STYD90-Reflective Assessment

In my second year, I undertook and completed placement at two clubs, Plymouth Pilgrims Netball Club and Marjon Football FC. Plymouth Pilgrims Netball Club had a mixture of team, from the first team until juniors. Due to be being busy on some days for the other clubs, the main team I worked alongside was their first team, this is where I went to training session and also their games, which were held on a Saturday morning. I occasionally went to their second team and third team games as they were both held on a Thursday and are normally back to back games. Due to the first playing regional netball and league netball, this put a lot of strain and pressure on the netball players from over playing during the week. At the club, there was a variety of ages, which was good when it came to treatment as I had to treat them all differently, due to age and ability. I also undertook another placement at Marjon Football FC, they trained on a Tuesday and played games on the weekend, sometimes they would plan more training sessions during the week, depending on availability. This placement was very similar to Plymouth Pilgrims, I stayed with their first team as that was the main team I worked alongside. This team ranged different treatment, as they ranged in different ages as well. Working with both of these teams was a good way to gain more experience and knowledge in different areas that I don’t normally treat. Due to clubs loosing and gaining players, it was a responsibility of mine to get to know the players so I could offer them the best treatment. Both clubs were very welcoming on my arrival and throughout each session I attended, this made it easier for me to get to know the players and feel welcomed. Overall, I found both placements very enjoyable as I was able to gain confidence and more knowledge that I can now use in the future.

One of my aims that I wanted to achieve in both of my placements was to use my knowledge that I already had, this being from extra research and knowledge from my first year at University. I also wanted to work on using stretching techniques as I have really struggled using these and understanding them. After doing some research, I started to understand why MET’s and other stretching techniques were really useful. Netball being my main sport, it was easier for me to understand, whereas football I didn’t really understand, so this meant I had to undertake more research to get a better understanding, this would then make it easier to help treat clients. After research, it had a better understanding on why particular muscles got tight in netball and football, this then meant I was able to use my previous research to then practise stretching techniques. In both netball and football, both sports require a lot of flexibility and also have very dynamic skills in both. This means it is good to identify good stretching techniques in both sports, this will help decrease injuries and improve range of motion/movement (ROM). The main role for my aim was to help improve my knowledge in the specific area that I had been struggling with, and also help treat injured players that may have tight muscles from too much training or game play. This job came with responsibilities, this means checking up on players to see how they are getting on and checking on other players to make sure they don’t injure themselves. Also treating clients by giving them stretching techniques to practise to help decrease the chances of them getting injured.

Another aim of mine during my time and Marjon Football FC and Plymouth Pilgrims Netball Club was to use a variety of treatment modalities, this can be ultrasound, hot and cold treatments, etc. As explained in my reflections, I started to treat a client with an Anterior Cruciate Ligament (ACL) tear, at the start of 2020 (Reflective blog post – 11/02/2020). Due to this client having previous rehabilitation provided after surgery, this was to help gain strength that they had previously lost. My first main aim was to help the client increase the ROM, this would help with pain and stiffness and regain movement back at the knee. ACL is a serve injury, in any sport, especially in football, and due to this client player football, it was important to get this client back playing in due time. When I first started seeing this client, they had already completed the dynamic stabilisation and core strengthening stage and was now weight bearing. This means that the client is now reaching the functional strengthening stage, this is to help the client improve load distribution over both lower extremities requiring double-leg stances. Improving single-limb landing force attenuation strategies.

This meant working with the client, I wanted to make sure I was prepared, and the client was prepared when it came to this stage as it was going to be mentally and physically draining for the client. With the client having this injury, I was able to use a variety of different treatment modalities, I was seeing this client before training and regularly seeing them during the week in clinic, this was to help improve the clients ROM and try and speed up injury time as I know they were eager to get back layer, but this client had good and bad weeks, but this was expected. Due to the client compensating on the non-injured leg, this muscles in this leg seemed to be tight, massages helped with improving muscle recovery from intense exercise, it is also good to help relieve muscle tension and spasms (Hemmings et al., 2000). I also decided to massage the injured leg, being extra careful with pressure as I didn’t want to hurt my client. Massaging the injured leg meant that the muscles wouldn’t shorten and would prevent them from being tight. Again, here I could show off my stretching techniques that I had learnt from my previous client to help improve this client’s ROM on the injured leg. Before starting any massage, it is important as a therapist to compare the injured and non-injured leg for ROM, the injured leg clearly having less range of movement due to being injured. This is good to test, this is because after a few weeks of treatment, it is good to test to see if the treatment is working and is correct for the client. This player could also be guarding the hamstring due to the injury, this could then prevent excessive extension. However, because massage is not long term, it is hard to maintain optimal hamstring length which could be a problem. This means as a therapist, it is important to give exercises e.g. extenders at 90 degrees to perform at home, this means they don’t go back and then are keeping optimal strength in the hamstring. The effect sports massage was shown when then the client had a better range of movement week by week, I started to see improvements and so did the client, meaning they were determined to keep as they were seeing results, giving me positive feedback as well. This meant by using this technique, I was applying my knowledge from first year as this was another aim of mine.

