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Describe and justify the assessment procedures you would carry out on an individual to assess a joint injury of your choice.

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Introduction

ST MARY'S COLLEGE A College of the University of Surrey SCHOOL OF HUMAN SCIENCES SPORT REHABILITATION PROGRAMME MODULE TITLE: CLIENT ASSESSMENT MODULE CODE: SR137 Coursework Title: Describe and justify the assessment procedures you would carry out on an individual to assess a joint injury of your choice. Introduction The ability to examine a joint completely and accurately is a critical part of the diagnostic process for the Sports Rehabilitator evaluating an orthopaedic problem. The assessment process follows a specific and logical order guiding the examiner to a clinical impression of the injury. The following four phases were used for the examination: Subjective questioning (S), objective examination (O), analysis of findings (A) and the treatment plan (P). The client is a 16 year old female in week 18 of a 20 week training program, presenting a symptom of posterior lower leg pain. Using the SOAP format (appendix 1) an examination was conducted and justification of each action and relevance is explained. Subjective Assessment The client was unaware the examination had started in the waiting area, observations of the clients presenting disabilities, level of function, posture, and gait were observed. It was observed that the left foot compared to the right had a decreased duration of heel strike and toe off, facial expirations suggested pain, questioning the client confirmed this to be the reason. ...read more.

Middle

The client was then suitably undressed for the objective assessment. This allows the practitioner to visually observe the client (appendix 1). Because of the clients' age and sex a chaperone was offered but declined (appendix 1). The clients' posture was generally poor. It was observed that the client had excessive bilateral pronation, with internal tibial rotation. This is an important observation because excessive pronation produces a whipping action in the Achilles tendon. The whipping action, may contribute to microtears in the tendon, particularly in the medial aspect, which may cause an inflammatory response (Clement et al, 1984). This action was observed during the clients' gait, which confirmed excessive pronation. Compared to the right the left Achilles was showing signs of inflammation with redness, evidence suggests this maybe related to morning stiffness as reported in the subjective assessment. The active ranges of motion (AROM) of the ankle were tested in the supine position with the knee flexed and extended. The established normal range of movement as suggested by the American Academy of Orthopaedic Surgeons, 1965, during plantar flexion is 0 - 50? and dorsi flexion 0 - 20? it was observed that the left ankle had a reduced range of movement compared to the right, this was due to the clients' pain however the right was also reduced from the normal AROM showing signs of possible bilateral gastrocnemius, tibialis anterior imbalance/tightness (appendix 1). ...read more.

Conclusion

The plan was broken down into short, intermediate and long term goals which where discussed and agreed with the client. Effective treatment required immediate withdrawal from all activities that induce symptoms. Crutch immobilization followed by gradual return to weight bearing activities. NSAIDs, could be taken according to directions which can be found in the British National Formulary 2000, along with ice treatment progressing to contrast baths and massage. Supplement normal training with swimming as it is non-weight bearing and allows for gentle motion of the feet at the ankle and weight training to minimize the decline in fitness. The client should wear well-designed and fitted footwear following gradual transition from one shoe to another. Correcting faulty foot biomechanics with prescribed orthotic devices which correct heel and forefoot misalignments and heel lifts to reduce strain on the tendon could be considered (Bates et al). The client will adhere to a consistent gradual training programme, without sudden changes in training intensities consisting of a daily program of lower leg mobility, strength training and flexibility exercises. Treatment Strategy for Achilles Tendininitis Brief Summary The SOAP notes format provided a systematic approach that allowed the Sports rehabilitator to assemble enough information through elimination to form a clinical impression, thus allowing both parties to formulate a treatment plan. It also was the start of professional relationship with the client. ...read more.

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