Today I spent 5.5 hours creating a dynamic warm up and static stretches cool down for Saints Southwest Football Academy.

Due to this whole worldwide situation, we are having to all work from home, so if an opportunity to help my placement out during this time of need comes around I certainly take it! I started off by listing dynamic exercises for the warm up which the athletes (ages 7-16) can do at home. I then decided that because it is just a list, they may not have known what each exercise was, so I decided to create a video showing them what each exercise is and how to perform correctly. Performing the exercises correctly will help prevent any injuries from occurring. I decided to create two videos; one of the dynamic exercises and the other the static stretches. I will be uploading these videos to my YouTube channel so then they are there for myself to use in the future if needs be!

Here is a list of the exercises and stretches I have prescribed to the athletes including the videos I created for the athletes to follow;

Warm-up

Dynamic movements- 10 of each

1. Jumping jacks
2. Walking knee hugs
3. Arm circles- both directions
4. Walking lunges- forwards and backwards
5. Squats
6. Leg swings
7. Inchworms
8. Press ups

Cool Down

Static stretches- hold for 30 seconds each

1. Hamstring stretch
2. V-sit stretch/ diamond
3. Quad stretch
4. Lunge stretch
5. Calf stretch
6. Bicep stretch
7. Side flexion
8. Chest/ tricep stretch 

Script for video

Page 3- Exercise Prescription:

According to Vines (2015), the rehabilitation process of a shoulder dislocation can be made up of three stages; the first stage occurs straight after the shoulder has been relocated and a sling is prescribed to wear for a maximum of two weeks, the NHS also advises over the counter painkillers and the use of cryotherapy- ice pack for example to relieve any pain. Stage two consists of increasing the range of movement which allows an increase in muscle strength. Stage 3 is to regain neuromuscular control of the shoulder including proprioception where a physiotherapist from the NHS will prescribe exercises to do.

• For strengthening- isometric/static exercises are best to start off with as there is no movement involved. This can be done by using a wall or a solid object to push against.
• Rotator cuff exercises- internal and external rotation of the shoulder, abduction and adduction and flexion. Starting off generally using own body weight then to strengthen resistance bands are a good material/equipment to use to add a little resistance to the exercises (making it a little harder).
• Progression- using other equipment such as an exercise ball for balance (into press up position with feet on ball), a wobble board (hands on the wobble board). These are also known as plyometric type shoulder stability exercises. A swimming pool or hydrotherapy pool can also be used for rehabilitation of the shoulder- using the range of movement exercises for flexion, extension, abduction, adduction, internal and external rotation. These can also be progressed with floats and change of speed. On the last slide there will be a list including all the leaflets that have been used, all available to be retrieved from the internet.

Page 4-

Resistance exercises to strengthen the shoulder to prevent dislocation occurring.

• Shoulder flexion- seated chest press machine/ front raise using dumbbells (DB)
• Shoulder extension- seated row machine/ single arm row or bent arm pullover using DB
• Shoulder abduction- shoulder press machine/ upright row using barbell (BB)
• Shoulder adduction- latissimus pull down machine or assisted pull ups- body weight (BW)
• Shoulder horizontal flexion- bench press machine or chest press machine/ bench press (BB) or Flyes (DB) or press up using BW
• Shoulder horizontal extension- seated row machine/ prone flye (DB)

Page 7- Training techniques:

Resistance training is an exercise that will improve muscular strength and endurance. You can use resistance from your own body weight, resistance bands and free weights such as a barbell, dumbbell or kettlebell. There are also resistance machines that can be found at a gym that can be used. Resistance training is known to improve your bone density and mental health.

Proprioception is having the awareness of the position and movement of the body or body part. This will help drastically when rehabilitating the shoulder from a dislocation as full range of movement needs to be applied before strength training is prescribed. This can be linked to balance training by adding a ball to the exercises from static strengthening to regain the mobility of the shoulder.

Strength training is designed to increase and improve the strength that is being trained. In this instance, the shoulder will need to regain its strength after the dislocation. Strength training can be developed from resistance training by adding more weight to the exercises. However, power and strength are sometimes mixed together due to the importance of the two, not just for sporting activities but for day to day activities (Hutchinson, 2011).

