08 December- Marjon clinic. (4 hours) 2 clients

My first client today was online with a young female who described a mild pain in her thigh after playing badminton the previous day (Yu et al., 2021).  I enquired if she had any previous injuries on this site or if she was on medication, which she said no. During our consultation, she described feeling a sharp pain when lunging forward, which was painful for a few minutes, but then appeared to go away, only for it to be painful later that night. From her description, she was not able to get to a laptop to allow me to view the limb, it sounded like a quadriceps muscle tear, possibly Rectus femoris (Fig 1), but I would have to conduct physical tests to be certain of the grading (Fig.2), hence booked her in for 2-days’ time, during which I advised PRICE and strapping minus any physical activity.  I was aware badminton had a high prevalence of injuries through a friend who played it, hence I would conduct some more research prior to seeing the patient (Pardiwala et al., 2020).

Fig.1 Muscles of Thigh

Fig.2: Grading of Thigh (quadriceps strains)

I will ensure I conduct a careful examination including observation, palpation, strength testing, and ROM at our next session. I know from experience, strain injuries of the quadriceps can present with an obvious deformity, such as a bulge or defect in the muscle belly. Signs (ecchymosis) may not develop until 24 hours after the injury, hence giving her 2-days should reveal any delayed onset of injuries. I will palpate the anterior thigh to locate the area of maximal tenderness, looking and feeling for any defect in the muscle. Strength testing of the quadriceps will include resistance of knee extension and hip flexion with strength testing of the rectus femoris inclusive of resisted knee extension with the hip flexed and extended both in the sitting and prone-lying positions. Pain is typically felt with resisted muscle activation, passive stretching, and direct palpation over the muscle strain. Assessing tenderness, any palpable defect, and strength at the onset of muscle injury will determine my grading of the injury, providing direction for potential further testing and/or treatment.

I am still wary of conducting interim diagnosis assessments online, as although it is a great means of reaching patients, I find it can be very subjective; I know it is meant to be, but I much prefer the 1:1 interaction of a physical assessment, where communications really come into their own. If I could have done anything differently, I would have enquired how much badminton she plays and at what level, as from experience, this can often provide more information, particularly on muscle strength etc.

My final client today was a 33-year-old male, who advised he was a keen runner, but was currently suffering knee pain. He described it as an aching pain somewhere in the front of the knee, under his kneecap (patella), which he said was slightly inflamed and he felt more when sitting down after exercise.  On palpation he had some tenderness along the inside border of your patella (Fig. 3).  He also advised he felt some crepitus when bending his knee, which felt a bit strange but was not that painful.

Fig. 3: Patellofemoral Pain Syndrome (PFPS)

I conducted a gait assessment, which was normal and a general knee assessment including ACL test, modified Lachmans Test for PCL, Medial & Lateral Minisci using compression, Thessaly’s test, duck waddling, Clarkes test, which were all negative, however on patellar apprehension test, this was positive as was the patellar compression test, which was also positive and patellar grind test, which was positive on quad contracting, and patellar glide test, which was slightly painful for the client.  I found this video online, which I found extremely useful as a reminder on basic special tests: Knee Special Tests  I spent quite a bit of time conducting all the tests, which left me slightly confused as the injury could have been a combination of things, but I stuck to my notes and eliminated everything I thought was not relevant and determined patellofemoral pain syndrome (PFPS) was the most likely diagnosis, as his patella did appear to be rubbing on his femur bone underneath. As I was not certain I asked a supervisor to assist, and she recommended conducting a Q-Test (Fig.4) to gauge the angle between the quadriceps muscles and the patella tendon, to assist ref. information about his general alignment of his knee joints.  In this case knee valgus was normal, but it was good to do the test, as I had only discussed it previously so putting into practice was good.  However, I sensed the client was getting a bit anxious with so many tests, hence decided based on evidence to date to treat the injury as PFPS.  I used patella taping (Whittingham et al.,2004) to support the knee hence got the client to do a squat (he had some pain) and then applied taping & do another squat (no pain).  I advised client to conduct stretching & strengthening exercises once the pain had subsided in conjunction with PRICE. 

Fig. 4: Q Angle of the knee

If I could have done anything differently, I would explained to the client it took a bit of time to conduct all required tests prior to embarking on them and tried to speed up the testing during this assessment, as I felt the client was getting a bit anxious, however, the client was satisfied with the attention he received, and appeared happy I had provided a diagnosis for him.  I will research the knee further, as although I was satisfied, I had done all I could, I still had a nagging feeling that I may have missed something, but with the treatment provided, I am confident I wont be doing any further harm.

References

Kobal, K. L., Rubertone, P. P., Kelly, S. P., & Finley, M. (2021). A Comparison of

Instructional Methods on Clinical Reasoning in Entry-Level Physical Therapy Students: A Pilot Study. Journal of Physical Therapy Education, 35(2), 138-145.

