Derby Days – 30 days to make a habit


Wow. A ‘working month’ has gone already and it’s been an insane 6 weeks or so.

Again, I’m trying to go in to everything I do with an open mind and with little, to no expectations.

I was nervous coming into this placement, having been recommended by my personal tutor, I didn’t want to let anyone down. Also, having made some decisions that would literally change the course of my upcoming year, I didn’t want to let myself down either.

Day one, having missed out on meeting my digs family earlier on in the month, I was also nervous about meeting them too. All I knew was the area that they lived in, that they had kids and a dog. Not that I hate kids, I don’t, but I was really hoping that they weren’t tiny, I like my sleep and having grown up with my nieces and nephews I know the ungodly hours that they can wake up with the energy of a duracell bunny. 7am wake up calls, pretty much everyday would not bode well if that was the case. Also, I was told that the dog would be quite vocal, having been a rescue dog, and it could take some time to get used to me. So, screaming kids and a yappy dog, didn’t seem highly encouraging but open mind and no expectations.

IMG_1013Thankfully, my fears were put to rest straight away having met my surrogate family.  Just so welcoming, open amd funny, I wouldn’t change my family for the world but if I had to choose one I would have definitely of chosen them and if you were wondering, me and Rex (the dog) get on like a house on fire.

My first working week has been an eye opener. When you’re in University you think its the be all and end all of everything. Get into class on time, push to understand everything (most things), revise, hit the deadlines, meet the criteria, and succeed. And in one sense it definitely is (still going for a first!) but my first week here has shown that actually, getting hands on experience with people, happy for you to make mistakes, is just as important into becoming a well rounded therapist.

In no way am I saying that its not pressured because it is but the pressure is different. Straight off the bat we were told that we wouldn’t be put into any situation we didn’t feel comfortable and they didn’t expect us to know everything. That sentence instantly lifted the weight off my shoulders,  I think I was still in Uni mode expecting an exam at the end. It hasn’t been like that, if anything its all the good bits of University with all the stressful horrible bits taken out. It’s basically practical sessions, all day, everyday without the exams (kind of).

The week has been pretty awesome, if nothing else it has confirmed 100% without fail, this is the job I want to do. To go in first day and hear about a player who has had a lateral tenodesis for ACL rupture you know you’re going to learn a hell of a lot. I’m also really pleased that we’ve been encouraged to practice our examination and assessment skills. Daunting at first, baring in mind up until now our clients have been our peers, who, more often than not, were not injured. Having been presented with a troublesome hip, I laughed to myself for a second remembering everyone’s least favoured lower limb joint, it just had to be mine in the first week. I think I did pretty well, I definitely need to brush up on my muscle and special tests but all things considered, not bad.

Rehabilitation I feel is my achillies heel. I want so much to be able to feel confident on this and make every session fun and creative, so feeling a bit down about the whole thing, I’m probably over thinking it but I’m just not getting it. Sometimes I’ll have the exercises given to me, sometimes not but either way I don’t feel that I’m either executing it well enough or it’s just boring. There’s no book that has all the answers and where ever I look for them I’m told its purely down to experience and knowing what you want to acheive in the movement and how that particular structure/muscle works. It’s definitely a work in progress and I will strive to find ways to improve that aspect of my tool box.

IMG_0760Week two is still fast paced, it started however with a task to find four research papers which all proved quite interesting. Leg length discrepancy and its common causes, Hot vs. Cold treatments,  Sand, training and rehabilitation and adductor squeeze (normalitive test values). The ones that stood out for me were the Hot vs. Cold treatments and the sand, training and rehabilitation, if I could choose my dissertation title again I probably would have gone with somethung like the latter. The outcome of our findings were that for the temperature modalities hot treatment was better than cold treatment immediately after exercise for recovery, the heat immediate group recovered by the second day compared to the cold immediate group still down on their scores by the third day. However, cold treatment was found to be better than hot 24 hours after exercise showing a faster recovery than the group of heat.

In the sand research, it was found that the surface could be a useful alternative tool for training, injury prevention and recovery process. And should also be considered for a reduction in risk. A rehabilitation module on just this would have sparked my interest a bit more I think or maybe it was just that it was too short and I couldn’t get in to it but again, rehab as a whole is a goal of mine to get the hang of and things like this do nothing but help.

New experiences and techniques were stand out moments of this week. First up was the Functional Movement Screen (FMS), this type of 0f screening tool is used to identify restrictions or imbalances in seven fundamental movement patterns that are key to functional movement quality in individuals with no current complaint of pain or known musculoskeletal injury. These movement patterns are designed to provide a platform whereby you can observe a performance of basic loco motor, manipulative and stabilising movements by placing an individual in extreme positions where weaknesses become identifiable. The FMS process is only performed at the start of the season and then used by the Strength and Conditioning (S&C) teams to create individual programmes.

We were just informed last night that we will be going to see one of the players in a Hyperbaric Oxygen Treatment (HBOT) not quite sure what that means as yet but I’m looking forward to it.

