Marjon Clinic – 11th February 2021 for 2 hours

In this injury consultation, the client explained to us that they had been experiencing a cramping pain in the hip, that radiated to the quadriceps, hamstrings and heel of the left foot. After a thorough assessment, the clinical impression was that the muscles around the hip were in spasm.

Reflective Summary 

In the session, I had an interesting conversation with the client around the use of medication, specifically Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) for pain management. NSAIDs provide a good level of pain relief in acute conditions such as sprains, strains and overuse injuries (Derry, Moore, Gaskell, McIntyre & Wiffen, 2015), emphasising that they may be more beneficial to use in the early stages of injury, to alleviate symptoms and restore normal function (Schoenfeld, 2012). As my clients symptoms was not affecting activities of daily living, they wanted to fix the problem, rather than using NSAIDs as a temporary method to reduce pain.

It is suggested that strength training may play a role in the reduction of pain. A study by Nelson (2015) found that strength training was beneficial for the improvement of strength, functional outcomes and pain, although this study focussed on people with fibromyalgia; when I was searching for literature in this area, there appeared to be limited research on populations that experienced similar pain to my client. Although, if the client had inflammation in the hip joint, progressive strength training may help to reduce this, as well as pain, by down-regulating nocioceptor activity (Casartelli et al., 2016).

I prescribed the client strengthening exercises for the muscles around the hip including glute bridges, donkey kicks, side lying hip abduction, sit to stand and forward lunges. I specifically included glute bridges and side lying abduction into the programme because a study by Reiman, Bolgla & Loudon (2012) found that glute bridges resulted in moderate activation of the gluteus medius, whereas side lying hip abduction allows for moderate activation of the gluteus maximus and high activation of the gluteus medius.

We also educated the client on running cadence, which is the step rate or stride frequency per minute (Hafer, Freedman Silvernail, Hillstrom & Boyer, 2016). It is important to understand as previous work has documented that increasing running cadence can reduce mechanical deviation therefore decreased the liklehood of injury (Hafer, Brown, DeMille, Hillstrom & Garber, 2015). In uninjured runners, an increase in cadence results in a decrease in peak hip adduction angle, knee flexion angle at initial contact, knee extensor moment, vertical loading rate and energy absorption at the knee (Hafer et al., 2016). Therefore, the client could analyse their step rate to see if they can increase the number so they can adopt more of a mid strike pattern.

What Went Well

I felt confident when explaining to the client how they could manage their pain. I also encouraged them to ask questions throughout so they were engaged with the consultation.

Areas for Improvement Action Plan
Ensure I communicate and demonstrate active movements clearly. Next time I have an online consultation, ensure I take the lead when asking clients to perform the specific movements.
With any clients that are runners ask 1)where the tread has worn on their trainers 2) where they have areas of hard skin on their feet. When I am planning my next consultation, write in the notes as a reminder to ask these questions as it can help us to understand what type of ‘foot striker’ they are.

Closing the Loop

Since completing these hours, I have seen a lot more clients  therefore have practiced communicating and demonstrating clearly. I have not had many other appointment with runners, so have not had the opportunity to ask questions relating to foot strike.

References

Casartelli, N. C., Maffiuletti, N. A., Bizzini, M., Kelly, B. T., Naal, F. D., & Leunig, M. (2016). The management of symptomatic femoroacetabular impingement: what is the rationale for non-surgical treatment? British Journal of Sports Medicine, 50(9), 511–512.

Derry, S., Moore, R. A., Gaskell, H., McIntyre, M., & Wiffen, P. J. (2015). Topical NSAIDs for acute musculoskeletal pain in adults. Cochrane Database of Systematic Reviews, (6), 1-138.

Hafer, J. F., Brown, A. M., DeMille, P., Hillstrom, H. J., & Garber, C. E. (2015). The effect of a cadence retraining protocol on running biomechanics and efficiency: a pilot study. Journal of sports sciences, 33(7), 724-731.

Hafer, J. F., Freedman Silvernail, J., Hillstrom, H. J., & Boyer, K. A. (2016). Changes in coordination and its variability with an increase in running cadence. Journal of sports sciences, 34(15), 1388-1395.

Nelson, N. L. (2015). Muscle strengthening activities and fibromyalgia: a review of pain and strength outcomes. Journal of bodywork and movement therapies, 19(2), 370-376.

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 practice28(4), 257-268.

Schoenfeld, B. J. (2012). The Use of Nonsteroidal anti-inflammatory drugs for exercise-induced muscle damage. Sports medicine, 42(12), 1017-1028.

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