Marjon Clinic – 10th May 2021 for 1.5 hours

Within these hours, I continue to make progress with a patient who is now ten week post lumbar spinal surgery. This has allowed my confidence to increase week in week out.

Reflective Summary

As the client had previously experienced sciatica from a disc herniation, they were worried that they now had a problem with the femoral nerve, due to the pain pattern in their thigh. The femoral nerve is the largest branch of the lumbar plexus (Astik & Dave, 2011) which is considered the collection of nerve roots from L1 to the L5/S1 disc space (Kepler, Bogner, Herzog & Huang, 2011). Conventionally the femoral nerve passes behind the inguinal ligament and divides into anterior and posterior divisions in the thigh (Astik & Dave, 2011). The prone knee bend test specifically places load on the upper/mid lumbar nerve roots (L2-L4) via movement of the femoral nerve during knee flexion (Trainor & Pinnington, 2011). A positive test is indicated when referred pain is produced before 90 degrees suggesting compression of the femoral nerve.

What Went Well 

The treatment that I performed, which included sot tissue massage and muscular energy techniques, appeared to be effective as the patient experienced the positive effects straight after the appointment finished. Moreover, as the client was a complex case, I believe that I came to the appropriate clinical impression as the treatment was beneficial which made be feel pleased.

Areas for Improvement Action Plan
Understand how to use the anti-gravity treadmill so I can utilise it within rehabilitation when required. Next time I am in the Sports Science Lab, ask one of the supervisors to show me how to use the equipment.
If the clinic supervisor suggests a clinical impression for a case, find out their rationale in order to understand fully. With my next client, if I have help and do not understand what they have suggested, ensure I ask lots of questions after the client has gone.

Closing the Loop

Since writing this reflection, I ensure that I fully understand the clients clinical impression, what treatment could be effective and WHY.

References

Astik, R. B., & Dave, U. H. (2011). Anatomical variations in formation and branching pattern of the femoral nerve in iliac fossa: a study in 64 human lumbar plexuses. People’s Journal of Scientific Research, 4(2), 14-19.

Kepler, C. K., Bogner, E. A., Herzog, R. J., & Huang, R. C. (2011). Anatomy of the psoas muscle and lumbar plexus with respect to the surgical approach for lateral transpsoas interbody fusion. European Spine Journal, 20(4), 550-556.

Trainor, K., & Pinnington, M. A. (2011). Reliability and diagnostic validity of the slump knee bend neurodynamic test for upper/mid lumbar nerve root compression: a pilot study. Physiotherapy, 97(1), 59-64.

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