3rd June 2021 Marjon clinic placement reflection
Supervisors: Alex and Mike
Hours: 6 hours (3 clients) `
My first client was a female and initially appeared to be quite a straightforward case however for some reason I spent an initial 10-minutes with this patient, and do not think took full control of this consultation as she was very chatty, and I found it hard adding structure to this. She had GP diagnosed plantar fasciitis and wanted to talk about treatment (Tseng et al., 2021). She had tried physio exercises previously, had NHS insoles fitted and was trying to lose weight but despite all of that she still was symptomatic. We discussed various treatment options available from our clinic, which she appeared keen on. She also enquired about the use of steroid injections, which I advised may assist, but she should try exercises and stretching in the first instance. I learnt from this session that this patient was quite anxious, I also learnt that I must be more forceful; in a nice way, with chatty patients, as my time is precious to all my scheduled patients, and to achieve this I must be more methodical and structured led, otherwise I will delay booked clients appointments. As I am still lacking in experience, I am certain I will be able to speed my diagnosis times through better use of communications and will ensure I take full advantage of joining in with more experienced supervisors to get more tips. I conducted stretching (Fig 1) in conjunction with palpation, toe curls with towel, marble pickups and resistance band exercises, advising client to continue these at home (Pinrattana et al., 2021)
Fig. 1 Plantar Facia Stretch
My second client was a female, 3- weeks away from having hip replacement surgery. The client had previously been working with another therapist who no longer required hours, hence stopped attending. My supervisors transferred the client to myself and another student therapist as a back-up should one of us be unable to do it one day.
We both greeted the client, who was thankful she was being looked after. I complimented her on her jewellery accessories; she had lots of flowers and butterfly pins on her, which I really liked, but I also wished her to feel comfortable, as we were new clinicians to her. When clients are swapped, I always feel it must be quite trying for the client having to meet new clinicians and personalities, so always go out my way to make them feel at ease. We immediately took her onto the anti-gravity machine as this is the only way she can bare weight, owing to pain levels in both her hips. She was able to put the suit on herself by flexing her hips, which I personally thought was quite impressive, considering she could not walk. I have learned through experience I am able to determine with some accuracy, if a client really wants to get better quickly, and this woman certainly fell into this category, as she had a lot of fight in her.
My clinician partner increased the gravity on the machine, and we constantly communicated with her reference speed etc, which went smoothly. During this treatment, we took the opportunity to discuss with the client more details reference hip history, and generally how she was feeling. This lady worked with disabled children in a school, however since she could not walk anymore, her employer told her not to attend anymore, which she was upset about. Clearly, I did not know all the details, but she was terribly upset about her situation, because she had good relationships with all the children, who were in wheelchairs. I consequently tried to make the conversation more positive after receiving this negative information, as I know how important it is for a patent to feel positive during recovery, as she was clearly feeling quite depressed (Lenzo et al., 2021). I moved the conversation onto her children and encouraged her to talk positively about them, whilst reassuring her that she will recover; I could tell she was feeling slightly vulnerable, which is completely understandable considering her present circumstances.
While she was walking, we continually checked her gait to ensure she was going through her foot and in a straight line. The client said because we had all been talking so much, she had forgotten that she was walking and felt her treatment went much quicker. I felt incredibly happy that I was able to help this lady in some way, even just through conversation. After a little while she advised she felt quite tired, and could we put it down, which we did. We got her to put the level down herself as we knew she was very capable of this, and it would be quicker, whilst she could also gauge her own comfort level. Unfortunately, I had to cut my time short with this client, as I had another client waiting, so I told her that I had to go and that it was genuinely nice meeting her. The other clinician carried on from there. I came away from this session feeling satisfied, that I may have helped by communicating more, but also slightly sad that this woman was in so much pain and distress, as I cannot imagine what it must be like waking up one day and not being able to walk, go into work or do anything she was previously used to. I really hope I can see her again, to assist her professionally.
My last client of the day was a pizza delivery driver complaining of pain in his lower back and down one leg. After the subjective assessment It sounded like he had sciatica and lower back pain. This was a different client than I was used to, as his health was sedentary, and visibly and verbally seemed to have given up on life a little bit, a bit depressed. I conducted an assessment on his joints; above and below, thoracic and hips. He had lots of pain in back movements and was very stiff in all ROM but advised this was normal for him.
The client was very nice, but clearly had poor hygiene standards, and smelled quite bad. I tried my hardest to ignore this and be as professional as I could, as I knew he had just got into bad habits, feeling down with his life, and appeared to be finding it hard to get motivated. I have no idea what has happened in his life, and he did not wish to discuss anything personal, which is perfectly acceptable as I am a stranger.
After my assessment, I advised my supervisors and they wished me to ask further questions that may assist. I did so, and my supervisor then came in to assist. My supervisor thought the symptoms were pointing towards a disc problem, and suggested we try repetitive movements to see if it eased the client’s pain. I had overlooked these movements, so my supervisor took charge and I observed. She first did repetitive prone lying hugging knees, then gentle cobra up and down, followed by a book under bum to relieve pain and finally a strengthening exercise for the core and hips, which was prone lying with alternate leg toe taps. She went through all of this slowly and made sure to get the client to do it with her whilst continually asking him how each movement felt and if it was helping. They all seemed to help, and he felt good about it.
Afterwards we went back to the clinic room and my supervisor had a talk with him about possibly going for some walks or exercise as previously when we asked him if he did any exercise, he responded that he was a pizza delivery driver and that was the only exercise he does, and on his one day off a week, he lies in his bed. My supervisor left and I continued the conversation with him asking if he liked music or podcasts and that he could listen to them whilst he walks, and perhaps he could set himself a short goal of walking at least once a week, as I advised him that will make a big difference. He seemed keen to do it, so I hope he does (Gable & Dreisbach, 2021). After this appointment I felt quite sad as I could see this man was in a bad state in life, and I found it quite emotional to see someone like that. I wished I could have done more for him, but I know that we did the best we could and hopefully we helped in some way giving him some exercises and advice. If I were to do this appointment again, I would have done a better subjective assessment as I skipped it a little bit as I could see he felt uncomfortable.
References
Gable, P. A., & Dreisbach, G. (2021). Approach motivation and positive affect. Current Opinion in Behavioral Sciences, 39, 203-208.
Lenzo, V., Quattropani, M. C., Sardella, A., Martino, G., & Bonanno, G. A. (2021).
Depression, anxiety, and stress among healthcare workers during the COVID-19 outbreak and relationships with expressive flexibility and context sensitivity. Frontiers in Psychology, 12, 348.
Pinrattana, S., Kanlayanaphotporn, R., & Pensri, P. (2021). Immediate and short-term
effects of kinesiotaping and lower extremity stretching on pain and disability in individuals with plantar fasciitis: a pilot randomized, controlled trial. Physiotherapy Theory and Practice, 1-12.
Tseng, W. C., Uy, J., Chiu, Y. H., Chen, W. S., & Vora, A. (2021). The Comparative
Effectiveness of Autologous Blood‐derived Products Versus Steroid Injections in Plantar Fasciitis: A Systematic Review and Meta‐analysis of Randomized Controlled Trials. PM&R, 13(1), 87-96.