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Method of Evaluation: Reflective Study

In patient sports therapy, differences in gender and sex of the individual are important factors to consider. Several legal, ethical and practical factors influence response to therapy in female patients. This has an impact in response to treatment, and choosing the methods best suited for them. This review aims at establishing the course of actions already taken and why, and what can be changed and the impact of this change.

The literature review done was based on research on the factors affecting sports therapy in females, and use of reflective study method for evaluation. (Dressler, Becker, Kawalilak & Arthur, 2018) Reflective method of study involves engaging in a continued observation and evaluation of one’s own actions, in order to have an understanding of these actions. In this method, the most important factor is to observe practice and establish ways to improve it on a continuous basis. Two different models exist; iterative and vertical.  Iterative model is cyclical, hence is repetitive. Example is when someone re-evaluates an experience by going back to it and dealing with their feelings, then coming up to a conclusion. Vertical model shows reflection as a process that is taking place at different levels. (Taylor, Ryan & Elphinstone, 2021) Our review was based on Gibb’s reflective cycle which is a cyclic model.

Through this model, the case study is described. History of the patient, evaluation of her situation, analysing her situation and coming up with the outcome. The last step was the action plan, which enabled us to come up with therapy based on this and evaluation of other cases. (Day, Wengreen & Heath, 2016)

In determining the method of treatment in sports therapy, reflective study involved learning from different environments, different clients/cases, different colleagues, new experiences/exposures, difficult/challenging situations, knowledge based and behaviour based. This enables us to understand various challenges and issues that females in sports face, as in our case study involving a female athlete.

Reflective study enables us to identify common issues surrounding females in sports, which has an impact in therapy. These issues/ challenges include:

Lack of role models to influence them. With current trends in social media, young females are influenced to give in to peer pressure, which is mostly all about focus on external beauty rather than features seen in athletes like confidence. If these positive role models were available, they would encourage and influence young girls to join sporting activities in order to maintain general health and wellness, as well as participate in competitions and tournaments. Established female players engaging with aspiring and upcoming athletes would help to inspire them. (Monnin, 2018)

Challenges Faced by Female Athletes

Attitudes regarding sexuality and gender. Gender stereotypes such as perceiving women to be naturally less conditioned to engage in sport activities, and viewing women participating in sports as less feminine, is key to contributing to women dropping out of sporting activities. Also, most lesbian or bisexual sex participants in sports report feeling unwelcome and unsafe when it comes to their participation in these sport activities. Eliminating gender stereotypes is a necessary step in enabling more girls to feel comfortable, and still feel feminine, while taking part in sports. It is also necessary to consider sexual preferences among sport participants to ensure no group feels sidelined. (Alaeddinoglu, 2020)

Parental influence. Since sporting activities were traditionally regarded as a male activity, some parents still have this same attitude, hence they do not encourage engagement in sports in their girls. Also, some parents are oblivious to the benefits of engaging in sport activities, ranging from social well being, easing anxiety, reducing the likelihood of engaging in immoral activities and many more benefits for their girls. Also, some parents hardly do any physical activity, hence the young girls have no one to emulate in order to also participate in sporting activities. Educating parents and the general population on the health benefits of sports is key to enabling more girls to participate in sporting activities. (Braham, Lester, Teal & Richards, 2016)

Lack of financial resources and gender inequality in pay. Generally, women earn less more than men. This makes it more difficult for them to acquire sports clubs membership, pay for sport clothing and equipment. Also, in most sporting activities, men are paid better than women, with sports like football and cricket displaying a really huge disparity in the pay. This could really demoralize women’s urge and willingness to participate in sport activities. Women should be supported more in order to allow them to participate more in sports. (Obloj & Zenger, 2022)

Security. In a study conducted on England female athletes, a third of women reported having been harassed while they were out running alone, and even most women felt safer if they were running in a group. Generally, women also report feeling unsafe and anxious while participating in outdoor sporting activities like walking, cycling and swimming. Urban streets and parks need to be designed or redesigned to accommodate and consider women in mind. (Jones, 2019)

