Placement hours 112 

22/09/2020 2 hours

This was the first session back as I continued my placement with argyle ladies. Most of the team had changed so we spent a large amount of time just observing the players during training. One of the players complained of a bruise covering the whole front of her shin, I wasn’t too sure on how you could treat this or on what information I could give her on how to help it heal quicker or what advice to give her, so this is something that I would want to look at in future so that I am more prepared for these types of incidences. I can treat players that get typical ‘football’ injuries, for example muscular injuries to quadriceps or gastrocnemius but the less affected areas I have found I am less confident with.

We spent the rest of the session observing the players and understanding their typical posture and gate. This would help us in future to be able to look out for slight differences in the gate while on the pitch and can help us to understand if they may or may not have a slight injury.

Thursday 24/09/2020 2 hours

One of the players in this session also had a slight quadriceps strain that was in the acute stage of injury she suffered it during a match, the Sunday before. She is also an individual that has suffered two ALC and meniscus tears to the knee opposite the quadricep strain. I was unsure on how to go about the assessment and treatment methods for them, I believed that the reason for the strain to the muscle could be because it has been overcompensating for the opposite leg for a while, and therefore had more opportunity to fatigue and become vulnerable to injury, however, I also thought that it would make more sense for the quadriceps on the side of the injured knee to have a strain due to it not being used to taking so much load, so I found it hard to determine if the previous knee injury had an effect on the injury.

Due to the injury being relatively acute I didn’t want to go over many exercises yet and I decided it would be best to give her things to do at home to help it such as ice until the pain reduces, and some stretches and strength exercise to do when the injury is no longer in the acute stages of injury. I think in future I want to be able to be more confident about what I can do and I how I can figure out the cause of injury that may have come without any obvious cause.

Sunday 27/09/2020 4 hours

In this game we didn’t have too much to do, we assessed the player from last week to see how she was. We found out that the hospital thought it was a grade 2 ATFL tear and that she would be back within the next 6 weeks. We spoke to another player who complained of pain on both of her shins and it was creating radiating pain into her calf’s. We were not too sure on what this could have been as we had not had much experience on shin pain. We thought it could possibly be tight tibialis anterior, caused by the kinetic chain as she also had tight quads. Massaging her tib anterior and stretching her quad and hamstring had a minor influence on decreasing pain. She described the pain as more uncomfortable than painful and that she would be able to play, however we did suggest that if the pain becomes too high that she stop play. Between us we decided that if her pain goes above a 4/VAS that she shouldn’t play. After this however we thought that it would have been beneficial not to tell the player the level at which would have been too painful to continue because the player told us the pain level was 3/VAS, we believe that even if she did have pain over 4/VAS she wouldn’t have told us this.

After this game I thought it would be beneficial to look over shin pain, as well as causes and common pathologies of shin pain and the symptoms that she described to us, with the referred pain in the calf are all very common amongst those with shin splints.

Tuesday 29/09/2020 2 hours

During this session we spent most of the time observing the training session. We also went through all of the equipment needed for our physio bags and what they do exactly, this was beneficial as I wasn’t sure on what exactly we would need. For experience at placement last year there were a lot of things on other people’s first aid bags that I was unsure of the reason for it, for example Vaseline, in this session we learnt what the majority of these things are for.

During observations we checked out players that seemed to be struggling with injury, a lot of the time it was no actually injury, but it was just down to how the players move due to fatigue.

It’s important for me in future to be able to notice slight little things that may indicate a player is suffering from an injury as they may not always tell you due to wanting to continue playing.

Wednesday 30/09/2020 2 hours

For the second training of the weak we looked at assessing the players ankle who had torn the ligaments in her ankle. We also looked at flushing the ankle, which I was unsure on what the reason was, but assumed it was because of surrounding lymph nodes that would help to remove waste and increase nutrition to the area. We were asked to assess how much strength and range of movement she had on her ankle now so that we could look at possibly doing some exercises which I thought would have been to early in the healing process but after researching this I found that within the first 72 hours you can look at rehabilitation depending on the stage that the particular injury is at Rehabilitation of the Ankle After Acute Sprain or Chronic Instability

Thursday 01/10/2020 2 hours

In this training session we looked back again at what could be done for the player with the shin splints, we also looked at another player who had knee pain. She suggested that the pain was on the medial portion of her knee. We found that this muscle was tight and that it was causing pain under her knee cap. From knee research I had done previously I suggested that it could have been patellofemoral pain syndrome, due to the vastus medialis being tight and the vastus lateralis being weak. Which causes the patella to be pulled across, so when the knee bends or is under heavy load it can cause the head of the femur to rub against the underside of the patella and cause cartilage damage. Some of the exercises suggested for her looked at quad strengthening, and we also looked at releasing the vastus medialis in hope that it would cause less pain and less pulling.