Pardiwala, D. N., Subbiah, K., Rao, N., & Modi, R. (2020). Badminton injuries in elite athletes: a review of epidemiology and biomechanics. Indian journal of orthopaedics, 54(3), 237-245.

Passarelli, A., & Kolb, D. (2021). 6 The Learning Way. The Oxford Handbook of Lifelong Learning, 97.

Whittingham, M., Palmer, S., & Macmillan, F. (2004). Effects of taping on pain and function in patellofemoral pain syndrome: a randomized controlled trial. Journal of Orthopaedic & Sports Physical Therapy, 34(9), 504-510.

3rd November – Duration: 5 Hours (3-clients).

My first client was online and a 34-year-old male suffering from hospital diagnosed degenerative osteoarthritis (Kumavat et al., 2021) which at this stage was impacting more on his hands, which had flared up and were now recovering.   I always feel sorry for younger patients who are afflicted with arthritis, as it is such a debilitating disease, however as a practitioner I am also aware, my primary role is to assist healing, prevent further injury and where appropriate provide appropriate advice.  As (Daste et al., 2021) revealed, movement via forms of exercise is the best treatment for most forms of arthritis, and when clients are physically able; minus too much pain, conduct such, should be encouraged to do so within capabilities, and in this case via simple hand exercises (Fig 1) as an intervention that aims to improve the client’s mobility and strength and therefore, improving his functional ability. I provided simple hand exercises including:

Fig 1: Hand exercises for arthritis

I always try and break my treatments down into workable chunks with mobilizing exercises (Increase or maintain range of motion) and strengthening exercises (using resistance from putty, a gel ball, or resistance or elastic bands to strengthen hand, fingers or wrist muscles).

There are many physical and medical conditions that may affect the hand and need exercise as an intervention to help patients to perform their ADL activities independently and increase the strength of handgrip.

My next two clients today had sprained finger injuries, which occurred three weeks previously playing rugby. I discussed this with both patients prior and with their agreement, booked them both in together, as I felt as they knew one another, receiving treatment together may be beneficial.  However, I am aware certain individuals may prefer to be treated individually for all sorts of reasons. Initial X-rays revealed no broken bones and previous assessments diagnosed ligament sprains (Volar plate & MTP) which were taped (Buddy & criss cross at back of joint) to immobilise, prevent further injury, and allow recovery (Fig.2).  Existing taping was gently removed to reveal all visible swelling had gone and ROM conducted revealing joint movement was achievable, but some pain remained with tenderness when passive ROM was applied.

Fig.2 Overview of Injured Joint

Individual finger exercises were provided to gently stretch the flexor digitorum profundus tendons and increase ROM and strength using various hand stretches (Fig.3) in conjunction with putty ball and resistance band exercises to exercise extensor digitorum communis and extensor pollicis longus. Wrist, forearm, and shoulder stretches were provided (if no pain on fingers were felt), to ensure no weakening occurred through lack of mobility. The fingers were retaped on completion of the session to protect them (Zu Reckendorf et al., 2021). Advice on using a tennis or sponge ball at home was provided and to continue to refrain from sport at this time.

As is normal with sports activists, both clients were keen to return to rugby training soonest, and I reminded them that this simple flexibility and strengthening exercises will assist to prevent future injuries. Loading will commence once no pain is evident (static holding with fingers only) and one arm dead hangs on a bar, into their rehabilitation once full ROM minus pain is achieved.

In treating various injuries, I have found many sports and non-sporting individuals are not overly knowledgeable on injury prevention or protection techniques in various sports or normal daily functioning (NDF) as (Steffen et al., 2010) examined, hence I will continue to research specific injury prevention mechanisms to pass onto my clients for the future.  In the case of finger injuries, which are often repeated in contact sports such as Rugby and Basketball, pre-taping (de Sire et al.,2021; Jones, 2013), is proven to prevent initial and re-injury.

Fig.3 Finger stretching & strengthening exercises.

References

Daste, C., Kirren, Q., Akoum, J., Lefèvre-Colau, M. M., Rannou, F., & Nguyen, C.

(2021). Physical activity for osteoarthritis: Efficiency and review of recommandations. Joint Bone Spine, 88(6), 105207.

de Sire, A., Curci, C., Ferrara, M., Losco, L., Spalek, R., Cisari, C., … & Solaro, C.

(2021). Effectiveness of kinesio taping on hand functioning in patients with mild carpal tunnel syndrome. A double-blind randomized controlled trial. Journal of Hand Therapy.

Jones, B. (2013). The Effect of Ankle Taping on Reactive Agility Performance in Male

Rugby.

