. Journal of Sport Rehabilitation, 22(1), 1–5.