Sunday 04/10/2020 4 hours

This was a home game with the development team. During this game there were multiple injuries. Originally it started off with a few little injuries such as being winded but as the game went on, as it was the first game of the season, they would have been more prone to injury if fitness is not up to the levels needed (Saragiotto, Di Pierro & Lopes, 2014).

The first thing that occurred was a player had a head injury, we took the player off and we assessed her for concussion. She stated that she was dizzy but other than that there were no symptoms of concussion. Due to this we suggested that she stayed off, for a while at least, make sure that she keeps her fluids up and we wanted to keep an eye on her. Unfortunately, when we were busy dealing with another player, the manager decided to bring her back on later in the second half. It was not until afterwards that we realised that she had gone back on, and we were not able to assess her again before going back on the pitch. We would have wanted to assess her again to guarantee that it was safe for her to go back onto the pitch. Since this game we have decided that no matter what if there is a head injury that shows any symptoms of concussion, it is only suitable that the player comes off and stays off.

Another injury that occurred was an ankle injury. The injury was on the lateral side of her ankle, she described it as making a ‘pop’ sound. This instantly made me feel as though she has either broken something or tore a ligament or tendon. She was taken off the pitch once she was able to become calm, I wanted to be able to help calm her and assure her, but I’m not sure on how exactly how to do that in these situations and I need to be able to be more of a calming influence, whereas I just waited next to her and didn’t really offer much support for her. When assessing her pain on her ankle, we could see that it had instantly started to swell, she described the pain as radiating down into her foot and we also found that the pain was predominantly on the ATFL. We suggested between us that it was most likely going to be ligament damage, and by the way it was described to us we thought it may be a grade 3 tear. We believed it could also have been a break, but that this was less likely. We suggested that it would be best to get it checked out at the hospital.

I would have liked to have been able to offer more suggestions for her on what to do and been able to give her a better understanding of what the injury was with more clarity, but I also believe that this is something I will be able to do better with the experience of dealing with these types of situations.

Tuesday 06/10/2020 2 hours

This session we went through many different exercises to help with a first team player who had struggled with pain in her quad, and it was usually causing pain when doing explosive movements such as sprinting and kicking a ball. The rehabilitation that we went through looked at slow movements like Bulgarian split squats. A play also complained of her semimembranosus feeling tight, I gave her a massage and it didn’t feel overly tight, I said to her to see how it feels playing on it but not to do anything such as kicking or sprint because that could agitate it. I would want to look at this more so that in the future I could give the best possible option for the player, as later she came back off saying it felt like it was close to pulling, so we suggested that she should carry on and we gave her another massage and some deep heat and suggested that she rest it and at home to use heat and to stretch it ready to assess next training.

Thursday 08/10/2020 2 hours

In this training I looked at a few different players who suffered injuries with the first team. One of the players had calf cramps, I checked if she could run without pain and contract the muscle without pain. I looked at doing some ankle and knee movements as well as calf and peroneal stretches for her, she was unable to train so I looked at doing calf strengthening.

I also strapped one of the players ankles as she has chronic ankle instability and went over it during the last game, it was not too bad, but I wanted to make sure it is strapped to secure it and give more stability to the ankle.

Lastly, I assessed the player with the ligament damage again, I looked at range of movements again and looked at doing balance and gait work with her crutches.

Sunday 11/10/2020 4 hours

This was a game; it was a quiet game and there were no injuries during the game. However, at the beginning of the game we looked at the player from the training on Thursday and found that training had aggravated the injury. This may not have been the worst thing because now it showed positive tests where on the Thursday it did not. We found she had a slight LCL strain but wasn’t too bad, our supervisor gave her some exercises that she can do. I also helped a player who came to me with tight adductors and asked how to strength it out, so I gave her a handful of stretching exercises to do and this helped to release the tightness.