Kumavat, R., Kumar, V., Malhotra, R., Pandit, H., Jones, E., Ponchel, F., & Biswas, S.

(2021). Biomarkers of joint damage in osteoarthritis: current status and future directions. Mediators of Inflammation, 2021.

Steffen, K., Andersen, T. E., Krosshaug, T., van Mechelen, W., Myklebust, G.,

Verhagen, E. A., & Bahr, R. (2010). ECSS Position Statement 2009: Prevention of acute sports injuries. European Journal of Sport Science, 10(4), 223-236.

Zu Reckendorf, G. M., Artuso, M., Kientzi, M., & Rouzaud, J. C. (2021). Collateral

ligament sprains of the metacarpophalangeal joint of the long fingers: Results of a surgical series of 15 patients. Orthopaedics & Traumatology: Surgery & Research, 102952.

24^th November – Duration: 4 Hours (2-clients).

My first client today was a commercial HGV driver suffering from right elbow pain and swelling.  He advised he had not knocked it, and only noticed it when leaning his elbow on the side of his vehicle when driving, but over the past week it had become too painful to do so. Post further questioning and examination; including observation of uninjured arm/elbow/neck and active/resisted ROM, which was fine (Active ROM Assessment; Functional Elbow Tests) but post observation, during palpation I noted he had some redness and a distinct swelling on his elbow joint, which was warmer than surrounding tissue, hence functional tests (grip, it appeared he had damaged his elbow joint through constant (repetitive) pressure being applied to it. I advised him I believed had elbow bursitis (olecranon bursitis) and immediately applied PRICE to start reducing the pain and inflammation, advising him to repeat at home or when driving every hour for 10-15 min until the pain and swelling had reduced.  I also advised him to seek medical assistance via his GP if it continued after treating with PRICE for the next week as the GP may offer anti-inflammatory drugs and other options (draining).  In the interim, I advised the client to wear an elbow pad when driving to ensure he did not put any pressure on the elbow.

Every so often I am sharply reminded that I must prioritise my workload to ensure my patients receive the attention they require.  My first patent today took over an hour and a half to deal with (way too long)!  However, I felt a thorough examination of his elbow was required to eliminate other possibilities (red/yellow flags).  I know I tend to spend too long with clients, but sometimes find it difficult to speed thing up, which I know is predominantly down to lack of clinic time, but I will try and get into a better routine, perhaps using tick of sheet to cover things quicker. I also need to prioritise better, as I know this will remain a necessity in a professional work setting and is part of effective time management.

My final client today was a young female tennis player, recovering from a Grade 2 calf strain (Kaiser et al., 2021; Sergot et al., 2021), which occurred whilst practicing serving over 10-days ago. Observation and palpation revealed the strain was healing well, with no pain evident during resisted plantar flexion or palpation. A rehab. programme Tennis Rehab. was being followed hence I started the session with foam rollout, and I applied STR to warm up the muscles prior to conducting step stretching, which was pain free, hence light loading was applied with step ups to strengthen the calf area in conjunction with step backs and resistance band exercises.  I discussed the injury with the client, and realised although a relatively experienced tennis player, she rarely conducted proper warm up/down exercises prior to training; other than playing, hence advised on some precautionary measures and quickly researched a Tennis orientated site she could use (Osakabe et al., 2021).

When discussing preventative precautions with the client, I sensed she may have been somewhat dismissive of my advice; perhaps as I had mentioned I had rarely played tennis, but whatever the reason, it reiterated to me why establishing good communications with the client is so important, and in hindsight I think if I had appeared more interested in tennis, I could have avoided a slightly awkward atmosphere that I personally felt prevailed, hence I will certainly try to achieve this going forward; even if not personally interested in the activity.

References

Kaiser, P., Stock, K., Benedikt, S., Ellenbecker, T., Kastenberger, T., Schmidle, G., & Arora, R. (2021). Acute Tennis Injuries in the Recreational Tennis Player. Orthopaedic Journal of Sports Medicine, 9(1), 2325967120973672.

Osakabe, J., Ohya, T., Koizumi, J., Inada, R., Matsumoto, T., & Umemura, Y. (2021). Tennis singles match play induces inspiratory muscle fatigue in female tennis players. The Journal of Physical Fitness and Sports Medicine, 10(1), 33-37.

Sergot, L., Leaper, O., Rolls, A., Williams, J., Chakraverty, R., & Chakraverty, J. (2021). Navigating the complexity of calf injuries in athletes: a review of MRI findings. Acta Radiologica, 02841851211016452.

1^st 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

Thursday 10^th June. Marjon clinic. Supervisors: Alex and Mike. (6 hours) 3 clients

My first client was a returning client from another clinician who had diagnosed her with Radiculopathy Facet Dysfunction (Anaya et al., 2021) with a differential diagnosis of shoulder impingement syndrome (Sharma et al., 2021).

