Medical OET · Test 03

Test 03 - Part C - Extract 1

Hello, I'm Chris Maloney, a physiotherapist specializing in sports injuries, and I'd like to present a case study to give you an idea of the sort of work I do.

Level: C1 · 60 sentences

Transcript

  1. Hello, I'm Chris Maloney, a physiotherapist specializing in sports injuries,
  2. and I'd like to present a case study to give you an idea of the sort of work I do.
  3. It features a very successful high jumper in her mid-twenties who was referred to me with severe pain in her right knee,
  4. and that's the leg she takes off from when she jumps.
  5. What's more, when she stepped up her training in preparation for a big competition,
  6. the pain worsened, and she'd been forced to pull out of the event.
  7. After that, she'd taken several months off training to rest and get treatment from various therapists.
  8. To her dismay, however, not only did the pain continue, it actually got worse,
  9. meaning she was unable to do any strength training, let alone jump-specific work.
  10. By the time I saw her, she was on the verge of giving up,
  11. having lost virtually all belief in her ability.
  12. My initial assessment quickly confirmed patellar tendinitis in the affected knee,
  13. accompanied by some swelling and significant tenderness over the lower part of the kneecap.
  14. This wasn't difficult to diagnose.
  15. I also noted that she was slightly overweight for her height
  16. and had rather flat feet, but that's not so unusual in high jumpers.
  17. Further assessment revealed that the gluteal muscles connecting the hips and thighs were considerably less sturdy than you'd expect in an athlete of this calibre,
  18. and both the lateral retinaculum connecting the patella to the femur and the iliotibial band,
  19. the ligament running down the outside of the thigh,
  20. were tight and tender.
  21. As a first stage, I was keen to show I could help by relieving some of the pain.
  22. So I worked at loosening her lateral retinaculum to see how much of the tendon pain was due to inflammation
  23. and how much came from restriction of normal patella movement.
  24. This manipulation and massage instantly cleared the pain she'd felt while doing a single leg dip exercise,
  25. where you stand on one leg and bend the knee.
  26. This indicated that her tendon pain was most likely due to patellofemoral joint dysfunction,
  27. caused by muscle imbalance and poor biomechanics,
  28. and not by an active inflammatory process or partial tear in her patella tendon.
  29. So an MRI scan wasn't needed.
  30. The treatment continued along similar lines for some weeks
  31. with loosening of the lateral retinaculum and deep tissue massage of the iliotibial band and other muscles.
  32. One option at this point was something called taping.
  33. This is a way of reducing pain so that athletes can continue with strength exercises.
  34. But it seemed clear from early on that we shouldn't put taping on this patient's patella and tendon until she started jumping again.
  35. She was getting pain relief and progress simply from the manual techniques,
  36. and taping might have led to problems later on.
  37. Athletes often become dependent on tape and other accessories.
  38. In other words, instead of aiming for 100% muscle strength and joint position control,
  39. they settle for 80% plus artificial support.
  40. The patient also had a specially designed program of gym activities.
  41. Although she needed to restore power to those muscles affected by inflammation and tenderness,
  42. the priority was to get her posture and alignment right.
  43. She started by doing double leg squats with her back to a wall in front of a mirror
  44. so that she could see whether her feet were arched and if her knees were over her feet.
  45. She also did squats while squeezing a ball between her knees.
  46. There was light leg press work followed by single leg stance work,
  47. first static then on wobble boards and with elastic resistance.
  48. She progressed to moving on and off steps, sometimes holding weights,
  49. all the time paying close attention to positioning and muscle and joint alignment.
  50. The next stage was to liaise with the patient's coach.
  51. She began running, jogging for stamina, and then sprint sessions.
  52. Work on power was stepped up gradually and included some weightlifting.
  53. After some analysis, we also decided to modify her run-up to the high jump bar.
  54. By beginning from a wider position and running in with much less of a curve,
  55. there was much less of an impact on the ankle, knees and hip,
  56. especially in her right jumping leg.
  57. Interestingly, the patient reported that remodelling the run-up felt fresh and motivating,
  58. and helped to reinforce the sense she had of being a reborn athlete.
  59. Once the rehabilitation process was complete,
  60. she was able to compete without pain and free of any reliance on taping or knee strapping.