24th March. Duration: 5 hours (3 clients)
My first client was recovering from a rotator cuff injury in the form of a supraspinatus tear, caused through falling on his shoulder in a rugby game. The client was in the functional phase of recovery, hence after assessing his passive/active ROM, I focussed on increasing power and endurance to his upper body muscles to strengthen the shoulder joint using a combination of resistance bands, ball throwing and medicine ball exercises (Garibaldi et al., 2021; Kuhn et al., 2013; Levy et al., 2008). Having reviewed several rotator cuff injuries during, I feel I am becoming more familiar with their common idiosyncrasies, particularly the similarities with frozen shoulder and particularly in older patients, muscle atrophy. Familiarity with injuries; especially sports injuries, is beginning to bring me more confidence in my diagnosis and treatment competencies, which I am incredibly pleased about, as I know I am starting to exude this confidence to my clients.
My second and third clients were both dancers, suffering from GP diagnosed piriformis syndrome believed to be caused through dancing. From experience and having suffered from such in the past, I was relatively well informed and experienced to offer guidance, treatment and advice moving forward, which was a good feeling to have (Błażkiewicz et al., 2021; Cejudo et al., 2021; Jensen et al., 2019). I conducted the straight leg raise test, slump test and lying face down, checked to see if their piriformis had reduced ROM of the hip joint, especially internal hip rotation (rotating the thigh inwards), which can be an indication. Both dancers displayed signs of tight adductor muscles. Both dancers were provided STR to release the tension in their piriformis muscles, which really helped, followed by foam roller exercises. Both clients received some relief from the STR massage, which were followed by a Piriformis stretch, outer hip stretch, and long/short abductor stretches. If no pain is evident, strengthening using resistance bands, side lying clams and hip extension exercises will be provided. Experience informs me that piriformis syndrome is predominantly caused by repetitive movements, hence during recovery, these activities must be stopped. Having delivered this clinic to two young dancers, I am aware they will likely continue to suffer periodically from piriformis syndrome if they continue dancing, and hence informed them to really focus on flexibility and strengthening exercises as part of their daily routine. If I could do anything differently, I would have informed them to really take their time with the recovery, and not to despair, as from personal experience, I am well aware when dancers are injured, they often rush any injury recovery to return to dance.
References:
BŁAŻKIEWICZ, M. (2021). Joint loads and muscle force distribution during classical
and jazz pirouettes. Acta of Bioengineering & Biomechanics, 23(1).
Cejudo, A., Gómez-Lozano, S., Sainz de Baranda, P., Vargas-Macías, A., &
Santonja-Medina, F. (2021). Sagittal Integral Morphotype of Female Classical Ballet Dancers and Predictors of Sciatica and Low Back Pain. International Journal of Environmental Research and Public Health, 18(9), 5039.
Garibaldi, R., Altomare, D., Sconza, C., Kon, E., Castagna, A., Marcacci, M., … & Di
Matteo, B. (2021). Conservative management vs. surgical repair in degenerative rotator cuff tears: a systematic review and meta-analysis. European Review for Medical and Pharmacological Sciences, 25(2), 609-619.
Jensen, R. K., Kongsted, A., Kjaer, P., & Koes, B. (2019). Diagnosis and treatment
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Kuhn, J. E., Dunn, W. R., Sanders, R., An, Q., Baumgarten, K. M., Bishop, J. Y., … &
MOON Shoulder Group. (2013). Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study. Journal of shoulder and elbow surgery, 22(10), 1371-1379.
Matteo, B. (2021). Conservative management vs. surgical repair in degenerative
rotator cuff tears: a systematic review and meta-analysis. European Review for Medical and Pharmacological Sciences, 25(2), 609-619.
Levy, O., Mullett, H., Roberts, S., & Copeland, S. (2008). The role of anterior deltoid
reeducation in patients with massive irreparable degenerative rotator cuff tears. Journal of shoulder and elbow surgery, 17(6), 863-870.