Individual with whom I worked with: Mick Smirthwaite
Before my placement:
Aims from today’s placement:
To observe Mick treating his clients and to get some hands on experience using soft tissue techniques.
To listen carefully to the clients when they talk about what they want from their visit to the clinic and gain an idea of the Musculoskeletal or functional problem that they are experiencing.
Mick has a full diary of appointments this afternoon, so I am expecting it to be busy. His first appointment for the afternoon is at 1 p.m. I arrived a little earlier so that I could talk to Mick about the appointments during the afternoon and be ready for the first client.
During my placement:
As each week goes by I feel more relaxed working with Mick, however there is always the anticipation of what each case will bring.
I believed that one of the afternoon appointments was a follow-up with the client who had torn his hamstring a few weeks ago. Unfortunately the client cancelled his appointment due to business commitments. It was a shame because it would have been good to see the effects of Mick’s treatment and how well the muscle tissue was healing.
After my placement:
Client 1 – The first client was a female weightlifter. She had tight hips and lower back, tight shoulders and upper back and she also wanted Mick to work on her Pectoralis Major muscle on the left anterior side of her chest. I observed Mick palpate the muscles and bony points in the lower back and hips. Mick let me palpate her lumber region. I noted that her gluteal muscles were tight. I observed Mick closely as he mobilised the Sacroiliac Joint (SIJ) and lumber spine. He also applied soft tissue massage (STM) and the Neuromuscular Technique (NMT) along the Erector Spinae, Quadratus Lumborum and the Gluteus Maximus and Medius. Mick showed me the mobilisation technique of the SIJ and Lumbar Spine and with the client’s encouragement I applied the technique on the right hip. I haven’t covered mobilisations in my Injury and Treatment Modalities module. We are due to cover joint remobilisation and mobilisation during late November and early December.
During the massage of the upper back, Mick gave me the opportunity to massage the client’s upper back on the right side of her body. The trigger points near the inferior medial border of the scapular were very hard and ‘knobbly’. I had to use my elbow to work on them to take the pressure away from my thumbs. Mick showed me how to massage deep under the medial border of the scapula to stretch the transverse muscle fibres of the Rhomboids.
Mick carried out mobilisation and stretching of the shoulder joints and also carried out NMT and Slow Tissue Release (STR) on the client’s left Pectoralis Major muscle.
Mick gave me feedback on the positioning of my thumbs and my hands when applying massage. It was good to receive this feedback. He said that it was important to position hands well during massage to avoid unnecessary stress on the fingers and thumbs. It was important for masseurs to look after their hands.
Client 2 – is a male business man who spends long periods of his working day driving. His lower back was stiff. There was stiffness on the right side of the body but the issue was on the left side. This may be due to the client guarding the tightness in the Quadratus Lumborum (QL) on the left side of the body.
Mick carried out joint mobilisation of the lumbar spine and high joint. He massaged the trigger points in the QL with NMT and also STR. He also massaged the client’s hamstrings and applied STR. I observed the treatment but was not involved in performing massage techniques.
We were expecting a third client but she did not turn up due to a mix up regarding the appointment date. She thought the appointment was next week.
Client 3 – The next client, a male cyclist/runner in his mid-forties – turned up earlier, so Mick saw him straight away. He said that he had an issue in the Sacroiliac Joint (SIJ)/lumbar region. His chiropractor thought that he may have a prolapsed disc. He also said that his Iliotibial Band (ITB), and his right shoulder were both tight and needed working on. The client was in prone position and Mick asked me to palpate his lower back. I could feel a raise in the tissues around the spinous processes L4 – L5, which appeared to be inflammation. Mick did not want to aggravate the vertebral discs in that area and decided not to apply joint mobilisation of the lumber spine and SIJ. He started to massage the Gluteus Medius and Maximus, the Tensor Fascia Latae (TFL) and the Iliotibial Band. He didn’t feel any issues with any of muscle tissue on palpation. The muscles were in good shape. He worked on the right shoulder and upper back. There were trigger points in the neck – Trapezius and the Rhomboids. Mick began massage of the area and allowed me to work on the trigger points. It felt very satisfying to help a client and ease the tension in the upper back.
How I felt through-out my placement today:
I didn’t feel anxious or confident. I was pleased with the guidance and feedback that Mick gave me. I was also pleased that he was confident enough to let me have the opportunity to be involved in the treatment of his clients. I felt that I had learned a little bit about mobilisation techniques and how to place my hands and protect them when applying massage and during palpation. I can empathise completely with Mick’s feedback. I was part of the Marjon Sports Therapy & Rehabilitation team who provided pre- and post-event massage at the Plymouth Half Marathon event in May 2019. After the event my hands were very tired and achy. Mick’s feedback resonated well with me.
At the end of Year 1 I felt very confident about my ability to apply soft tissue massage but observing an experienced sports therapy professional working with clients has made feel inadequate. I still have a lot to learn and I guess it is normal to feel that way.
Evaluate today’s placement activity:
I didn’t feel that anything went badly. I am concerned about the placement of my thumbs, fingers and hands when I massage after receiving feedback from Mick. He mentioned that he has seen a lot of sports therapists leave the profession due to the stress on their hands from massaging clients. I am very aware of it now.
A deeper, analytical and critical approach to today’s experiences:
Posture and hand placement during massage is important. I need to go back to the drawing board and read some of my massage texts regarding hand placement and practice on my family and friends to gain confidence.
I have never done joint mobilisation before. We are due to cover this in lectures and practical sessions in the next month. I am looking forward to learning these techniques.
Draw conclusions – what have I learned from today’s activities and my reflections:
The need to protect my fingers and thumbs from too much stress when applying massage and during palpation. I will review my massage texts and look at instructional videos and practise on my family and friends to correct my technique.
To think of other ways to apply massage without always using my hands. To get deeper into the muscle tissue and during NMT it is possible to use the forearm and the elbow.
A joint mobilisation technique of the hip.
Action plan – how will I apply what I have learned from today’s activities & my future professional and personal development:
Review massage techniques and hand placement by reading soft tissue massage textbooks and watching videos.
Practise massage on family and friends as much as possible.
Have any questions arisen from today’s placement that I need to discuss with my Placement Tutor or University Placement Tutor:
There were no questions arising from today’s placement.
Returning to my reflections: