Marjon Clinic – 5th May 2021 for 2 hours

During this clinical session, I had an appointment with a previous client who is now nine weeks post lumbar fusion surgery. The main aim of this session was to understand why the client is getting an achy pain on the medial side of the right knee that can become a shooting pain down the lateral shin.

Reflective Summary

In the appointment I felt quite overwhelmed as I was unsure what advice to give the client. Alongside this, I felt frustrated as I was not sure on a clinical impression as it was a complex case. I eventually came to the conclusion that it could be joint stiffness/mechanical restriction in the hip contributing to piriformis and quadricep tightness thus reducing muscle range of movement (ROM). This was because they had reduced ROM when externally rotating the hip when in neutral and at 90 degrees, as in both of these positions it is indicative of a more joint related pathology. After having a brief conversation at the end surrounding the clients gait I thought that they could have stiff knee gait. It is suggested in the literature that muscle overactivity can impair movement and function, particularly walking gait (Roche et al., 2019). Overactivity of the quadriceps and soleus during the late stance of gait is thought to reduce knee flexion velocity; more specifically, overactive quadriceps have been associated with stiff knee gait and may further elevate energy cost of walking (Lewek, Osborn & Wutzke, 2012).

What Went Well

Since revising anatomy, I understood the possible structures that could be affected based off of the client symptoms of pain. I was also pleased to hear that the client was content with previous shoulder issues which meant that my management strategies helped them to see an improvement.

Areas for Improvement Action Plan
Understand what the different movements at each joint test, in order to differentiate between muscle and joint. Revise and ensure I understand why a specific muscle does a particular movement.
Think about how exercises can be adapted for someone recovering from lower back surgery. Continue to review rehabilitation guidance for this type of surgery.

Closing the Loop

Since writing this reflection, I have started to revise what muscles allow for certain movements at joints. I have also reviewed the rehabilitation guidance for post lumbar fusion surgery.

References

Lewek, M. D., Osborn, A. J., & Wutzke, C. J. (2012). The influence of mechanically and physiologically imposed stiff-knee gait patterns on the energy cost of walking. Archives of physical medicine and rehabilitation, 93(1), 123-128.

Roche, N., Bonnyaud, C., Reynaud, V., Bensmail, D., Pradon, D., & Esquenazi, A. (2019). Motion analysis for the evaluation of muscle overactivity: a point of view. Annals of physical and rehabilitation medicine, 62(6), 442-452.

 

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