Marjon Clinic – 12th May 2021 for 1 hour

Within this hour, I had my final client at Marjon Sport & Health Clinic, as I have now completed all of my clinical hours.

Reflective Summary

The client has had an achilles problem on and off for approximately ten years. This prompted the clinical impression of a degenerative tendinopathy. Cook and Purdum (2009) proposed a three-stage tendon continuum where the final stage (degenerative tendinopathy) occurs if continued load is applied to the tendon and tends to mean that changes are irreversible. Based off of the athletes subjective assessment, I believe this is where the tendon sits on the continuum as they have continued to load the tendon, especially as they compete in 400m and 800m track events at a regional level.

In many athletes who experience symptoms with this condition, US can be used to provide a clear image of structural abnormalities, such as localised tendon thickening and altered vascularity (McAuliffe, McCreesh, Culloty, Purtill & O’Sullivan, 2016). It would also be interesting for me to see how the tendon presents on a diagnostic ultrasound machine. Imaging can vary depending on which stage of the continuum the tendon is in; with a degenerative tendinopathy vascular changes can be seen on an US machine (Cook and Purdum, 2009).

Previous research has suggested that an isometric exercise reduces cortical muscle inhibition which could cause a reduction in pain. It exerts a generalised pain inhibitory response (Naugle, Fillingim & Riley, 2012). Despite these findings, clear evidence in support of this approach is lacking; in those with patellar tendinopathy there have been suggestion of immediate pain relief following both isometric and isotonic exercises (Silbernagel, Vicenzino, Rathleff & Thorborg, 2019). Therefore, the benefit of isometric exercise may be less related to an analgesic effect and more to do with decreased load during these types of exercise.

What Went Well

I conducted a thorough objective assessment and provided the appropriate management techniques based off of the results of this assessment. For example, I used the knee to wall test to assess dorsiflexion, which was reduced so within the exercise prescription self-mobilisation during a lunge was implemented to try and improve the range.

Areas for Improvement Action Plan
Could have used a clinical measure with the client to understand when improvements are being made. Revise a variety of clinical/outcome measures ready for my final clinical exam.
Continue filming/taking pictures of different exercises that I prescribe to clients. Once I have finished university, when I have my level 2 Gym Instructor and level 3 Personal Trainer I can begin to create rehabilitation resources and post on my professional Instagram.

Closing the Loop

Since writing this reflection, I have revised different outcome measures that can be used for a variety of common pathologies specifically relating to pain, function, range of movement and strength.

References 

Cook, J. L., & Purdam, C. R. (2009). Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. British Journal of Sports Medicine43(6), 409-416.

McAuliffe, S., McCreesh, K., Culloty, F., Purtill, H., & O’Sullivan, K. (2016). Can ultrasound imaging predict the development of Achilles and patellar tendinopathy? A systematic review and meta-analysis. British journal of Sports Medicine50(24), 1516-1523.

Naugle, K. M., Fillingim, R. B., & Riley III, J. L. (2012). A meta-analytic review of the hypoalgesic effects of exercise. The Journal of Pain13(12), 1139-1150.

Silbernagel, K. G., Vicenzino, B. T., Rathleff, M. S., & Thorborg, K. (2019). Isometric exercise for acute pain relief: is it relevant in tendinopathy management? British Journal of Sports Medicine. 53(21), 1330-1331.

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