I conducted a full assessment; inclusive of ROM, for the cervical, thoracic and shoulders where I identified which body positions were limited and painful and discovered a slight difference from the other clinician’s notes. Through experience, I now know this is not uncommon, as the clinician may have been busy on the day or the patients’ symptoms were not as acute on a given day, but regardless, it reminded me to be as thorough as possible and not to take others notes as the definitive.

From the notes, the patient had deteriorated since her last assessment, however on questioning, she said she felt as though she had improved slightly, hence in this case, I believed that the last clinician may not have recorded the ROM correctly, as the notes explained she had no pain in internal ROM of the shoulder. However, this was the level of movement that caused the greatest pain and had the least strength in.

Through deduction, I decided the most appropriate special test should focus on internal impingement.  I was aware of the Hawkins-Kennedy test, but decided to do a quick search of YouTube to find another test for internal impingement, and found the posterior impingement test, which although it had a weak accuracy scale, may assist (Kamalden et al., 2021).

I was able to perform both tests successfully, despite it being a long time since I last conducted them. I also performed the Neer test for subacromial pain syndrome (SAPS). I had a little bit of trouble turning her arm inwards, but eventually got the correct placement of my hands. Post the assessments, I realised I need to practice conducting more special tests on the shoulder, to enable me to cut down the time with the patient, but more importantly, ensure the correct diagnosis is being made. After the ROM assessment I went onto palpation, which highlighted the patient did not actually have any pain, which indicated it may be mainly deep rather than superficial. I moved onto soft tissue massage focusing on trapezius and rhomboids. The client had a very crunchy feel in the inferior angle of their scapula, subscapularis, and rhomboid muscles. I consequently sought guidance from my supervisor who explained it was connective tissue; dense pockets of muscle, which almost every person has where connective tissue assists in supporting muscles. I believe it is good practice to seek guidance or a second opinion from a more experienced clinician, which also relays to the patient, we are doing everything possible to help them.

During the massage I continually asked (checked) if the pressure was OK. She was very polite and informed me the previous clinician was a bit too hard, and the pressure I was submitting, was much more comfortable. However, she did mention she did not inform the clinician to ease off, so I deduced she may be the type of person who would just accept the pain, so I made sure to not do too much pressure, as she has quite a small frame (Rodrigues et al., 2021).

My next client was online, where I shadowed another clinician with a patient with knee pain. He did a full assessment, which went well as the clinician demonstrated the ROM exercises well and was able to see his movement limitations on the screen. As this was an online assessment, it was chiefly subjective. From observation, I believed it could have been prepatellar bursitis (Samhan et al., 2021), previously commonly known inappropriately as housemaids’ knee. Overall, the patient performed well, and I believe was quite satisfied. If I were to do anything differently, I would probe more to try and narrow down the pain site, however, it was a subjective assessment, which I believe was performed well (Douglas‐Morris et al., 2021).

My last client today was also conducted shadowing a clinician. The patient presented with a possible diagnosis of Medial Epicondylopathy (Finnoff et al., 2021; Hodge & Schroeder, 2021); an overuse of the wrist extensors. It was a useful reminder for me when the clinician referenced TENS machines settings, and consequently I found the advice interesting, but also beneficial, and a good reminder to me that a sports therapist must have a broad range of up-to-date knowledge and experience, when discussing the clients home TENS machine (Park et al., 1984). We discussed acupuncture use as being more inclined to be used for chronic pain relief (Sheikh et al., 2021). For treatment, the clinician also used soft tissue massage utilising a technique called ‘transverse friction massage’, also known as cross-friction and cross-fibre massage, which is a technique that promotes optimal collagen healing by increasing circulation and decreasing collagen cross-linking, thus decreasing the formation of adhesions and scar tissue (Mylonas et al., 2021).

References

Anaya, J. E., Coelho, S. R., Taneja, A. K., Cardoso, F. N., Skaf, A. Y., & Aihara, A. Y.

(2021). Differential diagnosis of facet joint disorders. RadioGraphics, 41(2), 543-558.

Douglas‐Morris, J., Ritchie, H., Willis, C., & Reed, D. (2021). Identification‐Based

Multiple‐Choice Assessments in Anatomy can be as Reliable and Challenging as Their Free‐Response Equivalents. Anatomical Sciences Education.

Finnoff, J. T., & Johnson, W. (2021). Upper limb pain and dysfunction. In Braddom’s

Physical Medicine and Rehabilitation (pp. 715-726). Elsevier

Hodge, C., & Schroeder, J. D. (2021). Medial Epicondyle Apophysitis (Little League

Elbow).

