30 April. Duration: 6 hours (4 clients)

I paired up with another clinician for my first client today who was in the late stages of recovery from an adductor strain. We assessed his passive/active ROM before the rehabilitation session to gauge progress. Previously angles had been recorded; using eye judgement, for the patient’s knee flexion and lying abductor flexibility, and we noted a difference of approximately 5-degrees today. I agree eye judgements for angles can be used depending on the individuals experience, as from personal dance experience, I am used to using angles for foot and hand placements, hence I am personally proficient at making accurate angle judgements, but of course if complete accuracy is required a double-armed goniometer, gravity-based inclinometers or increasingly smart phone technology should be used (Shin et al., 2012).

*Ranges are for people of all ages. Age-specific ranges have not been established; however, values are typically lower in fully functional elderly people than in younger people. Extension beyond midline

Fig. 1 A selection of ROM Angles

Through research, I found this site particularly useful for a starting point (URL link here): Normal Values for Range of Motion of Joints*  (Fig. 1). After recording the angles of ROM and discussing improvements, we chatted to the client who was incredibly happy with his progress.

I believe this is a good way to relay information, as it helps the client’s motivation to provide short term goals and achieving them. Rehabilitation followed using the Aspetar protocol (URL link here): Aspetar protocol .

The session went well, and we provided lots of encouragement and observed the client ensuring their technique was correct. I think it is important to constantly provide positive feedback to clients throughout their session, even when things may not be going well for the client.  After the last session, we decided the client may benefit listening to music with a beat to assist him with the rhythm during agility work with the ladder (Silva et al., 2021). This worked well and did help him improve and importantly relax and appeared to help with the apprehension he exuded during the previous session.  I did not ask the client, but I should have done, as I believe the music made distracted him enough minus impacting on the exercise, as it came more naturally to him, assisting his nervousness. If the client does not mind, I will use music with these types of exercises after seeing how well it assisted this client.

If I could do anything differently, I would have conducted more stretching at the end of the session, as I felt we did not do enough, as the client was in a rush to leave for another commitment. We could have planned the timing of the session allowing more time for the cool down stretches, as this is an important part of rehabilitation.

I will also use my watch alarm more, to alert me via prompts where I should be in the session, allowing ample time for a proper cool down in the future.

The next female client was via an online consultation who described having pain in her feet when exercising. I enquired about her footwear, as from experience, I know this is often a simple but disregarded element in fitness training, and therefore an important part in the diagnostics. The client advised she had been running in air max trainers for the last few months, which from personal knowledge, are not designed as a running shoe; although are marketed as such, and most probably did not give the client the support she needs. Difficulties looking at the client’s feet online, prohibited a proper examination, as I wished to see if the client had flat feet, as this is risk factor for plantar fasciitis (Neufeld & Cerrato, 2008).

The client was reluctant to show me her feet online, she did not say this, but I could tell by her mannerisms she felt uncomfortable when showing me initially. So, I did not labour on this, rather I spoke to her and conducted a subjective assessment. I think I did well to notice and acknowledge my patient’s feelings and adapted the appointment to suit her requirements. I believe it is important to take note of the client’s demeanour, as often by saying the wrong thing, could prevent them from seeking help, hence if it takes a bit longer with the diagnosis, so be it. I booked her in for a face-to-face appointment and suggested she elevate her foot as much as possible at rest and use PRICE. I also tentatively suggested she think about investing in properly supported running shoes. The client seemed happy with the suggestions. I will assess the clients foot mechanics and conduct a full lower body assessment at the next appointment. If I could have done anything different, I would have taken more time, as I feel I slightly rushed the appointment as I was personally feeling slightly anxious on this day, perhaps caused through having to discuss this online with the client rather than face to face, which I always feel lacks the personal touch.

