Leg pain from sciatica
MediumSciatica Follow-up: New Parent
Setting: Outpatient physiotherapy clinic. Your role: Physiotherapist
Olivia Brown, a 26-year-old new parent, is returning for a follow-up appointment regarding her sciatica, which presents as shooting leg pain and lower back discomfort. You previously prescribed gentle exercises and pain management strategies. This consultation focuses on assessing her response to the previous plan and adjusting it as needed.
- Assess Olivia's response to the previous plan, specifically noting changes in the intensity and frequency of her shooting leg pain and lower back discomfort.
- Review symptom changes and what Olivia has noticed in the interval, particularly regarding activities like lifting her baby and any specific triggers or relief measures.
- Adjust the exercise regimen or pain management advice if needed, for instance, by modifying pelvic tilt exercises or suggesting specific body mechanics for childcare, sharing clear reasoning with Olivia.
- Reinforce what worked well in the previous plan, such as effective stretches or resting positions, encouraging Olivia to maintain these beneficial behaviours.
- Schedule a next review appointment in 2-3 weeks to monitor her progress and address any further concerns, ensuring the timing is practical for a new parent.
Practise this cardHeel pain rehabilitation
HardHeel Pain: Accommodating Prayer Times
Setting: Outpatient physiotherapy clinic. Your role: Physiotherapist
Mr. Peter Lawson, a 63-year-old taxi driver, is returning for a follow-up physiotherapy session for his chronic heel pain, diagnosed as plantar fasciitis. He has been experiencing significant morning pain and discomfort when loading his foot, affecting his work and daily activities.
- Listen attentively to Mr. Lawson's concerns regarding his daily prayer times and their impact on performing his prescribed heel pain exercises.
- Understand the cultural and religious significance of his five daily prayers (Salat) and how their fixed timings and physical movements pose a challenge to his physiotherapy regimen.
- Assess the clinical implications of modifying his current exercise plan, considering the importance of consistent loading, calf flexibility, and appropriate footwear in managing his plantar fasciitis, while respecting his religious commitments.
- Propose a specific, flexible exercise schedule or modified techniques for his stretches and strengthening exercises that accommodate his prayer times and movements, without compromising rehabilitation effectiveness.
- Confirm with Mr. Lawson that the suggested adjustments are practical, acceptable, and that he feels confident in integrating his physiotherapy into his daily routine.
Practise this cardHome exercises for cerebral palsy
MediumLeo's Home Exercise Refusal (CP)
Setting: Outpatient physiotherapy clinic. Your role: Physiotherapist
You are a physiotherapist seeing Mrs. Hannah Lee, mother of 6-year-old Leo, who has cerebral palsy. Mrs. Lee is concerned because Leo has recently started refusing a key home exercise, the 'airplane' exercise, which he previously tolerated well.
- Greet Mrs. Lee warmly and confirm her visit is regarding Leo's recent difficulties with his home physiotherapy exercises.
- Gather a focused history regarding Leo's specific challenges with the 'airplane' exercise, including its onset (approx. 3 weeks ago), frequency of refusal, any associated pain, and other changes in his mobility or mood.
- Clarify Leo's current physical capabilities and ask about any recent observations from school or other caregivers regarding his gross motor skills, considering his cerebral palsy and its impact on this particular movement.
- Explain potential reasons for Leo's resistance (e.g., developmental plateau, boredom, need for adaptation) and propose a revised, engaging play-based home exercise plan to achieve similar muscular benefits.
- Confirm Mrs. Lee understands the new exercise suggestions, feels confident in implementing them at home, and agree on a follow-up plan for monitoring Leo's progress.
Practise this cardReturn to sport after hamstring strain
HardHamstring Re-injury and Coding Marathon
Setting: Community rehabilitation centre. Your role: Physiotherapist
Mr. Isaac Wong, a 39-year-old software engineer, sustained a Grade 2 hamstring strain three weeks ago. He is making progress but is eager to return to competitive sport, specifically an upcoming 'TechSprint Hackathon', and appears reluctant to fully adhere to the recommended phased return plan due to perceived delays.
- Explore Mr. Wong's specific concerns regarding the current rehabilitation plan and his eagerness to return to activity, particularly any upcoming professional commitments.
- Validate his feelings about the importance of his career and the desire to recover quickly, acknowledging his perspective without dismissing his concerns.
- Share evidence about the high re-injury rate (up to 30%) for Grade 2 hamstring strains if return to activity is rushed, specifically relating it to his need for prolonged sitting and high-stakes concentration.
- Offer an adjusted, 'sport-specific' rehabilitation strategy that incorporates elements of sitting tolerance and cognitive focus relevant to his 'TechSprint Hackathon', while still prioritising hamstring recovery.
- Agree on one concrete, safe activity or exercise modification Mr. Wong is willing to commit to this week to progress towards his goals without increasing re-injury risk.
