Where? Marjon clinic

Description- what happened?

I took scat tests for most of the team B bucs basketball

Feelings-what were you thinking feeling?

I was feeling more confident than last time as I had experience now. I made sure no one else was in the room and that they felt comfortable. I believe I got each player to be as honest as possible and took effective Scat tests.

Where? Marjon basketball court

Description- what happened?

Before practice I gave one of the players a soft tissue back massage, mainly on their trapezius and levator scapula muscles, they just had muscle tightness from overuse. I used effleurage and pettrisage techniques. Another player needed back manipulations, I did this on his L2 and 3 centrally using PA. I got a player who was complaining of calf tightness to use a foam roller before I taped his gastrocnemius muscle using K-Tape as he was complaining of pain in his calf and wanted some extra relief for practice. During practice a player rolled over on his ankle (plantar flexed and inversion) I immediately got him to ice and elevate it. after practice he said it was feeling much better and the swelling had gone down a-lot, I believe it was a very acute injury and will be able to continue exercise in a few days again, after examination and cleared. After practice I gave the player with Piriformis syndrome Piriformis soft tissue release.

Feelings-what were you thinking feeling?

I felt confident giving the player a back massage and believe my treatment was effective. I was able to perform the manipulations at grade 3 (grade 3-4 are passive movement that move up to the point of resistance)-https://www.wrightpt.com/physical-therapy-and-joint-manipulation/

As I did not have time to give the player complaining of calf tightness a massage I got him to use a foam roller, I quickly showed him how to perform foam rolling safely and effectively. I believe in foam rolling even though theirs lots of contradicting research. I found a paper that explained it was determined that an acute bout of foam rolling is an effective method of increasing range of motion (Peacock, Krein, Silver, Sanders, & Carlowitz, 2014).When taping his calf I used two strips of tape at a 10% stretch from his head of fibula and tibula down to the Achilles and then a strip of tape along the site of pain. I smoothed it down well and used the before spray. The tape did not come off during practice and the player said he felt it helped him perform better without as much pain during practice. I felt confident performing soft tissue Piriformis release.

Conclusion- what else could you have done?

I didn’t want to make the player who hurt his ankle move it too much as he had just sustained the injury and I didn’t want to make it worse. I will assess the ankle tomorrow properly to see the verdict.

References:

Peacock, C. A., Krein, D. D., Silver, T. A., Sanders, G. J., & Von Carlowitz, K. P. A. (2014). An acute bout of self-myofascial release in the form of foam rolling improves performance testing. International journal of exercise science, 7(3), 202.

Where? Marjon basketball court

Description- what happened?

I gave one of the player as a soft tissue massage before practise on his legs as he has been partaking in heavy resistance leg training more than usual and has DOMS (delayed onset muscles soreness) Gentle massage has been shown in research studies to provide a reduction in the duration and severity of DOMS. (Valle et al 2014, Hill et al 2013, Nelson N. 2014.) However, deep tissue massage should be avoided during the first 24 hours. Excessive muscle stretching in this early phase should also be avoided.  https://physioworks.com.au/injuries-conditions-1/doms-delayed-onset-muscle-soreness Because it had been longer than 24 hours since the player had lifted weights I was able to perform PNF stretching with the player to improve hamstring ROM. Proprioceptive Neuromuscular Facilitation (PNF) is a stretching technique utilized to improve muscle elasticity and has been shown to have a positive effect on active and passive range of motions (Funk 2003; Lucas and Koslow, 1984; Wallin et al., 1985). However we did this after his practice as it has been proven from research that PNF stretching can decrease  strength and power when done prior to high intensity and maximal effort exercises, such as jumping, plyometrics, sprinting, cutting, and other similar movements. These effects can last longer than ninety minutes (Hindle, Whitcomb, Briggs & Hong, 2012). I took the warm up also, I counted the amount of reps aloud this time, as I believe it is more motivating when everyone does the exercises at the same time.

Feelings-what were you thinking feeling?

I felt confident with my soft tissue massage. The player didn’t want me to go too deep as he was about to practice. I also felt confident helping the player with PNF stretching, I really made him focus on his breathing and he said that this was useful in helping him relax more into the stretch. In the warm up not everyone did the reps at the same time that I was counting so I don’t think they particularly liked me counting, but I’m glad I tried it.

Conclusion- what else could you have done?

I only did PNF stretching on the players hamstrings. However, I could have also helped the player stretch his quads as well but we ran out of time. I will be sure to do this next time with him.

References

Hindle, K., Whitcomb, T., Briggs, W., & Hong, J. (2012). Proprioceptive neuromuscular facilitation (PNF): Its mechanisms and effects on range of motion and muscular function. Journal of human kinetics, 31, 105-113.

Where? Marjon basketball court

Description- what happened? I took the warm up before their practice and cleaned up one of the players hands that they cut during practice from a scratch from another player. I also performed Piriformis soft tissue release on the player with Piriformis syndrome before practice.