As I have explained in my previous reflections, at Marjon Football FC I was also seeing another client that was complaining of adductor strain (reflective blog post – 10/03/2020), this could be from kicking the ball or making an awkward turn in football. Due to not having much experience with this injury, I again had to do extra research to be able to give this client the best possible treatment in order for them to recover. Due to this player being an eager player and the coach still wanting to play him, he decided to carry on a this wasn’t a sever adductor strain and was more minor/mild. Adductor muscle injuries re the second most common injured muscle group (23%), behind hamstrings at (37%), these injuries can also be missed and are most frequent in football (Tyler et al., 2010). This sport requires strong eccentric contraction of the adductor musculature during competition, this is why they are commonly injured. Therefore, as a therapist I needed to come up with a plan to help to help aid this client in still playing football, this meant I had to produce a programme in aiding the client, giving the client exercises e.g. glute bridges, ball squeezes. This is to be done before game and training to help improve strength. Then, each week I would check in with my client to see how they are getting on and if it’s getting worse or getting better, because if there is a change, I would need to change my programme. Programming put me put me out of my comfort zone due to never doing a programme before, this is where I asked other people in order to help me achieve a programme. This also helped me expand my knowledge in this specific area, so I could use this knowledge again. As this put me out my comfort zone, I was not confident when it came to explaining the programme and the different exercises it involved. I think I need to believe in myself more and this is something I’m going to work on for next year as I doubt myself too much and think I don’t know the answer when I initially do.

At my time at both of my placements, I soon realised that taping was a weakness of mine and this was something I needed to work on. There are two types of taping, Kinesiology Tape (KT), is used to increase local circulation, reduce local oedema, improve circulation of blood to facilitating muscles and providing proper afferent input to the central nervous system (Öztürk et al., 2016).Ridgid Taping is used to help stabilise joints and prevent them from ‘giving way’, this is very common in chronic ankle stability (CAI), this is very common in netball players, this meant I needed to know more due to being on placement at a netball club (Lardenoye et al., 2012). Kinesiology tape I am more confident in compared to rigid taping, this is because I have had K tape used on me previously, so I have experienced this taping more, so I am more comfortable applying and having knowledge in this particular tape. On the other hand, I have not used or had experience in ridged taping, so this was something that I wasn’t very confident in applying. This was because I didn’t use taping as a treatment that much at both placements, I used massage and stretching techniques as my treatments as these were more appropriate techniques to use for the injuries. As explained in my blog post, (reflective blog post – 02/03/2020) I have only used rigid taping a handful of times so I am not very confident in this area, I have only taped the ankle for CAI, and only doing it more recently now as I am now suffering from ankle instability myself due to ligament damage and it not being very strong so I use it to stabilise my ankles, but still do not have much knowledge in this area. Other than occasionally taping my ankles and other clients a handful of times, this is the only place I have used rigid taping, so I wouldn’t be confident in using rigid taping in another place e.g. the knee. For my third year and my next placement, I would like to use rigid taping more, specifically in different areas to the body they I have no experience with, also expanding my knowledge in both taping strategies as I would like to know more about both.

Finally, something that I have really struggled with has been confidence, which I have previously stated. This has been a massive issue in both of my placements. This has also affected me in my everyday life, as I am always doubting myself so I also think I’m going to failure so I don’t end up doing something as I don’t like being wrong and getting something wrong as I don’t want to embarrass myself, so if I’m not confident I normally take a step back and let someone else lead, so I can watch them and then I know for next time. Showing confidence has always been a task for me, especially when it came to placement as I have a responsibility in looking after a numerous of clients, and if I don’t have confidence in my treatments or programmes, my clients will not have confidence in me to provide good care to them as they may not return if my not confident as my clients are looking at that, in order for me to help them recover. Also, if I’m not confident in delivering information, they could interrupt it wrong and could then make the injury worse and delay their return to play. Over the next few months and going in to third year, this is something that I’m going to work on as this will really help me going into third year.

To summarise, I feel that I have achieved my aims from both placements, there is still some things I think to work on e.g. confidence but that will come with time, I have gained more knowledge in areas I was not confident with, this will also help me in the future. Both of my placements have given me opportunities to gain knowledge and aid in areas I was not confident, speaking to clients have also helped me gain feedback. At my time with both placements, I have realised the things I need to work on to become a better sports therapist, but I believe this is achievable.

References:

 

Hemmings B, Smith M, Graydon J, et alEffects of massage on physiological restoration, perceived recovery, and repeated sports performance British Journal of Sports Medicine 2000;34:109-114.

 

Tyler, T. F., Silvers, H. J., Gerhardt, M. B., & Nicholas, S. J. (2010). Groin injuries in sports medicine. Sports health, 2(3), 231–236. https://doi.org/10.1177/1941738110366820

 

Öztürk, G., Külcü, D. G., Mesci, N., Şilte, A. D., & Aydog, E. (2016). Efficacy of kinesio tape application on pain and muscle strength in patients with myofascial pain syndrome: a placebo-controlled trial. Journal of physical therapy science, 28(4), 1074–1079. https://doi.org/10.1589/jpts.28.1074

 

Lardenoye, S., Theunissen, E., Cleffken, B. et al. The effect of taping versus semi-rigid bracing on patient outcome and satisfaction in ankle sprains: a prospective, randomized controlled trial. BMC Musculoskelet Disord 13, 81 (2012). https://doi.org/10.1186/1471-2474-13-81