During the three hours, I completed an injury consultation with a previous client, wrote the notes up after and sent out the relevant information which we discussed in the appointment.

Reflective Summary

In the session, the client explained that they are generally happy with their progress and wanted to know how they could increase their running distance, as they have signed up for a half marathon in July. Furthermore, my client also wanted some advice on how to manage Medial Tibial Stress Syndrome (MTSS).

With regards to the exercises, in the consultation, I explained to the client how they could be progressed and made more running specific. The exercises that I wanted her to work on for the next few weeks were single leg glute bridges, jump squats, reverse lunge knee drives and calf raises. It has been suggested that increasing the strength and endurance of the deep and superficial posterior compartments are essential, in order to prevent muscle fatigue related bone stress in those with MTSS (Pietrzak., 2014). Similarly, it is important to strengthen this compartment, so that there is less force going through the tibia. This is why calf raises have been included. Additionally, increasing the strength of the glutes and hips can improve running mechanics and decrease lower limb injuries, both of which are important to my client.

MTSS is considered an exercise-induced pain that is present along the posteromedial tibial border and can be identified if there is pain on palpation over the length of the border for more than 5cm (Winters, 2018).Moreover, It has been identified as the most common running related musculoskeletal injury with an incidence rate ranging from 13.6% to 20.0% and a prevalence of 9.5% (Lohrer, Malliaropoulos,Korakakis & Padhiar, 2019).

What Went Well

I was happy to hear that the clients hip pain was less intense and frequent; this increased my confidence further as it suggests that the exercises that I gave her initially, had worked. Furthermore, I was able to progress the programme by prescribing exercises that were more running related so could not only help with the hip pain but her running as well. Finally, I believe that I completed the notes to a good standard, as I ensured that I added extra information which was discussed into the treatment section such as running cadence and activity modification.

Areas for Improvement	Action Plan
Could have reassessed range of motion (ROM) to see if improvements had been made since the last appointment.	Next time I have a client, ensure I use other clinical measure other than pain to assess progress.
Find out more information on running related injuries (a lot of clients that I see tend to be runners).	Research this area further and find out how injuries can be prevented in the first place such as adjusting running cadence.

Closing the Loop

Since writing this reflection, I have ensured that I have used a range of clinical measures such as pain, ROM and rated perceived exertion (REP) scale. Furthermore, for certain common pathologies, I have researched questionnaires that could be used to evaluate progress through each of the stages of rehabilitation. For example, the patient rated tennis elbow evaluation (PRTEE) can be used to access function in those with tennis elbow. Similarly, the Cumberland Ankle Instability Tool (CAIT) can be utilised for clients with ankle instability which is common after recurrent sprains.

References

Lohrer, H., Malliaropoulos, N., Korakakis, V., & Padhiar, N. (2019). Exercise-induced leg pain in athletes: diagnostic, assessment, and management strategies. The Physician and sportsmedicine, 47(1), 47-59.

Pietrzak, M. (2014). Diagnosis and management of acute medial tibial stress syndrome in a 15 year old female surf lifesaving competitor. International journal of sports physical therapy, 9(4), 525.

Winters, M., Bakker, E. W. P., Moen, M. H., Barten, C. C., Teeuwen, R., & Weir, A. (2018). Medial tibial stress syndrome can be diagnosed reliably using history and physical examination. British Journal of Sports Medicine, 52(19), 1267-1272.