Musculoskeletal Condition and Nutritional Case

Reflection
Student: Connor Stuart – 12051576
Subject: Mr. K – 23-year-old Physically active male

Presentation
The subject was consulted after experiencing an Achilles injury which could prevent them from
participating in a national sporting squad for Rugby League. The healing process appears slow
but normal levels of strength and pain levels, but the subject’s nutritional habits may be
affecting the efficiency of the process as studies suggest the possibility of proinflammatory
effects of fructose from various sources (Della Corte et al., 2018). The patient has been
attending gym with a roommate who is training as per a personalized workout plan for a
weightlifting competition and states that he does not rest and reports diet as poor.
Medical history was not pertinent regarding the subjects nutritional or injury. Genetic factors
from a second-degree blood relative being native American predisposes the subject to diabetes,
substance abuse and addiction, sugar and caffeine in this case (Raade & Mandal, 2018). These
factors are accentuated by the psychosocial factors of the subject which have stressors from
work and romantic relationships. Dietary history was described as poor and is investigated
further and was asked to complete at least a food diary of 3 days or 5 if possible. The subject
appears to be in good shape other than likely lower-crossed syndrome and the poor
management of the injury early after onset.
No socioeconomic factors were found to be associated with diet or injury management. The
subject works as an electrical apprentice and reports being anxious the workplace which he
describes as toxic, this is associated with a recent end of relationship after relocating for the
individual. No medications are being taken to have side effects with the supplementation of
protein. The patient has not had and refuses to see a general practitioner to have a blood
assessment conducted.
Investigations
No visible deformity of the Achilles was present; positive tests for pain when squeezing the
gastrocnemius muscle, weak dorsiflexion and swelling of the tendon insertion at the posterior
left ankle ("Partial Tear of The Achilles Tendon", 2021). These suggest the recent occurrence of
an Achilles injury that has been healing but by this point in the process should have more
strength with minimal pain.
The patient participates in weekly games and training sessions of rugby league, Aus-Tag and
Touch rugby league along with resistance gym training every other day.
Subject likely has severe work-related stress and will purchase comfort food often for both
taste and convenience. When told about a regular day’s happenings of food consumption in
relation to exercise and some poor habits were immediately picked up. The subject often wakes
up from poor sleep and consumes one or multiple pre-packaged iced coffees and then to get
through either a gym or sports session they often have a full serving of a pre-workout used by
his roommate, then proceeding to struggle to sleep and continuing the next day (O'Callaghan,
Muurlink & Reid, 2018). The slowed tissue healing process is currently believed to be a
combination of poor management with high loads of work and continued physical activity with
a poor diet.

Biometric Measurements
Weight Blood BMR BMI Activity Level
Pressure
Pre 78kg 120/24 7.9 25 1.75 hours
Moderate-Intense
Post 80kg 118/20 8.1 26 1.5 hours
(2-Weeks) Intense

Relevant Medication Dose Pre-Intervention Dose Post-Intervention

CBD oil 3-4 drops when required 3-4 drops when required
(taken for sleep approx. twice a week)
Diagnosis
The subject has a left sided sub-acute grade one Achilles tendon tear, the injury is complicated
by high workload of physical activity and psychosocial stress from relationships and mentally
unsafe work environment.
Subject often becomes frustrated with slow or stunted progression and performance or
physical appearance. This can drastically complicate the efficiency of the recommendations and
the likelihood of the subject maintaining positive adjustments to create new habits. This may be
due to poor management of injury affecting performance, following an exercise plan made for a
different individual combined with poor diet.

Treatment
Negative Recommendations:

 Limit pre-made iced coffees to one a day and only of small size if needed
 Stop having pre-workout in the evening
 When consuming alcohol, try the sugar free variation of pre-mixed vodkas if unable to
mix yourself with natural fruit juice or mineral water
Positive Recommendations:

 Change the pre-packaged frozen meals to brands like “MyMuscleChef”, “YouFoodz” or

