Date: 16/11/ 2020

Hours: 4

Total hours: 26

This session in the Marjon clinic began with a lecture provided by clinic supervisors. This had included work with the isokinetic dynamometer where a demonstration was provided on how to use the equipment. This shown how using the clients hight and weight measurements, the correct adjustments can be made to the chair to create the most accurate results possible. The isokinetic dynamometer can be used to assess strength within the lower extremity, for example this can be used to compare the difference in hamstring to quadricep strength in a client with an ACL reconstruction before return to play. This was beneficial as this is a piece of equipment which can be used with future clients in the clinic to assess progress and strength.

The rest of the session involved a follow up gym-based session for a 42-year-old female client with low back pain. Before this session began, the client’s ROM was assessed to identify if the previously provided exercises had been successful in decreasing pain and improving ROM. Lx and Tx was assessed in flexion, extension, side flexion and rotation with no pain, however, did report of some pain (NRS 5/10) on the left-hand side of the lower back in extension. The hip was also assessed in flexion, extension, abduction, adduction, internal/external rotation with no pain however some pain present (NRS 5/10) in the left-hand side of the lower back in abduction.

After this assessment, the client’s session continued in the on-site gym. Due to COVID 19 and new government regulations, this required the appropriate PPE to be worn with social distancing maintained within the gym and throughout the session.

This session within the gym began with 15 minutes on an exercise bike using an RPE scale as a method of measuring the client’s rate of exertion. After a short warm up, the client began working at a speed of 70 with an incline of 4. This then increased to an incline of 7 where the client was still able to maintain a constant speed with an RPE of 4, meaning that they did not find this to be too difficult. After approximately 12 minutes at this incline and speed, the client reported an RPE of 5, suggesting that they were now beginning to find the intensity to increase and was becoming increasingly difficult. By the end of the 15-minute cycle the client reported an RPE of 5.

As the client had mentioned in a previous session how they would like to improve on their upper body strength, this was also incorporated into the exercise programme. This included 8-10 reps and 3 sets of bicep curls, dumbbell shoulder press, hammer curls, bent over rows and body weight/kettle bell squats.

The client began with a weight of 4kg however found this too easy, so this was increased to a weight of 5kg which was slightly more challenging. They found that the shoulder press and the bent over rows were the most difficult to complete and fatigued much faster. To help with this in future sessions, the shoulders can be strengthened, and fewer reps can be incorporated.

The client had reported that they were enjoying their home work outs with the exercises that had previously been provided. They also mentioned how they are enjoying the squatting exercises the most, meaning that a progression within the gym was able to be adapted to incorporate a kettle bell to increase the difficulty and help to build strength within the lower extremity.

Within the next session, it will be investigated how some progressions can be made within the lower extremity to make this slightly more difficult. This could include increasing the reps or weight during their squats. The shoulder exercises will also be simplified with fewer reps or a lighter weight to ensure that the client is still increasing strength but is not fatiguing too quickly or injuring themselves.