Feelings-what were you thinking feeling? During the warm up some of the players were not participating in the warm up properly. It really annoyed me as I didn’t feel respected. However, they are old enough to know what they are doing is wrong and Its not my place to force them to do it. They know If they do not warm up properly theirs a risk of injury. So I carried on regardless and ignored the ones not participating. I felt more confident this time performing the Piriformis release and believe I have improved getting the right pressure. The players cut was not very deep and was small. I used gloves and an antiseptic wipe to wipe away the blood. I then used petroleum jelly to stop the cut from bleeding before I placed a plaster over the wound. The plaster was not sticking properly, so I used a bandage aswel to keep it in place, the player was happy to continue practice after this and felt the bandage was secure.

Conclusion- what else could you have done?

I could have asked the players to perform the warm up properly. Or talked to the coach afterwards to ask him to talk to some of the players about it.

Where? Marjon basketball court

Description- what happened? During practice one of the players didn’t participate in the warm up until the last exercise which was dynamic stretching (leg swings) he said he felt a ‘popping’ sensation in his hamstring. This would be because he did not warm up properly. I told him to sit out for a moment but he refused and carried on practice. Because of this his hamstring got worse. He eventually had to sit down. I assessed his ROM and he could not straighten or bend his leg. Because of this he most likely had pulled his hamstring, there was not much I could do till the next day except ice the leg and raise it.

Before the next basketball teams practice, one of the players in this team is currently suffering with Piriformis syndrome. Therefore before each practice one of the therapist uses different stretch techniques to try and release the hip and gluteus muscles before the player exercises. I had been researching different stretch techniques to try. I found a good website with some different stretching techniques which I performed on the player.   https://releasemuscletherapy.com/piriformis-release-techniques/

During this practice no other injured occurred.

Feelings-what were you thinking feeling? I was feeling quite annoyed that the player had not listened to me in the first place, however I did my best at giving the advice I know and it was his decision not to follow it. I felt confident performing the different soft tissue Piriformis techniques, however I still need some practice on getting the right pressure. I believe this will come with practice.

Action plan- if the situation arose again what would you do? I would tell the player who did not participate in the warm up till the end that he must run laps or something similar, I was just a little nervous to give orders like that.

Where? Marjon Clinic

Description- what happened? A player came to me complaining of lower back pain. I assessed the player and put the pain down to muscular tightness in the thoracic-lumber fascia and external and internal obliques on both sides. I used effleurage an petrissage massage technique. I then went onto spinal manipulations centrally, as the pain was on both sides. I chose grade 3 to help improve range of movement and pain. I chose this grade because the patients symptoms are improved but restricted in activities by pain, so this would be the appropriate grade to use (Kirkaldy-Willis & Cassidy,1985).

Spinal manipulation is a manual therapy technique designed to offer immediate pain relief and improved mobility for many areas of the body, including the neck, low back, ribs, mid-back, and shoulders -https://holycrossmedicalcenter.org/service/spinal-manipulation-mobilization/

Feelings-what were you thinking feeling? I was feeling confident during the spinal assessment and believe I carried out the assessment effectively. I wasn’t sure wether to do the manipulations central or unilateral. So I asked a clinic supervisor and they were able to explain to me that you perform mobilisations wherever the pain is recreated the most, which in this case was centrally.

Evaluation- what was good/bad about the situation? What was good about the situation was the players ROM and pain had decreased after the treatment and I felt confident performing the assessment and treatment.

Conclusion- what else could you have done? I also could have showed the player stretches for his back and hips which he could do to relieve the pain further and strengthen his back muscles and core, which could potentially be related to his back problem.

Action plan- if the situation arose again what would you do? I would give the player further stretches for his back and hips. As well as strengthening exercises. I will talk to the player the next time I see him to carry out this plan.

References:

Kirkaldy-Willis, W. H., & Cassidy, J. D. (1985). Spinal manipulation in the treatment of low-back pain. Canadian Family Physician, 31, 535.

Where? Clinic/Marjon basketball court

Description- what happened? I took the warm up for the player practice. I used a simple and effective warm up that consisted of running, jumping, static holds and change of directions. I then worked with a player who is in the late stages of a lateral ankle sprain and is looking to return to practice. As replication of basketballs physical demands are key at this stage, I came up with some exercises. 1) calf raises into landing progressed with change of direction and single leg landing. 2) banded forward and backwards skating. 3) diagonal cuts from a platform (plyo box). I then watched some of the practice whilst the player was carrying out his exercises. After practice I gave a player complaining of calf tightness a massage.

Feelings-what were you thinking feeling? I wasn’t really sure on what exercises to give the player with a lateral ankle sprain to return to sport. So I read up on journals and websites to find appropriate exercises. I was able to do this  before practice, as I had been in contact with the player. I got most of my information from youtube and discussed with my supervisors before.