Practise this cardRehabilitation after knee replacement
MediumKnee Rehab Adherence: Carer Counselling
Setting: Outpatient physiotherapy clinic. Your role: Physiotherapist
Mrs Grace Turner is here today regarding her 67-year-old husband, Mr David Turner, who is 3 months post-Total Knee Replacement (TKR). He is experiencing significant stiffness and pain, and his knee flexion is currently limited to 70 degrees. Mrs Turner is concerned about his lack of consistent adherence to home exercises and his ability to regain function.
- Assess Mrs Turner's readiness to support her husband in consistently performing his knee rehabilitation exercises.
- Understand Mrs Turner's specific motivation for seeking help today regarding her husband's limited knee movement and pain.
- Set a SMART goal with Mrs Turner for Mr Turner's home exercise adherence, focusing on increasing knee flexion or reducing swelling within a defined timeframe (e.g., 2 weeks).
- Discuss concrete support strategies Mrs Turner can implement or access to help her husband adhere to his home exercises consistently.
- Schedule a follow-up appointment or phone check-in with Mrs Turner to review Mr Turner's progress towards the agreed-upon goal.
Practise this cardRehabilitation after ACL injury
HardACL Rehab Adherence & Goal Setting
Setting: Outpatient physiotherapy clinic. Your role: Physiotherapist
Ms. Sofia Garcia, 48, an office manager, is 6 weeks post-ACL reconstruction. She has an appointment today for her follow-up, but her adherence to the prescribed home exercise program has been inconsistent, putting her recovery at risk. Your goal is to re-engage her in her rehabilitation.
- Assess Ms. Garcia's current commitment to her rehabilitation exercises and her understanding of their importance for long-term knee stability and function.
- Understand the specific personal motivations driving Ms. Garcia to fully recover from her ACL injury and adhere to her progressive rehabilitation plan.
- Set a SMART goal with Ms. Garcia for her next two weeks of rehabilitation, focusing on a measurable increase in specific exercises like quad sets or single leg balance.
- Discuss concrete support systems or strategies Ms. Garcia can utilise to consistently perform her daily exercises and manage any pain or fatigue between sessions.
- Schedule a follow-up appointment within 2-3 weeks to review progress towards her SMART goal and adjust her rehabilitation plan as needed for her return to activity.
Practise this cardActivity pacing with widespread pain
MediumActivity Pacing Non-Adherence - Grace Turner
Setting: Community rehabilitation centre. Your role: Physiotherapist
Mrs Grace Turner, 64, a part-time librarian, is attending her follow-up appointment for widespread pain management. She was previously advised on activity pacing, specifically breaking down tasks into 15-minute segments with 30-minute rest periods to avoid 'boom-bust' cycles. However, her pain has flared, and she admits she hasn't consistently followed the plan.
- Explore the barriers Mrs. Turner faced in consistently applying the 15-minute activity/30-minute rest pacing strategy, without judgment.
- Validate Mrs. Turner's difficulties with her work schedule and family commitments, while still emphasising the importance of pacing for managing her widespread pain.
- Co-design a revised activity pacing plan with Mrs. Turner that is more realistic for her current part-time librarian work and daily life, perhaps focusing on one specific activity to start.
- Safety-net Mrs. Turner, discussing what she should do if the revised pacing plan also proves challenging or if her pain significantly worsens.
- Schedule a specific follow-up phone call or short appointment within the next two weeks to review her progress with the new pacing strategy.
Practise this cardBreathing control in COPD
HardManaging COPD Breathlessness: Family Views
Setting: Outpatient physiotherapy clinic. Your role: Physiotherapist
Mr. Samuel Reed, a 50-year-old train conductor diagnosed with COPD, has been referred to you due to increasing breathlessness which is significantly impacting his ability to perform daily activities and work. He is seeking strategies to improve his breathing control, but there are differing opinions within his family regarding the intensity and approach of his physiotherapy.
- Acknowledge Mr. Reed's desire to regain independence, his wife Sarah's concerns about potential overexertion, and his son David's belief that he should push harder to improve his lung function.
- Name the overarching shared goal for all family members: improving Mr. Reed's quality of life and managing his COPD symptoms effectively and safely.
- Clarify the medical facts regarding COPD progression, the evidence-based benefits of controlled breathing techniques (pursed-lip breathing, pacing), and the importance of balancing activity with rest to avoid deconditioning without over-straining.
- Mediate a compromise by proposing a personalised physiotherapy plan that integrates pursed-lip breathing and pacing techniques, emphasizes gradual progression, and includes strategies for panic management, ensuring it addresses both safety and improvement.
- Confirm a specific, detailed plan for Mr. Reed's initial physiotherapy sessions, including frequency, initial exercises (e.g., 5-minute walking with pursed-lip breathing), and how progress will be monitored, ensuring he feels comfortable with the agreed approach.
Practise this card
