This site may have some stuff that could help with your case studies. They've got a 'Guide to Case studies' on their CPD page. I think Elaine said you can attach documents - if I could see how I would but I'm afraid you'll have to make do with the link [DLMURL] http://www.thelondonmassagecompany.com/cpd.aspx [/DLMURL]
Hope it helps.
M
VTCT Certificate in Swedish & Sports Massage case studies
Hope this helps everyone for 3 case studies - one maintenance, one injury specific treatment and one course of 3 progressive treatments on the same client.
This site was a life saver for late nights, tiredness, rushing around with children and still trying desperately to establish this career change! Thanks to those who have posted their work as its supported me tremendously and now its my turn!
I'm about to hand in this work so it has not been viewed by my tutor but hey I'm confident and have done very in previous assignments. Good luck y'all 🙂
ps. All names are ficticious.
pps. The picture are of stretches all googled from images - really easy to find.
VTCT Certificate in Swedish & Sports Massage
Unit VR17 Exhibit knowledge of the anatomy and physiology Swedish massage
Case Study (A) one maintenance treatment:
Client Details: David Grey Age: 28 Reason for treatment: Left Strained Hamstring
Client Medical History: Refer to patient assessment record sheet for details.
Life Style - a general overview:
Home - David is married with 3 children under 8 yrs. He describes himself as an active family man enjoying outdoor pursuits with the children to give his wife some rest and space. STRESS LEVEL: 3 OUT OF 10
Work - Dave is a Senior Manager of a employment recruitment team. His team are very stable as they are very few staff changes given its a very established and mature company. He maintains very professional relationships and enjoys his job. STRESS LEVEL: 3 OF 10
Physical - David is a keen amateur football player who plays regular matches once a week during season and trains 2 x weekly after work despite sometimes feeling tired. His diet is good and he drinks plenty of water through the day to keep well hydrated.
Posture - Posture is good with full ROM for all joints except his left leg having strained his hamstrings, he can achieve ROM but slowly and does complain of slight pain.
The Problem/Reason for Treatment - Left Strained Hamstring.
Occasionally complains of a mild lower back pain. He had an examination by his doctor and our on-site Sports Physiotherapist who says that due to the tighten hamstrings the lower back is compensating for the injury.
His injury is no longer acute so its not a contraindication.
Dave feels that his injury occurred due when he was very tired on a training day followed by poor exercise technique. Lack of concentration.
Assessment:
Daves symptoms are tightness in the back of the thigh, muscle spasms sometimes to the lower back when walking for too long.
He has been seen by our on-site Sports Physiotherapist who has referred him to me for specific treatment to the hamstrings especially his left leg.
The Treatment Plan:
To assess range of movement.
Once the hamstrings have been warmed up with effleurage strokes and wringing, I shall advance to cross fibre friction with movement i.e. knuckling, digital etc.
PNF Stretches to the hamstrings.
Assess again Daves ROM to see how much he can go through a full range of motion without pain.
Book the next massage with a suggestion of three further massages and do ROM assessments.
How did Client feel during treatment:
Dave expressed apprehension and some nervousness as he thought the treatment would be very painful and was pleasantly surprised, he really enjoyed the experience and was very relaxed.
He said that the massage was very deep and he could feel his muscles being manipulated like a wringing effect. This was one of the techniques I used.
He was comfortable with the PNF stretches as they do this a lot during football training.
Post-Massage Assessment & Reflection:
Daves ROM was very limited to his left leg than his right being fine.
I could feel during the palpation phase of the massage scarred tissue/a small nodule to his left hamstrings which also felt tight.
I advised that he keeps well hydrated as its quite common to feel thirsty after a deep massage session.
Dave was generally quite tense which I assume it was because he didnt know what to expect in the treatment and I was a new massage therapist to the practice.
Therefore, I will spent more time on effleurage strokes and ulna boarder to really prepare the body for deep pressure strokes.
How did Client feedback after treatment:
Dave said he felt very relaxed, not so tight especially the lower back area. He was very thirsty (I gave him water directly afterwards) and he continued drinking for the remainder of the evening. He was pleased with the massage and felt very safe with me. I took this as a good measure of trust and he was happy to continue the rest of my treatment so we booked the next session.
Following days Client Feedback:
He remarked again about being very thirsty that evening then feeling very tired.
Following day the complete area of his left hamstring felt sore but not painful. The soreness quickly eased days later.
He liked the strengthening and stretching exercises as he could do some of them at work during the day. Plus he could incorporate them easily into his football training.
Demonstrated Homecare Advice Given:
I have shown Dave some hamstring strengthening exercises following quick mobility warm-ups of the joints. He should do these exercises 3 x daily:
?Straighten, hold for 10secs (increase to 30secs), slow return of leg.
