06 October – Marjon clinic. (4 hours) 2 clients

My first client today was a male aged 55 years who worked as a self-employed stage installer for the theatre Royal in Plymouth. During our consultation, he advised one year previously (20 Oct 2020) he had extreme low back and a right anterior thigh pain episode. During this period, he saw his GP who referred him for an MRI that he obtained in January 2021, which did not display any noticeable bone issues. He was then referred for physiotherapy at Derriford, which was cancelled (C-19), and when he eventually did attend Derriford (May 2021), he had a lot of trouble parking, and the sessions were noticeably short, hence he decided to try our clinic.

Post subjective assessment via observation via  functional gait assessment (Beninato, & Ludlow, 2016), which appeared normal, and active/passive ROM of legs, neck and entire back area, his thigh pain appeared to have resolved, but he was notably stiff in his neck area, and had highlighted how concerned he was about his stiff back at the end of the day, which he said was not painful, and enquired if this were normal or not, advising he had been given a few exercises by Derriford to do but could I show him different exercises.  I advised him I certainly could and would. During the session, I was aware the client was very tense; perhaps through MRI not identifying anything, as I’m aware patients with painful back injuries, which are extremely difficult to cure, are always looking for the cause, this and the constant stiffness in his back, hence, to calm things down, I advised him MRIs do not always highlight everything, and I asked if he could remember lifting anything last year, which may have brought the pain on, but he said it just gradually happened.  At this stage, my thoughts were leaning towards some type of early degenerative arthritis (osteoarthritis is most common), which was causing his stiffness, or his stiff neck may be impacting on his lower back, which felt very stiff at the end of the day.  I asked him if he had trouble sleeping at night, and he said he often did, hence I advised him it may assist if he tried a cervical, memory foam or feather pillow type, and to try and consciously retain a straight stature during the day; including his head upright where possible, to see if this assisted. The client appeared a bit more talkative after this, perhaps because this was new information, which provided hope, but regardless, it certainly lightened the mood of the consultation.

I conducted Effleurage followed by Petrissage on his neck and back followed by forward, lateral, and sternocleidomastoid neck stretches (Singh et al., 2021), and lower lumber rotation, lower back stretch, latissimus dorsa, cat stretch, lumber rotation and side stretch, advising the client he should try and conduct these stretches at least three times per day (3x 20-min sessions), which should assist in easing his stiff back over the course of 1-4 weeks (Schega et al., 2021). The client advised his lower back felt relaxed at this point, which he was incredibly happy about. I also discussed the benefits of stretching daily for everyone (Chilibeck, 2021), highlighting static, dynamic, Proprioceptive Neuromuscular Facilitation (PNF) and Muscle Energy Techniques (METs).  I finished the session advising the client he could return in 2-weeks if he wished (use booking system), where we would re-assess his condition, which he appeared grateful for.  This session started awkwardly from a communicative perspective but ended positively, although I am still not 100% certain I have pinpointed the real cause of his stiffness, however, as the client appeared to get some relief from the treatment and advice provided, at this stage I am satisfied I did all I could.

My final client today was at stage 3 recovery from a groin strain, caused playing pro professional football.  Progressive stretches and weighting exercises were performed in sets inclusive of straight leg standing groin stretch; seated groin stretch; hip flexor stretches and strengthening exercises via progressively stronger resistance bands; light kicking motions and squeezing various sized balls between legs; eccentric adduction, straight leg raises, hip adduction using chair and unsupported increasing difficulty and core strength exercises.  The client was progressing well minus any pain, but still needed more strength in his abductor muscles, hence I was careful not to push his recovery via too many loads hence used various Eccentric exercises using cables.  I was satisfied with this client’s progression, and having dealt with several groin strains previously, was acutely aware, too much loading at this stage was very dangerous, hence constantly advised the client to take things very slowly to enable us to move onto functional exercises in a week or so.  I am always slightly surprised when football players advise me, they rarely conduct specific abductor exercises for the sport, as through my limited experience treating such, appears to be the main cause of most groin injuries in football (Esteve et al., 2021).

References

Beninato, M., & Ludlow, L. H. (2016). The functional gait assessment in older adults: validation through Rasch modeling. Physical therapy, 96(4), 456-468.

Chilibeck, P. D. (2021). Response to “Commentary on: Stretching is Superior to Brisk

Walking for Reducing Blood Pressure in People With High–Normal Blood Pressure or Stage I Hypertension”. Journal of Physical Activity and Health, 18(4), 347-347.

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.

Schega, L., Kaps, B., Broscheid, K. C., Bielitzki, R., Behrens, M., Meiler, K., … &

Franke, J. (2021). Effects of a multimodal exercise intervention on physical and cognitive functions in patients with chronic low back pain (MultiMove): study protocol for a randomized controlled trial. BMC geriatrics, 21(1), 1-13.

Singh, R., Jagga, V., & Kaur, S. (2021). Effect of Combining Stretching and Strengthening Exercises of Neck Muscles in Forward Head Posture among Desk Job Operators. Asian Journal of Orthopaedic Research, 1-5.