19/03/2021- Marjon Sports Injury clinic- 3hrs

During this session, I shadowed another therapist and assisted in the treatment of the same client we had last week.

The session started with AROM testing the Lx movements of Flexion and extension, flexion is pain free and extension is painful, we also tested side flexion the right was limited and painful and the left had full range of motion and was pain free and Hip movements performing fabers which was painful and faiders which was pain free.

We then moved into the gym for the following session:

1. Warm up of 10 minutes cycling on the stationary bike at level 12 aiming for an RPM of 70, at 5 minutes the client has an RPE of 3 and so we continued this level until 6 minutes in where they could feel themselves fatiguing and therefore, they were put on level 10 and at 7 minutes they were no longer fatigued so they continued level 10 for the duration of the 10 minutes.
2. Stretching, we continued the session by doing some stretches before moving onto exercise.
   1. Knee hugs (2×10 second hold-no pain)
   2. Cat/cow (4sets 5 reps- no pain)
   3. Cobra into child’s pose (4 sets 5 reps- no pain)
   4. Crucifixes stretch “feels loads better than last week when I couldn’t complete the stretch”.
   5. PIR in hamstrings 3×10 second holds on each leg (definite improvement from last weeks ROM and increased during this week’s session also.

We then continued to do a series of exercises that have been included as part of the client’s gym-based exercise programme:

1. Squats (10kg 3 sets 6 reps) a free-standing squat became painful after 4 sets, so the client moved to an adapted squat with a bench doing sit to stand exercises with the weights and continued pain free for the rest of the reps/sets.
2. Hip thrusts- (10kg first set 25kg second and third set with a TheraBand on the legs all pain free and the client also progressed to performing the movements on the heels for the final set with a 2 second hold at the top).
3. Bulgarian Split squats (4kg in each hand (8kg) the client began to fatigue at the 4^th rep of the first set, however, did not feel pain and therefore continued the 3 dets of 6 reps as planned).
4. DB RDL- (8kg kettle bell 3 sets 6 reps)
5. Wood chop- (3.75kg 3 sets 6 reps each side)
6. Crab walks (the clients struggled to perform more than 12 steps last week with pain onsetting which stopped them, this week they managed to perform 17 steps before fatigue started to set in and completed with 20 steps when they felt pain and had to stop meaning they increased by 6 steps this week).

The session finished with a cool down on the stationary bike at level 8 with an RPM between 60 and 70.

At the end of this session after the client had left me and the other therapist revaluated our recent diagnosis of a hip impingement and we are now under the assumption that this could be an SIJ issue. This is due to the area of which the client is experiencing pain during the movements, stretches and weighted exercises. To help solidify this impression we aim to complete combined movements in the next session to differentiate between a facet joint or disc issue for the SIJ if possible, to do so. This is something we should have done in previous sessions to rule out this as a DDx however we did not complete that and therefore we will complete it in the next session and learn from this week in the next session.

We could improve on this by writing a plan of everything that needs to be done in the session before the session and having regular discussions about opinion of the injury.