CLINIC LOG FOR DAIANA BRANCO

Date of Submission: October 30, 2014

Date

Time

02/10/14

12:00
p.m to
1:00
p.m

02/10/14

1:30
p.m to
2:20
p.m

Patient
ID
100924

Type/ Focus of
Treatment Plan
First Patient:
Rehabilitation
Focused on lower back
region, QL and erector
spinae

Second Patient:
Rehabilitation
Focused on the erector
spinae, rhomboids,
upper trapezius

Clinic Instructor: Andrew Clapperton

Procedures Completed (Assessment/ Treatment/
Modalities/ Home Care)
Patient was a returning patient; I reviewed the
previous SOAP note to see what other tests I
could get my patient to perform. I tested the
gluteus medius bilaterally and there was no pain
both were a grade 5. I also tested QL; the patient
had some discomfort on both QLs. I focused the
treatment on the patients QL and erector spinae,
by first palpating the muscles to see if I found
anything abnormal I then performing effleurage
and some petrissage techniques. I had used the
hydrocollator on his lower back to warm up the
QL muscle. As for home care my mentor had
showed my patient a QL stretch that he could
perform at home.
Patient was a returning patient to the client but
fist time I had seen them. I reviewed the soap
note and seen she was treated for head, neck and
shoulder pain. When she came in I asked her if
there were any changes to her health history and
how her head, neck and shoulders were feeling.
The patient wanted me to focus on her back pain
that happened recent and also shoulders. Before
treatment I did AROM of the thoracolumbar
which she had pain when I added over pressure to
flexion and extension of the thoracolumbar.

Comments
- I was glad I had my mentor
there by my side because she
helped me a lot by showing me
techniques, body mechanics for
those techniques, as well as
how to test the muscle

- Couldnt perform the rest of

the ROM to the thoracolumbar
because she had to leave early.
- I was a little nervous because I
had never treated someone
with scoliosis.

9/10/14

12:00
p.m
to
1:00
p.m

100934

First Patient:
Rehabilitation
Focused on lower back,
QL, erector spinae and
shoulders

9/10/2014

1:30
p.m
to
2:30

101049

Second Patient:
Wellness
Focused on shoulder

16/10/14

12:00
p.m

100924

First Patient:
Rehabilitation

While I was treating her I did some joint play but

she didnt have any pain. As for techniques I
performed some effleurage and petrissage
techniques.
Patient was a returning patient to the client but
first time I had seen them. I reviewed the soap
note and had seen she was treated for head, neck
and shoulders. The patient had no changes to her
health history. Her main complaints were lower
back pain and also shoulder pain. She had pain
while performing flexion of the neck and knee.
She also had some discomfort during her ROM;
she felt pain on her left side while performing
right lateral flexion. RROM she had pain-doing
extension of the thoracolumbar of a scale of 2.
She was positive for quadrants test and felt more
pain on the right side compared to the left. She
also had pain on L5-L3 while I performed joint
play. During treatment I had used a hydrocollator
on her lower back to warm up the tissues. I had
used effleurage as well as petrissage as my
techniques.
My second patient was an initial patient. Her
reason for seeking a massage was for wellness
even though she has some shoulder pain. I went
through her health history form and assessments,
everything was good she had no pain during her
different ROM of the shoulder, as for her postural
assessment her left shoulder was slightly
elevated. I had focused the treatment mainly on
her upper traps, but also treated her whole back
for a little. Some techniques that I used were
effleurage and petrissage techniques.
Patient was a returning patient; he had no
changes to his health history form. I read through

- I definitely felt more

comfortable know her
complaint was lower back pain
because I had a previous
patient with the same issue so
therefore use the same test on
her and see what her result are
like.

- I was glad to get some pointer

from other classmates as well
from my teacher on what how
to use the hand, and the fist to
treat the neck instead of consist
finger and thumb use because
it started to hurt at a certain
point because of the over use
to it.

- I was surprised that my

patient shook a lot while doing

to
1:00
p.m

16/10/14

1:30
p.m
to
2:30

Focused on QL,
hamstrings, lower back
and gluteus medius.