Tuesday 13/10/2020 2 hours

We again looked at the player with the quad strain, we carried on doing isometric contractions, the strength and the range of movement had improved a lot from the previous session. We also looked at the player who had tight groin on both legs, we went through different stretches with her and gave her massage to try to release the muscles. in this session I asked my supervisor some questions and she was able to help me a lot, I have been able to investigate it more and it has helped me a lot since. I asked how you know when is best to start doing rehab, because I didn’t want to do onto doing isometric or eccentric contractions and risk re-injury. She told me that you can do all the common things with acute injuries such as heat or ice, and you can keep checking the ROM of the injury. Once this has been achieved you can look at testing ROM in a passive, active and resisted range. Once you can do this you can look at starting to do isometric contractions so that the muscle can strengthen just doing the movement again, you can then progress to do eccentric and concentric movements, such as lunges or squats for quad, focusing on both the pushing off and the standing back up movements, which will help to build the strength back up and avoid re-injury.

Thursday 15/10/2020 2 hours

We went through some strength tests with the player that had originally done the quad strain, I wanted to include the player with the quad strain from the day before but after doing some ROM tests I found that they were not ready to do more strength work. The player who had strength work done was in a good position, so we done some work with her including lunges, squats, we used resistance bands and I had her go through kicking movements, we also done game-based things such as kicking the ball to each other progressing the distance and moving at the same time, she said at the end of the session that it felt good, she was hoping to be back for Sunday. I said for her to come along but that it doesn’t mean she is going to be able to play but could get assessed before the game and possibly get some game time towards the end of the game.

Sunday 18/10/2020 4 hours

This is a game, firstly we assessed the player that was hoping to be able to play but was still looking at rehabilitation from the quad strain. We looked assessed her running gait as well as her ROM which had no problems, we performed a T test which she passed and we also looked at more strength, specifically resisted and explosive strength movements such as jumping, and she passed and was able to play. The game didn’t have many stoppages due to any injuries and in total was a relatively simple day.

Tuesday 20/10/2020 2 hours

This training session was a quiet one, there were no new injuries that we did not know about, however a player did come to us who said she had pain when bending her leg and also when she opens up her body to pass the ball. She said the pain was on the inside of her knee and behind her knee slightly. We went through a few different movements and tests to try and find out what it was. Initially we thought that it would be LCL injury but after doing the special test for it there was no positive test for it. No pain reoccurred from the movements that we done, and she said the pain had gone down already from when the injury first happened. We said for her to train and see how it is and if it is painful for her to stop. She said she could feel it, but it didn’t hurt.

Thursday 22/10/2020 2 hours

During training I was assessing a player with a grade 2-3 ankle sprain (ATFL), she was no longer on crutches so we went over her ROM at the ankle, everything was quite good other than inversion and eversion, so I went over different movements that she could do using a resistance band, I also went over some gait movements. During the assessment I also found that she had a swollen Achilles still, which we already knew but she was always swollen, however her whole ankle was swollen, now that the ankle swelling had gone down, we could see that the Achilles was still swollen, which made me believe she possible has an Achilles tendinopathy. I also wanted to look at doing some proprioception exercises with her which included doing single leg Bulgarian deadlift without weight, we placed a towel on the floor Infront of her and asked her to pick it. I also got her doing some game-based things, her ankle injury is on her strong foot, so I had her doing passes to me within a close range on her week foot to help build her weak foot and help to increase the strength and the balance of her injured ankle.

Sunday 25/10/2020 4 hours

This is a game, firstly we assessed the player that was hoping to be able to play but was still looking at rehabilitation from the quad strain. We looked assessed her running gait as well as her ROM which had no problems, we performed a T test which she passed and we also looked at more strength, specifically resisted and explosive strength movements such as jumping, and she passed and was able to play. The game didn’t have many stoppages due to any injuries and in total was a relatively simple day.

Tuesday 27/10/2020 2 hours

This session we took 3 players, one with an ankle injury, one with a calf injury and one with adductor injury, they are all late stage of rehab, so we just went through some different exercises, these involved concentric, eccentric, and isometric exercises, towards the end of the session we then went and done some game-based training with 2 of the players, the player with the ankle injury wasn’t ready to return to game-based training. This changed her attitude a lot and she was disappointed; I didn’t know how to react to this, and in future I want to be able to do something for the player in this situation.