Evaluation- what was good/bad about the situation? I was able to learn different exercises for this specific return to play injury, which was good. However, I did need to read a lot and discover the answer which is ok , however if I had not been in discussion with the player before practice I wouldn’t of been able to help as much as I wouldn’t have done any previous reading on this injury which is very common. I need to start reading more so I have knowledge when problems arise unexpectedly.

Analysis- what sense can you make of the situation? I believe I was able to explain the exercises well and the player was executing them effectively and safely. I also planned it well so that the player was never waiting around and was constantly training.

Conclusion- what else could you have done? I could have also done ultra sound on the effected area after and assessed ROM before and after practice to see if their was any improvements in that way. With the player I gave a soft tissue calf massage afterwards I could have also carried out PIR stretching and assessed ROM before and after, however I only carried out the massage.

Action plan- if the situation arose again what would you do? I would still give all the same exercises but would have gave the player more treatment after practice.

Where? Clinic and marjon basketball court

Description- what happened? One player was complaining of pain in his tibia. He said it has been for around 1 week.  I suspected it was possibly tibial stress syndrome, also known as ‘shin splints’ The player was complaining of tightness and throbbing around the border of his tibia and explained that it gets worse when he’s running, especially at the start of training, which is when the pain becomes sharp. However, he doesn’t get pain at rest and the pain eventually goes away during practice.Which means its at an acute stage, as Galbraith & Lavallee, (2009) explains,In the early course of MTSS, pain is worse at the beginning of exercise and gradually subsides during training and within minutes of cessation of exercise. I assessed his shoes as generally worn out shoes can contribute toward this injury (Galbraith & Lavallee, 2009).So I suggested the player invest in more supportive shoes to help with the problem. I then gave the player a soft tissue massage on his gastrocnemius and soleus muscles, and have the player a tennis ball to massage the plantaris muscles of his feet, which he can also regularly do at home, as tightness around these muscles is commonly associated with MTSS (Galbraith & Lavallee, 2009). I then treated the painful areas of his tibia with ultra sound, before using K-Tape to tape his painful tibia before training. I then watched the basketball training. The other therapist took the warm up and afterwards I took the players through the stretch. There were no injuries during practice.

Feelings-what were you thinking feeling? I have shin splints myself and have read a lot about it so I felt fairly confident when treating this player. I felt confident carrying out a massage and ultra sound treatment. The tape wasn’t sticking as the patient had very hairy legs, so I used the before spray which helped it stick down more and really smoothed out the tape for a few minutes to make sure it was stuck down properly.

Evaluation- what was good/bad about the situation? What was bad about the situation was that I wasn’t sure what the differential diagnosis could be. However, I have now read some more about this and have found that according to research from, McClure & Oh, (2019), chronic exertions compartment syndrome (CECS), and vascular etiologies (e.g. functional popliteal artery entrapment syndrome, peripheral arterial disease, etc.) are the differential diagnosis and I will read more about these to find out how I can tell if it may be one of these instead of shin splints.

Analysis- what sense can you make of the situation? I feel the player was feeling pain and wanted to see if there was anything that could reduce this pain. I believe I did a good job at calming the player down and giving him confidence to carry on training.

Conclusion- what else could you have done? From further reading I have now done. It has ben found that ‘decreasing weekly running distance, frequency, and intensity by 50% will likely improve symptoms’ therefore, I am not sure if I should have told the player to not participate in practice. I am going to find out from my supervisors what they suggest. I have now also found that Ice may be applied to the affected area directly after exercise for approximately 15–20 min. So next practice I will make sure the player ices his tibia after practice. From my reading I also found that ‘weakness of core muscles is an important risk factor for lower extremity injuries’ I am going to incorporate core exercises into the regular warm up and try and suggest the player also included core exercises in his regular day activities.

Action plan- if the situation arose again what would you do?

I would carry out the same treatment I did as I believe it was affective.

REFERENCES-

-Galbraith, R. M., & Lavallee, M. E. (2009). Medial tibial stress syndrome: conservative treatment options. Current reviews in musculoskeletal medicine, 2(3), 127-133.

-McClure, C. J., & Oh, R. (2019). Medial Tibial Stress Syndrome. In StatPearls [Internet]. StatPearls Publishing.

Where? Marjon sport hall- Bucs basketball Game

Description- what happened?

The basketball team had a game against Southhampton uni. I taped the players ankle with inversion rolling worries and watched the game incase of any injuries. I also took the warm up

Feelings-what were you thinking feeling?

I was feeling confident taking the warm up and felt I was louder than last time. I also felt confident taping the player now as I had done it before.

Evaluation- what was good/bad about the situation?

What was good about the situation was the warm up was affective as the players were warm after. and the players ankle I taped was happy and felt more confident after I taped him. What was bad about the situation was that I had to rush the warm up slightly as the game was starting.

Conclusion- what else could you have done?

I could have started the warm up earlier. But I wasn’t aware of the time and had to cut the warm up a little short.

Action plan- if the situation arose again what would you do?

I would be more time efficient and aware of the time.