IMG_0930So we’re are off to Midlands Diving Chamber  one of only a few in the country that deal with sports specific related treatments. HBOT is, as it says, a treatment, which uses oxygen to promote healing. In a chamber, with an atmospheric pressure higher than that of sea level, the patients breathe in 100% oxygen. Thinking of the injured area, there may be a blood flow restriction due to surgery, illness or the injury itself resulting in red blood cells blocking the blood vessels which in turn is unable to transfer oxygen to the cells on the other side of the occlusion (blockage).  HBOT also forces more oxygen into the tissue, encouraging the formation of new blood vessels. As these new blood vessels develop, the red blood cells start to flow, delivering even more oxygen to the affected area. This creates the best environment for the body’s natural healing processes to repair damaged tissue. HBOT is said to have the potential to effectively resolve tissue, cells and organ function as well as reducing rehabilitation time. We got the chance to go into the chamber, and experience the decompression which was interesting but it would be naive of me to say the few minutes we spent in made use experts, so we interviewed the player and got his feedback on his experience.

Natalie Crosby: What were your first thoughts on HBOT?

DCFC Player: “I had heard about it before when Rooney underwent treatment and I mentioned it to the doctor here. [My physiotherapist] was also on board having used it before. In my mind, it could only help and I knew of no negative reasons not to try it. I was open minded and had no hesitation in giving it a go.”

NC: How did you feel after your first treatment?

DCFC Player: “Nothing much happened after the first session but after the first week the infection was better, less lumpy and the redness had died down. After 6 to 7 sessions the infection had gone. And that’s what the treatment was initially used for so I’m pleased with that.”

“The x-ray will confirm whether it’s helped [with the bone healing] too.”

NC: Why have you decided to continue with the treatment?

DCFC Player: “There is no evidence to say that it does harm. When they said about the oxygen saturation and blood cells recovery, it makes sense. Also it started to look better and has become a habit.”

NC: What would you say to anyone thinking of having the treatments?

DCFC Player: “IMG_0929I would recommend it. Don’t expect anything to happen after one session, do a minimum of 3 to 4 sessions to get a positive reaction. Stick with it! If you’re willing to keep going you will reap the benefits. Patience helps and make sure you take a book in with you.”

NC: If you sustained another injury would you use it again?

DCFC Player: “Yes. After the plate gets removed I would asked to go in again to speed up my recovery.”

Week three and we have  just spent the last few days pooping our pants about the presentation  we have to give on HBOT but I think, well at least, I feel happier about where we are.

I’m pressing on with my rehab, I have totally gotten the hang of bike CV. I definitely feel comfortable with that, as well as, pool CV having watched and created a few sessions, plus learning to use the underwater treadmill. If I can do that with gym stuff I will be happy.

E & A, I’m still working at the little bits that will make the difference. Again, once I have two minutes to myself I need to get the book on mobilisations back and research the ones that I’ve learned while being here.

I have also spent some time with the soft-tissue therapists and what an eye opener that has been. He’s brilliant, so enthusiastic and just truly keen to impart his knowledge on us. We were talking about myofascial release techniques and how they are much more than massage in soft-tissue. He’s given me a few journals to read which I will fill you in on once I’ve got through them, slightly looking forward to that, sad I know.

Week four, started very slowly doing the not so glamorous side of working in a professional medical team. Filing medical notes, storing medical notes, shredding medical notes but a side of the job that is as important as any other but it ended in the part of the job I know I will love.

IMG_0928Having recovered from a previous upper limb injury one of the players were reinjured from an innocuous challenge. We are all hoping for the best out of the situation. He walked off the pitch and that was a start.

Long story short, having looked at the results he had probably one of the worst outcomes imaginable.

An ACL rupture, MCL tear, lateral meniscus tear and a grade one PCL tear. To say the least this was not what anyone wanted, first point of call was to get the swelling down. Maybe on reflection, no pain post knee injury could be the indicator that signals a complete rupture. When the ligament is severed, the nerve endings that record pain would be severed too.

After hearing the news he was feeling and being optimistic and it was my job to keep him that way, as well as, to get him to meet his markers for a potential operation in two weeks from now.

I’ve been working with him for a couple of days and feel I’m learning more about myself as a therapist. In the attempt not offend I’m not firm enough with the guys, it’s a difficult thing to get right, you don’t want to be best friends with them and be a pushover but at the same time you don’t want to be Sergeant Major. It’s hard but I have this in mind most of the time, little steps, mutual respect and setting out my stall. We can have fun but keep doing what I’m asking at a tempo that is consistent and realistic. A work in progress. p.s Don’t work hungry!!

Having worked with the players for quite a few days now, we have eight days until he gets rechecked for surgery, he has to hit 110° of flexion in 0° of extension. My thoughts have been to increase contrast time (one-minute hot, three minutes cold from one and two minutes respectively). We’ve also started using a swiss ball on knee bends to encourage extension. Making sure that the knee stays in alignment (guiding where necessary) it seems to be a visual cue that he uses to engage in actively extending his knee, which is a bonus!

Everything this working month seems to be going well, there are definitely things that need to be practised and revised and practised again but I feel at home, which is good, I know longer feel like a lost puppy following people around. I’m trying to be proactive in the work that I do solely and receptive in the work that I watch and am watched in and continue to learn.

Let’s hope my player makes his markers for surgery, I’ll be very proud of my involvement in that if he does but let’s see how it goes.

One working month done and I have appreciate every minute. COYR!


Derby Days – 30 days to make a habit

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