I spent this time in clinic, helping another student with a client who we initially thought had a lateral meniscus tear and also conducted an appointment with a previous client who presented with costovertebral dysfunction.
A virtual appointment had been previously completed with the first client (see reflection).To summarise, from the subjective assessment it sounded like a lateral meniscus tear, however all of the special tests that correspond to this pathology were negative. This prompted us to revaluate the clinical impression. Other common causes of lateral knee pain include lateral collateral ligament sprain, patellofemoral dysfunction, biceps femoris tendonitis and iliotibial band syndrome (Winslow, 2014).
When observing the clients squat, we noticed that they lifted there heels off the ground, as they got deeper into the squat position. This suggested that dorsiflexion range of movement (ROM) was reduced therefore exercises such as self ankle mobilisations and heel lowers were used to increased this range at the ankle. Ankle dorsiflexion is essential during terminal stance of gait, if reduced in can affect kinetic and kinematics at the knee and cause problems further up the kinetic chain (Ota et al., 2014). There is an abundance of literature validating the effective of strengthening and aerobic conditioning programmes in managing knee pain (Chirichella et al., 2019). Because of this isometric quad exercise, terminal extensions, clamshells, side lying abductions and crab walks were all prescribed.
My second client had been into clinic previously (see reflection).I was thrilled to hear that she no longer had any pain in the thoracic region which implies that a combination of manual therapy and mobility exercises worked. However, they were now experiencing a sharp pain in both sides of the lower back. After completing a thorough objective assessment including ROM, palpations and special tests, it was considered to be non-specific lower back pain. This term is used when the pathoanatomical cause of pain cannot be determined (Maher, Underwood & Buchbinder, 2017). It is suggested that the onset and course of pain are influenced by stress (Crettaz et al., 2013) which is apparent with this client as they described their stress levels as high.
What Went Well
I feel happy with my progress regarding the completion of the subjective and objective assessment. I need to continue to work on devising clinical impressions based off of the assessment information with a rationale for why.
|Areas for Improvement||Action Plan|
|Need to understand the anatomy of the body to help differentiate between different clinical impressions.||Over Easter begin to revise anatomy.|
|What abnormalities could be seen in specific functional movements||Find out what areas of the body we need to watch for any abnormalities when conducting functional movements|
Closing the Loop
Since writing this reflection, I have began to revise anatomy in order to develop my understanding further.
Chirichella, P. S., Jow, S., Iacono, S., Wey, H. E., & Malanga, G. A. (2019). Treatment of knee meniscus pathology: rehabilitation, surgery, and orthobiologics. PM&R, 11(3), 292-308.
Crettaz, B., Marziniak, M., Willeke, P., Young, P., Hellhammer, D., Stumpf, A., & Burgmer, M. (2013). Stress-induced allodynia–evidence of increased pain sensitivity in healthy humans and patients with chronic pain after experimentally induced psychosocial stress. PloS one, 8(8), e69460.
Maher, C., Underwood, M., & Buchbinder, R. (2017). Non-specific low back pain. The Lancet, 389(10070), 736-747.
Ota, S., Ueda, M., Aimoto, K., Suzuki, Y., & Sigward, S. M. (2014). Acute influence of restricted ankle dorsiflexion angle on knee joint mechanics during gait. The Knee, 21(3), 669-675.
Winslow, J. (2014). Treatment of lateral knee pain using soft tissue mobilization in four female triathletes. International journal of therapeutic massage & bodywork, 7(3), 25-31.