Hours gained: 8
Total hours: 73
This week I had a total of five clients, one initial consultation and four follow-up appointments. All of my follow-up appointments were for massage as this was someone from the raiders team. They wanted their quadriceps, hamstrings, and calves done as well as their back, shoulders, and neck. I knew I wouldn’t be able to fit a whole-body massage into one appointment and so I extended his to two since I had a free hour after this. I tested ROMs of everything first and found that the ranges were all full. He had been stretching and foam rolling after every session which he said had helped him. I massaged everything and found a lot of adhesions and tension points I worked into. His hamstrings were particularly tight and so I spent extra time around that area. I made sure I didn’t ask him to turn over too much and so I massaged his calves, hamstring, back, shoulders, and neck first. After the massage, the client felt much better.
The next appointment was also a follow-up. I read the clients notes and found that she was suffering from fibromyalgia and many back pathologies, and wanted an STM and to use the anti-gravity treadmill. When she came in and I saw she was using a walking aid to help her. From her notes, she used this as she felt very unstable and was scared of falling again. Falling had caused many of her back pathologies which is why she was frightened of it. I first started with checking ROMs of the lumbar spine and saw that they were exactly the same. She had been doing the exercises and she even said that the pain was getting better as well. I wasn’t sure whether she was doing this as a way of protecting herself as I know she doesn’t enjoy any movements from her spine. I massaged her back and released her gluteal muscles as that is what she said helps her the most. We then went to the anti-gravity treadmill and since there weren’t any notes about the settings they used I asked if she knew what bodyweight she was using. She didn’t, so I started at 75% which was too high. I took it down to 65% and that was perfect for her. She got very emotional during this time as she was running for the first time in seven years. During this, I really learned how important it is for an injured client to feel a little normalcy they used to have, especially with conditions that last forever. This helped me understand how therapists could also help their clients psychologically “get over” or accept their conditions or injuries. We finished off the session with her doing her exercises at the clinic as she didn’t feel comfortable enough to do them at home where no one was there watching her.
The next client was an initial consultation. The client came in complaining of pain in her left wrist which causes some of her fingers to go numb. At times the pain travelled up the arm to the midway of the forearm and the pain also kept her up at night. The fingers that were affected was the thumb, index finger, and middle finger. The client also had diabetes and worked in construction. I went through the ROMs of the fingers, wrist, and elbow and didn’t find limitations. When testing resisted movements there was a big difference between right and left (left was weaker). I thought it could be carpal tunnel syndrome but wasn’t sure so I asked Alex to help me. I told her the subjective and objective history and then she came in and did the carpal tunnel syndrome test where you put the median nerve on a stretch. She also kept tapping on over the carpal tunnel. Both tests came back positive. Alex taught me how to treat carpal tunnel syndrome as I didn’t know any other way other than operative measures. Alex showed me something called flossing of the nerve which is said to help. Isometric exercises were done against the wall as well as resisted flexion of the wrist. Alex had a conversation with the client about splinting her wrist whilst sleeping as it was stopping her from sleeping as well as using ice-packs when there was a lot of pain.
As I didn’t know a lot about diagnosing and treating carpal tunnel syndrome I decided to research it in my free hour. Carpal Tunnel Syndrome is caused by the compression of the median nerve that innervates the thumb, index finger, middle finger, and the base of the ring finger (Page et al, 2012). There’s added pressure through the carpal tunnel and so pinches the nerve. This syndrome can be affected by diabetes, high blood pressure, fractures to the wrist, fluid retention, thyroid dysfunction, and rheumatoid arthritis (Renato J Verdugo et al, 2008). Treatment of this syndrome can range from surgery to NSAID’s. Exercise and splinting are common ways that this injury is managed without the use of surgery.
The last client I had wanted a massage on his quadriceps and hamstrings since they felt “tight”. I measured ROMs and found that the ranges were all full, I also measured the lengths of the muscles to find out they were good too. I started massaging his legs and he mentioned that the previous therapist did some stretching technique and so I added METs to the treatment as well. I asked if he would like stretches and he declined as he had a personal therapist who trained him so he already did them.
The remainder of the hours I shadowed the master students. The first client came in with pain in her lower calf which started three weeks ago when she started running. The pain was in the mid-portion of the Achilles tendon and it was a classic case of Achilles tendinopathy in the reactive stage. The therapist explained the importance of increasing running in increments and that you shouldn’t start off exercises off without a warm-up. She then massaged the calf and exercises were given (isometrics for pain, sit to stand). I would’ve given more exercises that were slightly more challenging as the client came in walking. I would have added calf raises and single-leg stance which would have worked balance and neuromuscular control too. It also would have worked and activated the gluteal muscles. The next session saw an elderly client, this was a follow-up session, who was going through training on the anti-gravity treadmill. She had injured her knee and was an avid runner. The therapist thought the anti-gravity treadmill would help and so has been using it for two months now. The weight she was working at was 60% body weight. According to me, her gait was altered on the anti-grav and she had been on it for too long. She should’ve been progressed down to at least 75% body weight as she had been doing this plan for eight weeks. The last shadowing session saw a raiders player come in to get massaged and use the game ready. I helped with the massage to the legs and so it was done faster.
Page, M. J., O’Connor, D., Pitt, V. and Massy-Westropp, N. (2012) Exercise and mobilisation interventions for carpal tunnel syndrome. Cochrane Database of Systematic Reviews. No, 6: 1.
Verdugo, R. J., Salinas, R. A., Castillo J. L. and Cea G. (2008) Surgical versus non‐surgical treatment for carpal tunnel syndrome. Cochrane Database of Systematic Reviews. No, 4: 1.