101110

Second Patient:
Rehabilitation
Focused on scalene,
SCM, levator scapulae,
rhomboids, and upper
traps

his health history and made sure I had covered all

of the necessary assessments that needed to be
done. Before treatment I tested how strong his QL
was by asking my patient to go on a side plank
and making sure his stomach was pushed out. I
got my patient to do 10 sets of 5 reps for each
side with a 30-minute break. He wasnt able to
perform the inter set he was shaking a lot and
also had pain on his left side from a pain scale of 3
and some discomfort on his right side. I then
treated the patient and focused on his QL, lower
back, hamstrings and also gluteus medius. I had
performed effleurage as well as petrissage
techniques. I relieved some trigger points he had
on his gluteus medius. As for take home care I
told my patient to do 15 reps of 3 sets once a day
as well as to continue stretching his QL for 30
seconds once a day.
My second patient was an initial patient. Her
reason for seeking a massage was for neck and
upper traps pain. I went through her health
history form and assessments. Her health history
was clear; her BP was normal as for ROM of her
neck she has some stiffness on the right side
during lateral flexion to the left. Joint play of the
cervical she had stiffness on C3 and C4 of a pain
scale of 2. She was negative for distraction,
Spurlings, and vertebral artery. Her ROM for her
thoracolumbar was all normal minus when I was
ruling out her hip doing internal rotation she felt a
pinch in her back. She had no pain during joint
play of the lumbar. She felt a pinch on her right
side while performing Quadrants test on her left
side of a pain scale of 2. I focused the treatment
on treating her mid back as well as neck and

the side plank, since he is very

fit I just thought he would be
able to do the side planks
without any shaking.
- I definitely have to get better
with once seeing them the
second time knowing what to
ask and just making everything
flow together, such as planning
it before it happens.

- I didnt feel very confident in

myself on treating the neck
because Im not used to
treating the neck so I always
feel like Im very superficial and
not sure how to exactly target
each muscle cause some are
small and very close to each
other. Im also very scared of
hurting her just because the
neck is such a small area to
treat.

23/10/14

23/10/14

12:00
p.m
to
1:00
p.m

1:30
p.m
to
2:30
p.m

100934

Frist patient:
Rehabilitation
Focused on QL and
upper traps

Second patient:
Rehabilitation
Focused on the
brachioradialis, and the
radial ulnar joint.

upper traps. The techniques that I used were

effleurage and petrissage.
Patient was returning patient, there was no
changes to the health history. Patients main
complain was still shoulder and lower back pain. I
perform some joint play to her cervical from C7C5 and she had pain of a pain scale of 4. While
palpation her left QL had a high muscle tone
compared to her right side. I focused the
treatments on treating her QL especially her left
side since she had pain of a pain scale of 3. I also
treated her upper traps but mainly the right
upper trap just because she is constantly leaned
on her left side because she always carrys her
school bag only on the left shoulder. Techniques
that were used were effleurage and petrissage.
Home care stretches that I showed her was QL
stretch, upper traps and also levator scapulae, I
asked her to hold the stretch for 30 sec once a
day.
My second patient was an initial patient who was
a facility at Humber. I went through his health
history form and saw he had asthma. His BP was
normal. His main reason for seeking a massage
was to relieve pain in his brachioradialis, radial
ulnar joint all in the right arm as well as lower
back pain. During assessment I notice his left
shoulder was slightly higher then the right. While I
ruled out the wrist he had pain when he extended
the elbow on his right arm. For RROM the patient
had pain during flexion and extension of a pain
scale of 3 on the right arm only. During his ROM
of the shoulder he had pain with every movement
with a pain scale of 3 except internal and external
rotation when he did AROM but for RROM he had

- I definitely feel confident in

myself treat the lower back as
well as providing home care for
the lower back.
- I definitely need to get better
at treating the neck reason and
just feel confident in myself and
putting what I learned into the
muscle that are bothering the
patient.

- When I saw I was treating a

facility I started to feel a little
nervous.
- I should have focused the
assessment on either the
shoulder or lower back instead
of doing assessment for
everything and having barely
any time to treat which now I
know for next only focus on
one area and tell them to
rebook to focus on the other
area.

pain on extension and external rotation on the

right arm. His ROM for his thoracolumbar was
good, no pain. I focused the treatment on his
brachioradialis and well as radial ulnar joint. The
techniques that I used were effleurage and
petrissage.

