9^th April. Duration:6 hours (4 clients)

My first online client was a 19-year-old female who explained she had redness and itching in her left ear after swimming in Plymouth sound during a charity swim. I asked the client if she had seen her GP yet, and she advised she had not.  I assessed her by looking at her ear for signs of cuts and saw none, nor inflammation on the screen.  I asked the client if she had any pain or had previously suffered from sore ears after swimming and she said no. I also asked if she had used ear buds to clean it out & she advised she had, but only tentatively as it was sore deeper inside.  She advised she had no hearing loss, but it felt a bit ‘bunged up’.  I also asked if she suffered from eczema, asthma, as through reading, I knew these could cause the sufferer to develop Otitis externa quicker, but she advised she did not.  I advised, I thought it may be swimmers’ ear (Fig. 1) known as Otitis externa (Aboutalebian et al., 2021) likely caught owing to dirty water entering her ear drum, and that it should clear up on its own, but she should try using an antibiotic ear drop (if not allergic) in liaison with her local chemist to determine the most suitable ointment.  I also thought it prudent to advise her she should seek GP assistance if her inner/outer ear started to get painful, or the swelling/rash got worse.  If I could do anything differently, post further research, I could have advised her to avoid further swimming whilst suffering, and when she returned to swimming, to try and keep her ears dry (wear a cap or ear plugs) and always immediately shower and dry off with clean towels.

Fig. 1: Swimmers Ear (Otitis externa):

I conducted a passive/active ROM test and advised she must progress gradually, as excessive loading will cause further injury, but provided further stretching exercises emphasising if pain is felt she should stop immediately:

1. Sitting on her heels, gently push down on the heels to feel a stretch the front of the lower leg, holding the stretch for 10 to 20 seconds and repeat 3 times.
2. To increase the stretch, do one leg at a time and lift the knee of the stretching leg.
3. Repeating foot raises in a sitting position to work the tibialis anterior muscle.
4. Various resistance band exercises

I felt this session went very well and advised the client we could conduct another assessment on her injury on a one-to-one session next week.  She agreed to this, and I have booked her in.  Although I was satisfied, with my advice on this call, I felt it would be best to bring her in and conduct a few tests (Star excursion balance; Single limb balance) to really gauge her progress (Karagiannakis et al., 2020).

My next two clients were military returnees, recuperating from lateral meniscus tears, last seen on 26^th March 2021.  Both clients had clearly been diligently conducting their provided exercises and informed me they were going to start conducting physiotherapy rehabilitation with their military counterpart, who had started doing sessions again, hence this would be their final session. I assessed both clients using passive/active ROM and conducted the Y Balance Test (Johnston et al., 2021) and as the clients were extremely keen, I decided to do the test as well as I knew they enjoyed team activities. This worked well.  Test results, were positive, indicating both clients’ mobility and strength were progressing, displaying they had kept to their progressive training schedule (Fig.2).  As the clients would be working with their military physiotherapist, I did not wish to push a further training schedule on them, so conducted some light plyometric exercises, and advised them to inform their military trainer to get in touch with me if he wished to see their Y-Balance Test results, and discuss training provided to date.  They were incredibly happy with this and finished the session on a high.