Repeat 5 to 10 times on each side.
Hamstring and lower back: 1) Lie on your side with your knees bent. Gently pull the top knee up and out toward the shoulder. 2) Hold for 30 seconds. Then lower your leg. Repeat 5 to 10 times on each side.
I have shown Dave some stretches to at home after a hot bath or shower and during the stretching phase of his training (when body is warm) and to note the following observations:
Always stretch slowly.
Stretch to the point where you feel mild tension.
Should include full deep breaths, expanding the diaphragm on inhalation, for maximum results.
Hold for 30 to 40 seconds. Don't bounce.
Relax.
?Bend forward from the hips (not waist), keeping back and shoulders straight at all times. When upper body is parallel to floor, hold position for 10/30 seconds. You should feel a stretch in the backs of your thighs.
?Safe seated hamstring stretch. Aim towards toes, do not clasp and no bouncing!
Overall Assessment:
After the third session Dave had regained his full ROM and has returned back to full training. He has requested to see me fortnightly for maintenance of his legs and relaxation.
I was very pleased with Daves outcome and the nodule could no longer be felt.
Dave is not as tense as the first time treating him.
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VTCT Certificate in Swedish & Sports Massage
Unit VR17 Exhibit knowledge of the anatomy and physiology Swedish massage
Case Study (B) one injury specific treatment:
Client Details: Sam Spence Age: 21 Reason for treatment: Right Ankle sprain
Client Medical History: Refer to patient assessment record sheet for details.
The Injury Assessment:
How did the injury happen? Home game basketball, Sam felt a slight pull to her right ankle and could no longer play. She was assisted off the court.
What were the symptoms? Slight swelling, Sam complained of slight pain and tenderness with a limited ROM on passive stretching.
No fractures, dislocation nor subluxation therefore the RICE method can be followed.
Appearance: The area felt hot to touch and slight swelling around the ankle bone was apparent.
Has this happened before and when? No injury this year to ankle but did happen to left last year.
Exercise and Training? Very disciplined 3 x wkly and no other problems.
The Treatment (including homecare advice):
REST. Sam was advised to rest ankle for 3 to 4 days. No weight bearing exercises and minimise movements where possible to allow for natural healing/recovery time.
ICE was applied to area (immediately off court) and massaged for 15/20mins to help reduce the swelling. The ice pack was removed to allow some heat for 15mins then reapplied. This treatment was continued for the rest of the game (1 hour) and Sam was advice to continue the treatment at home for a further two hours.
COMPRESSED the ankle (off court) with an elasticated bandage including the ice pack.
ELEVATED her foot to also reduce the swelling. Refer back to point 1.
If pain and swelling continued she was advised to consult a medical professional.
Reflective Practice after Treatment:
How did the client feel during the treatment?
The client expressed she was very satisfied with the treatment as ice was immediately applied to her foot which was later compressed and elevated. She was also encouraged to drink plenty of water.
How did the client feel after the treatment?
Client was able to continue the treatment at home as she understood this would reduce the swelling and aid recovery.
Overall conclusion of the treatment?
The treatment was immediate to the sport, professional in my approach to administer treatment and after-care advise.
VTCT Certificate in Swedish & Sports Massage
Unit VR17 Exhibit knowledge of the anatomy and physiology Swedish massage
Case Study (C) one course of three progressive treatments on the same client:
Client Details: Ty Goddard Age: 55 Reason for treatment: Lower back strain
Client Medical History: Refer to patient assessment record sheet for details.
CLIENT PROFILE - A brief summary:
Ty has no contra-indicators to holistic massage so GP permission is not required. Ty has signed my informed client medical history, (card).
Ty has been happily married for 25 years. He has 2 children living at home, age 20 and 22.
He is a self-employed contract computer project management consultant and is currently between contracts. His work is mainly sedentary and in different places often involving working away from home during the week returning at the weekends. Staying in hotels is not ideal but he enjoys the freedom of working for himself.
Tys health is generally very good but he knows he is overweight. His posture is good although he did report a tendency to hunch over his laptop with recent work at home. He does not smoke and drinks alcohol socially. He enjoys his food, particularly fresh vegetables and drinks 2 glasses of water a day and 3 cups of black coffee. He takes a general mineral and vitamin supplement daily. STRESS LEVEL: 8 OUT OF 10
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Reason for Treatment (further explained):
Ty has decided to have a massage sessions as he is currently feeling a little stressed due to his unemployed situation. He says this is unusual for him as he is normally very laid back.
He has also been experiencing some lower back pain and discomfort which he attributes to working on his lap top at home.
