This was the fourth week of the back pain clinic. During the session we focused on resistance training, as the group felt that they lacked knowledge using the equipment associated with this type of training including resistance bands and weighted machines.

Reflective Summary

During this clinical reflection I am going to utilise another model which will allow me to be critical rather than descriptive. Bourtons Development Framework identifies three key questions in the reflective process; ‘what?’, ‘so what?’ and ‘now what?’. ‘What?’ promotes the reflector to describe the experience, ‘so what?’ is when the experience is conceptualised and evaluated where you can discuss the outcomes, state what you learnt and why the experience was important and finally ‘now what?’ is the action plan, how do you improve outcomes (see table below) (Skinner & Mitchell, 2016). It is important to remember that these steps may not always happen sequentially.

At the start of the session it was important for the group to consider the difference between physical activity and exercise. The World Health Organisation (WHO) defines physical activity as any movements produced by skeletal muscles that requires energy expenditure, including activities undertaken while working, playing, travelling and engaging recreationally, where as exercise is planned, structured and repetitive, that aims to improve or maintain one or more components of fitness (Geneen et al., 2017). These were important to understand so that the patients could discuss their barriers to physical activity, exercise and resistance training. From the task, both members of the group identified that they satisfied the physical activity guidelines for aerobic exercises but were not completing two strength training sessions a week. This is why we spent an hour in the gym increasing their knowledge on resistance training, as this was there main barrier for why they did not satisfy the guidelines for strength.

Before going down to the gym, we discussed why a good diet is important and what types of food can help with sleep, therefore can contribute to a decrease in non-specific lower back pain. Those who sleep less are more likely to consume energy-rich foods, get a higher proportion of calories form fats and refined carbohydrates, consume lower proportions of fruit and vegetables and consume snacks more often than those sleeping more (Peuhkuri, Sihvola & Korpela, 2012). This not only reminded the group, but myself as well and encouraged me to access my diet to ensure I am able to optimise my sleep; a balanced diet that is rich is fruit, vegetables, whole grain and low fat protein sources can improve sleep (Peuhkuri, Sihvola & Korpela, 2012).

We also had a discussion on different types of sleep surfaces on back pain and sleep quality. Jacobson, Boolani, Dunklee, Shepardson & Acharya (2010) study accessed sleep quality and comfort of participants diagnosed with back pain following sleep on individually prescribed mattresses based on sleeping position. From there results, it was concluded that sleep surfaces are related to sleep discomfort and it is possible to reduce pain and improve sleep quality in those with chronic back pain by having mattresses based on sleep position. This study also supports the evidence that medium-firm beds are suitable in providing sleep quality and comfort. This piece of research has given me more knowledge on how sleep can be improved in people with back pain, however I need to read more research papers in order to ensure my theory is backed with evidence based practice.

For the remaining hour, we went into the gym to do some practical work with the group. The practitioner demonstrated a sufficient warm up, which the group can utilise to ensure they have warmed up sufficiently before any exercise. I can also use this warm up with certain populations that come into clinic like those with lower back pain, in the elderly range or who require a lower intensity warm up. I now know this would be suitable for these populations so would be confident when delivering it. Even though exercise cannot fully prevent ageing of the neuromuscular system, resistance training can help to mitigate age-related changes by increasing muscle strength (Borde, Hortobagyi & Grancacher, 2015). Borde, Hortobagyi and Grancacher (2015) study found that two sessions per week, 60 seconds rest between sets, 2-3 sets per exercise, 7-9 reps per set and 4 seconds between reps could have the greatest effects on improving maximal voluntary strength in healthy older adults. I can use these figures when leading resistance training sessions for older adults.

Area for Improvement	Action Plan
Begin to develop my knowledge on nutrition and diet	I could look at attending CPD courses on this topic, so I am able to give basic advice about what clients should and shouldn’t be eating
Learn and revise how to use all the weighted machines in the gym	Get a gym membership and practice using all the equipment, so when I use it with a client I am confident that I can set it up effectively and provide the appropriate feedback

Closing the Loop

I am yet to complete any CPD regarding nutrition and diet – this was more of an aim for after university. As I have discussed in previous entries, I have not managed to get a gym membership yet due to different commitments but this back pain clinic did give me more exposure to equipment in the gym and how it can be utilised.

References

Borde, R., Hortobágyi, T., & Granacher, U. (2015). Dose–response relationships of resistance training in healthy old adults: a systematic review and meta-analysis. Sports medicine, 45(12), 1693-1720.

Geneen, L. J., Moore, R. A., Clarke, C., Martin, D., Colvin, L. A., & Smith, B. H. (2017). Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews, (4).

Peuhkuri, K., Sihvola, N., & Korpela, R. (2012). Diet promotes sleep duration and quality. Nutrition research, 32(5), 309-319.

Skinner, M., & Mitchell, D. (2016). “What? So What? Now What?” Applying Borton and Rolfe’s Models of Reflexive Practice in Healthcare Contexts. Health and Social Care Chaplaincy, 4(1), 10-19.