1st December – Marjon clinic. (5 hours) 3 clients
My first client today was recovering from heel pain (plantar fasciitis) on their right foot, caused through running, which occurred 3-weeks previous (Hamstra-Wright et al, 2021). Taping was being used to support the arch of their foot, and today post rehab. I would replace the tape. The patient was using orthotic insoles, which she advised was helping to ease the pain especially when first walking on it as she was previously diagnosed as overpronating. During palpation from her heel (calcaneus) to forefoot, she still had some slight tenderness in the arch of her foot during passive ROM. I enquired if she was using a night splint (Fig 2), but she was not.
Fig.1 Plantar Faciitis
Post removing existing tape I provided STR to calf area, which was still relatively tight before conducting various stretching and strengthening exercises (Fig.2) before reapplying the tape (Mettler (2021). The patient was sweating quite a bit hence I cleaned and dried the area and applied adhesive spray, which assisted although the tape was still not sticking properly! During taping I asked patent if they were icing daily and conducting frequent stretches, which they advised they sometimes forgot. I reiterated the importance of stretching and icing with this injury to aid recovery but also prevent further damage.
Fig. 2: Plantar Fasciitis Stretches (Gastrocnemius & Soleus Muscles)
Although I felt I gave the patient the correct advice, it is always their prerogative reference implementing, and in this case, I was genuinely worried they were not doing all they could to prevent an escalation. The patient advised she was a single mum and terribly busy with two kids of school age, which took up a lot of her time. With this knowledge, I felt a bit guilty as I think she went into a bit of a defensive mode (work/life balance), hence I quickly changed tactics and offered more supportive advice, where she could involve her children in her treatment by getting them to join in during bath times etc. She liked this idea, and thankfully I believe I made a regain of sorts, which put her more at ease. I will take more time to listen to my patients, be patient centred and perhaps not ask so many probing questions in the future, as although this situation worked out satisfactory, I could so easily have inadvertently made the patient feel awkward from my appearing too judgemental, and although this certainly was not my intention, I think I strayed into dangerous territory, which I should have known better not to do as Givron & Desseilles, (2021) advocated. I have really learned from this slightly negative experience.
My second and third clients today were male footballers who had recently started stage 5 rehabilitation for grade 2 groin strains (Guy & Wagner 2021), evidenced through their previous 3 sessions ability to perform 3 sets x 6 reps side lunges and squats pain-free where they did not have any pain. Functional exercises are always good to do with patients, as I find the patients mood has almost always notably raised in expectation of returning full time to their chosen sport or pastimes. These tow players were no different, and we were able to work through various stretching and loaded strengthening exercises minus difficulties.
I really feel I have learned so much over these last three years, particularly about patient and practitioner communications (Thompson et al., 2021), which on reflection (Paterson & Phillips, 2021) has been almost if not more enlightening than the physical aspects of anatomy and physiology study. Putting theory into practice on the sports field and within a clinical environment has taught me so much about the human psyche, without such, I doubt sports therapists would be able to operate effectively. I will endeavour to keep learning, as I have come to learn good communications is a large part of being an effective practitioner.
References
Givron, H., & Desseilles, M. (2021). The role of emotional competencies in predicting
medical students’ attitudes towards communication skills training. Patient Education and Counseling.
Guy, J., & Wagner, A. (2021). Muscle Strains in Football. In Football Injuries (pp. 107-
120). Springer, Cham
Hamstra-Wright, K. L., Huxel Bliven, K. C., Bay, R. C., & Aydemir, B. (2021). Risk
Factors for Plantar Fasciitis in Physically Active Individuals: A Systematic Review and Meta-analysis. Sports Health, 13(3), 296-303.
Mettler, J. H. (2021). Strain estimations of the plantar fascia and other ligaments of
the foot: Implications for plantar fasciitis (Doctoral dissertation, Iowa State University).
Paterson, C., & Phillips, N. (2021). Developing Sports Physiotherapy Expertise–The
Value of Informal Learning. International Journal of Sports Physical Therapy, 16(3), 959.
Thompson, J., Gabriel, L., Yoward, S., & Dawson, P. (2021). The advanced
practitioners’ perspective. Exploring the decision‐making process between musculoskeletal advanced practitioners and their patients: An interpretive phenomenological study. Musculoskeletal Care