Kamalden, T. F. T., Gasibat, Q., Rafieda, A. E., Sulayman, W. A., Dev, R. D. O.,

Syazwan, A. S., & Wazir, M. R. (2021). Influence of Nonoperative Treatments for Subacromial Shoulder Pain: A Review Article.

Mylonas, K., Angelopoulos, P., Tsepis, E., Billis, E., & Fousekis, K. (2021). Soft-Tissue

Techniques in Sports Injuries Prevention and Rehabilitation. In Recent Advances in Sport Science. IntechOpen.

Park, S. P., Thomas, P. S., Chen, L., Yuan, H. A., Frederiekson, B. E., & Zauder, H.

68. (1984). Transcutaneous electrical nerve stimulation (Tens) for postoperative pain control. Pain, 18, S68.

Rodrigues, M. G. D. R., Pauly, C. B., Thentz, C., Boegli, M., Curtin, F., Luthy, C., … &

Desmeules, J. (2021). Impacts of Touch massage on the experience of patients with chronic pain: A protocol for a mixed method study. Complementary therapies in clinical practice, 43, 101276.

Samhan, L. F., Alfarra, A. H., & Abu-Naser, S. S. (2021). An Expert System for Knee

Problems Diagnosis. International Journal of Academic Information Systems Research (IJAISR), 5(4).

Sharma, S., Hussain, M. E., & Sharma, S. (2021). Effects of exercise therapy plus

manual therapy on muscle activity, latency timing and SPADI score in shoulder impingement syndrome. Complementary Therapies in Clinical Practice, 44, 101390.

Sheikh, F., Brandt, N., Vinh, D., & Elon, R. D. (2021). Management of Chronic Pain

in Nursing Homes: Navigating Challenges to Improve Person-Centered Care. Journal of the American Medical Directors Association, 22(6), 1199-1205.

28th September

Marjon Clinic

Supervisors: Alex and Mike

This session was the first of the year within the clinic at Plymouth Marjon university. As part of a placement module in 3^rd year, the clinic is based on the university campus to help achieve 200 hours needed to complete this module. During this placement, each week clients will be treated who have booked in for an injury consultation both online and face to face.

During this session, the group were provided with information on how the clinic was to run this year. This included how the online consultation process will be delivered, face to face appointments, the booking process and how the correct PPE is to be used including an apron, gloves, mask and visor.

Due to the recent COVID 19 pandemics, this was also important to be covered to ensure that the correct protocols were to be carried out. This included the ‘donning and doffing’ process of wearing PPE, social distancing, and the use of the one-way system within the clinic and sports centre and how to work with clients in this space.

Towards the end of the session, there was revision for various case studies and scenarios. This was especially useful as this meant we were able to discuss in groups and share information. Case studies involved both upper and lower limb scenarios. This had also helped to identify which areas that are needed to focus on within revision before beginning placement in the clinic.

3^rd 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.

.1^st June 2021 Marjon Clinic placement reflection

Supervisors: Mike and Alex

Hours: 4 hours (2 clients)

My first patient today was a female experiencing bilateral pain in both knees, which she described as preventing her achieving her goal of being able to run. A full assessment was conducted; inclusive of knees, on her joints above and below her knees (hips and ankles). The assessment progressed well, allowing me to go through applicable range of motion (ROM) tests. Through discussion, I discovered she had taken up Pilates post retiring in 2020, which explained why she demonstrated very good ROM and strength, considering her age and painful joints issue. She advised before she started Pilates, her range of movement and strength was poor.  As I practice Pilates, I discussed how beneficial I believed Pilates was (Choi et al., 2021) and if it assisted her ROM and felt good, she should continue. The patient was incredibly happy I had provided positive feedback on her activities, and I could visibly see it had encouraged her to continue. I felt very satisfied I had in some small way made her feel good, which as I gain in experience, I have become increasingly conscious that a patient’s mental health is just as important as their physical health in aiding recovery. During gait assessment, the patient had slight valgus when walking and when the patient conducted functional movements, such as squatting, I observed she had valgus knees (da Costa et al., 2021).  I requested her to do a lunge, whereupon she explained she did not like doing these, as they caused her pain. As an alternative, to lessen the pain, I got her to do a supported single leg squat, which also evoked pain.

However, the patient retained good balance and stable ankles, hence through deduction, I suspected her hip and knee stability were weakened, as her form during exercises was poor indicating her joints needed to be stronger to complete basic ROM minus valgus knees, which with exercises, should prevent or lessen her knee pain to allow her to achieve her running/jogging goal. Increased strength, ROM and form will lessen impact on her joints during this activity. Post patient assessment, I discussed my findings and initial diagnosis after conducting special tests: Thessaly test- positive; McMurray test-negative; patella grind test-negative and joint line tenderness- positive (Abdelgawad & Genrich, 2021; da Silva Boitrago et al., 2021; Karachalios et al., 2005) with my supervisor, explaining I suspected patella femoral pain syndrome, damaged meniscus, weak quads, and hamstring.