“GymFood”
 Attempt some home-made meals for a week and take them to work
 Incorporate one cup of spinach or snap frozen vegetables into dinners
 Take fresh fruit to work to have as a snack instead of hot box or processed snacks
 Purchase a liter bottle of water and attempt to start drinking its entirety in a day, more if
able
 Change caffeine consumption to a barista made coffee or even instant and use little
sugar if needed
The goals of dietary recommendations are aimed to reduce processed foods to limit intake of
sugar and additives. These recommendations will be reflected to benefit quality of sleep. The
subject does not have medical advice on the use of CBD oil to assist sleep, but material has
been provided and the patient says they only use it when they believe they will not sleep
otherwise (Grinspoon, 2020). A men’s multi vitamin has also been recommended to the patient
as they are likely deficient with many micronutrients and I am currently uncertain on how well
improve diet to improve nutrient consumption via diet.
Subject has been referred to a local physiotherapist by his general practitioner soon after injury
but has reported that he has not committed to the many stretches and exercises prescribed by
the therapist. The importance and benefit of tissue sparring movements have been explained
along with prescription of light resistance band and isometric exercises as they cannot recall
those prescribed ("Achilles Tendon Injuries", 2021). With the new job the subject has moved
into, the start times are later in the mornings, it has been suggested that the patient trial a few
days a week of working out prior to commencement of work (Yamanaka et al., 2015). Switching
from late evening workouts could further assist with both ability to and quality of sleep. With
this their pre-workout can be consumed as a kickstart to the day and may reduce the need for
further coffees during the day, which reduces the opportunity for added sugar and artificial
sweeteners.
The subject has been informed of the safety to chiropractic care and the possible benefits to
their specific condition but currently wishes not to undergo manipulation. Soft tissue of
bilateral tight hamstrings and quadriceps applied with massage and instrument assisted soft
tissue manipulation (IASTM). Support and proprioceptive assistance provided with kinesiology
taping which was reported to help during drill-based training sessions.
The subject has similar goals to his roommate as per performance and physique for a future
weight-lifting competition however it has been explained to the subject that going by an im-
personal training plan, made for someone of a different body type and composition may do
more harm than good and should go through the same process to receive a personalized
nutrition and training plan which incorporates the stretches prescribed. The subject seems less
resistant at the idea of visiting his GP and it has been recommended that if he does to ask for
referral for a blood test to examine for any deficiencies to be specifically addressed.
The occupational stress seems adequate when informed of work scenarios and the subject has
since found a new job in a field that allows them to work intimately with individuals seeking
work and to assist them. The new job appears to already have reduced the subjects stress and
will play a large factor in the continued benefit of the subject’s physical and mental health. Now
the subject has an apparently improving mental state already but if similar feelings towards
their workplace return than psychological referral may be indicated.
Management and Review
Incorporate activation and cool down programs to gym sessions. This was done with basic
rehabilitation exercises with the use of resistance bands and dynamic stretches which were
progressed and recommended to continue with bands of greater resistance and isometric
movements. The subject’s average diet after receiving back a three-day diary showed high
calories from mostly nutrient-low foods and a large excess of sugar. Recommendations have
been made to address this which may reflect to assist other areas of weakness in his lifestyle.
To continue the management of their Achilles injury the patient has been educated on the
possible continued complications of letting it heal unassisted and basic exercises have now
been prescribed.
At the conclusion of the interaction when follow-up results were recorded, the patient’s goals
remained the same to increase lifting weight and improve physique. They have improved in
both lifting ability and physique but has now been asked that if they can have an individual plan
made to assist future results. Stress has reduced after changing workplace and
recommendations have been made to improve sleep and tissue healing with exercises, diet and
lifestyle changes. The subject’s biometric measurements have not changed but the patient
believes they have noticed a shift in body composition, so it is not currently a considered a
concern with their general health.
3-Day Food Diary (Included Weekend)
DA BREAKFAST SNACKS LUNCH DINNER DRINKS MACRO
Y
Thursday

Bacon, egg Nil McCain 1x Hello 2x medium Carb: 116.4

muffin Frozen fresh dare ice Protein: 105.3
Healthy spaghetti coffee Fats: 87.7
Choice bolognaise (mocha) Sugar: 141.2
Chicken 2x
1x water Calories: 2398
Friday

Bacon, egg 1x chicken, 280g Latina 1x Core Large dare Carb: 186.5
muffin cheese beef ravioli Power foods iced coffee Protein: 124.9
toasted 106g Latina Smokey BBQ (mocha) Fats: 90.6
sandwich carbonara Chicken Pizza 1L red Sugar: 90.5
(white) sauce 300g maximus Calories: 2350
Saturday

310g Latina 2x Maggi 2- 1x big mac 1x medium 9x Berry Carb: 152.9

beef ravioli minute and large donor kebab vodka cruiser Protein: 123.2
106g Latina chicken MacDonald (meat, 1.2L water Fats: 104.9
carbonara noodles chips lettuce, Sugar: 247.8
sauce 360g cheese) Calories: 4177
DIARY DAILY AVERAGE
Carbohydrate: 151.9 g
Protein: 117.8g
Fats: 94.4g
Sugar: 159.8g ↑
Calories: 2,975 ↑
Water: 830ml ↓
For the patient’s intense physical activity levels and goals protein intake is good; calories however are
too high for the individual’s physique goals. The carbohydrate and total fat levels are high but not
excessive in relation to the high calorie intake. Sugar is not usually included in the main nutrient
count, but it was thought to be a factor to consider when first talking to patient and even more so
when the diary was received ("Nutrients", 2017) ("Sugars intake for adults and children", 2015).

