27th April. Duration:4 hours (2 clients)
My first client was a 23-year-old female rugby player who had been stamped on during a rugby ruck, around her right buttock, 3-days previously, and her trainer advised her to visit the clinic. She told me she had been using ice daily, and through observation, bruising was evident, but not excessive, and during passive ROM she advised the area still felt a bit stiff and in active ROM her glute muscles were slightly tender to touch, causing mild discomfort when sitting down. I was aware of contraindications with this injury, including hematoma (Burton et al., 2021), compartment syndrome (Jackson & Schreyer, 2021), Compartment Syndrome Symptoms; spondyloarthropathies (Kiratiseavee & Brent, 2004), tumour or Infections of bone and joint, however, given the injury history, symptoms and observations, I was satisfied this was mild to medium bruising, which would dissipate with continued ice treatment, rest and gentle stretching. In treating this client, I was aware she had some apprehension reference her injury, which although having taken knocks elsewhere, had never had a buttock injury, hence was worried hence, I constantly reassured her it would be fine. I conducted some gentle stretching of the gluteus maximus in the supine position (front & back) on both sides, including leg raises. I advised the client to continue with gentle exercises until pain free, when she should start loading the exercises with light weights on leg raises and/or use resistance bands, and to use a heat pad once all swelling has gone. I finished the session advising the client if she felt the bruising was getting worse or the pain was intensifying, then she should visit her GP. Having conducted pitch side support in rugby assisted me to communicate with this client, as I felt she was comfortable discussing her injury whilst talking about the sport, which she clearly loved. I have learned communications, in conjunction with sport knowledge and anatomy, is a vital part of sports therapy, which must constantly be improved to put the client at ease quickly, as this often encourages clients relax more, which can engender greater knowledge of their injuries and concerns.
My final client today was a 32-year-old male who was at stage 4 of recovery from a groin strain received playing football. The client advised he had suffered several groin strains over the past 10-years, which often indicates weak abductor muscles (Esteve ET AL., 2021; Serner et al., 2021). Through passive/active ROM the client had progressed significantly through phase 3 exercises (dynamic groin exercises with resistance band/cables and dynamic exercises involving movement against resistance) and had started functional exercises (side lunges/ wide leg squats using resistance bands (Beato et al., 2021). Having worked extensively with football teams in year one of the course, I felt confident providing a variety of functional exercises to enable this client to progress using progressive loading during strengthening and, proprioception training to improve awareness and balance. The client wished to progress quicker, but through gentle reminders reference his injury history, I was able to get him to focus more on building his abductor muscles through stretching and importantly progressive loading, as it was clear this was a weak area in his muscles, which had failed him several times. I believe being firm and honest with clients is often the best approach; particularly with younger clients, who often just want to get back playing and consequently have short-term goals. If I could have done anything differently, I would have asked the client what position he played, as this does have a bearing on specific exercises i.e., left or right of park and activity on the park. I will ensure I follow up with the client to determine this for his next session.
References
Beato, M., Maroto-Izquierdo, S., Turner, A. N., & Bishop, C. (2021). Implementing
strength training strategies for injury prevention in soccer: scientific rationale and methodological recommendations. International journal of sports physiology and performance, 16(3), 456-461.
Burton, H., Mossadegh, S., & McCarthy, R. (2021). Hockey: a pain in the butt!
Isolated superior gluteal artery rupture following blunt pelvic trauma–an unusual case. The Annals of The Royal College of Surgeons of England, 103(3), e91-e93.
Esteve, E., Casals, M., Saez, M., Rathleff, M. S., Clausen, M. B., Vicens-Bordas, J.,
… & Thorborg, K. (2021). Past-season, pre-season and in-season risk assessment of groin problems in male football players: a prospective full-season study. British Journal of Sports Medicine.
Jackson, J. R., & Schreyer, K. (2021). A Pain in the Butt: A Case Series of Gluteal
Compartment Syndrome. Clinical Practice and Cases in Emergency Medicine.
Kiratiseavee, S., & Brent, L. H. (2004). Spondyloarthropathies: Using presentation to
make the diagnosis. Cleveland clinic Journal of medicine, 71(3), 184-207
Serner, A., Hölmich, P., Tol, J. L., Thorborg, K., Lanzinger, S., Otten, R., … & Weir,
- (2021). Progression of Strength, Flexibility, and Palpation Pain During Rehabilitation of Athletes With Acute Adductor Injuries: A Prospective Cohort Study. journal of orthopaedic & sports physical therapy, 51(3), 126-134.