The results and feedback from the first treatment session were pretty encouraging. The ROM increased a minimal amount, however, the freedom of movement and the quality of movement increased significantly. The swelling was varying day to day depending on how much time the patient had to spend on their feet. However, main difference was the freedom of movement.
The patient was becoming more comfortable on the foot without the air cast boot, however, there was still a significant limp, which both the patient and I were quite impatient to minimise.
One of the other big changes since last treatment was the reduction in sensitivity. I had to really go steady with the treatment last time, but now being less sensitive I could start working a little deeper. My main goal in this session was to repeat the previous session, but increasing the intensity a little. So I started with IASTM, working through the scars and the most sensitive areas. I started at about the same level as last time to make sure it was not too sensitive. As the treatment progressed I increased the pressure with the massage tool, the patient was able to tolerate this with no problem.
In the first treatment and the start of this one the patient was passive as I worked with the massage tool. However, after I had worked on the ankle at the deeper level I felt I needed to back off a little. So I reduced the pressure and asked to patient to actively move through dorsiflexion and plantar flexion while I worked with the massage tool. This was really successful and continued to ‘free up’ the movement of the ankle.
We then progressed to standing, but I was reluctant to ‘scrape’ too much more (mainly because of the skin), so we checked functional dorsiflexion, which was continuing to improve. In fact it had improved so much the patient was starting to feel tightness in the calf, which was previously hidden by the lack of joint movement. We recapped the HEP and tweaked the range a little to make sure we were still at the threshold. It’s important that the patient understand a little about tweaking so they can make the right decisions when they are too far off the threshold or on a bad day…beyond it. They need to be able to adjust day to day to maximise their own progress. He’s really good at it and this is partly why he’s doing so well.
I finished off by continuing the kinesiotaping strategy I had used on the first treatment. Again I used 2 lymphatic drainage fans on the lower leg that extended from just below the knee to a little below the ankle. The patent left walking a little more easily, I would love to spend more time in each session, however, there is only so much I can fit into these short sessions…so we had to call it a day there.
Next time I’m planning some joint mobilisations and some more advanced exercises to push things along….as well as the IASTM of course!!
Ankle Fracture Dislocation: Third Treatment
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