This was the final clinic session before Christmas, so I ensured that my clients were fully equipped with the appropriate knowledge on how to control and improve their conditions over the next month and further into the future.

Reflective Summary

Within this reflection I am going to utilise Bourtons Development Framework in order to critically reflect. It enables the reader to consider three key questions within the process; ‘what?’, ‘so what?’ and ‘now what?’ (Skinner & Mitchell, 2016).

One of my clients had been experiencing a ‘drilling’ pain within the hips, although on return to clinic it was exciting to hear that the pain had significantly decreased. Within the session, I took the client into the gym and included exercises that would continue to improve strength around the hips, while ensuring they were working within full range of motion (ROM), particularly flexion, as this was the movement that the initial pain was provoked in.

On observation, I noticed that when the client was performing squats, they had right knee valgus; medial collapse of the knee (Ekegren, Miller, Celebrini, Eng & Macintyre, 2009). I thought this could have been due to weakness of the glute muscles. This is why I included exercises such as glute bridges and side lying hip abduction. Reiman, Bolgla & Loudon (2012) reviewed the literature regarding activation of gluteus maximus and medius during rehabilitation exercises. Interestingly, they found that side lying hip abduction caused high activation of the gluteus medius, meanwhile a single leg glute bridge caused moderate activation of the gluteus maximus and high activation of the gluteus medius.

It has also been suggested that there is an association between gluteus muscular strength and knee valgus, particularly in patient with patellofemoral pain (dos Anjos Rabelo & Lucareli, 2018). This is why it is so important to improve the clients glute strength, so they are at a decreased risk of experiencing knee pain.

My final client had come into clinic in the previous week; their lateral epicondylopathy was not improving, despite prescribing exercises to help stretch and strengthen the wrist extensors and using manual therapy techniques. Therefore, the focus was on activity modification. I was pleased to hear that the pain around the elbow had decreased, which could have been due to modifying activity or applying K tape, although the physiological effects of this method are still unknown.

Areas for Improvement	Action Plan
Rather than sending pictures of the exercises to clients, I could send videos so they can see the full movement	Begin to create videos of a variety of exercises and include top tips for each one.
Ensure I demonstrate the exercises prescribed and watch the client do it to ensure their technique is correct	Leave time within each appointment to demonstrate and get the client to do the exercise
RPE measures the intensity of exercise and can be used not only within aerobic activity but strength as well	Next time the client is performing different exercises RPE should be used to access if the sets and reps are suitable

Closing the Loop

When I go back to clinic, I will ensure when writing the notes before I plan for extra time at the end of the sessions so I can demonstrate the exercises to the client. Similarly, I will ensure I use RPE when accessing the suitability of sets and reps.

References

dos Anjos Rabelo, N. D., & Lucareli, P. R. G. (2018). Do hip muscle weakness and dynamic knee valgus matter for the clinical evaluation and decision-making process in patients with patellofemoral pain?. Brazilian journal of physical therapy, 22(2), 105-109.

Ekegren, C. L., Miller, W. C., Celebrini, R. G., Eng, J. J., & Macintyre, D. L. (2009). Reliability and validity of observational risk screening in evaluating dynamic knee valgus. journal of orthopaedic & sports physical therapy, 39(9), 665-674.

Reiman, M. P., Bolgla, L. A., & Loudon, J. K. (2012). A literature review of studies evaluating gluteus maximus and gluteus medius activation during rehabilitation exercises. Physiotherapy theory and practice, 28(4), 257-268.

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.