Date: 23/10/19

Total hours to date: 4

 

Torquay United Ladies fc played a home match against a highly competitive team. Many of the players were carrying injuries before the match where pre match treatment was provided in the treatment room. In some incidences, treatment was required on the pitch throughout the game.

Client A received pre match treatment after complaints of calf pain. Upon assessment, the affected area shown tightness and some slight pain and tightness during plantar flexion. The right calf had a larger muscle bulk than the left, which was the clients more dominant leg, causing them the most pain. The treatment provided was massage to the gastrocnemius and soleus muscles to help relieve muscle tightness. After treatment, the client was able to perform plantar flexion without complaints of tightness through the calf area. The client didn’t appear to receive any problems with their calf’s during the match, however the same client had complaints of a groin injury around 35 minutes in to the match. Cryotherapy treatment was provided on the pitch using a cold spray which helped to subside the pain where the player was then able to continue for the duration of the match without further complaints of pain to either injury.

Client B also received pre match treatment with complaints of pain at the patella tendon of the left leg, as well as plantar pain of the sole of the right foot. The client mentioned that they received no pain when resting, neither pain on palpation, however pain is present when running during a match. Kinesiology tape was applied at the left leg from the calcaneus, moving proximally over the patella tendon and the gastrocnemius with no stretch applied to the tape. This tape provided some support around the patella tendon whilst also allowing movement when running. With the pain in the right foot, this was treated as a potential plantar fasciitis. Kinesiology tape was applied at the sole of the foot extending to the calcaneus. A second strip of k-tape was applied over the first strip of tape, forming a cross under the foot. The client was able to complete the whole duration of the match without any pain, afterwards claiming that the taping was successful with no pain or feeling of being restricted when running.

After the match both clients claimed that pain had subsided after the treatment that was provided. However, there were many players on the team how had suffered a groin injury during the match, these injuries could be down to improper pre match warm ups and stretching. This information was passed onto the coaching staff to ensure that these injuries are reduced in future games and training sessions.

 

 

Date: 31.10.19
Total hours to date: 6
Before a training session, Client A had complaints of tightness in their right calf as they run. Massage was used to help treat this. The client did not experience any pain on palpation and full ROM in plantar flexion and dorsiflexion was achieved. There was some pain during effleurage (5/10 NRS), however pain had decreased during petrissage and tapotement techniques. When treating the soleus, there was no pain. Muscle tightness in the calf had reduced and the client was able to complete the training session with less pain.
Client B has had a previous MCL sprain approximately one month previous. After completing rehabilitation with a physiotherapist away from the pitch, the client is now attending training sessions and is hoping to regain match fitness. The client was able to complete most of the training session without any pain, however they suffered some light contact at the knee. With some slight noticeable swelling, the client was advised to sit out from the rest of the session to then ice and rest the injury. There was no pain and swelling had decreased significantly by the end of the training session. The client was able to flex and extend the knee without any pain or restrictions.

 

Date: 3/11/19
Total hours to date: 10
At a home match with Torquay United ladies, client A had complaints of some tightness in their left hamstring after the previous training session. There was some pain and tightness on palpation at the semitendinosus muscle belly. Range of motion was limited at around 45-55 degree hip flexion where the client complained of some pain and stretching of the hamstring. Treatment provided was soft tissue massage at the hamstring to help increase the blood flow and relax the muscle. Muscular energy techniques were also used on the hamstring to help lengthen the muscle as well as strengthening it. After the match the client said they felt some pain and tightness however had decreased from before treatment.
Client B suffered with ankle pain around 40 minutes into the match after rolling their foot after a tackle with an opponent. The client has not had any previous ankle injuries or complaints of pain. Upon pitch side assessment, the client did not appear to have any increase in pain, however appeared to struggle with weight baring when walking and running. The client was still able to continue with the match with no increase in pain. However, the client appeared to be struggling with the weight baring pain when running as they were seen limping off the pitch. Upon assessment post-match, the client did not suffer with any pain on palpation on the lateral side of the ankle. Pain had decreased after the match and the client was advised to rest the injury.

 

Date: 7/11/19

Total hours to date: 12

During this training session, client A had complaints of quadricep pain after an intense training session at the gym 24 hours previous. The client was suffering with DOMS throughout the day and prior to the football training session. Upon assessment, there was some pain on palpation, range of motion (ROM) in knee flexion and extension was limited in the left leg, with the right having much better ROM. This suggested a muscle tightness with the hamstrings as well as the quadriceps. Hip flexion was limited in both legs, with some pain at the left hip (NRS 4/10), which may suggest tight hip flexors and rectus femoris. The Thomas test was carried out to examine flexibility of the hip flexors. With the right leg brought close to the chest, the left leg appeared to remain straight and bounced back when pushed down, which was an indicator to a tight Rectus femoris. When testing the right leg, there was a much greater difference however was still a large indication to a tight rectus femoris.