Thursday 29/10/2020 2 hours

This was a quiet session, not much happened, we watched a lot of the players and watched our supervisor and listened to what she was saying, she was looking at a few players and giving them exercises for their quad and ankles.

Sunday 01/11/2020 7 hours

This was a match day, and it involved a lot of travelling, I left at 10 and didn’t get to the ground until 12:30, we began by going through some game-based assessments to see if they would be able to return to play for this game. One of the players was able to play but the other said they felt okay, we decided it was best not to risk them. Early in the game one of the players that we passed to play said she could feel it so had to come off, her calf had started to go tight and painful so we gave her an ice pack to start with to help reduce the inflammation and then we would look at it later in the game. The player that replaced her then also went down with cramp in both calf muscles. when we looked at the player that went off first, we found that we believed it was her soleus muscles as most of her pain came from when she was stretching, walking, and jogging rather than when she was sprinting, we would have expected there to be more pain when sprinting if it was due to the gastrocnemius. One player went down late in the first half after falling and one of the opposition players fell on top of her. She was holding her neck and said they fell onto her neck. We assessed her for pain and done all necessary things required to be sure that she could continue to play, however she didn’t seem to want to let us assess her very much which was worrying as it was a neck injury. We assessed her as much as we could and found that she seemed to be okay, but we kept an eye on her, in the future I would like to know exactly how to handle the situation and if a player doesn’t want to be assessed, I need to know if it is best to just not allow them to play until we can be sure there are no problems.

Tuesday 03/11/2020 2 hours

This was the last training session before lockdown started, we went over a few little things with some of the players, one player had a bit of pain in their ankle and we went over some of the rehab stuff for the player and for her to do during the lockdown, the rest of the session we spent watching and seeing how the players were, being there in case anything happens.

Thursday 01/04/2021 2 hours

The first training back was 4 months since December, and I had found at that one of the players who injured their ACL 11 months previously had their surgery late December. She was roughly 4 months post op and was looking at building up more strength. This was a big injury, so I was less hands on, however I watched as my supervisor went over rehabilitation exercises. The injured player is also a PT and was already relatively strong and ahead of schedule as she had been doing rehabilitation exercises prior to the ACL reconstruction surgery.

Sunday 04/04/2021 4 hours

This was a game; we treated a handful of players before the game after training that they found difficult and left them with a few aches and pains as they were not as used to the intensity of training despite being given fitness plans to keep up with over lockdown. One of the players took a kick in the ribs late in the second half, I assessed her however found it difficult. The only thing I was able to do was assess for pain on touch, assess breather and assess her movements, she was in shock and a bit of pain, however, did not have difficulty breathing and all movements were fine. She continued to play, however in the last 5 minutes of the game she had the ball kicked at her which hit her in the face which gave her a nosebleed, so I had to go on, I did not have any tissue in my first aid kit so had to improvise. That has since taught me to make sure I have a pack of tissues in my bag or any other way of being able to deal with a nosebleed.

Tuesday 06/04/2021 2 hours

This was a quiet session, we watched a lot of the players and watched our supervisor and listened to what she was saying, she was looking at a few players and giving them exercises for their quad and ankles. We assessed some of the players who took knocks on the Sunday, but no one was too bad, and they were all okay to continue to train.

Thursday 08/04/2021 2 hours

We started with some pre training massage for some plyers that felt they needed it. They mentioned that training felt quite intense since they had not done much over lockdown. We were prepared for a few players to feel quite sore and need treatment, as well as some of the players that suffer with CAI, so we made sure to tape ankles effectively as they may have weakened further during lockdown.

Sunday 11/04/2021 4 hours

This was only the second game back post lockdown; I was trying to make sure that I had gone to every training and game as I knew I would be tight for placement hours. We had a few players that suffered minor injuries, such as calf and quad strains. They had to come off due to this and needed treatment on the side lines.

Tuesday 13/04/2021 2 hours

We assessed some of the players with little injuries from the game, however it was a quiet day, we went through our first aid kits to see if we had everything we needed and we got extra Ice packs as we were running out.

