6th April. Duration: 4 hours (2 clients)
My first client was a face-to-face emergency appointment. The client had rolled over their ankle during a football game and injured it, however they advised they had a crucial game the next day and needed to carry on regardless of injury. I provided advice against doing such, but the client advised he did not care and would play regardless. As a dancer, I fully understood the mindset of this individual, and tried to reason with him reference potential longer-term outcomes, but he was adamant he would play regardless of treatment. As a therapist, I believed the best thing I could do was to assist the client to get through the game as safely as possible, otherwise they may inflict further irreparable damage. I conducted a full ankle assessment (Bertrand-Charette et al., 2020) deeming it to be a suspected Anterior Talo-Fibular Ligament (ATFL) sprain (Martin et al., 2021), as the mechanism of injury was inversion and plantar flexion. I carried out observation, passive/active ROM, palpation, and a special test (anterior drawer test). This test went well; I have learned not to apply too much pressure. As suspected, the test proved positive.
I then tested the calcaneus ligament (Fig 1) as that is a common area for injury with suspected ATFL. I used the talar tilt test, which assesses both ATFL and CFL ligaments. As (Japp et al., 2021), discoursed, the sensitivity and specificity of these tests are best gauged two-five days after injury, hence I am not sure how reliable my test results really, as only one day had lapsed post injury. As the patient was not listening to my supervisor’s or my advice reference not playing, we collectively felt the best thing to do was to strap his ankle providing as much support as able for the game using rigid tape and taping technique allowing the patient to move his foot, but which would assist in preventing him inverting it. I was also aware, compressing the ankle assists to prevent swelling. When taping I felt that I was able to do this process smoothly. I did not tape the heel to ensure he retained movement, and I consciously did not make it too tight, to enable some movement.
I felt given the circumstances, I maintained good communications with the patient and consequently they advised they would return post the game for further treatment! I advised the patient to keep his foot elevated for the next 24 hours as much as possible to help blood flow and reduce swelling. If I could have done anything different, I may have used the cryotherapy (Miranda et al, 2021) to reduce swelling and pain.
I felt this appointment went well, and perhaps in hindsight, we could have been more forceful with him reference not playing, but it was a difficult conversation, as it was noticeably clear he was going to play regardless of advice or treatment provided. I fully understood, but knew he was in a denial stage reference his injury, but perhaps I could have sought assistance from his football team’s therapist, but this would have broached our practitioner and patient confidentiality. I urged him to return after the game for another assessment to see what assistance we could provide.
My second client was a basketball player who had hurt his knee. The patient only experienced pain when exercising. This knowledge proved to be an important aspect when grading the injury. I had initially suspected patella tendinosis (jumpers’ knee) as this is a common basketball players injury, and this injury appeared to be encroaching gradually. My assessment findings were also pointing towards this injury diagnosis. Further ultrasound or MRI exams would assist, but the client advised a lack of money for private diagnosis and waiting times on NHS impacted, the patient was satisfied with my clinical findings at this time. As the patient only experiences pain when exercising, I believe this is currently a grade one injury. Under the circumstances, this is a good, as it means early treatment may prevent further damage. I suggested they stop playing basketball, running, and jumping for the next week, and start gentle stretching and strengthening of the lower leg muscles.
I felt confident when performing the tests and assessment. My assessment indicated they have a weakness in their quadriceps and hamstrings compared to their uninjured side, which is a contributing factor why this injury developed. They explained they had dramatically increased their plyometric training (Correia et al., 2020) over the last 2 weeks, which likely contributed to this injury. I suggested one week initially minus jumping and running, to see if the pain reduced. If successful, a rehabilitation programme will be implemented. I believe I approached this patient’s case very professionally, whilst keeping my supervisor in the loop. I am currently researching further knee strengthening exercises with Thera Band’s (Karakurt & AĞGÖN, 2018), as when I demonstrated a prone knee flexion exercise with a TheraBand I initially struggled tying it properly, when the patient was watching me so, I practiced directly after they had gone to ensure I did not do this again. The patient was booked in again after two weeks for further assessment and strengthening exercises during which they would mainly rest. I am really looking forward to seeing this patient making good progress.
Fig. 1 Ligaments & Tendons of Foot
References:
Bertrand-Charette, M., Dambreville, C., Bouyer, L. J., & Roy, J. S. (2020).
Systematic review of motor control and somatosensation assessment tests for the ankle. BMJ Open Sport & Exercise Medicine, 6(1), e000685.
Correia, G. A. F., Freitas Júnior, C. G. D., Lira, H. A. A. D. S., Oliveira, S. F. M. D.,
Santos, W. R. D., Silva, C. K. D. F. B. D., … & Paes, P. P. (2020). The effect of plyometric training on vertical jump performance in young basketball athletes. Journal of Physical Education, 31.
Japp, A. G., Robertson, C., Wright, R. J., Reed, M. J., Robson, A., Alakare, J., … &
Schmidt, H. (2020). Macleod’s clinical diagnosis 2nd edition= Diagnostiikka akuuttilääketieteessä.
Karakurt, S., & AĞGÖN, E. (2018). Effect of dynamic and static strength training
using Thera-Band (R) on elite athletes muscular strength.
Martin, R. L., Davenport, T. E., Fraser, J. J., Sawdon-Bea, J., Carcia, C. R., Carroll,
- A., … & Carreira, D. (2021). Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health From the Academy of Orthopaedic Physical Therapy of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy, 51(4), CPG1-CPG80.
Miranda, J. P., Silva, W. T., Silva, H. J., Mascarenhas, R. O., & Oliveira, V. C.
(2021). Effectiveness of cryotherapy on pain intensity, swelling, range of motion, function and recurrence in acute ankle sprain: A systematic review of randomized controlled trials. Physical Therapy in Sport.