LEARNING LOG FOR DAIANA BRANCO

Date of Submission: October 30, 2014
Date
02/10/14

Description of Experience
This week during the first half of internship my mentor came
to observe me treating my patient. Before my patient arrived
my mentor and I talked about what assessment I should
perform. Since my patient came in with lower back pain I had
thought about testing the gluteus medius as well as the QL
because there could be trigger points associating pain into
the lower back. Before my patient arrived my mentor had
showed me the MMT for the QL so that I could perform it on
my patient. When my patient arrived I had felt more
confidence in myself and built a picture in my head of
everything I wanted my patient to perform before treatment.
Before I performed the assessment of muscle strength, I had
gone through with my patient letting him know exactly what
I was going to do and why, the benefits, risks and that I
would communicate with him the findings. I tested the
gluteus medius and QL bilaterally. I then stepped out of the
cubicle allowing my patient to get on the table as my mentor
held the curtains. During treatment my mentor had showed
me different techniques that I could use to target the QL
muscle, which I found very helpful. I also had made sure to

Clinic Instructor: Andrew Clapperton

Performance Indicator Achieved
2.1.m Perform muscle strength assessment.
1. Identify the indications, contraindications and precautions for
performing muscle strength assessment.
2. Communicate the assessment procedure to patient.
3. Describe the process for performing muscle strength assessment.
4. Demonstrate muscle strength assessment base upon patient history
and presentation.
5. Differentiate between normal and abnormal findings.
3.1.l Apply biomechanical and postural skills for therapist selfprotection.
1. Demonstrate biomechanical and postural skills that support
therapist safety.
2. Adapt biomechanics and posture as required during treatment.

02/10/14

9/10/14

use the right body mechanics during treatment.

In the second half of internship I had treated a returning patient
to the client. I had asked her if there were any changes to her
health history as well as listened to the patient as she told me
about the lower back pain that happened recently. I only did her
ROM of her thoracolumbar as well as some joint play before the
treatment was started because she had to leave early. I learned
how to manage my time effectively since my patient had t leave
early for class and made sure I wasnt spending to much time
focusing on one thing only. I also learned that theres no
difference from treating someone who has scoliosis compared
to someone who doesnt. I had never had the chance to treat
someone with scoliosis until this day, it was nice to see exactly
how there spine feels and looks like actually in front of you
instead of looking at a picture.
This week on the first half of internship I had treated a returning
patient to the client. I had asked her after reading the previous
soap notes how her shoulder and neck pain where, which she
said they still hurt but mainly her shoulder because of all the
weight she carrys. I then performed ROM to her thoracolumbar
since that was her main concern as well asked my patient to
perform certain SOT that I thought would be most beneficial to
finding exactly what is causing her pain. I had made sure that I
always had involved my patient into the treatment by letting
them know exactly what I was going to perform and why. I
learned that this was my second patient with lower back pain
and I definitely felt more confidence in myself knowing exactly
what ROM I needed them to perform as well as what SOT
needed to be perform for the thoracolumbar such as joint play,
quadratus lumborum, etc.

1.1.f Utilize active listening skills.

2. Demonstrate active listening.
3. Affirm key points.
4. Clarify contradictions.
2.1kj Perform range of motion assessment
1. Identify the indications, contraindications and precautions for
performing range of motion assessment.
2. Communicate the assessment procedure to patient.
3. Describe the process for performing range of motion assessment.
4. Demonstrate range of motion assessment base upon patient
history and presentation.
5. Differentiate between normal and abnormal findings.

2.1.q Perform appropriate special tests (specific selected assessments)

1. Identify the indications, contraindications and precautions
for selecting a specific assessment.
2. Explain the purpose of the selected assessment.
3. Explain how the selected assessment affects the involved
tissues.
4. Communicate the assessment procedure to the patient.
5. Demonstrate the selected assessment.
2.1.d Select and perform assessment incorporating knowledge of
patient history, contraindications and precautions.
1. Identify assessment needs
2. Select appropriate assessment procedures.
3. Explain approach to assessment.
4. Perform assessment.

