Hey everyone, hope you all had a great long weekend and are ready for the last week of our second prac (YAY!!)
Coming to the end of my musculo prac I'm actually quite suprised that I haven't had many problems with patient compliance. I do, however, have one patient who sprained his ankle (ATFL) quite a while ago. He had been in a POP and off work (as a laborour) for 5 weeks and has now been back working for 2 weeks. He returned to work before his ankle was 100% better and now re-injures it at least 2 times a week either through forced PF or DF due to the uneven surfaces at his work sites. On top of this, he is too tired to do any of his HEP, but managed to attend his pre-season rugby training this past week.
I am getting fairly frusterated with this situation because I end up spending the majority of our session trying to determine what is causing all of his new pains, from his most recent re-injury, and have very little time to do any treatment with him. I have tried to educate him about returning to sport, protecting his ankle at work and have put alot of focus of our HEP on increasing proprioception and strength, to avoid this further injury.
I am not sure what to do next with him, since he is not complying to the program and is no longer improving due to his continuous re-injury. How much effort do you put in before you decide that treatment is no longer beneficial and it is time for D/C?
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Hey les, tough gig...he sounds like he doesn't really want to put the work into getting better. Have you thought about strapping or wearing a rigid ankle brace for him for work, which would reduce the risk of re-injury, and if it is less sore after work, he might be more compliant and do he his exercises at night/morning. If he is going to keep going to training, maybe give him a program to incorporate into training (or he could give it to his coach/fitness coach). If nothing else works, I've found that honesty is the best policy...tell him if he is not compliant, it work get better and you can't help him any more, so you'll have to discharge him.
Hope that helps
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