The next client was a face-to-face appointment with a client recovering from an ankle sprain. They were in later stages of rehabilitation and a client of another clinician that unfortunately could not make it that day.  I reviewed the previous notes of the client and talked to my supervisor about their progress to plan the rehabilitation session, accordingly, negating a requirement for the client to explain everything to me, which I know may have frustrated them slightly causing demotivation, and regardless, it was the professional approach to take. With the client I went predominantly focussed on strengthening and proprioception work.

My favourite rehabilitation methodology is proprioception, which I find interesting, believing it is such an amazing skill to acquire with several challenges requiring focus to achieve aims (Khorjahani et al., 2021).  I planned the session starting with a passive/active ROM followed by a warmup, strength, mostly utilising the assisted squat machine, with calf raises and loading weights appropriately for the client’s ability. I ensured I was careful not to overload, but also use enough loading to achieve progress. I did not find this hard to do as I communicated well with the client and loaded the weights slowly to find the perfect load. I added tempo with the calf raises to progress the exercise as my client was very capable and had zero pain.

I moved onto proprioception and worked up to the unstable surface to make sure the client was ready to add the bosu-ball to their balances (Wang et al, 2021).  She was ready and once on the ball, she was very wobbly, but I was able to talk her through techniques to help her, which improved her balance in a short space of time. I did this through telling her to hold her core, find a spot on the wall to focus on and keep her body engaged but relaxed. Although it took longer than expected for my client to understand and comprehend what I was saying, she eventually grasped it. I believe I maintained good patience throughout this. I will work on finding a simpler explanation reference these techniques before the client attempts an unstable surface, to give them more confidence. I have noted this down and will try a different approach next time. Overall, the session went well, and I was pleased with how calm I remained during the session (Lucre & Clapton, 2021).

My final client was an online appointment with a 45-year-old male who informed me he was a long-distance runner. He explained he had noticed a slight swelling at the back of his knee, which he felt was stiffening up restricting his mobility. He said it was not particularly painful, but he had never felt this before, although he had had several knee injuries in the past.  I got the client to show me the site of the swelling (right leg) against his left leg, and although slight, I could see some swelling. I informed the client to perform PRICE on the site of the injury at this juncture, and rest as much as possible.  I booked him in for a face-to-face appointment in 2-days’ time, during which I would perform a full assessment.  I thought it prudent to inform the client there were several potential causes (popliteal cyst, underlying knee injury, such as meniscus, arthritis etc), to give him some confidence in my abilities.  I was also aware it may be a tumour or aneurysm hence although I did not relay this to the client, I advised him if he felt it was getting worse, had painful swelling, tingling or numbness anywhere, he should seek advice from his local GP or attend A&E in the first instance.   If I could have done anything different, I would ask the client if he was on any medical prescriptions related to blood disorders and have tried a bit harder to get the client in for a one-to-one check-up quicker, but he was adamant he was unavailable for 2-days.

References

Khorjahani, A., Mirmoezzi, M., Bagheri, M., & Kalantariyan, M. (2021). Effects of

TRX Suspension Training on Proprioception and Muscle Strength in Female Athletes with Functional Ankle Instability. Asian Journal of Sports Medicine, 12(2).

Lucre, K., & Clapton, N. (2021). The Compassionate Kitbag: A creative and

integrative approach to compassion‐focused therapy. Psychology and Psychotherapy: Theory, Research and Practice, 94, 497-516.

Neufeld, S. K., & Cerrato, R. (2008). Plantar fasciitis: evaluation and

treatment. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 16(6), 338-346.

Silva, N. R. D. S., Rizardi, F. G., Fujita, R. A., Villalba, M. M., & Gomes, M. M.

(2021). Preferred music genre benefits during strength tests: Increased maximal strength and strength-endurance and reduced perceived exertion. Perceptual and Motor Skills, 128(1), 324-337.

Wang, H., Yu, H., Kim, Y. H., & Kan, W. (2021). Comparison of the Effect of

Resistance and Balance Training on Isokinetic Eversion Strength, Dynamic Balance, Hop Test, and Ankle Score in Ankle Sprain. Life, 11(4), 307.