27.11.19 – Visit 5 – Daily Record of Visit to External Placement

Date: 27.11.19

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.

I have had more massage practice since last week and I feel more confident.  I need to be mindful of the placement of my hands during massage and not putting too much pressure on my fingers when I can use the palm and heel of my hands, my fists and my elbows to apply more pressure when applying NMT and getting deeper into the muscle tissue.

During my placement:

I felt enthusiastic about this afternoon’s placement and excited about the clients that were scheduled to visit Mick’s clinic.  I have noticed that I am feeling less anxious and my confidence is starting to improve.

During the treatment of the third client Mick checked the ROM of the right ankle.  It was quite stiff in plantarflexion and inversion.  The client was being treated for a soleus strain.  I had noticed during the acupuncture treatment that there was a reaction (pulsing of the tissue) near the origin of the peroneal longus and also further down the lateral side of the leg – on the peroneal brevis.  I mentioned to him that perhaps it was a peroneal injury, not a soleus strain.  He was already thinking that perhaps the original diagnosis wasn’t quite right because of the reduced ROM in the ankle. He did change the focus of the treatment, but the acupuncture needles had been inserted on the lateral side of the leg, so it was still effective for a peroneal injury.

After my placement:

I didn’t have time to talk about the clients that were scheduled to see Mick today.  The first client had arrived early so we went straight into the consultation.

Client 1 – A female weight lifter and gymnast

I observed Mick treat the client for tight Tensor Fascia Latae (TFL), Quadriceps and hips.  On palpation the right side was tighter than the left side particularly in the Glutes and Quadratus Lumborum (QL).  Mick applied STR to the Gluteus Medius during external rotation of the hip.  He inserted acupuncture needles in the Gluteus Medius, the TFL.  The muscles were tight and they grabbed the needle.  He attached the electroacupuncture scope to the needles.  I asked Mick the length of time that the needles are left in the muscle tissue. He leaves the needles inserted in the muscles for 5 minutes or until they become loose.  This means that the muscles have relaxed.  He uses acupuncture to avoid causing the client discomfort with massage.

Figure 2
Figure 1

The client also had tightness in the anterior hip.  Mick palpated the abdomen and asked me what structure it was that he was palpating.  I thought it was the Iliacus but it was in fact the Inguinal ligament.  He invited me to palpate it and it was very different from palpating muscle tissue.  I need to remember where the Inguinal ligament is for the future.  He asked me to massage the Quads on the left leg.  I located trigger points along the lateral side of the thigh along the Vastus Lateralis.  I worked on them until they dissipated.  Mick massaged the right quad.  It felt really good to be involved and to apply massage with confidence.

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

The Client had had a PT session the previous Friday and also went to the gym the following day.  He had been focusing on the left glutes during his PT session because they were not firing.  As a result his left glutes were very sore and his right hip flexor felt tight and sore too.

Mick palpated L4 & L5 spinous processes.  The Left hip was slightly higher than the right hip due to the tight glute muscles.  The client felt discomfort at the bottom of the left glute close to the attachment site.  Mick applied STR at the attachment site.  A small exercise ball was placed between the client’s feet. The client squeezed the ball and extended his legs off the bed whilst Mick applied NMT.  He removed the ball and placed a thermaband around the client’s ankles.  The client had to lift the feet off of the bed and laterally abduct the legs against resistance of the band, whilst Mick applied NMT.

Mick massaged the left hamstring applying NMT and STR to dissipate the trigger points and ease tension.  I was invited to massage the client’s left hamstring muscles.  I too applied NMT and STR techniques to break down trigger points and release tension in the muscle tissue.  The client was using the hamstring muscles more because the left glute wasn’t firing, so the muscles were tense.

With the client in supine position Mick worked on mobilising the right hip.  He applied traction to the right hip joint, pulling the leg which was turning out.  After traction the right leg wasn’t turning out so much.

Figure 3

Client 3 – Female long distance runner

This lady had been doing a log of long distance running in preparation for training for the London Marathon in 2020.  She thinks that the soleus strain is on the mend and has completed two walk/runs this week.  She always gets niggles and issues on the left side usually in the quads and the calf muscles.  She said that although she felt the injury was on the mend she felt some soreness on the lateral side of her lower leg and was a little concerned.  After palpation Mick decided to use acupuncture and the electroacupuncture scope to encourage tissue repair and reduce the soreness.  Whilst the acupuncture treatment was taking place we could see the muscle tissue twitching in the peroneus longus and the tissue was also slightly raised down the lateral side of the leg.  I was beginning to wonder whether the issue was actually related to the peroneal muscles and not the soleus.  Mick checked the ROM of the ankle and there was some stiffness in plantarflexion and inversion.  He asked the client whether she had twisted her ankle when she first hurt her calf.  She couldn’t remember.  She had tripped over whilst running and couldn’t remember if she had twisted her ankle.  She got up and carried on running.  We realised that the client may have strained the peroneal muscles and not the soleus.  After the acupuncture was completed, Mick massaged the client’s calf muscles.

Figure 4


Figure 5

Client 4 – 12-year old male swimmer

During the original visit this young lad had slight scapular winging and protracted shoulders – poor posture. The right shoulder was elevated.  This week there was an improvement in the posture and the there was only slight elevation in the right shoulder.  There was tension in Levator Scapulae, Scalenes, upper fibres of the Trapezius and the Rhomboids.  Mick released the tension with massage.  He also released tension by working on the trigger points in the neck and STR.  It is quite challenging treating a young lad as they do not endure discomfort the same way that an adult does.  He was a bit fidgety.

How I felt through-out my placement today:

I was really happy and motivated after today’s placement.  I actually realised that the source of client 3’s injury was not connected to the soleus as was previously thought by Mick.  The source of the client’s pain was in the peroneal longus and brevis.  It made me feel good that I had realised, during the treatment, the true source of the client’s pain.

Evaluate today’s placement activity:

I felt that I repeated the techniques that were demonstrated, quite well, but I must learn to relax my shoulders when getting deeper to palpate deeper muscles.  I enjoyed palpation today and feeling the trigger points in the piriformis of a client.  The piriformis is quite deep in the buttocks but if you rotate the hip laterally you can feel it if you palpate deeply.

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

Continue to practise palpation and massage.  I had a very busy week since I last saw Mick. I have been supporting the BUCS Futsal, swimming and water polo teams which has involved the use of palpation and massage skills.

Continuing to practise palpation and massage is a priority.  Moving muscle groups whilst palpating them has enhanced my understanding and I am beginning to identify the difference between fascia, muscle tissue and tendons.  My anatomy is helping me to locate origin and insertion points of muscles by feel.

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

I saw a number of different treatments today.  The use of a thermaband and ball by the client whilst Mick applied an MET.  I also saw Mick perform traction on a client’s hip using a strap.  We have not covered mobilisations yet in our modalities module but I am looking forward to learning more and being able to apply those techniques on clients myself.

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

Practise palpations and massage techniques.

Keep up with the revision of the anatomy and different pathologies.

Try to read as much as possible about massage techniques, the fascia, anatomy trains and the kinetic chain. I am so busy at the moment with lectures, fitting in massages and treatments of swimmers, water polo and ladies futsal teams that I am finding it difficult to find time to read, but hopefully things will quieten down over the Christmas period.

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

I did not have any questions at the end of today’s placement.  I asked questions at the time they occurred to me during each assessment and treatment of each client.

During our post placement discussion Mick said that he was very happy with my progress today and said that I had done very well.

Returning to my reflections:


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