Hours gained: 9
Total hours: 132
This was a long session, I had one initial consultation and five follow-up appointments. The initial consultation was for a woman who was complaining of pain in her hip that was sending pain into her leg. Her foot often got numb as well. The pain increased when the client was playing tennis which she usually would have done three times a week. The pain was intermittent and came on usually during/after sport, prolonged sitting, or when her leg was in a rotated position. My immediate thought was disc prolapse but as I went through the objective assessment, I started to think of it as more piriformis syndrome. This was due to the tenderness and numbness present when pressing into the buttock, where the piriformis muscle would be. As the muscle is quite small and deep it is hard knowing whether you’ve palpated the muscle. When rotating the hip, the pain came on as well as the numbness in the leg. This also led me to believe it was piriformis syndrome. I massaged her lower back and gluteal area to try and warm the muscle so it was easier to stretch when doing METs and STRs. I then gave the client stretches to help lengthen the piriformis muscle. The stretches included resisted hip abduction, single-leg knee hugs, and knees to the side. I didn’t feel too comfortable with this case as I wasn’t too sure it was piriformis syndrome. I should’ve asked Alfie for help but I didn’t which then didn’t provide the best service for the client. I knew enough about the pathology but didn’t know much about how to treat it. I didn’t give the best exercises for the pathology or the client. Next time to prevent that from happening, I should just ask for confirmation of the diagnosis and treatment plan from the clinic supervisor.
The next client was a follow-up who was suffering from lumbar facet joint stiffness at L3, L4, and L5. The client had been feeling better since the previous appointment. I tested ROMs for the lumbar spine and found flexion and extension to be limited but still better than the previous measurements. I massaged her lumbar back to help relax the muscles and stop the spasming she’s been experiencing. I then started PAs on L3 first and worked my way downward. I started PAs at grade II but the client said I could press harder as last time the therapist pressed harder. I worked on grade IV and kept ensuring that it wasn’t too much. I worked for 3 sets of 60 oscillations for each level. After this, I checked on the exercises she had been given last week and they still worked so I didn’t need to progress or regress any of them. After the first appointment, I was really happy to get a pathology I understood very well as it built my confidence levels up again. Overall I felt like I did well on this client as I did everything I had planned to with them. I also managed my time well. I didn’t have to progress her exercises as she wasn’t ready for it, however, I did write down a plan for progressions for the exercises.
I had my regular client who suffered from adhesive capsulitis his left shoulder. He came in with no resting pain in his shoulder or upper arm. He could successfully do all ROMs of the shoulder, even abduction, without pain. His biceps were tight and so I massaged his shoulders and upper left arm to help with that. I tested the strength of all movements and found that they were better than his non-affected shoulder. I mentioned to him that he needed to continue moving the shoulder around and doing his exercises which he said he would. This was the last time I treated him as his injury had healed. This was the first-ever client I ever had and so I was very happy and impressed with myself that I helped him get better. Even though I made a few mistakes whilst learning about appropriate loading, he still got better.
I didn’t have a client for the next hour so I shadowed one of the master students. This was a follow-up appointment and so he had already been diagnosed with a quadriceps strain on the left leg. The client was a rugby player who injured himself one week ago in a game. The therapist used ultrasound over the injured site after massaging the quadriceps. The exercises didn’t need to be changed as they were still helping him. During this session, I learned that you can put the therapeutic ultrasound on quadriceps strains. When researching this, I found that there is split research to show whether it would help or not (Kary, 2010).
The next hour, I had a follow-up client who was complaining of tight muscles and so wanted a deep tissue massage on his legs. I tested ROMs of the quadriceps, hamstrings, and calves which were full. I massaged the legs and found that the muscle belly had a lot of adhesions which I worked into. I also added METs as the client said he had them before and it helped him. I gave him some stretches (knee to wall, static side lunge, and lying quadricep stretch) to do at home to help.
The next client I had was also a follow-up appointment for a raiders player that wanted a full leg massage. I tested ROMs to find that they were all full, as usual. I massaged the legs paying particular attention to his quadriceps as they had a lot of adhesions and tension points. I didn’t bother asking about stretches or exercises as I knew they never took them.
The next two hours were spent shadowing master students again. The first client had pain in her ankle as she had rolled over it when playing badminton two days ago. The therapist did all the tests to find out what it was. After testing ROM and finding inversion painful, the therapist diagnosed her with a sprained ankle. Since it was still swollen she used the game ready to help reduce that. She then gave her gentle exercises such as resisted movements against a towel to help with the pain. The therapist also taped her ankle up for stability. It helped to keep her ankle from an excessive movement which helped her feel more secure putting weight on it. The second client was a follow-up appointment which was a shoulder massage. I helped the therapist with METs as she wasn’t 100% sure with METs for the shoulders. I then had a conversation with Sally, a Ph.D. student using the traction for her study to find out that it helps referred pain from disc prolapses. I mentioned to her that I also had a few disc prolapses that send referred pain down to my right leg and made my foot numb. She hooked me up to the traction so I knew how it felt and understood how it worked.
The last client I had just came in for a massage on his shoulders but came in late for it. The ROMs for his shoulder and neck were full and after the massage, the only difference was the quality of the movement which bettered. I massaged the shoulders to find that they weren’t very taut. I couldn’t feel any adhesions either so I didn’t have much to work on. After the massage, the client refused any exercises or stretches as he had some from the last time that he still had yet to do.
Overall I think this session went well with the exception of the initial consultation. I felt confident in how I was treating the clients and I knew I was doing the best I could for them. Next time I struggle, I will make sure I ask for help from the supervisor or anyone shadowing if I need to. This will help me provide the best for the clients that I have.
Kary J. M. (2010). Diagnosis and management of quadriceps strains and contusions. Current reviews in musculoskeletal medicine. Vol. 3, No. 1-4: 26–31.