Cindy Staszak PTA 2950 10/22-2013 Case Study Ankle

R.W. is a 35 y/o M computer programmer who sustained a Grade II inversion sprain of his R ankle when landing on the foot of an opponent during a rebound playing basketball. Swelling and discoloration is observed in the ant/lat R ankle. Pt experiences marked in pain with inversion and plantarflexion tests, with anterior gliding of the Talus and with palpation over the involved ligament. Ms guarding prevented strength testing from being administered. Impairments: 1. Pain with inversion, plantar flexion, anterior gliding of Talus and with palpation over Anterior Talofibular and Calcaneofibular ligaments. 2. Difficulty walking, climbing stairs, driving. 3 Goals: 1. To be able to raise up onto toes without pain (heel raises) 2. To be able to walk, jog and run pain free. 3. To jump/land pain free. Intervention Strategy for each goal and progression: Maximum protection phase (2-3 days) Pt first dealt with his injury during the first 2 days with compression and ice, then had an x-ray taken on the third day. I would encourage pt to utilize PRICE Moderate protection phase (~ 2 weeks) 1. To be able to raise up onto toes without pain (heel raises) Ankle plantar flexion = (I would also have pt do the exercises for the L uninvolved ankle as well) PROM > AROM of R ankle. Seated ABCs > Seated BAPS board plantarflexion/dorsiflexion/circles/side to side Seated 4-way ankle with light Theraband > Manual resistance/PNF by PTA Standing B heel raises > single leg heel raises Stair progression Minimum protection phase 2. To be able to walk, jog and run pain free Walking > heel/toe walking (tandem) on line Fwd lunges > bwd lunges Sideways lunges > walking grapevine SLS on floor > SLS on Dyna Disc Standing 4 way hip emphasizing Hip Abd without resistance > with light ankle wts High marches > skipping Light jogging > running

3. To jump/land pain free Partial squats > full squats Side lying Hip ABD no resistance > with added ankle wts Standing hip hikers on floor > standing hip hikers off of Reebok Step to facilitate more controlled hip ABD control and motion. Short hops on floor > Rebounder > hop off rebounder to focus on landing Step ups onto and off of Reebok step > Jumping up onto and off of step (Plyometrics)

What criteria was used to determine when it would be safe to return to previous activities? When pt achieved palpable R ankle pain, pain with R ankle ROM, R ankle pain with activity, and when pt was able to tolerate strength testing in the R ankle as well as matching the strength of the R ankle with the uninvolved L ankle. I would also encourage him to see the PT and or doctor for full release. How would I protect the R ankle when he does return to former activities? I would have been taping him for activities and then encourage him to wear bracing for several months until he was released from the PT and or doctor to try activities without bracing. I would also encourage him to ice after activities PRN.