During the 5 hours that I was timetabled into clinic, I saw three clients where I utilised many different techniques in order to manage their aches and pains; this included soft tissue massage, rehabilitation exercises, stretching, a high intensity interval session (HIIT) and cycling on the watt bike.

Reflective Summary

My most interesting client had a clinical impression of a grade 1a gastrocnemius strain and lateral epicondlopathy of the right elbow. Grade 1a is a fatigue induced muscle disorder (Muller-Wohlfahrt et al., 2013) which extends from the fascia, but no greater than 10% into the muscle with a longitudinal length of less than 5cm within the muscle (Pollock, James, Lee & Chakraverty, 2014). With a gastrocnemius strain, clinical you would expect there to be a sudden onset of pain, tenderness which is localised to the musculotendinous junction of the medial head and a palpable defect in the medial muscle belly (Nsitem, 2013). With regards to treatment the Alfredson protocol could be used. The protocol involves a programme of eccentric heel drop exercises that has been well documented for achilles tendon injury rehabilitation (Stevens & Tan, 2014). Despite this, it can be an option for gastrocnemius injuries as the calf muscles and achilles tendon work together as part of the same musculotendinous unit (Coffey & Khan, 2020).

From the subjective assessment, I identified that the clients onset of pain was during exercise on a cross trainer. A cross trainer involves both the lower and upper extremity muscles to act synchronously, therefore when using the equipment it is important to be aware of this so the client can get optimal physical response (Sozen, 2010). Despite this, due to the repetitive nature of the cross trainer it could have caused the lateral epicondylitis; Lateral epicondylitis is one of the most common overuse injuries and affects 1-3% of the population, with a higher incidence rate in women than men and 45 years to 64 years, so emphasises that my client is at a higher risk (Wong et al., 2017).

This client had a personal goal of improving cardiovascular fitness and wanted to have exposure to a variety of HIIT sessions with guidance from a sports therapist. A benefit of HIIT is that it encompasses exercise prescriptions that are tailored to the individual and can be completed in any exercise setting (Ross, Porter & Durstine, 2016). Currently, this is important as it gives people an alternative method of exercise, especially as gyms are closed.

Area for Improvement	Action Plan
Re-access ROM and special tests in a follow up session	Ensure I do this next time a client comes in for a follow up appointment, as this will provide other objective measures apart from pain
Increase my knowledge on progressions and regressions for a variety of exercises	I can begin to film myself doing a variety of exercises, demonstrating how they can be progressed and regressed
If I am using equipment in the gym ensure I record the setting, load or sets/reps	Become more familiar with the different setting on the cardio machines so I can make the session on the equipment specific to the client
During a HIIT session, I can use RPE and NRS to understand how hard the client is working	Print off the RPE and NRS as it will remind me to utilise these scales with the client

Closing the Loop

Since reflecting on these sessions, I now understand why it is so important to use clinical measures (in order to see improvements), therefore I will ensure I re access a variety of things when a client comes back into clinic such as pain, ROM, special and functional tests.I have started to film myself demonstrating certain exercises, so once I have my level 2 gym instructor and level 3 personal trainer I can post exercises with regressions and progressions on my professional instagram account. Before lockdown, I was planning on getting a gym membership to become more familiar with the equipment but I have not yet achieved this due to a national lockdown and going home for Christmas.During HITT sessions, instead of having to print off sheets with RPE and NRS, I get the scale that I am wanting to use up on my phone.

References

Coffey, R., & Khan, Y. S. (2020). Gastrocnemius Rupture. StatPearls [Internet].

Mueller-Wohlfahrt, H. W., Haensel, L., Mithoefer, K., Ekstrand, J., English, B., McNally, S., … & Blottner, D. (2013). Terminology and classification of muscle injuries in sport: the Munich consensus statement. British journal of sports medicine, 47(6), 342-350.

Nsitem, V. (2013). Diagnosis and rehabilitation of gastrocnemius muscle tear: a case report. The Journal of the Canadian Chiropractic Association, 57(4), 327.

Pollock, N., James, S. L., Lee, J. C., & Chakraverty, R. (2014). British athletics muscle injury classification: a new grading system. British journal of sports medicine, 48(18), 1347-1351.

Ross, L. M., Porter, R. R., & Durstine, J. L. (2016). High-intensity interval training (HIIT) for patients with chronic diseases. Journal of sport and health science, 5(2), 139-144.

Sozen, H. (2010). Comparison of muscle activation during elliptical trainer, treadmill and bike exercise. Biology of Sport, 27(3), 203.

Stevens, M., & Tan, C. W. (2014). Effectiveness of the Alfredson protocol compared with a lower repetition-volume protocol for midportion Achilles tendinopathy: a randomized controlled trial. journal of orthopaedic & sports physical therapy, 44(2), 59-67.

Wong, C. W. Y., Ng, E. Y. L., Fung, P. W., Mok, K. M., Yung, P. S. H., & Chan, K. M. (2017). Comparison of treatment effects on lateral epicondylitis between acupuncture and extracorporeal shockwave therapy. Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology, 7, 21-26.