Social media. This may negatively influence female participation in sporting activities, as some female sport participants report feeling sexually harassed by some males who give unsolicited opinions and send inappropriate private messages to them. Some women also feel that the media does not do enough to encourage female participation in sports, though this has significantly improved in the recent past. (Sheffer, 2020)

Case Study: Assessment, Treatment, and Follow-Up

Other issues women face include; not feeling supported by their clubs to continue participating in sports after having a baby, feeling forced to be in sport clothing they feel is inappropriate and uncomfortable for them, which does not apply to their male counterparts.Some women also feel threatened to participate in sports due to racism and some are conscious about their body image. (Voelker, Petrie, Huang & Chandran, 2019)

In my review, reflective study enabled me to widely understand and think critically about the treatment choice for the female patient who was presented.

The patient was a 38 year old female athlete, who presented with right sided quadratus lumborum tightness grade 1, and ankle imbalance grade 2. The injury had happened a week back as she played judo, and did a sudden twist in a throw in which she had not expected her trainee to go over. She has not used any previous medication. The patient had had a similar injury 5 years ago. The patient is a university lecturer. She plays, demonstrates and coaches   the game of judo, four times a week for 2 hours per session. She had an Achilles surgery five years ago and has Haglund’s deformity for the last 5 years to date. She reports having good sleep though she wakes up sometimes, getting up, sitting and moving aggravate the pain. The pain eases when she moves around. She also feels general muscle tightness.

On assessment, active hip motion revealed lower back pain, and flexion was more on the right than left. Passive hip motion revealed feels in adductors on right side, the left side was okay. Hip resistance on both right and left side. On thoracic assessment, there was right side glute firing on rotation, the left was okay. There was no pain in glutes. Banana test and Trendelenburg test were negative.

Treatment prescribed was soft tissue work for the quadratus lumborum muscle and for the lower back. Patient also had another date set to rebook appointment for follow up, and for a rehab plan. This was upon the first visit. During the next visit, patient reported soreness after previous appointment on left scapula, felt like a bruise but couldn’t see the back. This soreness ceased after a few days. She had weak and painful shoulder, slight improvement in arc, and felt sore while trying to lift and pick up jacket. She had not noticed any change. She also found it difficult to exercise. Treatment recommended was rehab plan and follow up.

 When treating patients, sex differences have to be put into consideration as body structure may be a factor in injury during sports. Some injuries such as knee meniscal injuries, fractures, concussions, ankle sprains and strains are common among both male and female. The most common injuries are anterior cruciate ligament injuries, which are more common in females than in males. (Weir, 2021) This can be put down to factors such as the sport one is involved in, equipment used, environmental factors, natural athlete conditioning and skills and the experience that the athlete has. These factors are all extrinsic. Among the intrinsic factors specifically related to body structure are laxity of the ligament, influence of hormones, intercondylar  notch width and biomechanical alignment. Possibility to have certain injuries can therefore be linked to sex.

Lower extremity injuries are more linked to sex/ gender of individual, occurring more in females. Factors such as sex hormones, individual anatomy and neuromuscular imbalance are suggested to be linked to likelihood of occurrence of these injuries. (Luedke & Rauh, 2022)

The female athlete triad also affect the choice of treatment. ("The Female Athlete Triad (Care of the Young Athlete)", 2021)  This triad consists of a syndrome in which an individual has reduced energy levels, energy, altered menstrual function and bone mineral density is also altered. Amenorrhea may also be a presenting feature. The most individuals at risk are those female athletes at high school, campus and colleges and elite levels. Our patient in this case falls under this category, as she is a couch in judo in university. This therefore plays a role in the choice of treatment. This treatment involves a multidisciplinary approach, to re establish menstrual flow and improve the bone mineral density. (Lenkeit, Westphal, Schäfer & Ekkernkamp, 2016) This can be done by modifying diet, changing unhealthy behaviours, creating patient awareness and exercise training. (Maarouf, Norasteh, Daneshmandi & Atri, 2021) If necessary, medication can be recommended which may include giving oral contraceptive pills or administration of oestrogen for control of hormonal imbalance. Since the female triad may also be correlated with stress and depression, rehabilitation may be necessary. This was the reason for considering rehabilitation in our case. (Sonesson & Kvist, 2022)

After establishing factors affecting female participation in sexual activities, injuries that are more likely to occur in female athletes and the reasons for this, we were able to come up with legal, ethical and practical considerations for sports therapy in female patients and the impact of this on the female population. Using the reflective study method, we were able to establish how different environments play a role in this. The reflective method enabled analysis of new exposures, difference cases of other female athletes and challenging situations that they face. Consideration of gender in conclusion, is therefore a very important aspect in choice of treatment in participants in sport activities.