References

Guy’s and St Thomas. (2017, march 1). Hydrotherapy for shoulder- exercise sheet. Retrieved from NHS foundation Trust: https://www.guysandstthomas.nhs.uk/resources/patient-information/therapies/physiotherapy/hydrotherapy-for-shoulder.pdf

Hutchinson, A. (2011). Which comes first, cardio or weights? New York: Harper Collins Publishers.

Salles, J. I., Velasques, B., Cossich, V., Nicoliche, E., Ribeiro, P., Amaral, M. V., & Motta, G. (2015). Strength training and shoulder proprioception. Journal of Athletic Training, 277-280.

Steele, J., Fisher, J., Skivington, M., Dunn, C., Arnold, J., Tew, G., . . . Winett, R. (2017). A higher effort-based paradigm in physical activity and exercise for public health: Making the case for greater emphasis on resistance training. BMC Public Health, 17, 1-8.

Vines, A. (2015, August 1). Rehabilitation after shoulder dislocation: Information for patients. Retrieved from NHS Trust: https://www.ouh.nhs.uk/patient-guide/leaflets/files/121210shoulderdislocation.pdf

4 Week Exercise/Activity Programme Overview

Aim: Increase strength/power in both shoulders

Warm up-

• Skipping using a jump rope for 5 minutes
• Shadow boxing in the mirror for 5-10 minutes
• Light pad work- going through all the punches for 5 minutes

Stretches-

These need to be dynamic and not static as we want the body to stay/get warm.

• Arm circles- forwards and backwards 10 seconds each direction
• Arm swings- open and closing the arms 20 seconds
• Side flexion (both sides) hold for 5- 10 seconds

Resistance training-

These are completed using a resistance band.

• Pull apart- arms out in-front of you with a slight bend at the elbow, ensuring there is always tension in the band- open and close the arms.
• Triceps pull- holding the band behind your back vertically, the bottom hand bringing the band around to the side of the body, the top hand making sure the elbow is pointing up, extend that arm up and down again, making sure there is always tension in the band
• Lat pull down/ overhead pull downs- wrapping the band around a machine (i.e. pull up bar) starting with your hands above your head, pull down either side of your body with the finishing position being your arms are out straight either side of you, and release.
• Bicep curls- standing on the resistance band you can the option to curl one arm up and a time or both at the same time. Ensuring the elbows are stuck to your body and that your wrists are strong. Your hand position can either be palms up (in a fist) or thumbs up.
• Seated row/ or standing row with an external rotation
• External rotation- attaching the band to a solid object, gripping hold of the band in the hand furthest away, keeping the elbow into your side and open and close the forearm to your body.
• Internal rotation- in the same position, use the arm closest to the band that is connected to the object (machine for e.g.) and open and close your forearm keeping your elbow attached at your side.
• Upward row- standing on the resistance band, starting with your arms down, pull both elbows up past your ears and push down again.

Free Weight Training-

These are completed with a 5kg or 10kg weight.

• Front raises
• Bent arm pullover
• Bench press
• Prone flye
• Bicep curls

Using smaller hand weights; gentle jog on the spot while punching hand weights in-front. Ensuring that the arms are rotating causing the fists to rotate (from thumb up to thumb sideways).

Cardio burst exercises-

• Touch and jump
• Squats/ squat jumps/ box jumps
• Lunges/ lunge jumps
• Burpees
• Mountain climbers
• Star jumps
• Jogging on the spot for 20 seconds then sprint for 10 seconds.

Cool down

Static stretches

• Hamstrings- legs straight out in front, then legs apart (V-sit)
• Quads- standing, hand on the wall for balance, one leg up behind gasp hold of your ankle and bend your resting knee.
• Calf’s- push into the wall/solid object, stand in a lunge position, front leg bent back leg straight, making sure toes are facing forward (should feel the stretch in the back leg)- then switch legs
• Hip flexors- move your hands off of the wall/object, slightly bend the back leg and push your weight in the hips forward, you should feel the stretch in the back leg at the front (top of thigh)
• Triceps- arm straight across the chest, wrap the other arm under and pull into the body, making sure you stretch both arms
• Side flexion- feet together, both arms up, lean down to one side and then the other.
• Biceps- place your palms on the lower part of your back and squeeze your elbows together.

Resistance training:

Free weight training:

Cardio Bursts:

Here is my 5-10 minute presentation for Part B of this assignment.