Thursday 15/04/2021 2 hours

During this training session it was very quiet, I had a player come to me who had stiffness from a session they had done on the Monday, she said her quad was tight, so I gave her a massage, the rest of the session I just observed and watched for any injuries

Sunday 18/04/2021 4 hours

This game was quiet, we gave a few massages out before the game and I helped one of the players stretch their adductors. She then also mentioned that she had lower back pain so we assessed her and found that she struggled with side flexion to the right as it would send pain down her right hip. This wasn’t something that I was completely sure on, so I watched how my supervisor dealt with the situation. She looked at soft tissue release, as well as slightly resisted movements. No injuries occurred during the game.

Tuesday 20/04/2021 2 hours

This training session was played as a ‘pre-season’ type of game between the club. One of the players said that they had knee pain. I assessed it and found that there was insertion pain and the mechanism of injury and movement that replicated the pain was replicated by a movement caused by the Sartorius. She described the pain as knee pain. I suggested not playing this game and gave her some exercises, including isometrics of quads and hamstrings as well as specific light weight strengthening for the Sartorius.

Thursday 22/04/2021 2 hours

This was a quiet session, however towards the end of the session a player went down after ‘twisting’ her knee. I assessed the area and found that her knee was hotter compared to the other and had begun to swell, as well as having pain on palpation around the knee cap. Due to the swelling I wasn’t able to complete a full assessment of her knee at this time so she came to the side line, we applied Ice, and wanted to see her next week so that we could assess her appropriately.

Sunday 25/04/2021 4 hours

This game we had a player that mentioned her calves were getting tight after only 20 minutes of playing. We suggested trying to stretch them out more before the game, however during the game we gave her a massage to try to reduce the tightness she was experiencing, as well as looking at METs. We also assessed a player for adductor pain who was not playing. We found that she had a slight adductor strain and prescribed home based exercises for her to be doing until we saw her again.

Tuesday 27/04/2021 2 hours

The player that previously injured her knee the week before came to see us, the swelling had gone down, and she was able to walk on it fine. She said that she didn’t get much pain with it, so we assessed the area and found that she had not done any damage to her knee,

Thursday 29/04/2021 2 hours

Beginning of this session I assessed a player who had a quad pain, initially it only looked to be delayed onset muscle soreness, but after doing more assessments I found that it appeared to be a tendinopathy. I had to look up more on what I was doing for the quad strain, when doing this I found that It was just simply a quad strain that was targeted at the vastus medialis going down into the top of the knee. I looked at doing some isometric contractions for this, I had to look up which I could do, and I asked my supervisor and was told just to do muscle contractions holding for 8 seconds, doing these 10 times. I also looked at doing glute bridges, holding that position for 6 seconds, 10 times.

Sunday 02/05/2021 4 hours

This was a game, not much happened however there was an injury where a player fell awkwardly and injured her back. We had to go on to give treatment however she was not able to continue and was assessed at the side-line. She was struggling with movements and was in obvious discomfort. Another player injured her hamstring; however, she had been struggling with this for a while with a distal hamstring tendinopathy.

Tuesday 04/05/2021 2 hours

In this session I had to look at a player who had strained their quad on their right leg and had pain on their left knee when flexing it. I done a few tests, they said that the pain in their knee felt like something was trying to push through their kneecap from the back and it felt like a build-up of pressure. After doing a few tests, I originally thought that it could be meniscus, but the tests came back negative, as did all ligament tests. The only test that came up as positive was a test for patellar femoral syndrome. I also found that it could be a tendon strain although that seemed less likely.

Thursday 06/05/2021 2 hours

This session gave us an opportunity to work with a player that was returning to training. She had recently suffered a grade 3 quadricep strain. I mainly observed the treatment and method of assessment used for her while also giving my ideas to exercises that could be beneficial.

I found using the VAS/10 scale was a good indicator as to how to assess their pain when looking at doing rehabilitation. I was able to suggest good functional quadricep exercises and assess their level of strength when getting them to do exercise at a percentage of their maximal output.

At the end of the session, we gave her quadriceps a massage and we would look to assess her again during the next session.

Sunday 09/05/2021 4 hours

This was the development team and we started by assessing a player that had calf tightness. There was no injury, no strength deficits, however, both calf’s suffered from tightness so it was difficult to tell, we have been trying a few different things with her each week and have realised that this type of thing is very specific to the individual, for some, massage may be enough, however today we tried PIR stretching to see if that helped before the game, at half time she mentioned that they felt tight again so it may not have worked or it may be something we have to continue to try over time.