Treatment provided for client A was soft tissue massage at the quadricep group, concentrating on the rectus femoris. Effleurage did not cause any pain; however some petrissage techniques caused some pain (NRS 3/10). After treatment, the client felt a decrease in muscle pain and tightness. ROM during knee flexion and extension had improved, as well as ROM during hip flexion.

 

 

Date: 10/11/19
Total hours to date: 16
During this away game, client A received pre match treatment following an MCL sprain 2 months ago. Treatment provided was kinesiology tape around the medial patella with a second strip across this to help provide support whilst also allowing full movement throughout the match. The client was able to play the entire 90 minutes without receiving any pain, after assessing post-match, there was no swelling or any pain.
Client B also received treatment after complaints of pain at the lateral ankle which was radiating proximally. Pain was located at the peroneal muscles, which increased during eversion and when running for prolonged amounts of time. There was little pain on palpation, however most pain was located more distally around the lateral malleolus (NRS 4/10). K-tape was applied from the lateral malleolus and proximally over the muscle belly of the peroneal longus muscle, to the origin at the head of fibula. This helped to support the muscle at the tendon as well as reducing pain by relieving pressure. The client experienced some ankle pain during the match and was removed from the pitch after approximately 55 minutes of play, however this was due to other circumstances as the client also suffers with severe asthma.
During the match, client C was treated pitch side due to a potential head injury due to an opponent making direct contact to the clients’ cheek bone with their arm. This occurred approximately 70 minutes into the match. Upon approach, it was clear that the client was fully conscious and aware of the situation. They were able to explain what had happened in detail and was aware of the accident. The client was still removed from the field of play so that the game can resume. Upon assessment, there was no swelling or bruising noticeable and the client had full awareness of the situation. With no signs of a concussion, it was agreed that the player was fully fit and was able to continue with the match.
After the match, client C was assessed again and there were still no signs or symptoms of a potential concussion or head injury. However, it was recommended to club officials that all players on the team should carry out a SCAT test to help determine and reduce the risk of concussion, as this is the main cause for concern during the contact sport.

 

Date: 14/11/19

Total hours to date: 18

During this training session, a client still had complaints of lateral ankle pain from the previous match (NRS 4/10). The client does not recall any type of previous direct trauma injury to the ankle. They claimed that the k-tape that was applied during the match helped to reduce pain through the lateral ankle and leg when they were running, however there was still some pain. The client also mentioned that they felt no pain or tightness during rest periods.

Upon assessment, the client did not feel any pain on palpation, however felt some pain during eversion at the peroneal tendon when asked to perform active movements of the ankle. When looking at resisted movements, it was noticed that the client struggled greatly during ankle eversion against a resisted force. After all tests for ligament sprain were negative, it suggested weakness in the peroneal muscles, however a peroneal tendinopathy should also be considered due to an inflamed tendon and overuse during running and weight baring activities (Walker, 2007).

During the session the client was provided with various strengthening exercises to help aim and increase stability of the lateral ankle. The client performed standing calf raises which were progressed to elevated calf raises where the client performed the action on a step, this will also help to strengthen the gastrocnemius and soleus muscles. This exercise can be progressed further to a single leg stance. Resistance bands may also be incorporated to help strengthen the ankle evertors by adding a resisted force to the movement, however the client felt most comfortable using a band that provided the least amount of resistance. This can be progressed to a band of higher resistance.

The progress of the clients ankle strength can be further assessed at the next training session after the client has had a week to complete the exercises provided.

References:

Walker, B. (2007). The Anatomy of sports injuries. Lotus Publishing.