In this video you will find extra detail on the exercise prescriptions and training techniques, covering the other parts slightly. Attached to this post you will find a script of the video of everything that is spoken about in the presentation.

This document consists of a checklist that was completed throughout my placement journey. These dates include meeting between myself and my university tutor and myself and my placement.

Placement checklist

Total Hours: 52

January

• 27/01/2020- 2.5 hours
• 30/01/2020- 2 hours

February

• 01/02/2020- 3hours
• 03/02/2020- 2.5 hours
• 06/02/2020- 2 hours
• 08/02/2020- 3 hours
• 10/02/2020- 2.5 hours
• 13/02/2020- 2 hours
• 22/02/2020- 3 hours
• 24/02/2020- 2.5 hours
• 27/02/2020- 2 hours
• 28/02/2020- 2 hours
• 29/02/2020- 3 hours

March

• 02/03/2020- 2.5 hours
• 05/03/2020- 2 hours
• 07/03/2020- 3 hours
• 09/03/2020- 2.5 hours
• 12/03/2020- 2 hours
• 16/03/2020- 2.5 hours

April

• 24/04/2020- 5.5 hours

Today was Monday night training session for the older age groups; ; U11’s, U12’s, U13’s, U14’s and U16’s.

For this evenings training session, I had 2 clients booked in, both being follow ups. I needed to make sure I took extra precaution when palpating and being in contact with my clients due to this new outbreak of a new virus that is spreading across the world, Covid-19 (also known as the Coronavirus). I needed to make sure my hands were properly washed/cleaned (even though that come natural to me before being in contact with any of my clients). I also needed to make sure my clients didn’t have any of the following symptoms: headache or sore throat, as these are the main symptoms that can occur if you have Covid-19.

My first client had the groin pain, which was no longer causing any pain! It is still slightly tight, so I gave him a quick deep tissue massage using the deep heat balm to aid the warmup of the quadriceps and groin. His dad mentioned to me that he will not be participating in training this evening as he wants to ensure this covid-19 ‘blows over’ as a precaution of his son catching it. This was totally understandable as this is a new virus and no one knows what to expect.

My second client was also a follow up appointment, and again his pain from his heel has gone! He told me that he feels more confident in his ankle/heel as there is no pain ‘stopping’ him. I advised to make sure that he keeps stretching and to stop at any given time that the pain becomes more than a 5/10.

After my two clients I headed up to the AstroTurf where I needed to assist a couple of players. One went down due to an ankle injury, he said he had rolled him ankle. I checked him ROM and compared it to his non-injured ankle, he said that the pain was still there, but it had reduced from an 8/10 to a 4/10 within 2 minutes. I asked him if he felt like he could get up and carry on training and he said, ‘yes I’ll be fine’. A second player went down from being ‘winded’ by the football. This is where the football has been kicked straight to his stomach which has caused him to have a shortness of breath. I was able to calm him down and told him to place his hands on the back of his head and to take a deep breath in through his nose and out of his mouth 10 times. After this, this seemed to have calmed him down, and there was no longer any shortness of breath.

For the last 10-minutes of the training session, I gathered all the age groups into the middle of the pitch and went through stretches with them.

Thursday night training session for the younger age groups at South Dartmoor CC in Ashburton.

I had one client booked in, the same as last week. Tonight, I visually saw some progress in my client, no pain on palpation, no pain during the deep tissue massage on his groin and quad. His ROM improved drastically compared to the first week. During the deep tissue massaged I used the deep heat balm as my client seemed to be more comfortable with this rather than oil. He mentioned to me how grateful he is of me from giving him exercises and stretches to do at home to help ‘speed up’ the recovery time of his injury. It has now been 5 weeks since his injury happened, and tonight he said that he felt confident to try to join in his training session on Monday. This made me feel so relieved, and proud of myself to be able to see the progress and the adaptations of the injury unveil. This also made me realise that I need to stop questioning myself about my ability and knowledge of treatment. I advised this client to make sure he gradually goes into training due to him missing out for 5 weeks, also to keep doing his exercises and stretches at home.

Monday night training session at South Dartmoor CC, with the older age groups; ; U11’s, U12’s, U13’s, U14’s and U16’s.

Today I had 3 clients parents message me prior to this evenings training session wanting to book their child to see me.

