Marjon Clinic – 22nd April 2021 for 4 hours

Within these four hours, I treated two clients face to face in clinic who I had seen previously. Both were making progress so I felt happy that I was able to influence and improve their pain.

Reflective Summary

My first client has been into clinic many times as he is recovering from post lumbar spine surgery. He has previously had stiffness within the cosotvertebral joints around the thoracic spine but this has improved after a few sessions of PA mobilisations. The pain has now moved to the right side just below the shoulder blade.This could be related to previous trauma where he fell onto his shoulder and fully torn the rotator cuff muscles. These types of tears can either be traumatic or degenerative (Pandey & Willems, 2015); in the clients case it could be a combination of these. Another concept to acknowledge, is that in some cases, those with chronic rotator cuff tears can have a loss of active range of motion (ROM) which is present with my client (Collin, Matsumura, Lädermann, Denard & Walch, 2014). Mobilisations of the shoulder can be used to improve range at a grade 3/4

As the athlete moves into the intermediate stages of rehabilitation, open and closed kinetic chain exercises can be implemented to improve strength of the muscles around the shoulder (Weiss, Wang, Hendel, Buzzerio & Rodeo, 2018). Open kinetic chain exercises are effective when isolated strengthening for specific muscles are required (Karandikar  & Vargas, 2011). Closed kinetic chain exercises such as a press up has been shown to generate higher muscle activation of the serratus anterior (Weiss, Wang, Hendel, Buzzerio & Rodeo, 2018). Similarly, closed kinetic chain exercises have been found to stimulate mechanoreceptors that recruit the stabilising muscles around the shoulder, allowing for adequate shoulder stabilisation (De Mey et al., 2014).

Open Kinetic chain exercises Closed kinetic chain exercises
Bicep curl Press ups
Bench press Plank
Lat pull-down
Chest fly
Triceps extension

My client had also been experiencing some knee pain although it is possible that it could be osteoarthritis as they have this in other joints. Treatment for osteoarthritis consists of strengthening exercises particularly for the quadriceps (Khan, Adili, Winemaker & Bhandari, 2018). Other management techniques include weight loss, modification of activity by reducing load and direct knee joint stress during movement.

Osteoarthritis is characterised by degeneration of the hyaline articular cartilage and changes in the underlying bone, the synovial membrane and other periarticular soft tissue structures such as ligaments and tendons (Beasley, 2012). Whereas rheumatoid arthritis is an inflammatory process that generally occurs in synovial tissue (Beasley, 2012).Osteoporosis is slightly different and results in bone loss and deterioration, a process that leads to reduced bone strength and an increased risk of fragility fractures (Bultink & Lems, 2013). Interestingly, osteoarthritis and osteoporosis are both considered heridatry however genetics can increase your chances of developing rheumatoid arthritis.

My second client had been experiencing non-specific lower back pain that appears to be psychosocial related. The client was surprised that small changes in diet and sleep has allowed the pain to be less intense. Slight modification with lifestyle related factors can also help to increase quality of life which is as important as we want to work with the whole patient, not just the injured site.

What Went Well

I conducted all the relevant special tests for the knee joint with my client and believe I completed them correctly. Furthermore, I also feel confident with my management techniques as the clients are both progressing.

Areas for Improvement Action plan
Become familiar with the positioning that is required for different joint mobilisations. Watch videos on mobilisations and practice when I get the chance to in clinic.
Ensure I am confident with using all the different equipment within the gym. Continue practicing with the different equipment when I am using the gym.

Closing the Loop

Since writing this reflection, I have practiced joint mobilisations ready for my exam. I have also continued to utilise the gym in order to perfect my technique and coaching points.

References

Bultink, I. E., & Lems, W. F. (2013). Osteoarthritis and osteoporosis: what is the overlap?. Current rheumatology reports, 15(5), 328.

Collin, P., Matsumura, N., Lädermann, A., Denard, P. J., & Walch, G. (2014). Relationship between massive chronic rotator cuff tear pattern and loss of active shoulder range of motion. Journal of shoulder and elbow surgery, 23(8), 1195-1202.

De Mey, K., Danneels, L., Cagnie, B., Borms, D., T’Jonck, Z., Van Damme, E., & Cools, A. M. (2014). Shoulder muscle activation levels during four closed kinetic chain exercises with and without Redcord slings. The Journal of Strength & Conditioning Research, 28(6), 1626-1635.

Karandikar, N., & Vargas, O. O. O. (2011). Kinetic chains: a review of the concept and its clinical applications. PM&R3(8), 739-745.

Khan, M., Adili, A., Winemaker, M., & Bhandari, M. (2018). Management of osteoarthritis of the knee in younger patients. Canadian Medical Association Journal, 190(3), E72-E79.

Pandey, V., & Willems, W. J. (2015). Rotator cuff tear: A detailed update. Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology, 2(1), 1-14.

Weiss, L. J., Wang, D., Hendel, M., Buzzerio, P., & Rodeo, S. A. (2018). Management of rotator cuff injuries in the elite athlete. Current Reviews in Musculoskeletal Medicine11(1), 102-112.

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