References

Alaeddinoglu, V. (2020). The Attitudes of University Students Regarding Physical Education and Sports Lesson. Ambient Science, 07Sp(1). doi: 10.21276/ambi.2020.07.sp1.oa20

Braham, R., Lester, L., Teal, R., & Richards, J. (2016). Does Previous Injury Influence Parental Risk Perception In Junior Sport?. Medicine & Science In Sports & Exercise, 48, 331. doi: 10.1249/01.mss.0000486001.96550.37

Day, J., Wengreen, H., & Heath, E. (2016). Prevalence of Low Energy Availability in Collegiate Female Runners and Implementation of Nutrition Education Intervention. Sports Nutrition And Therapy, 1(1). doi: 10.4172/2473-6449.1000101

Dressler, R., Becker, S., Kawalilak, C., & Arthur, N. (2018). The cross-cultural reflective model for post-sojourn debriefing. Reflective Practice, 19(4), 490-504. doi: 10.1080/14623943.2018.1530207

Jones, S. (2019). Gender studies. New York, NY: Clanrye International.

Lenkeit, I., Westphal, S., Schäfer, S., & Ekkernkamp, A. (2016). Sport bei Osteoporose. Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin, 26(04). doi: 10.1055/s-0036-1587634

Luedke, L., & Rauh, M. (2022). Plank Times and Lower Extremity Overuse Injury in Collegiate Track-and-Field and Cross Country Athletes. Sports, 10(3), 45. doi: 10.3390/sports10030045

Maarouf, A., Norasteh, A., Daneshmandi, H., & Atri, A. (2021). The Effect of a Corrective Exercise Program Based on Scapula Stability on Scapular Upward Rotation and Scapulohumeral Rhythm in Wheelchair Basketball Athletes With Bilateral Scapula Rotational Syndrome. Journal Of Rehabilitation, 21(4), 488-507. doi: 10.32598/rj.21.4.3105.1

Monnin, É. (2018). Olympic education and sports role models. IJASS(International Journal Of Applied Sports Sciences), 30(2), 91-97. doi: 10.24985/ijass.2018.30.2.91

Obloj, T., & Zenger, T. (2022). The influence of pay transparency on (gender) inequity, inequality and the performance basis of pay. Nature Human Behaviour. doi: 10.1038/s41562-022-01288-9

Sheffer, M. (2020). New Media, Old Ways: An Analysis of Sports Media’s Depiction of Female Athletes on Instagram and Snapchat. Journal Of Sports Media, 15(2), 31-50. doi: 10.1353/jsm.2020.0009

Sonesson, S., & Kvist, J. (2022). Rehabilitation after ACL injury and reconstruction from the patients’ perspective. Physical Therapy In Sport, 53, 158-165. doi: 10.1016/j.ptsp.2021.10.001

Taylor, S., Ryan, M., & Elphinstone, L. (2021). Generating genuine inclusion in higher education utilising an original, transferable, and customisable model for teaching and assessing reflective learning. Reflective Practice, 1-19. doi: 10.1080/14623943.2021.1933408

The Female Athlete Triad (Care of the Young Athlete). (2021). Pediatric Patient Education. doi: 10.1542/peo_document572

Voelker, D., Petrie, T., Huang, Q., & Chandran, A. (2019). Bodies in Motion: An empirical evaluation of a program to support positive body image in female collegiate athletes. Body Image, 28, 149-158. doi: 10.1016/j.bodyim.2019.01.008

Weir, G. (2021). Anterior cruciate ligament injury prevention in sport: biomechanically informed approaches. Sports Biomechanics, 1-21. doi: 10.1080/14763141.2021.2016925

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