My first client was a follow up appointment after being advised to get a scan on his Achilles, the results came back fine so the other week i applied K-tape to his heel to give the support he felt like he was missing. This week I checked his ROM with active, passive and resisted movements and all has improved brilliantly. His pain is still occurring at the attachment site of the Achilles but only a 2/10, due to this he felt like he was ready to return to play, I was certainly happy to hear this! I spoke to my client and his parent and said that if they were both happy with their treatment and no need for further questions, that I was happy to not need to rebook him for another session, his pain has decreased, his ROM has increased. I did however advise to take training easy, gradually build himself back up as he has missed a few weeks. I then told him to make sure he keep doing his calf stretches to prevent the Achilles becoming tight and pulling from the attachment site, especially while he is still growing.

My next client that was booked in was also a follow up appointment with an achilles injury. I started off with palpation around the heel, mainly to see if there was any pain on palpation (PoP) which there wasn’t. after palpation was cleared, I then checked the ROM of his ankle with resisted movements and all was fine. He asked if I could apply K-tape to his heel as it makes him feel more confident, I applied it starting from the base of his heel following up the achilles to the point of where the gastrocnemius starts, I then added another piece across the where the pain site used to be (back of the heel). I advised to keep stretching his calves and there was no need for a follow up appointment for next week, unless the pain comes back.

My last client of the day was a new client. His parent, prior to the appointment, mentioned that he had an ankle injury. When my client came through the door with his other parent, he told me that it wasn’t his ankle it was more his heel. I palpated the area where he pointed to (Achilles) while he was sat on the edge of the bed, he said there was no pain while touching it. While he was still sat on the edge of the bed I cleared the joints above and below, ensuring the ROM was fine at the knee and the ankle; actively, passively and resisted. After this I got my client to lay on his front on the physio bed so I could have a feel of his Achilles, his calf muscles and his hamstrings. While palpating, I noticed there was slight tightness in his calf muscles which may have been causing the pain in his achilles. I decided to perform the Thompson test on him to make sure that his achilles was still attached, this came back negative which means that his achilles was still attached. I decided to give him a soft tissue massage on his gastrocnemius, while doing so I found that his med head was tighter than the lateral gastroc head, which managed to loosen as I carried on massaging. I then helped him stretch his calf and advised to make sure he drinks plenty of water and to keep stretching, especially after sporting activities.

Due to having a little time left, I managed to head up to the AstroTruf to make sure the boys were all doing their stretches for their cool down. The coach of U13’s asked if I could teach the stretches to his players again, to make sure they were all doing them appropriately and correctly.

Today’s Saturday morning match was away at Ivybridge Community College against Plymouth Argyle Academy. Once I had driven there, I met up with the coaches and the players outside the changing room and waited for all the players to arrive. Today I had help with a Masters’ student from Marjon University which was very helpful due to having to be a therapist to 4 different groups/teams. There were two age groups at Ivybridge CC today; U9’s and U10’s which were then split into two groups in both age groups, creating 4 teams altogether.

Today the match consisted of 4 20-minute intervals. In the first and second interval there were no injuries that occurred. During the third interval a player went down with an ankle injury, I needed to wait a few seconds to see if he would ‘bounceback’ which he did, however, he came straight off the pitch and came to me. I checked his range of movement; actively, passively and also resisted which all seemed ‘normal’ I asked him what his pain was out of 10 and he said it was down to a 2/10 so I allowed him back on the pitch after he said he felt fine to continue.  5-Minutes later another player went down from falling on his elbow after jumping up to attack the ball into their goal. He was a little shook up- mentally felt like something was wrong, after I calmed him down, I asked him if he could move his forearm which he did. I then passively checked his ROM while checking for any contusions or abrasions that needed general first aid. All was fine, he shook it off and kept playing.

In the last 5-minutes of the final interval, a player went down from full contact onto his knee. I went onto the pitch and helped him off the pitch on the other side so I could assist him fully. Before moving the player off the pitch, I looked for any red flags (mainly any broken bones) and I asked if he could move off the pitch with my assistance. I checked the players ROM ensuring all was not reduced (which it wasn’t), I asked him how he felt and he said he wanted to stand up to try and walk it off. I helped him to his feet, he put pressure through to his foot and seemed to have regained confidence in his leg again before the injury happened, he thanked me for my help and jumped off (literally!).