Monday 28th February 2022
Hours: 3
Patient presentations:
- Netball player with suspected whiplash
- Football player – lateral ankle sprain
Reflection Focus
- Lateral ankle sprain
Reflection Model
- Gibbs Reflective Cycle 1988
What Happened?
- Football player presenting with intermittent pain and weakness of the right ankle after being tackled 3.5 weeks ago during a game a football.
- Patient was able to walk after injury so did not suspect a break or fracture.
- PoP at site of the tackle (anterior ankle – talus) and PoP over lateral ligament complex (ATFL & CFL).
- Plantar flexion was the most uncomfortable movement for the participant. ROM was symmetrical compared to uninjured side.
- Prescribed ROM exercises to maintain ROM, seated and standing calf raises to begin strengthening around the joint and single leg balance to work on postural stability.
What were you thinking and feeling?
- I was quite confident that the patient was presenting with a lateral ankle sprain (LAS). He was reporting pain when he ‘misplaced’ his foot and that sometimes it feels like her has never used his foot before. To me, this suggested instability of the ankle a common reason for, and also a consequence, of a LAS. Further supporting this, is that the patient feels he cannot perform more complex sporting tasks, such as change of direction, and plantarflexion was painful.
- I was a bit unsure of the pain experienced around the talus; however, when he mentioned that this was where the opponent tackled him I believed that this was just a lingering effect of the blunt trauma. However, I have the patient booked in for a follow-up so will continue to monitor this.
- The patients single leg balance on both legs was poor. Therefore, he may have potentially been an at-risk individual identified a pre-participant screening, if this happened on his football team. However, this was a contact injury out of the participants control – his ankle was forced into plantarflexion/inversion so, it is likely this injury would have occurred with or without prehab.
Analysis and Evaluation
- A recent systmatic review has reported that exercise based rehabilitation of lateral ankle sprains reduced the rate of re-injury by 40% (Wagemans, et al., 2022). However, it also reported that there was no favourable protocol to dictate exercise selection, intensity or volume. Therefore, I intend to use my knowledge around LAS to help rehabilitate this patient and prescribe exercise on symptom presentation. I am happy with the single leg balance prescription; however, I would like to move onto eversion movements as this movement counteracts those likely to cause a LAS.
Conclusion
- Overall, I was really happy with how I handled this situation. Previously, I haven’t been particularly confident with the ankle; however I think I am improving with my ability to stay calm and rationalise a treatment plan.
Revisiting Reflection
References
- Wagemans, J., Bleakley, C., Taeymans, J., Schurz, A. P., Kuppens, K., Baur, H., & Vissers, D. (2022). Exercise-based rehabilitation reduces reinjury following acute lateral ankle sprain: A systematic review update with meta-analysis. PloS one, 17(2), e0262023. https://doi.org/10.1371/journal.pone.0262023