 

Date: 17/11/19
Total hours to date: 22
Before an away match with Torquay United ladies, client A had complaints of pain at the calcaneal tendon. There was some pain and tightness on palpation of the tendon and the gastrocnemius muscle. With the foot put into dorsiflexion to keep the gastrocnemius muscle stretched, kinesiology tape was applied from the posterior calcaneus, proximally up the gastrocnemius. A second strip of tape was applied across the calcaneal tendon to help support the tendon. Kinesiology tape will help to still allow movement when running. After the match, the client claimed that there was less pain and felt more supported at the posterior ankle when running.
Client B had complaints of groin pain during a warm up before the match. The client mentioned pain at the gracilis muscle in the left leg. There was no pain on palpation however there was some tightness present within the hamstring at semimembranosus. The client was able to achieve full hip flexion and extension in both legs with out any pain. Although the client did feel some pain (4/10 NRS) in adduction. Soft tissue massage was applied to the area to help increase blood flow and provide warmth to the muscle. Some METs were also applied to help stretch the muscle further. For additional support during the game, k-tape was also applied to the gracilis and adductor muscles. The client did not participate in the full match; however, they played approximately 20 minutes of the second half and did not feel too much pain when running. However, there was still some pain after the muscle had been rested the next day. A rehabilitation programme consisting of stretches and strengthening exercises over a four week period will be created and then implemented into the clients daily and training routine.

 

Date: 28.11.19

Total hours to date: 28

At a training session with Torquay United Ladies, some players seemed to still be carrying injuries from the previous match day. A client who was previously treated for hamstring pain still had some complaints of tightness and some pain when kicking the ball or when excessive weight was put through the right leg. The client had no other previous injury at the right leg however had been suffering with this injury for 3 weeks after starting a new job as a carer, which involves helping her clients with daily activities and sometimes helping them walk.

The client was treated during the training session after they completed a warmup and still had complaints of some pain. Upon assessment there was tightness of palpation at the right hamstring in the semitendinosus muscle, which was significantly tighter than the left. Full ROM was achieved in flexion and extension at the hip and in the knee. However, the client appeared to struggle with some functional exercises such as squatting, lunging and standing on one leg with some complaints of pain at the hamstring.

The client received STM as treatment which was applied to help relieve pain and tightness at the muscle. The client did not experience any pain throughout treatment. Some stretching (METs) were also applied to help reduce symptoms of pain as well as improve overall functionality. After treatment, the client was again tested in functional exercises to see if there have been any further improvements and reduction of pain during these movements. The client claimed that there was less pain during a lunge movements and slightly less pain when standing on one leg, however their balance seemed to have improved. There was still some pain when squatting, however this could be due to a tightness at the glutes. Further coaching when squatting could help to improve this as the client appeared to struggle with the position.

The client could be provided with further exercises to help improve strength and mobility of the hamstring muscles. The client may also need to be advised on how these different exercises are to be completed to avoid further injury and to ensure that this is helping to improve. The muscles within the glutes should also have been assessed to rule out any tightness or weaknesses which may be affecting the lower body.

 

Date: 01.12.19
Total hours to date: 28
With this match being a highly competitive cup game, each members of the team were checked for any injury complaints before kick-off. Many plyers that have been suffering with more serious injuries were not included in the squad, meaning there was less injured players to treat before the game.
During a warmup before kick-off, one player appeared to be struggling with some calf tightness and ankle pain. This player was then taken back to the treatment room for assessment to decide if this injury could be worsened by participating in the game. STM was applied after assessment proved that there were no signs of no potential damage to ligaments or tendons, although there was tightness at the gastrocnemius. ROM was also tested in plantar flexion and dorsiflexion, which the client shown that they struggled with. After treatment, the client claimed that symptoms of pain had been relieved, ROM had also improved slightly with less tightness on palpation. Kinesiology tape was applied at the back of the Achilles tendon and calf muscle to help relieve pain throughout the match and provide further support whilst also allowing for the ankle to move efficiently. The client did not experience any increase in pain during or after the match.
During the match, there were few injuries with the most severe being a potential head injury. The player involved was the teams goalkeeper, who has not previously had a serious head injury or previous concussions. Upon impact, the player went down and needed immediate attention. After assessing the client and the situation, any injury to the c-spine was ruled out due to the nature of the injury and that the client had not experienced any pain. The client was fully conscious and aware of what had happened. With no open wound, swelling or bruising present, further questions were asked to the player to help decide whether concussion may be present. It was decided by a team of two people that the player was fit to continue the game. The player was also checked both at half time and full time with no symptoms of concussion present.
With the likeliness of concussion being a serious risk with contact sports, it important that assessment and treatment is carried out affectively to help prevent any further complications. To help with this process, a SCAT test can be carried out at a future training session. This can help to identify symptoms of a potential concussion more quickly.

