Date: 04.12.19

Duration: 1300-1700

Individual with whom I worked with: Mick Smirthwaite

Before my placement:

Aims from today’s placement:

To observe Mick treating his clients and to be invited to get involved with some hands on soft tissue massage techniques.

Gain better understanding of Mick’s regular clients’ musculoskeletal issues that they present with each week.

During my placement:

Today was the first time that I felt keen to get involved in today’s clinic.  I felt more confident and enthusiastic about what today’s cases would bring.

After my placement:

Client 1 – A female weight lifter and gymnast

Posterior:

During the Subjective Assessment (SA) the client said that she felt good and that there was nothing major to deal with today.  She asked Mick to look at her back, shoulders and the subscapularis.  I observed Mick palpate the client’s lumbar and thoracic spinous process, the glute, erector spinae and quadratus lumborum muscles and the muscles in the upper back.  The muscles were tighter on the left side of the body.  Mick applied peripheral mobilisations to the right thoracic vertebrae in order to loosen up stiffness on the left side of the body.  He massaged the erector spinae muscles, the trapezius.  He applied NMT to the upper fibres of the trapezius and the Rhomboids to ease out trigger points.  He manipulated the fascia to check for any tension.  He also massage the quadratus lumborum both left and right to ease tension in the lower back.

Anterior:

I observed as Mick palpated the subscapularis on the right side of the upper body. He also palpated the biceps short and long head tendons and the muscle bellies down to the insertion.  He applied NMT to the subscaplaris and STR to the biceps.  There was also tension and tenderness in the brachioradialis.  Mick applied STR to the origin, muscle bellie and insertion whilst flexing the wrist and pronating the forearm.  He applied traction to the wrist joint.  Mick applied the same treatment to the left side of the upper body and arm.  The client had been elevating her body from blocks, with only her arms supporting the body during the elevation.  This caused tension and stress to the upper arm, forearms and wrists.

Client 2 – Male client with ongoing lower back and hip issues as a result of a car accident 5 years ago.

During the SA the client mentioned that he had twisted whilst working in his workshop 6/7.  His lower back locked and he had difficulty moving.  It was sore for the next two days but had eased by Monday.  He was able to do his PT session yesterday.  He has piriformis pain in his left glute and pain in his right hip.  During his PT session his physical trainer noticed that he had difficulty with hip extension on the left side and that his glutes weren’t firing.  This issue was present during the client’s visit to the clinic last Wednesday.  The PT has been helping the client with strengthening exercises to encourage the left glute to fire.

Psycho/social factors:  The client was more positive this week.  Last week he was very down and emotional.  He slept for 14 hours the evening after his treatment with Mick.

I observed Mick palpate the client’s right and left lumbar spine, quadratus lumborum (QL) and glute muscles.  Mick invited me to palpate the lumbar region and I noticed immediately tension in the left QL.  Mick applied NMT on the left gluteus medius and encouraged the client to internally and externally rotate his left leg.  He also carried out peripheral mobilisations along the lumbar spine (Level 4 – deep with small oscillations).  Mick also applied deep tissue massage work with the client extending the hip to encourage the glutes to fire, improve proprioception.  He also applied STR on the hamstrings which were really tense because they were firing before the glutes.  The client was eventually able to engage the glutes during hip extension, rather than the hamstrings and the muscles in the lower back.

Client 3 – 12-year old male swimmer

The first time that the client visited Mick, his serratus anterior muscles weren’t firing, he had scapular winging and the suprasinatus was tight.  The shoulders were also protracted.

During the past week the client has refrained from swimming butterfly during training sessions. Right shoulder and arm feeling much better.  He was able to participate in 5 races over the weekend.  During the postural assessment there was less elevation in the right shoulder and posture was much improved.  Mick applied mobilisation of the spine, massage of the upper fibres of the Trapezius (UFT), Infraspinatus, teres minor, erector spinae and rhomboids.  He also applied NMT to the trigger points in the levator scapulae and pectoralis major.  He palpated bicep tendons and applied traction of the arm and shoulder joint to check the movement of the latissimus dorsi.

I observed how Mick coped with treating a 12 year-old child.  When pressure is applied during treatments his endurance or tolerance was much less than that of an adult.  He wriggled a lot.  Getting a child to engage in the treatment is quite difficult.  It was good to have the parent there encouraging his son to stop wriggling during the treatment.

Mick was very pleased with the client’s progress and said that he didn’t need to see him again the following week.

How I felt through-out my placement today:

I can never say that I am disappointed during my placement.  The only disappointment would be with myself and I certainly haven’t felt that.  I did feel disappointed that one of the clients that we were due to see this afternoon cancelled her appointment.  It would have been nice to see how she was progressing and whether she was recovering well from her injury.

I felt quite relaxed during the clinic and enjoyed observing Mick as he worked with his clients.

Evaluate today’s placement activity:

I would have liked an opportunity to massage one of the clients today but I learned quite a lot from the observation and the treatments applied.  I am finding the long-term cases that Mick has, quite interesting and observing the different way that he approaches each client and their treatment.

A deeper, analytical and critical approach to today’s experiences:

There wasn’t anything that happened during today’s clinic that didn’t go well.  The clinic went as I expected.

Draw conclusions – what have I learned from today’s activities and my reflections:

I am beginning to understand how getting clients to move the tight or strained muscles during the application of particular massage applications helps you to understand muscle movements and identify what the problem actually is.

Action plan – how will I apply what I have learned from today’s activities & my future professional and personal development:

I read the text books that I have recently purchaseed called Fascia in Sport and Movement and Becoming a Supple Leopard. Both texts will help me to understand how the body moves and how to resolve dysfunctional movement patterns that can affect movement and lead to pain. Gain a better understanding of the Fascia’s structure and function and learn about the latest research.

Have any questions arisen from today’s placement that I need to discuss with my Placement Tutor or University Placement Tutor:

At the end of the placement I discussed each individual client with my Placement Supervisor and the treatments that were applied.  He answered the questions that I had regarding massage applications that were used and confirmed my own understanding of why they were applied.

Featured Photo by Marcus Ng on Unsplash

Returning to my reflections: