Within these four hours, I had an online consultation with a client who had lower back pain; this required me to plan the session, lead the appointment and prescribe exercises. I also researched exercises for the early rehabilitation stage of a rotator cuff injury such as a tendinopathy.

Reflective Summary

My client had no specific pain patterns when performing active movements which may suggest that  they have non-specific lower back pain. This problem is described as lower back pain which is not attributed to a recognisable known specific pathology such as a fracture, osteoporosis or radicular syndrome (Balagué, Mannion, Pellisé & Cedraschi, 2012). It is important to be aware of, as the point prevalence for this condition is 18%, so emphasises that it is prevalent in a large proportion of the population (Oliveira et al., 2018).The management of non-specific lower back pain typically consists of education and reassurance, non-pharmacological therapies and ensuring reviews are completed (Maher, Underwood & Buchbinder, 2017). I gave the client mobility and strengthening exercises for the lower back, in hope that it would decrease their pain and improve range of movement. Moreover, I also gave the client some important advice on how they could get the most out of walking, especially as they do not enjoy running. This included incorporating short bursts of faster walking, walking up gradients (and repeating) and exaggerating the swing of their arms. Once my clients pain has decreased, I could implement resistance training into their exercise schedule, especially as they have access to resistance bands.

The client also explained that they had previously tried Bowen Therapy to help with their symptoms but did not find it useful. Bowen Therapy is a form of soft tissue manipulation, that is commonly used to treat musculoskeletal conditions (Lee & Lewis, 2020); gentle pressure movements are applied with the thumbs and fingers onto specific muscles, tendons and ligaments (Gustafson, 2016). Despite this type of treatment being increasingly sought after by clients for pain relief, relaxation and postural support, there is very limited high-quality research examining the effects of Bowen Therapy (Lee & Lewis, 2020).

I wanted to focus on exercises for an early stage rotator cuff injury, as I have not had a chance to work with this condition, despite it being common; rotator cuff injuries are one of the most prevalent  musculoskeletal pathologies and are a major cause of shoulder pain, weakness and loss of range of movement (ROM) (McMahon, Prasad & Francis, 2014). The condition approximately affects 30-50% of the population, specifically in those aged 50 and older, so emphasises its high prevalence (Longo et al., 2019). Exercises which I would include in the early stages are isometric shoulder contractions (in the movement that is painful), posterior capsule stretching, pendulum swings and shoulder movements with a stick. These exercises should help decrease pain and improve range of motion.

What Went Well

I felt that I asked all the relevant questions with regards to the subjective assessment and was able to adapt parts of the objective assessment in order to find out as much information as I could. I demonstrated the movements that I wanted the client to perform and clearly communicated the position that I wanted them to be in. This can be hard online if internet connection becomes interrupted, although I have learnt to adapt and stay calm.

Areas for Improvement	Action Plan
Find out more information on alternative treatment that clients may have had previously, to help with their symptoms	Create a mind map of the different alternative therapies including what is it, what it does and who may use it
Continue to research exercises used in different rehab stages for specific injuries	Once done the research, add to current resource which contains a description of the exercise and what it can be used for.
Always consider that lifestyle factors may influence the patient’s symptoms	When planning the session, as a reminder, write down the questions that need to be asked regarding sleep, stress, diet, alcohol and smoking

Closing the Loop

Since these hours, I have not had a chance to research other alternative therapies, although once I have graduated, I will have more time to do extra continuing professional development (CPD), possibly on alternative treatment. My exercise prescription document is growing and in recent injury consultations I have always considered the patients lifestyle factors and how this can be incorporated into the treatment, ensuring I think about the patient as a whole, not just the area of pain.

References

Balagué, F., Mannion, A. F., Pellisé, F., & Cedraschi, C. (2012). Non-specific low back pain. The lancet, 379(9814), 482-491.

Gustafson, S. L. (2016). Bowenwork for migraine relief: a case report. International journal of therapeutic massage & bodywork, 9(1), 19.

Lee, K., & Lewis, G. N. (2020). Short term relief of multisite chronicpain with Bowen Therapy: A double-blind, randomized controlled trial. Journal of Bodywork and Movement Therapies, 24(4), 271-279.

Longo, U. G., Candela, V., Berton, A., Salvatore, G., Guarnieri, A., DeAngelis, J., … & Denaro, V. (2019). Genetic basis of rotator cuff injury: a systematic review. BMC Medical Genetics, 20(1), 149.

Maher, C., Underwood, M., & Buchbinder, R. (2017). Non-specific low back pain. The Lancet, 389(10070), 736-747.

McMahon, P. J., Prasad, A., & Francis, K. A. (2014). What is the prevalence of senior-athlete rotator cuff injuries and are they associated with pain and dysfunction? Clinical Orthopaedics and Related Research®, 472(8), 2427-2432.

Oliveira, C. B., Maher, C. G., Pinto, R. Z., Traeger, A. C., Lin, C. W. C., Chenot, J. F., … & Koes, B. W. (2018). Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. European Spine Journal, 27(11), 2791-2803.