Practice Practical

The patient is a 16-year-old high school basketball player who reports injuring her L ankle 2
days ago when she landed on another player’s ankle when landing from an attempted rebound. She reports a lot of swelling, trouble moving the ankle especially to the inside and outside. She is able to walk but needs to limp significantly. She rates her pain at 2/10 currently and up to a level of 5-6/10 with walking around at school. She reports having an X-ray the night of the injury that was negative for a fracture. She reports previous ankle sprains on both ankles.
Based on the case develop 2-3 hypotheses and include rationale for each:

• high ankle sprain - syndesmoses

• medial ankle - deltoid

• lateral ankle - ATFL CFL PTFL

• chronic ankle instability

Based on the history and your hypotheses list, outline your examination. Prioritize 2-3 special
tests, 1 passive accessory motions/joint play assessment, and 1-2 additional appropriate tests
and measures to help rule in/rule out your hypotheses.

• ankle inversion and eversion ROM

• ankle PF, DF, inversion and eversion MMT

• talocrural anterior and posterior glides

• kleiger’s test

• talar tilt test

• squeeze test medial lateral glides

• gait

Identify up to 3 interventions that would be appropriate to include in your plan of care based
on the information you have.

• Strengthening exercises for the ankle to improve stability and mobility.

  • resisted PF, DF, inversion, eversion

• Manual therapy techniques to enhance joint range of motion and reduce pain.

  • massage

  • possible taping

• Proprioceptive training to improve balance and coordination during functional activities.

  • once in later stage of healing - balance work and jumping