Week 2.2 Entry

Myself and Bec experienced what will probably happen many more times in our careers as physios….we doubled booked. This worked out well for us though given that both were returning patients and the assessment aspect wasn’t as in depth as the first time and it also gave both of us an opportunity to run through the whole assessment process individually. My patient was returning after a bilateral calcaneal fracture 9/52 ago. He was progressing well, the swelling and pain had decreased and his ankle ROM (esp. DF) had increased. He had been completing his daily exercises which was great to hear considering his past history of not following physiotherapist prescribed exercises. He was very happy with his progression and still showed eagerness to get back to work asap. I was a bit unsure as to how I should progress his treatment and exercises given that the injury was a fracture and did not want to have him weight bearing excessively even though he progressed well and he was managing the original exercises easily. The main factor still was to improve his ROM within pain limits which was fairly easy given that he was very tolerant to pain. I carried out passive physiological DF with a slightly increased amount of force to EOR, this marginally improved the ROM and will possibly progress this to a Gr4 pass phys mobilization next time. I maintained the same exercise program but increased the resistance of the theraband which he managed very well.

The patient was revisiting the surgeon (ORIF on R calcaneus) in 3 weeks so I was a bit cautious about progressing treatment and exercises too soon before we had confirmation that the fractures had healed sufficiently enough. I will need to look into acceptable progressions for his current situation (PTs. Internet etc). The assessment process is very relaxed with this individual and I felt I clearly explained everything and if he had any questions he would be happy to ask. Forward planning for all possible outcomes is important and as we develop our skills this will come more and more easily but at the moment every possibility needs to be thought through. I was very pleased with how everything progressed and I look forward to seeing him next time.