A positive discussion with my supervisors, enabled me to clearly and quickly explain my findings with the client whereupon applicable exercises were started (side plank with hip abduction). The patient tried however, was unable to lift her leg in this position, hence reverted to a side plank enabling the patient to build strength to work towards improving her strength. I did not wish to dishearten the patient so quickly started standing hip adductions and was satisfied I was able to think quickly and work with my client’s individual capabilities and needs, rather than just giving the exercises and minus considering the clients personal abilities. I used side lying clams to target the gluteal muscles, primarily gluteus medius to build and stabilise the pelvis and maintain balance, whilst providing support to the knees and lower legs. I lay down on the mats with my client and conducted all the exercises with her, which I believe is a good way of encouraging the patients to perform all movements whilst simultaneously correcting their placement and form, as they will remember this when conducting at home. The next exercises were hip drops off a stepper. The client struggled keeping their supporting leg straight, but through perseverance and my corrections, she completed the exercise. I felt I had explained and demonstrated simply maintaining good communications throughout with the client, particularly their likes and dislikes. I ensured the client felt the muscle stretches in the correct place for all exercises indicating they were being conducted correctly, in conjunction with their form and placement.

During the exercises I mentioned her knees could be supported with K-tape. The client really liked this idea, and consequently I placed K-tape on her as a ‘tester’, which if assisted, she could purchase and apply it herself whenever she completed exercises ( I placed two pieces of tape under the kneecap with zero stretch, another piece from the middle laterally of the bicep femora’s and across over the lateral side of the knee to the medial side of the knee and then the same on the opposite side). It was awkward placing the tape, as it was not sticking well and was a bit fiddly, however, I completed it successfully and the client was satisfied and comfortable. If I were to do this again, I would ensure to measure out the tape prior, to speed up this process.

My next client was a female suffering from what sounded like bilateral calf pain. The assessment went smoothly, and I was able to find out lots of information through good communication and empathy towards the client. Through deduction, I diagnosed medial tibial stress syndrome (Reshef, & Guelich, 2012) and general gastrocnemius weakness. The patient had her child with her who was a little bit hyperactive, hence I thought it would be best if I engaged the child (a boy) what I was doing, and got him involved by palpating the opposite side, which was fun and kept him entertained whilst also putting his mother at ease during the assessment minus worrying about her child.

Accommodating patients’ needs, who also have busy schedules, is always high on the agenda, and in this instance, I felt I handled this situation well, and the parent was certainly very appreciative, and once again it was a real-life learning situation, which I will remember for possible similar instances. I went through at home exercises with the patient, as through observation and ROM, she had good arches in her calf raises, and consequently was advanced enough to add tempo training (Wilk et al., 2021). I explained this and got her to perform the tempo training to ensure she understood. I also put an objector in reference how many toe-taps she could do in 30 seconds, to compare on her next appointment, after completing her at home exercises. I explained this to her and felt it was a good way of pushing her to adhere to exercise giving her goals. After the exercises I gave the client a 5-minute massage on each calf, as they felt tight, however post speaking to the client, I thought she was a bit stressed with her daily life and this would also release some tension. During massage, the client opened up about her child’s learning difficulties at school etc. I think I did a good job at letting her unwind, as she may not have such opportunities that often. The massage went well, and I ensured constant communications was maintained reference pain (good or bad). I have learned to ensure an explanation is provided reference pain tolerance levels and palpation pressure, as I have noticed some people; often male, tend to try and bear any pain rather than tell you, which could be attributed to a macho thing.

References

Abdelgawad, A., & Genrich, C. M. (2021). Sport Injury: Lower Extremity. In Pediatric

Orthopedics and Sports Medicine (pp. 199-222). Springer, Cham.

Choi, W., Joo, Y., & Lee, S. (2021). Pilates exercise focused on ankle movements for

improving gait ability in older women. Journal of women & aging, 33(1), 30-40.

Cui, J. C., Wu, W. T., Xin, L., Chen, Z. W., & Lei, P. F. (2021). Efficacy of Arthroscopic

Treatment for Concurrent Medial Meniscus Posterior Horn and Lateral Meniscus Anterior Horn Injury: A Retrospective Single Center Study. Orthopaedic Surgery, 13(1), 45-52. da Costa, G. V., de Castro, M. P., Sanchotene, C. G., Ribeiro, D. C., de Brito Fontana,

H., & Ruschel, C. (2021). Relationship between passive ankle dorsiflexion range, dynamic ankle dorsiflexion range and lower limb and trunk kinematics during the single-leg squat. Gait & Posture, 86, 106-111.

da Silva Boitrago, M. V., de Mello, N. N., Barin, F. R., Júnior, P. L., de Souza Borges,

99. H., & Oliveira, M. (2021). Effects of proprioceptive exercises and strengthening on pain and functionality for patellofemoral pain syndrome in women: A randomized controlled trial. Journal of Clinical Orthopaedics and Trauma, 18, 94-99.