TREATMENT PLAN
The benefits and the different aspects of holistic massage were explained and discussed and the plan is to receive treatment over three sessions, spaced at weekly intervals. The third session will included a brief review of treatment to date, the benefits and any changes for a new treatment course.
The initial treatment will be a full body massage to help relax and de-stress but paying particular attention to the lower back, hips, gluteus maximus and hamstrings. I will also massage over the scapula, the trapezius and into the neck area as this seems to be a likely trigger route for Ty leaning over his laptop and working hunched back.
Further massage treatments will be adapted to Tys needs and will mostly be tailored to relieve his current stress related feelings.
Treatment 1 Date: 3/05/09
This was Tys first treatment massage so I explained about the oils, keeping hydrated and a brief summary what to expect. Ty has no allergies so I used almond oil as my massage medium.
I proceeded through the classical movements of effleurage, petrissage and kneading to Tys back including wringing, hacking and cupping to his legs.
I verbally checked the pressure used during kneading and hacking to ensure he was comfortable with the techniques. More kneading and stronger effleurage was performed the hip areas and gluteus maximus.
On his back I used kneading to the scapula and trapezius, with deeper petrissage around the scapula up to the shoulder and ulna bordering for relaxation. I used firmer effleurage strokes in circling motions down the back from the shoulders, decreasing to gentler circling and knuckling strokes around the lumbar spine to the sacrum.
CLIENT FEEDBACK DURING TREATMENT
Ty liked the kneading to his shoulders and up into the neck. It made him think about his posture when on the laptop not being ideal as it creates unaware tension.
CLIENT FEEDBACK AFTER TREATMENT
Ty said that he felt much more relaxed, his legs, hips and lower back were more comfortable. He could also feel that his upper back, shoulder and neck were a lot looser and also felt warm.
POST TREATMENT ADVICE
General advice was given in a fact sheet and I advised him to drink more water which would help flush out the released accumulated toxins in his body. But the most important advice was for Ty to assume a better position when using the laptop to improve his posture, i.e. correct table height and a better chair which would help with his lower back problem.
REFLECTIVE PRACTICE
Ty was the first larger male that Ive massaged. His longer body meant that I had to alter my stance more often and I had to change my striding position for the longer limbs. I also found some difficulty in reaching over his body to massage his glutes occasionally standing on tiptoes. I realised afterwards to overcome that problem I should have lowered my bed. I checked frequently enough my pressure of the movements which he liked as I would adjust to his comments if necessary.
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Treatment 2 Date 10/05/09
FOLLOW-UP CLIENT FEEDBACK FROM PREVIOUS TREATMENT
Tys lower back pain was easing not straight after the last session but he had not noticed over the last two days. He has bought a rolling chair and a computer desk to change his posture when using the laptop. He is still experiencing discomfort in his right shoulder but not as much as before. He needed to use the toilet frequently the day of his last session. He also felt extremely tired and had slept better. He has increased his water intake and has enjoyed daily gentle strolls benefiting from the fresh air instead of being indoors all the time.
TREATMENT
Using almond oil as the massage medium I gave a full body massage to Ty concentrating on his right shoulder area. I kneaded the scapula and trapezius, and then petrissage up around the medial side of the scapula making sure the pressure was not too hard for him. Further kneading was carried out over the shoulder area and into both sides of the neck which felt very tense. I worked on the posterior legs and glutes. I then returned to the back; effleurage and kneading the whole scapula area up into the lower neck. Then petrissage of the erector spinae muscles either side of the spine which was followed with long downward strokes from the cervical vertebral area down to the sacrum.
CLIENT FEEDBACK DURING TREATMENT
Ty said the kneading to the shoulder and neck was very relaxing but with a very slight discomfort. He did not respond when I returned to his back after working on his legs, he appeared to be asleep!
CLIENT FEEDBACK AFTER TREATMENT
Ty had fallen asleep by the end of the treatment. He said he felt very relaxed and that his shoulder felt much more comfortable.
POST TREATMENT ADVICE
I advised Ty to continue with his increased water intake and exercise. We talked about how much time he spends on his laptop and he agreed that he should take more frequent breaks, to rest his eyes and move his shoulders, upper torso, rotate his hips and I demonstrated some stretches for his lower back.
1. 2. Sit on chair, rest left leg above knee and gently lean over.
Hold 15-20secs let hand fall and repeat x 4. Swop legs.
REFLECTIVE PRACTICE
Ty fell asleep towards the end of the session. This gave me confidence to feel that he trusts me and feels very relaxed. As I began tidying up so he awoke. The treatment itself appeared to go well and we were both pleased.
As it was Tys first time to massage, I felt it was too much for him to remember particular stretches in his after-care advise hence why I saved the stretches for this week giving him another area to focus on having sorted out his computer sitting arrangements and his water intake.