Reflection
Before the topic of the nutrition reflection’s subject participant, a brief word on my frustration
experienced when I attempted to calculate the sugar content of a vodka cruiser. Each time the
words cruiser was combined with sugar in a search engine I received numerous tabs to alcohol
merchants selling the sugar free edition of the beverage. I eventually assumed that being a
beverage the entire carbohydrate content were sugars but there was not a single source that
directly addressed the amount of sugar in the drink.
I am genuinely happy with the chosen subject in both the topic of nutritional incorporation to a
musculoskeletal complaint and with their understanding and appreciation of the information
provided to them with this process. The injury appears to have already been nearing the end of
the healing process despite poor management and continuing loss of function, but it made for
very small positive results when testing so the pain and weaknesses described were
exaggerated to reflect how the injury was initially reported to be. Ideally the condition would
be more acute to get larger differences in testing pre- and post-interventions, although the
selection of this subject may largely benefit their general health due to the nutritional
assessment and recommendations.
Psychosocial factors appeared to play a large role in the subject’s wellbeing and was casually
addressed in the first interaction which resulted in a positive lifestyle change that the subject is
very happy about. The subject’s nutrition is based largely on taste and convenience; therefore,
health took a backseat despite fitness and physique being a priority. The genetic factors of the
subject may predispose them certain conditions which can be exacerbated with poor diet so a
set of blood results before and after dietary recommendations would have been an effective
tool to explain the importance of diet. The biometric measurements for this young and
relatively healthy patient do not provide immensely helpful information but should continue to
be monitored as new habits are formed. The only medication used is CBD oil which the patient
has not received medical guidance in terms of use and I am in no position of title nor
knowledge to instruct the subject on how to change its use so I only referred to their past
experience and that they should mention it when next seeing their general practitioner.

Limitations were seen when recommending dietary changes, prior to meeting they were made
to reflect the average workday at the subjects previous job, they have not yet formed
consistent habits as far as available amenities or times for breaks. It was assumed that there
will be the opportunity to access a fridge and heat source to limit chances of being around fast
food for purchase. Recommendations were made not to fully disregard continuing and personal
enjoyment such as their choice of cold beverage for day-to-day and alcohol, so
recommendations were made to limit the intake of refined sugar. The only negative
recommendation to eliminate and not just reduce was their habitual consumption of a pre-
workout in the late evening and night prior to a gym session. That accompanies the suggestion
of trialing morning or early afternoon workouts to improve sleep quality. This recommendation
could have been supported by detailing the active ingredients in their chosen product and the
exact effect it has on quality sleep.
Chiropractic care with the potential benefits and low risk was explained to along with options
for treatment via the student clinic to reduce financial costs. The subject still wished to refrain
from manipulation but found some benefit with soft tissue therapy and kinesiology taping.
Consent to chiropractic care would have made for a more interesting and personally intriguing
outcome in seeing the benefit of manipulation on their injury and general function. The food
diary was to be used as a brief tool but ended up giving a great insight to the subjects eating
habits and if I was to do the exercise again, I would re-calculate to include calcium and sodium
intake.

References
Partial Tear of The Achilles Tendon. (2021). https://www.physio.co.uk/what-we-
treat/musculoskeletal/conditions/ankle/partial-tear-of-the-achilles-tendon.php
Achilles Tendon Injuries. (2021). https://sma.org.au/resources-advice/injury-fact-
sheets/achilles-tendon-injuries/#:~:text=An%20Achilles%20tendon%20can%20partially,the
%20back%20of%20the%20leg.
Grinspoon, P. (2020). Cannabidiol (CBD). https://www.health.harvard.edu/blog/cannabidiol-
cbd-what-we-know-and-what-we-dont-2018082414476#:~:text=CBD%20is%20commonly
%20used%20to,different%20types%20of%20chronic%20pain.
Yamanaka, Y., Hashimoto, S., Takasu, N., Tanahashi, Y., Nishide, S., Honma, S., & Honma, K.
(2015). Morning and evening physical exercise differentially regulate the autonomic nervous
system during nocturnal sleep in humans. American Journal Of Physiology-Regulatory,
Integrative And Comparative Physiology, 309(9), 1112-1121. doi: 10.1152/ajpregu.00127.2015
Nutrients. (2017). Ministry of Health. https://www.nrv.gov.au/nutrients
Sugars intake for adults and children. (2015). https://www.who.int/docs/default-
source/searo/myanmar/factsheet-sugar.pdf?sfvrsn=d0cdcffa_4
O'Callaghan, F., Muurlink, O., & Reid, N. (2018). Effects of caffeine on sleep quality and daytime
functioning. Risk Management And Healthcare Policy, Volume 11, 263-271. doi:
10.2147/rmhp.s156404
Raade, J., & Mandal, P. (2018). Major health issues of American Indians. Journal Of Applied
Biotechnology & Bioengineering, 5(3). doi: 10.15406/jabb.2018.05.00136
Della Corte, K., Perrar, I., Penczynski, K., Schwingshackl, L., Herder, C., & Buyken, A. (2018).
Effect of Dietary Sugar Intake on Biomarkers of Subclinical Inflammation: A Systematic Review
and Meta-Analysis of Intervention Studies. Nutrients, 10(5), 606. doi: 10.3390/nu10050606