Karachalios, T., Hantes, M., Zibis, A. H., Zachos, V., Karantanas, A. H., & Malizos, K.

962. (2005). Diagnostic accuracy of a new clinical test (the Thessaly test) for early detection of meniscal tears. JBJS, 87(5), 955-962.

Reshef, N., & Guelich, D. R. (2012). Medial tibial stress syndrome. Clinics in sports

medicine, 31(2), 273-290.

Wilk, M., Zajac, A., & Tufano, J. J. (2021). The Influence of Movement Tempo During

Resistance Training on Muscular Strength and Hypertrophy Responses: A Review. Sports Medicine, 1-22.

14^th May. Duration:6 hours (4 clients)

My first client was a 29-year-old male recreational basketball player who was experiencing pain in their right foot on the back of their heel, with swelling at the top of his heel and lower Achilles’ area.  The client explained they had been training outside on a concrete court for several months during lockdown, and although he had felt pain previously in the same area and a tightness I his calf, it was much more painful after his last session, and he was now finding it difficult to put on his work shoes.  I was aware this could be related to gait pronation and a lack of stretching; hence I asked the client if he stretched before/after training/games, and he said not that often. Also, if he wore good supportive basketball shoes and he said he did, but they were quite old now. Through assessment involving passive/active ROM on his foot followed by a Thompson test, which displayed plantar flexion and palpation around the lower Achilles and heel, I noted the client was experiencing tenderness, which when depressed felt a bit spongy. I was a bit apprehensive to offer a diagnosis but advised it looked like Achilles’ bursitis (Aaron et al., 2011).

As the client was experiencing pain, I did not wish to exacerbate this so conducted a visual inspection of their arches, which were extremely low and a gait assessment (Lee & Erdman, 2021), using the ‘Wet Foot Test’ as opposed to a foot scanner or treadmill analysis, looking for overpronation, under pronation or neutral gait, which although not perfect, I believed would provide a rough estimate of pronation type.  The footprint indicted he was more inclined to have a flat or low arch, indicating overpronation (Fig 1; Fig 2; Fig 3).  I Was a bit apprehensive doing this test as it was the first time, I had used it, but it was relatively simple and produced good results.

Fig.1: Footprint Pronation Identification

Fig 2: Pronation Types

Fig 3: Wet Foot Test

The client’s calf muscle was also very tight; hence I conducted observation first and passive/active ROM, then provided STR to relieve the tension and pain and during this provided advice on a rehabilitation package involving protection, rest, ice, compression, and elevation (PRICE), in conjunction with passive stretching at home if there was no pain, involving resistance bands, wall stretches, and toe raises. NSAIDs could also be taken for 2-5 days if clients GP allowed, until the acute pain phase had passed, which would be followed by a programme of exercises at the clinic to stretch and strengthen the area. The client was advised to avoid footwear with a prominent heel area, hence sandals were suggested, and when shoes were used, to use orthotic insoles, particularly in the basketball shoes, which should be replaced if old, to reduce the strain on his Achilles tendon. On reflection, I could also have looked at their basketball and work shoes to see if wearing occurred on the insides to corroborate initial diagnosis.

On the clients next visit, stretching exercises, for the calf muscles will be done focussing on the larger gastrocnemius muscle and the lower soleus muscle to increase flexibility to decrease strain on the bursa at the back of the heel. Calf stretches will be done with the knee both straight and bent to stretch both the gastrocnemius and soleus muscles.  Although I was satisfied, I had provided the client with good advice, which would not exacerbate the injury, I could have advised them to make an appointment with their GP to eliminate alternative injuries and will do this in future.