Tuesday 11/05/2021 2 hours

In this session we saw a player that had injured her foot. She was new to the club after coming down from Manchester. She said she works for the NHS and they didn’t think it was anything serious. She was getting pain from her ankle and into her foot and had a small amount of bruising. I assessed it and it didn’t seem as though it had a break or had any tendon or ligament damage. There was no blood pooling in the bottom of her foot either. She had some impact bruising across the top of her foot, around the four MTP joints, and around the big toe.

Thursday 13/05/2021 2 hours

The player that injured her back a few weeks ago was here, as well as a player that injured her knee. We watched as our supervisor went through some exercises and movements for the individual with the injured back, I suggested mobilisations and was told that I should try some on her. This included having her lay supine with her foot crossed over her opposite knee. She struggled to get her leg high enough to reach my shoulder as I was on the floor so had to bend her knee to be able to flex at her hip without causing discomfit in her back. I then rotated her knee so that it could create a separation of the facet joint in her lower back, how I was taught to do it in clinic. After doing the mobilisations she had a slow walk for a few minutes and afterwards mentioned that although the pain persists, it has helped.

Sunday 16/05/2021 7 hours

This was an away game at Bournemouth. We started this match by assessing the ankle of a player with lateral ankle pain. We assessed the passive and active range of movements as well as assessing the pain levels of the player. I also treated a player who said she felt as though she had tight calves. I started with doing some massage for her, I thought that it would be more beneficial to use the foam roller on her calf but was unsure, I want to look at that more so that I know when is more beneficial to foam roll the calf.

 

Clinic hours 76

23/9/20 2 hours

As a group we went onto a zoom call and all set up our cliniko websites. We went over how to set each day so that we can have bookings and how we are able to book some people in. we also went over what happens if we can’t make it to clinic and do treatment with the clients.

9/10/20 6 hours

Firstly, we went over some of the Cliniko things such as how to set up and do the client forms, such as the covid-19 forms. We then done a case study. We went through all the common pathologies of knee injuries that it may have been for this case study, we then looked at common causes of each of these pathologies, we looked at causes and signs and symptoms of patellar femoral pain, patellar tendonitis, meniscus damage, quad strain and LCL pain. I then wrote notes down whilst another person asked questions. From doing this I found I need to work on my abbreviations and also my movements such as internal and external rotation at each joint and also degrees of movement at each joint.

12/10/20 2 hours

I came in on the Monday for the induction as I missed the previous induction. We went through all the assessments that we need to do and how to do it. We went over ways of asking the threads questions and all the red flags questions. For example, told to ask questions rather than if they have a particular thing, such as cauda equina.

16/10/20 6 hours

This Patient came in complaining of headaches for 2 weeks. She said that it has not eased off and she is currently on medication for the headaches. I went through all of the assessments that I could through the online triage and later that afternoon had her in for a face-to-face meeting. I assessment her movements and palpated around her upper back and neck. I found that she was resisted from the movements around her neck. We went through some massage for her focusing on her upper traps and her SCM. She stated that it was painful on the SCM, so I didn’t go so deep but felt it was necessary to massage there as it felt tight and seems to be a possible cause for the headaches as she also stated previously that the pain was from the attachment site for the SCM. She said after the massage that she felt slightly better, but the headaches had not gone yet. I gave her some exercises and booked her in for the next week for another face-to-face to possibly go over more exercises and lifestyle modifications.

23/10/20 6 hours

The same patient from the previous week with the headaches was booked in again for another face-to-face meeting. I asked her how she felt following the last face-to-face meeting. She said that she didn’t do the exercises, but she was feeling much better a day after the massage. She said that it felt better a few hours after the treatment and the headaches completely went a day afterwards. She said we didn’t need to do much, but she said she wanted to continue with the massage for this session and she would look to book in in the future to help with maintenance. I gave her another STM of the upper traps and SCM and she said she felt as though that really helped with her head aches.

I also saw a patient that had complaints of back pain and also ankle pain. The back pain was the main priority for the participant, and we found out through the subjective assessment that we believe the pain was coming from her knitting as she felt the pain was exacerbated in the evening when she knits. It’s believed that it is supraspinatus as it causes abduction of the arm, but it is hard to find the differential diagnosis until I see her face-to-face, so I booked her for a face-to-face treatment in the next session which is the week after reading week. I gave her some exercises to do in the meantime as it was possible muscle weakness and also muscle fatigue due to weakness. These exercises were light weight and were comfort dependant, which involved retraction, flexion and abduction of the arm.