9/10/14

16/10/14

This week on the second half of internship I had treated an

initial student. The patient had came in for wellness and wanted
to feel relaxed. Before I had gone through her health history
form I told here everything we talk about is call confidential
unless by law or her permission. I then got consent for all of the
assessment I was going to perform such as vitals, postural, and
ROM. Before treatment I made sure to assessed her ROM of the
shoulder since she had some pain but wasnt her main
complaint. I also made sure that my patient was involved in ever
step of the treatment such telling her exactly what I was going
to do, the reason to why I was doing it, the benefit, and risk.
Once the assessments were done I had stepped out of the
cubicle and allowed her to remove as much clothing as she was
comfortable with and then proceeded with the treatment. Some
indicators that were performed were I made sure that
everything in the cubicle and all the tools where all cleaned as
well as working properly.
This week during the first part of internship I had treated a
returning patient. I felt very comfortable in myself because I had
already treated my patient a few times before and also a
therapeutic relationship was built. I had learned that I was
allowed to ask my patient to perform muscle strengthen tests
before treatment and now have to wait after treatment as well
as stretches, depending on whether the patient still had the
same or different complaint of pain. I also had learned that if the
patient doesnt feel a stretch after trying different movement it
can mean that there muscle is already stretched and needs to be
strengthen. Before I started the treatment I had asked my
patient to do 10 sets of 5 reps on a side plank causing him to lift
from his knee up off the table and back down to see how
strengthen his QL are. I had stepped out of the cubicle and
allowed the patient the patient to get on the table as I washed
my hands. Once treatment started I made sure to put my
patient in the appropriate position in order for my to treat the

3.1.b Maintain a safe and comfortable treatment environment.

2. Establish and maintain a safe and comfortable environment.
3. Ensure setting and equipment meet patient needs.
4. Maintain equipment in proper working order.
3.1.c Apply standard hygiene and infection control precautions.
3. Demonstrate standard hygiene practices.
4. Apply standard precautions for infection control.
1.3.d Comply with confidentiality and information privacy
requirements.
2. Maintain the confidentiality of patient information.

1.3.b Maintain professional boundaries in relationship with patient.

2. Manage personal responses to patient reactions.
5. Demonstrate respect for the personal boundaries of patients.
3.1.a Treat in a manner that reflects the
principles of massage therapy.
2. Inform patient of approach to treatment.
3. Apply the principles of massage therapy to
treatment.
3.1.f Apply draping as relevant.
2. Drape patient appropriately for
treatment.
3.1.g Position patient for selected therapeutic techniques
1. Select appropriate positioning
2. Direct and position patient.
3. Modify position according to patient response.

16/10/14

QL and the gluteus medius. During treatment I had used the

different techniques that my mentor had shown me as well as
relieve trigger points in the gluteus medius. I made sure I had
draped his leg properly and didnt cross any boundaries that
would make him feel uncomfortable. I had provided my patient
with take home exercises which was to side plank once a day
doing 15 reps of 3 sets as well as to continue doing the QL
stretch once a day for 30 sec.
This week on the second half of internship I had seen an initial
patient. We had gone through her health history and I told her
about the confidentially and how Im not allowed to share any of
the information unless I have her permission or if law asks. I had
got her consent for health history, assessment and as well for
treatment. Once assessment were done such as pain
assessment, ROM, postural assessment were all done I then
choose some SOT that I thought would be appropriate for her
main claimant which was neck and upper traps. I had responded
to the patient needs closing during treatment because she didnt
feel comfortable with it all open. Before I had started the
treatment had palpated her lower back to see if theyre
anything different from one side to the other. I then just
proceeded with the different techniques.

1.3.a Display positive regard toward patient.

2. Demonstrate respect for the patient.
4. Establish rapport with the patient.
5. Respond empathetically.
1.3.c Respect the patients physical privacy.
1. Direct patient in degree of disrobing
2. Create an environment od privacy and safety
3. Respond to patients individual privacy needs.
2.1.h Perform palpatory assessment.
1. Identify the indications, contraindications and precautions for
performing palpatory assessment.
2. Communicate the assessment procedure to patient.
3. Describe the process for performing palpatory assessment.
4. Demonstrate palpatory assessment base upon patient history and
presentation.
5. Differentiate between normal and abnormal finding

23/10/14

23/10/14

This week on the first half of internship I had a returning patient.