I also lowered the table and found that I was able to reach over his body for example, kneading and did not have to go on my tip-toes.
Treatment 3 Date 17/05/09
CLIENT FEEDBACK FROM PREVIOUS TREATMENT
Tys shoulder was much looser and more comfortable. Once again, he felt tired after the last session and had slept well that night. He has enjoyed getting out more, he is managing his contract work-fielding better taking longer breaks oppose to sitting on the laptop and making calls all day. Ty has requested the back of legs (hamstrings) as he is walking more and at the end working on his back and shoulders.
TREATMENT
Ty is not a hairy male and suggested if he would like to try a massage cream for this session and he agreed.
The planned full body massage was carried out but with more attention to the legs and I was massaged his heels quite thoroughly as this is a trigger point since he has taken up past-time walking. I check with the client if comfort, if my depth and firmness of pressure was fine. I performed kneading, wringing, hacking and cupping followed by deep effleurage to the upper legs over the quadriceps (biceps femoris, semimembranosus and semitendinosus). And posteriorly over the hamstrings (rector femoris, vastus lateralis, vastus intermedius and vastus medialis).
I finished by re-massaging Tys shoulders with deep effleurage, petrissage of the erector spinae muscles either side of the spine, kneading of the scapula and trapezius and petrissage on the upper vertebra up to the occipital, to further relax the neck and shoulders.
CLIENT FEEDBACK DURING TREATMENT
Ty really enjoyed the feel of the massage cream when massaging his feet. When checking the pressure of the strokes he did ask for more work, especially hacking and cupping to his upper legs - he said it was quite invigorating.
CLIENT FEEDBACK AFTER TREATMENT
Ty said he felt extremely relaxed and was enjoying the sessions more than at the start. His upper legs were feeling very warm and his feet were nice and soft but not oily as on previous sessions. He said he often gets dry and cracked heels and uses a specific Scholl cream for that purpose but not regularly. He said that he preferred the almond oil for body work but did like the feel of the cream on his feet.
POST TREATMENT ADVICE
To continue with the stretches that I last showed him and to incorporate some mobility exercises before he starts his walks. We discussed footwear as inadequate shoes will return the lower back pain being on the trigger point from the feet.
Ty demonstrated his stretches and we will change these next week. We also discussed his future treatments as Ty would like to book another five sessions before his holiday late June.
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REFLECTIVE PRACTICE
This was the first time I had used massage cream outside of class. I prefer the feel of it on the client and the gliding on my hands. Im glad that the treatment relaxes Ty so well to the point of sleep, its a compliment but I am unsure at times how to go about waking the client without making them feel uncomfortable or embarrassed. Turning the lights up and changing the music to something more up tempo helps whilst I bustle around tidying up appears to work as Ty woke up!
Overall Review
The first session dealt primarily with Tys shoulders, back and legs. Listening to his initial complaint of lower back pains and his work situation of trying to create contracts was very stressful which I felt was being transferred to the limbs in pain. His poor seating posture when using a laptop at home was not conducive to the situation and I felt this had to be addressed almost immediately if Ty was to benefit from future treatments. Knowing what to expect after the first session I could see that Ty was completely relaxed and was more pro-active in saying what he wanted to gain from the experience.
The second session focused on his shoulder discomfort since his lower back was no longer troubling him as much. He has made alterations to his lifestyle, walking regularly and drinking more water. I suggested walking as a subtle approach to addressing his weight and time management. He seemed quite bogged down with work and not taking breaks putting additional stress on his limbs especially bend over his laptop.
I was pleased to hear that he made changes to his personal environment by creating an office space with a new chair and table at home.
By the third session Ty was more relaxed throughout the massage as his shoulder was feeling much more comfortable. This session was mainly focused on relaxation to de-stress and remove tension throughout the body. I did notice that his heels were cracked and used massage cream to soften the area. This session also concentrated on his upper legs where the muscles were very tense during his enthusiasm in walking. Ty also spoke very honestly about his weight and wants to lose a few pounds to reduce his body fat. This would be ideal especially to the stress felt in his lower back to lose weight off his stomach. Ty is looking into joining a gym.
Chatting about the different massage mediums revealed that he liked the massage cream used on his feet but preferred the overall feeling of almond oil. He is still interested in receiving massage treatments and will return on a less frequent basis.
Overall I think the sessions with Ty went well, he didnt seem aware of any shortcomings on my part. I was able to practise different strengths of pressure and movements. Working on a larger man for the first time was interesting, different body shape and length meant I to use more body pressure and adjust the table accordingly. It was tiring for me and I think I shall need to increase on my stamina and strength training at the gym!
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