6/11/20 6 hours

The patient from the two weeks before came in for a face-to-face meeting so we can go through an objective assessment. We came to find that she did have supraspinatus strain grade 1, with a differential diagnosis of rhomboid strain. Also, I assessed the ankle from the patient and found that she had chronic ankle instability with a differential diagnosis of tibialis tendinopathy and flexor hallucis longus strain grade 1.

I didn’t give her any treatment regarding the ankle; however, I did give her some more exercises as she stated that she did not do any of the exercises that I gave her the previous session. We looked to create a mid-stage rehab plan looking at strength, balance and proprioception exercises from her next visit to clinic, however she hasn’t booked in again for the next week.

13/11/20 3 hours

This patient was complaining of lower calf pain, the patient suggested that they thought it was soleus. After doing some online movements with and without a bent knee I was able to determine that it was less likely to be soleus and more likely to be a gastrocnemius strain. I gave her some exercises to take home with her so that she can build some eccentric and isometric strength with eccentric calf raises, sit to stand and seated dumbbell rows. The patient was not able to book with me again, however, has rebooked with someone on a day that fits their schedule.

20/11/20 6 hours

I saw a patient with restricted hip movement, the complained that they struggled with external rotation and flexion in sitting. They had previous medical history that suggests that they have osteoarthritis, the differential diagnosis was osteoarthritis of the hip and FAI with associated muscle weakness. They were given exercises that will help to keep him active and moving as they are sedentary due to current lockdown. The exercises given were for ROM and strengthening of surrounding muscles as well as cardiovascular exercises to raise the heart rate. They have been invited for a face-to-face to go over more objective assessments however they are diabetic and currently shielding and currently they are not comfortable meeting for a face-to-face with current circumstances. The exercises given were side lying abduction, glut bridges and hip hikes.

The next person I saw was a woman with complaints of sciatica, they suggested that it is worse when sat, when talking to Alex she suggested that because of flexion it puts stress on the discs, which could suggest a herniated disc on the sciatic nerve. Because of this we decided to give her extension exercises. She booked in for the next week so we could go through face-to-face objective assessment, we gave her the McKenzie protocol, glut bridges and dead bug core exercises.

27/11/20 6 hours

The woman with complaints of sciatica came in for a face to face and we went from ROM of also some special tests for the patient, she suggested that the exercises given over the last week had helped and the sciatica pain had subsided. We went through some exercises and found that some still caused pain at the lower back, however the radiating pain down the right leg had reduced. We looked at progressing the exercises to see if that helps to improve lower back pain and sciatica symptoms.

The next patient that came in had a complaint of rhomboid pain, they had already had a online triage and it was suggested that they had a rhomboid strain. I went over some rhomboid strength tests and was found that they had normal strength of their right rhomboid and it was equal to their non-injured left rhomboid. They also had pain and restricted movement on rotation of the thoracic spine, and it was suggested that they may have costovertebral joint stiffness. I done some mobilisations for the patient to help mobilise the joint and reduce the pain. I also gave some exercises for them to do until I next see them, however I was not able to book them in for next week due to work commitments and hope to see them again soon to see how they are getting on.

4/12/20 6 hours

I had one client in on this day, it was a male with radiating symptoms down his left hand. It was a remote consultation so was difficult to do movements and assessments over video call. I observed shoulders, neck, arms and found that the effected side showed some shoulder depression. After asking the client to do some movements we fund that cervical movements other than extension he found ‘tight’. He also found thoracic movements were uncomfortable, but all lumbar movements were ‘tight’. I mentioned in my notes that flexion and extension were caused by the thoracic spine, however now I know that it occurs at the lumbar spine, as des side flexion, which is something I want to be able to be better at. We Invited him for a F2F for treatment and during the next session wanted to discussed possible progressions of ulna and radius nerve flossing to include Cx movements (Central Tensioning and Slacking). Exercise prescription included Sets, Reps and x a week. Cx Anterior glide/Chin Retraction 3 x 10 Cx MET/PNR – Extension, Rotation and SF. Tx Thread the needle 3 x 5 per side. Straight Arm Press Up 3 x 5 per side. Shoulder; Horizontal Row’s 3 x 12 External Rotations 3 x 6 per side, Kneeling halos 3 x 8.

