23rd March. Duration: 4 hours (2 clients)
Supervisors: Alex and Mike
My first client was at the latter stage of recovery from an overuse injury via running, causing tibialis anterior tendinopathy. I conducted an examination using resisted dorsiflexion and resisted eccentric inversion. The client had no pain at the front of the ankle on either of these tests indicating the tibialis anterior tendon was healing well. I conducted a cross friction massage on the ankle area (Moshrif et al., 2020) followed by some resistance band exercises to both warmup & gently stretch the area before further stretching and strengthening exercises for the tibialis anterior muscle to increase the loads through the tendon. The client enjoyed the massage and resisted band work, which they had not done before (Robinson et al., 2020). From my own ballet experience, I believe resistance band work is underused and underrated, and as clients can conduct at home, should be incorporated more in rehabilitation. I conducted increasingly more resisted eccentric inversion on the impacted ankle, followed by some repeating foot raises in a sitting position to work the tibialis anterior muscle. I feel the client benefitted from what some may believe was too much pre-warm up exercises and stretching, but as this injury can easily repeat, I felt it necessary and to cut down the clinic time, I will advise the client to conduct pre-warm up stretching and exercises before attending in future. From experience I believe I am getting better at judging whether an individual is likely to conduct exercises at home from the in-session discussions we have, which I think is a good skill to attain.
My second client was recovering from a volar plate injury caused through a rugby ball bending his index finger (digitus secundus) back during training 7-weeks previously (Pattni et al., 2016). No avulsion fracture occurred, merely soft tissue. The client was no longer taping, but described she felt it was still a bit tender when bending the finger. I conducted STR around the hand and fingers followed by several myofascial exercises for hands & fingers (de Faria Santos et al., 2021). I had not conducted a lot of the myofascial exercises previously, and although simple, I believe it is adding to my learning, which is assisting me to offer the client alternative exercises, which they can safely do at home to increase recovery times. I will investigate alternative myofascial exercises, which clients may be able to do at home more.
References:
de Faria Santos, G., Cardoso, M. L., da Costa Cabral, V. R., de Azevedo, C. M., da
Silva, P. S., de Castro, J. B. P., & de Souza Vale, R. G. (2021). Acute effects of myofascial release and static stretching on handgrip strength in jiu-jitsu fighters. Sport Sciences for Health, 1-6.
Moshrif, A., Elwan, M., & Daifullah, O. S. (2020). Deep friction massage versus local
steroid injection for treatment of plantar fasciitis: a randomized controlled trial. Egyptian Rheumatology and Rehabilitation, 47(1), 1-5.
Pattni, A., Jones, M., & Gujral, S. (2016). Volar plate avulsion injury. Eplasty, 16.
Robinson, D., Mitchkash, M., Wasserman, L., & Tenforde, A. S. (2020). Nonsurgical
Approach in Management of Tibialis Posterior Tendinopathy With Combined Radial Shockwave and Foot Core Exercises: A Case Series. The Journal of Foot and Ankle Surgery, 59(5), 1058-1061.