I had asked my patient how she was feeling from the previous
treatment, which she said better but still has lower back pain as
well as shoulder pain but not as much as previously. I then
performed some joint play to her cervical to see exactly where
she has pain, which was from C7-C5. Before treatment started I
had stepped out of the cubicle and allowed her to get on the
table as I went to go and wash my hands. Before I started the
treatment I did some palpation assessing her muscles and seeing
if I find anything abnormal compared to the right from the left
side and visa versa. While I palpating my patient back I told her
that I felt high muscle tension on her left QL. During treatment
she did tell me that my pressure was a little to much on her left
QL and that it was she would feel pain if I touch it lightly. I had
provided her with some take home stretched such as upper
traps, QL, and levator scapulae. I learned how to teach stretch
those following muscles by asking my teacher exactly how they
were done properly.

This week on the second half of internship I got a change to

treat my first initial faculty. Before I started the treatment I told
my patient that everything we speak about is all confidential, as
well as I got his consent and I explained the importance of

1.2.j Utilize professional judgement

2. Apply continuous learning to clinical decision making.
3. Ensure patients safety, dignity and autonomy in provision of
care.
4. Apply principles of code of ethics and standards of practice.
5. Manage time effectively.
1.2.n Access and, where relevant, utilize research and
professional literature in massage therapy and related
disciplines to enhance patient care.
1. Access reliable sources of published research
and professional literature.
2. Analyze the information presented
3. Integrate new information into practice,
where appropriate.
4. Communicate research findings to colleagues and other
stakeholders.
1.1.d Communicate in a manner that respects diversity
1. Respond appropriately to recipients
individuality.
2. Employ approaches that respect recipient diversity.
1.1.b Utilize effective oral communication
1. Employ clear, concise and profession-specific
language.
2. Speak in a manner that corresponds to the needs of the listener.
3. Employ appropriate pace, tone, and projection of
voice.
4. Employ effective questioning techniques.

2.1.a Obtain comprehensive case history from patient.

1. Explain the importance of obtaining case history.
3. Interview patient to obtain case history and their desired treatment
outcomes.

keeping the health history updated. I also got consent for the
pain assessment as well as for the rest of the assessment such as
vitals, postural, ROM and I made sure I explained the risk,
benefits and reason to why I was performing postural
assessments, vitals, and ROM such as active, passive and
resisted. I then stepped out the cubicle and allowed the patient
to get in the table, and just started the treatment once he was
ready. I had focused the treatment on his brachioradialis as well
as the whole right arm cause that was his main complaint.

2.1.g Perform postural assessment.

1. Identify the indications, contraindications and precautions for
performing postural assessment.
2. Communicate the assessment procedure to patient.
3. Describe the process for performing postural assessment.
4. Demonstrate postural assessment base upon patient history and
presentation.
5. Differentiate between normal and abnormal findings.
2.1.p Perform vital signs assessment
1. Identify the indications, contraindications and precautions for
performing vital signs assessment.
2. Communicate the assessment procedure to patient.
3. Describe the process for performing vital signs assessment.
4. Demonstrate vital signs assessment base upon patient history
and presentation.
5. Differentiate between normal and abnormal findings.

Three (3) Performance Indicators I have not achieved are

1.Performing muscle lengthen assessments
2. Performing joint play assessments
3. Havent fully achieved my critical thinking skills
My plan for achieving these three performance indicators is
The steps that I plan on achieving these three indicators are by practicing them first and making sure Im very familiarized with them when it
come to performing them on a patient. I will also perform them when its necessary depending on the patients case. As for critical thinking I plan
on achieving it by actually thinking more out of the box such as what other muscle near by are causing the issue instead do the muscle where the
pain occurs.
I am SATISFIED with my progress in this Internship so far
Because I have learned a lot since day one, I feel like Im slowly improving at the days go on. Yes I do know that there are areas were Im very
weak on and need to improve in them such as asking more questions on things happen, or even pain scale when there in pain or have some
discomfort. In the end Im satisfied with everything Ive done so far and just will keep on improving everyday.