Hours gained: 5
Total hours: 31
This week consisted of two initial consultations and one follow-up. The first client was an initial consultation and so I had to wait to find out what injury I would be working on. The first client had upper back and neck pain that started a week ago. It was always present but felt more of a dull ache rather than pain itself. She tried heat and ice once but they didn’t help her. During the objective assessment, I found that her shoulders were internally rotated and that her shoulders were also elevated. All neck movements were not painful but they were limited. Thoracic movements created no pain however they were limited, overpressure movement was limited as well. During palpations, I found several adhesions along the rhomboids, trapezius, SCM, levator scapulae and erector spinae. These muscles also felt taut. I did PA’s on the neck and the thoracic spine which showed stiffness at C2, C4, C5, T4, T7 and T9 (all central). I concluded that the pain came from facet joint stiffness in the cervical spine and thoracic spine along with taut muscles and adhesions. The client mainly came in for an STM on the upper body and neck which is how I started my treatment. I also started PAs on the cervical spine. I tried to start my PA’s at grade two and for 60 oscillations, however, this was too much for the client. So, I did grade one PA, on C2 and C4, for four sets of 40 oscillations. I didn’t get time to continue PAs down to the thoracic spine and I thought it would have been too much anyway. The client wasn’t interested in any exercises and so prevented me from giving them to her.
During the first session, I realised I didn’t clear the shoulder or check shoulder movements which could have added more information if there were restricted movements. This could cause a problem as I might misdiagnose the client and disregard some differential diagnoses due to lack of information.
The next client was also an initial consultation. The client had two pathologies to look at; his neck and the tops of shoulders, and his left quadricep. Since he thought the neck and shoulders were a bigger problem we focused on that first. The neck pain came on 1o days ago when he was doing a forward roll and felt a sharp pain in his neck which later travelled to the shoulders. He always had some pain in his neck due to the very limited movement because of mechanical problems. In the objective assessment, I observed internally rotated and elevated shoulders and flexion in the thoracic spine. All movements of the neck increased pain and moved no more than 15 degrees, sometimes less. I made sure I cleared the shoulder this time as I know I didn’t in the previous client. There wasn’t any added pain and the ROM was also full. When palpating around the shoulders and neck, I found taut posterior deltoids, upper trapezius, and erector spinae. There was also stiffness in the facet joints, T4 to T10, when doing central PAs. I also checked the seat belt test which increased pain. I still hadn’t come to a conclusion of what it could be so I asked Alfie to come help me. Alfie came to the conclusion that it was a trapezius strain. He also told me to make sure I always ruled out thoracic outlet syndrome as it could have been a differential diagnosis. He also showed me the special test again. The client requested an STM due to being very “tight” so that was how I started my treatment. I gave resisted shoulder shrugs which is an isometric exercise said to reduce pain (Anwer and Alghadir, 2014; De Mey et al., 2009). I didn’t have time to do any PAs as part of the treatment so I added it to the future plan.
I had become better at focusing on one pathology at a time to help better manage my time and prevent rushing. However, during that session, I felt I had spent too much time on the objective assessment and should have called Alfie sooner to help me. This would’ve allowed for more treatment time. I spent the hour after this session researching and asking Alfie about how he knew it was specifically trapezius strain. I learned from Alfie that trapezius strains usually present themselves suddenly, the muscles are very tight and/or spasms and tight neck/shoulder complex. After researching a bit more, I found out that anxiety and low moods are also symptoms of trapezius strain/myalgia (Sjors et al., 2009). I struggled to find update research as well as research specifically about trapezius strain so I aimed my questions at Alfie instead. I wanted to know how to differentiate which muscle is strained. I was told that it’s based on movement and here the pain is. Palpating also helped differentiate the muscles too.
The follow-up client was a raiders player wanting to use the game ready and requested STM on his legs (quadriceps, hamstrings, and calves). I hadn’t used the game ready since the first year of university and so Alfie showed me how to use it again. Once that was set up, the client used it on his calves. The STM was done after as I didn’t want to warm the muscles up only to cool them down quickly again. I spoke about stretches to which he replied that he already did them and so I didn’t need to give him anymore. This was a very easy and quick appointment as I already knew I had done everything to help the client.
The last hour was spent shadowing another therapist. She had a client who had been coming for the past three weeks to use the anti-gravity treadmill. The client had a running injury which was caused by overtraining and had been that way for four weeks. The pain in the ankle and calf had reduced, ROM had increased and resisted movements had increased as well which showed signs of healing and strength as well. The therapist had the client running at 65% body weight at 11mph and on a slight incline to reduce the changes in gait.
Anwer, S. and Alghadir, A. (2014) Effect of Isometric Quadriceps Exercise on Muscle Strength, Pain, and Function in Patients with Knee Osteoarthritis: A Randomized Controlled Study. Journal of Physical Therapy Science. Vol. 26, No. 5: 745-748.
De Mey, K., Cagnie, B., Van De Velde, A., Danneels, L. and Cools, A. M. (2009) Trapezius Muscle Timing During Selected Shoulder Rehabilitation Exercises. Journal of Orthopaedic & Sports Physical Therapy. Vol. 39, No. 10: 743-752.
Sjors, A., Larsson, B, Dahlman, J., Falkmer, T. and Gerdle, B. (2009) Physiological responses to low-force work and psychosocial stress in women with chronic trapezius myalgia. BMC Musculoskeletal Disorders. Vol. 10, No. 1: 63.