My next two clients had sprained finger injuries (Appendix A), which occurred seven and nine days previously through the basketball hitting their fingers at pace during games. They were now coming to the clinic daily. Both patients had been x-rayed and no bones were broken but suffered painful injuries in the areas of the intermediate and proximal phalanges of ring finger (digitus annularis) and pinky finger (digitus minimus manus) finger (Williams et al., 2020). Existing finger buddy taping was gently removed to reveal all visible swelling had gone and passive/active ROM was conducted revealing joint movement was achievable with minimal pain, although some tenderness existed in parts.  Finger exercises were provided to gently stretch the flexor digitorum profundus tendons and increase ROM and strength using various putty ball and rubber band exercises to exercise extensor digitorum communis and extensor pollicis longus.  Wrist, forearm, and shoulder stretches were provided (if no pain on fingers were felt), to ensure no weakening occurred through lack of mobility.  The fingers were retaped on completion of the session to protect them (Zu Reckendorf et al., 2021).  I provided advice on using a tennis or sponge ball to use at home with advice not to participate in basketball exercises, which involved ball work with hands.  I got the impression both clients were keen to get back on the court hence I thought it appropriate to remind them that strengthening exercises at home for the hand/fingers, will really improve their overall strength allowing them to play better minus fear of a recurring injury, and importantly get back in action quicker.  I will progressively add weights (static holding with fingers only) and one arm dead hangs on a bar, into their rehabilitation once full ROM minus pain is achieved.

My next client was recovering from a previously diagnosed and treated navicular stress fracture on their left foot caused through sprinting. They had been out of the cast for 2-weeks and were walking minus pain. Through assessment using passive/active ROM, I looked at the foot, ankle, and calf areas, where it was evident mobility and strengthening exercises were required through lack of usage.  I started the session by giving STR (Balletto, 2019) to the general area to warm up, and gently stretch the muscles, followed by a visible gait analysis on the treadmill, which indicated a neutral pronation.  I believe my STR skills and knowledge have improved significantly through progressive clinical practice, where I have learned to listen more to the client and adapt my practice accordingly post conducting further research if required.  From experience, I was aware, pain radiated along the inside arch of the foot and went away quickly with rest, often returning as training resumes, hence informed the client to remain cognisant of this and not to ignore pain if it occurs in their haste to return to full time training.  I felt the client appreciated receiving this advice and felt personally satisfied I had built a level of professional trust in the relationship.

Calf raises and exercises for the small muscles in the foot were provided and STR in the calf muscles to restore them to normal function. Through experience, I knew it was also important to eliminate factors which could cause the injury to recur, hence discussed the client’s equipment and training methods to determine if I could assist, as training errors in technique or overtraining may have caused the injury. I also discussed the use of orthotic inserts in their shoes, and I believe I have developed my communications in this aspect i.e., suggesting ideas to assist and improve clients’ performances and health.  Full ankle mobility and basic strength of the joint could be achieved within a week when gentle jogging should resume to build up to resuming normal training loads over a period of 6 weeks.  I was very satisfied with this session, as the client appeared to really appreciate the professional service they had received and feel my confidence levels are improving.

My next client was in the final stages of shin splint rehabilitation, initially thought to have been caused through using a weighted vest to increase resistance whilst running. The client has started gentle running again.  I conducted passive/active ROM followed by STR on the muscle areas around the tibia followed by a calf massage using effleurage, petrissage, and deeper stripping techniques.  I think the client really appreciated the massage and was ready to conduct stretching and strengthening exercises of the gastrocnemius & soleus muscle.  I also discussed and offered advice on running periodization (Severo-Silveira et al., 2021) which the client, really appreciated.  I feel I am getting much better at achieving a balanced professional bond with clients, through shared health and fitness interests, which allows me to interact much better during treatment.  I am, however, very aware, some clients may not appreciate receiving guidance on certain aspects of their training, hence will ensure I only offer guidance as the situation dictates.

References:

Aaron, D. L., Patel, A., Kayiaros, S., & Calfee, R. (2011). Four common types of

bursitis: diagnosis and management. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 19(6), 359-367.

Balletto, J. J. (2019). Soft Tissue and Trigger Point Release. International journal of

therapeutic massage & bodywork, 12(2), 31.

Lee, A. K., & Erdman, M. K. (2021). Analysis of Gait. Hoppenfeld’s Treatment and

Rehabilitation of Fractures.

Severo-Silveira, L., Dornelles, M. P., Lima-E-Silva, F. X., Marchiori, C. L., Medeiros,

1013. M., Pappas, E., & Baroni, B. M. (2021). Progressive workload periodization maximizes effects of nordic hamstring exercise on muscle injury risk factors. The Journal of Strength & Conditioning Research, 35(4), 1006-1013.

Williams, D., Richmond, S., Black, A., Babul, S., & Pike, I. (2020). Evidence

Summary: Basketball.

Zu Reckendorf, G. M., Artuso, M., Kientzi, M., & Jean-Claude, R. (2021). Collateral

ligament sprains of the metacarpophalangeal joint of the long fingers: Results of a surgical series of 15 patients. Orthopaedics & Traumatology: Surgery & Research.

Appendices

Appendix A: Finger Sprain

11^th 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

Black.

Serner, A., Tol, J. L., Jomaah, N., Weir, A., Whiteley, R., Thorborg, K., … & Hölmich,

1864. (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.