Monday 28th June 2021
Hours: 4 (Observational)
Patient presentations:
- Total Knee Replacement
- MUA for Adhesive Capsulitis
- ECRB release
Reflection Focus
- ECRB Release
Reflection Model
- The ERA cycle (Jasper, 2013)
Experience
- The patient was in the early stages of rehabilitation after having surgery for lateral epicondylitis. He was happy with the progress he was making; however he was complaining of tightness in his forearm. The physio prescribed eccentric wrist extension with a 1kg dumbbell.
Reflection
- I was unaware that there was a surgical intervention for lateral epicondylitis so was unsure of what the process entailed. However, the physio iterated that the rehabilitation process would be much like a ‘normal’ conservative approach – reducing pain, restoring ROM and strength, etc. The patient was clearly in the very early stages of rehabilitation as his current prescription was exercises to improve ROM. The eccentric wrist extension was the first exercise prescribed with load. Eccentric wrist extension is an accepted exercise prescription for the treatment of lateral epicondylitis as it is activities that require repetitive wrist extension that can result in its onset (Bahr, 2012).
- Prescribing eccentric wrist extension in this instance was not only addressing the patients complaint but it is also adhering to the acute phase on rehabilitation – normalising ROM. If the wrist extensors are restricted due to muscular tightness it would not be possible to improve ROM of the wrist without addressing this limitation.
Action
- I am not particularly confident with wrist and forearm pathologies. I would have know that an eccentric wrist extension would be an appropriate exercise for this patient due to their explicit complaint. However, I believe that my knowledge in this area is lacking. As a result, I will aim to cement my knowledge and understanding of lateral epicondylitis as this is a common injury seen in practice.
Revisiting Reflection
- Not too long after this experience, a personal training client of mine fractured her collarbone. At the time we focused on rehabilitation once she was out of her sling; however, what I overlooked was the increasing amount of load going through her other arm during ADLs. As a result, a few months down the line my client developed lateral epicondylitis at the elbow of the contralateral arm. My exercise prescription included eccentric wrist extensions; however when revising for my manual therapy exams I also found evidence to suggest that METs can be beneficial for this pathology (Thomas, et al., 2019). Therefore, once a week we complete an MET which she can also replicate at home with help from her partner. I also taught her how to apply deep transverse frictions to alleviate pain and we altered her training programme so her wrist would remain in a neutral rather than extended position.
References
- Bahr, R., Mccroy, P., Laprade, R., Meeuwisse, W., & Engebretsen, L. (Eds.). (2004). The IOC manual of sports injuries: An illustrated guide to the management of injuries in physical activity. Wiley-Blackwell.
- Thomas, E., Cavallaro, A. R., Mani, D., Bianco, A., & Palma, A. (2019). The efficacy of muscle energy techniques in symptomatic and asymptomatic subjects: a systematic review. Chiropractic & manual therapies, 27, 35. https://doi.org/10.1186/s12998-019-0258-7