29/01/21 2 hours

I was late to this session so was unable to be part of the clinical note taking process, however I was informed of what the problem was, and I was able to put together some exercises for the client after the appointment. She had lower back pain with the clinical impression being lumbar radiculopathy – joint dysfunction or a possible disc herniation. The prescribed exercises included Pigeon stretches, Knee hugs, Piriformis stretches and Quad stretch.

5/3/21 2 hours

This session was over lockdown, so the call was a short one online. During this appointment the client mentioned pain in his ankle. He mentioned that it felt like bones not aligned properly. He also mentioned that repetitive movements were the most common cause of pain. The clinical impression was talocrural ankle impingement, we invited him for a face-to-face when the clinic opens again, however advised him to engage in the HBE for ankle mobilisation and ankle strengthening which included Slow single leg calf raises, Self-mobilisations, Lunge (progress to calf raise) and Heal raised squat.

19/3/21 2 hours

This was my first face to face appointment post lockdown; it was someone that had already been in for a face to face, so I was trying to get back into it with an unfamiliar client. His previous clinical impression as a peroneal/calf strain grade 1. We prescribed him with exercises for strengthening gastrocnemius, soleus, hamstrings, and glutes. Alphabet’s w/ Resistance, Bilateral Isometric Calf Raises, 4 Way banded Resistance, Step-ups w/ external rotation and eversion, Isometric RDL and Isometric Glute Bridge.

26/3/21 4 hours

This client came in with lower leg pain, mentioned the pain came up a few years ago and was getting worse with running and walking making it more painful, with her usually running 6-10 on average, however it was becoming difficult due to pain travelling towards her knee. The clinical impression was medial tibial stress syndrome (shin splints), however we were unable to complete the rest of the consultation due to connectivity problems so was invited in for a face-to-face appointment.

23/4/21 4 hours

In this session a woman came in with pain in her right foot that was traveling all around different areas of her foot. When she came in she was not showing any clinical impressions so it was difficult as she said pain had drastically reduced possibly due to using walking sticks and having shoe insoles. We assessed her for strength and balance of the effected foot and found that although movements were okay, mobility, strength and proprioception was poor when compared to the non-effected side. We gave her some exercises to be doing over the next 2 weeks and advised her to come back again to reassess and progress exercises.

30/4/21 4 hours

This client mentioned that they had pain in their gastrocnemius which came on roughly 5 weeks previously. They mentioned it felt like a ‘small tear’ and felt ‘sharp’, with running being the main aggravator of the pain. The client mentioned that they believed it was caused due to overuse as they enjoy running regularly. They were given some home-based exercises to engage in over the next week which included Isometric calf hold, Seated calf raises, calf raise on step, Plantarflexion with resistance band and Active eversion – progress to light weight.

7/5/21 4 hours

The client on this day came in after previously seeing the osteopathy clinic as he was advised by them to visit the clinic. He was complaining of lower back pain that caused radiating down the front of the right leg. The clinical impression made from the osteopathy were SIJ dysfunction as well as possible facet joint. It was also noted about weak glutes and ITB syndrome. I also took part in a formative assessment for a second-year student. They had given me some treatment and I noted what they did and did not do for their clinical module.

14/5/21 5 hours

In this session I started with a formative assessment for a first-year student, they had given me some treatment and I noted what they did and did not do for their clinical module. I then had the patient with foot pain back, she had said she engaged in the home-based exercises and that she felt she had improved, we again tested her functional movements and her motor control movements and found that she had improved from the appointment 2 weeks prior. We looked to see if we could progress her calf raises exercises to single leg however, she found this difficult, so we were not able to progress to this point just yet. I also had an online consolation with someone; however, I was unable to do any clinic assessments even over video call as the appointment was made over a phone call. The information given was that he was retired and that he had pain in his knees for the last few years, he found it particularly painful when he was in knee flexion and when he was walking up and down stairs or hills. He mentioned the pain was under his kneecap and occasionally behind his knee. From the information that he had given me I was able to make a clinical impression of patellofemoral pain syndrome (chondromalacia) and was able to give him a few lightweight exercises that he would be able to do as he currently goes to the gym. He was invited for a face-to-face for next week.