Date:10th November
Location: Marjon Clinic
Duration:3 Hours (3pm-6pm)
Supervisors: Alex & Mike
1ST hour: This patient was a previous patient who had a stage 3 lateral ankle sprain last time. I went through a full objective and subjective assessment and found that the patient was still not weight baring but was able t move his ankle. My supervisor did another subjective assessment on the patient and asked more specific questions about other possible issues and found possible sciatica and apprehension. I learnt from this that I need to ask more specific questions if things aren’t making sense. I took the patient onto the anti-gravity machine to try and give him the confidence to walk on his foot again. The set-up of the machine went well. I just had to have help from another practitioner to zip the shorts to the machine. The exercises I gave the patient were simple. I demonstrated them well and got him to repeat the movements and give tips on improving technique. This was good because I believe it gave the patient confidence in doing the exercises at home alone. I wish that I had taped his ankle again, but I completely forgot about it. I need to be more careful when things aren’t going well to make sure I still focus to remember what else could help.
2nd hour: This hour I I had free to write my notes up and research for my next clients. I managed to write up a small rehab plan to send over to the lateral ankle sprain patient. I got advice from my supervisors on seated calf raises which I had never thought of before and adding weight onto his knees in his hand for a progression exercise. I videoed the exercises as well and sent them over. my supervisor checked my technique for the exercises, which all was fine.
3rd hour: I had another previous client who I was treating for lower back pain. My supervisor got another practitioner who is doing a masters to take the objective and subjective assessment again to try and re-diagnose as the treatment for muscular pain with prescribed exercises and stretches was not working to reduce the pain, only the mobility of the patient. I took the notes while the other practitioner did this. She found her flexion was very limited and extension was limited and painful. The supervisor came in asked if we had done extension with overpressure. We hadn’t so she performed this and found that to be very painful. She then explained she believed it to be facet joint pain. She palpated the lower back area and believed it to be central facet joint dysfunction which is I found out caused by ‘Excessive rotation, extension, or flexion of the spine (repeated overuse) Strain of the lumbar facet joint is highest at end-range extension. The supervisor believed the condition to be apprehension as well about getting into a flexed position, so she gave her self-mobilisations at home to improve flexion. I found this interesting as it’s getting patients to get into positions slowly if they’re apprehensive and need more help to get into them, this was a great learning moment for me. The treatment we did was PA L4/L5 lateral mobilisations. The supervisor did the first 60 to show me before I did it. I was able to copy well as I have done this technique before. I found it best using the palm of the hand as that is less pressure than using the thumb, even though it’s harder to be in the right point. I was able to communicate well with my client to find the most appropriate pressure that didn’t cause too much pain. Because the pain was mainly on L5 we were doing the mobilisations on L4, so it wasn’t painful for the client. The supervisor explained to the client what exactly was facet joint dysfunction and how mobilisations can help, she did this using a model spine. I think this was really good for the client and put them in trust of the practitioner and the method of treatment. I will take this on and try and explain to my clients the mechanics if I feel they would be interested.