 

Date: 05.12.19

Total hours to date: 30

At a training session with Torquay united, a player had complaints of lateral ankle pain towards the end of the session after twisting and landing on the right ankle. Upon observation, there was no swelling or bruising at the lateral ankle. The client did not experience any pain when actively moving the ankle in eversion or inversion, as well as no pain on palpation. This ruled out any potential tears of the ligaments or tendons. However, the client did experience some pain across the anterior ankle when standing and walking. The client complained of some pain radiating up the shin. The client claimed that they had previously suffered an ATFL tear 5 years previous and has suffered with some ankle instability since. The client was advised to rest the ankle and apply ice to help reduce symptoms of pain.

Some exercises could be provided for further treatment to help improve overall functionality and strength at the ankle, reducing any symptoms of chronic ankle instability. These exercises can be provided so that the client can complete these at home. Work with proprioception can also help to improve the strength at the ankle.

 

Date: 08.12.19
Total hours to date: 34
During an away match with Torquay United ladies, only one player required pre match treatment. The first client had complaints of shin pain in the right leg. Upon assessment there was some limitations in ankle dorsiflexion and tightness on palpation proximally at the shin. For comparison, there was a considerable difference to the left shin, having better ROM and less pain than the right. This helped to identify some weakness at the tibialis anterior.
For treatment, some slight massage was applied to help warm up the muscle. This started to decrease any symptoms of pain and ROM could be seen to start improving however still did not reach full ROM. The application of ankle mobilisations in dorsiflexion appeared to help improve the client’s active ROM significantly. This also helped to decrease any symptoms of pain. Grades 1-4 were applied with mobilisations at the talus bone as when assessed, this appeared to be the cause of the most stiffness.
After mobilisations were completed, the client’s dorsiflexion of the right ankle had improved significantly, with a reduction in pain on palpation at the tibialis anterior. This treatment was a good example how massage and mobilisations have different affects to achieve better results. The improvement of the clients ROM after mobilisations at the talus proved that this was the most effective form of treatment and is what will be used in the future.

 

Date: 12/12/19
Total hours to date: 36
At a training session the players were involved in a fitness programme which involved various sprints and body weight exercises. There were not many players attending due to various injuries, the smaller numbers made it easier to identify any players struggling during any strenuous activities.
During some sets of sprints, one player had to stop due to complaints of knee pain. When assessing this, the player had knee pain after changing direction. When asked, the player claimed that the pain was at a 4/10 on the NRS. The client did not hear any popping or clicking sounds and there were no signs of swelling or bruising. This suggested that there were no torn ligaments or broken bones.
Due to the pain being caused when a change of direction had occurred, this suggests damage to one of the knee ligaments, in particular the ACL. After checking for swelling, bruising and pain the ACL was then checked. As the pain wasn’t too high, this should not cause too much of an issue however it was important to check that there was no potential damage to this ligament as it is most commonly injured among footballers. An anterior drawer test was completed to assess the integrity of the ACL, this test resulted negative with no further signs of damage to the ACL.
As there were no indications to serious injury and with the player claiming that the pain was beginning to subside, they were advised to rest before the decision was made to allow the player to continue with the training session. The player had no further complaints or issues with knee pain for the rest of the training session.
Treatment provided for the player was acted upon fast and thoroughly. Although the player did not have a serious injury and the pain had completely subsided, it was important that this was treated as though there was a potential injury as there may have been other underlying issues.

 

Date: 15/12/19
Total hours to date: 40
Before an away match, a player with complaints of hamstring pain was treated. The player confirmed that this is a common problem that has been reoccurring for some time now. The client regularly plays football and has a job working in a care home, where they claim that this involved being in different positions such as squatting or bending over for long periods.
Upon assessment, the client had some tightness on palpation along the left hamstring, particularly along the bicep femoris and semitendinosus. This was significantly tighter than the right hamstring. When asking the client to perform an active straight leg raise, they shown that this was uncomfortable. It was also noticeable that the right hamstring had a better ROM than the left, with the left having approximately 45-degree ROM. With the average ROM for hip flexion being 0-125 degrees, this shows a significant amount of tightness in the left hamstring.
Treatment provided was soft tissue massage at both hamstrings. As this was pre match treatment, the massage was not too deep at this relaxation of the muscle would not be beneficial before the match. Further treatment was provided after the match which involved more deep tissue massage. Light effleurage and some petrissage techniques were applied for pre match massage to help relieve some tightness and stimulate blood flow to this area.
METs were also applied at the hamstrings during a straight leg raise. This helped to stretch the hamstrings and increase the ROM at both legs to increase strength and flexibility.
Further strengthening exercises could be provided to the client as this is a reoccurring injury. Strengthening at the legs, hip flexors, glutes and lower back muscles may help to relieve some of the tension within the hamstrings as they are currently being over worked.