11th May. Duration: 4 hours (2-clients)
My first client was an online appointment who was having trouble with their right hamstring and ‘felt’ they had possibly pulled it, but advised they were worried it was something more serious and wanted to get it checked. I tend to be more cautious when a client advises they are worried their injury may be something else, as it raises the possibility, they already know it is and are seeking more clarification or a second opinion or they may just be a naturally anxious individual.
I went through an assessment online that primarily consisted of assessing passive ROM of the lower leg, hip, and foot, comparing it with the clients’ uninjured side. It is always more difficult to gauge and record exact degrees of movement using visual means only online, which was not aided through a weak signal. However, I continued regardless and kept the communications positive throughout. I was keen to try and rule out a rupture, which although difficult identifying if there was a palpable gap and was unable to conduct a physical test by contraction of the muscle during a resistance test, which is usually painful with obvious weakness (Rolf, 2007). As I could not do this online, I booked my client in for a face-to-face appointment the next day with another clinician. I believe this appointment went well considering the circumstances and was satisfied I had done the right thing re-booking an appointment for the following day, given this client appeared very anxious. If I could do anything differently, I would ask more questions reference injury history, and tried to pinpoint the exact pain site to get more of an understanding reference level of injury the patient may be suffering from. I was terribly busy today, and feel I may have rushed the appointment slightly, which I must try not to do in future, regardless of other commitments, as the patients wellbeing is paramount (Visser et al., 2021).
My second client was face to face with a male hockey player aged 22, who thinks he may have pulled a groin muscle the previous day in a training session, when he went off, but then returned to play 10-min later minus warming up (Mason et al., 2021). I gathered as much history as I could, where he described the pain now as a throbbing mild discomfort, which came on straight away after sprinting, turning, and hitting the ball, where he experienced a sharp twinge on the inside of his right thigh, but little pain.
I assessed the injury by observation and conducted passive ROM whilst palpating the groin and thigh areas, where some tenderness was evident, and conducted active ROM tests on the hip and short groin muscles and resistance tests, which all indicated he had obtained a mild strain, likely in his abductor longus, where he was feeling most sensitivity (Serner et al., 2015). As the injury was less than 48-hrs old applied a cold pad for 10-min followed by an elastic adhesion bandage wrap, showing him how to apply the wrapping, starting, and finishing on the thigh muscle, informing him to keep applying ice for 10 minutes every hour initially, until his symptoms start to get better, which should be within 2-3 days. I informed the client I thought he had a grade 1 groin strain, and this this will help to stop any internal bleeding, reduce his pain and swelling to speed up the healing process. I was aware, he did not seem too keen on bandaging, hence advised he could also use compression shorts, which were not as good, but better than nothing. I informed the client to return in 3-days, where he would be assessed and if progressing, we would start a rehabilitation programme, inclusive of massage, but he must not exercise during this period, and get rest. If I could have done anything differently, I would have asked more questions about any previous injuries he had had, as if this was repeat injury, the grading may be incorrect, and his treatment would differ, hence I will ensure when he returns, I do this.
References
Mason, J., Wellmann, K., Groll, A., Braumann, K. M., Junge, A., Hollander, K., &
Zech, A. (2021). Game exposure, player characteristics, and neuromuscular performance influence injury risk in professional and youth field hockey players. Orthopaedic journal of sports medicine, 9(4), 2325967121995167
Rolf, C. (2007). The sports injuries handbook: diagnosis and management. A&C
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Serner, A., Tol, J. L., Jomaah, N., Weir, A., Whiteley, R., Thorborg, K., … & Hölmich,
- (2015). Diagnosis of acute groin injuries: a prospective study of 110 athletes. The American journal of sports medicine, 43(8), 1857-1864.
Visser, E., Den Oudsten, B. L., Traa, M. J., Gosens, T., & De Vries, J. (2021).
Patients’ experiences and wellbeing after injury: A focus group study. PLoS one, 16(1), e0245198.