Currently on my musculo outpatient placement, I sore a young guy who presented with a two week history of knee pain after a tackle in soccer whereby he hyperextented his knee. Initial examination revealed a possible lateral meniscus tear/sprain with an associated stain of popliteus. There was no additional laxity of any of the cruciate or collateral ligaments in his affected knee, although the patient was quite lax in both knees and generally hypermobile. Initial treatment consisted of mainly RICE to remove swelling, VMO exercises, quad co-contraction and taping to prevent hyperextension of the affected knee. The patient was seen a further two times and was progressing well with his HEP and was getting symptomatic relief from the taping. The patient was very eager to get back to soccer and asked if he could play a game that weekend, he was advised that his knee would most likely need 1-2 more weeks of rehab but he should test it out at training first.
He returned the following week having played a soccer game and further hurt his knee. He reported falling whilst running, with his knee collapsing laterally, he reported hearing a pop. Assessment revealed further damage to lateral meniscus, laxity and pain over LCL and possible damage to ACL/PCL. Mark was thus referred on to an orthopaedic surgeon.
Upon reflection of this event I ponded whether there was any thing I could have further done to prevent this situation. Should I have alert the patient not to play? Was further injury avoidable?
I discussed this with my supervisor and she concluded that this event was unavoidable and it was highly likely that it was going to happen at some point due to the patients generally lax ligaments. She had initially checked the ligamentous tests in the knee and was confident with the initial diagnosis. Even so, I still can’t help but think that if we had worked on his rehabilitation for a few more sessions’ maybe then re-injury was avoidable.
If a similar situation was to occur again, I think I would educate my patient to avoid sport for a longer period before returning. Testing the knee gradually at training until full intensity can be achieved. At that point, report back to the physio and then get the all clear to play. Patient advice has to be aimed at giving the patient a broader picture, explaining to them estimated time out from sport and risk of re-injury if this time is not given. By doing this, the patient can make an informed decision if they wish to play.
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2 comments:
This is a tough situation to deal with, because as therapists we want to help people and assist them to avoid further harm. It seems as though you provided your patient with information regarding not playing for 1-2 weeks, and they still played that weekend. Sometimes you can educate patients until you are blue in the face, but the informed decisions that they make off of this advice are not always the right ones. It is frustrating from a therapists point of view, but short physically restraining them, once they leave the clinic the decision is theirs and theirs alone.
Unfortunately, you can't hold the patients hand all the time! Especially young people!The main thing is you tried and that is all that matters as you fulfilled your duty of care. If we were held responsible for everything patients did outside of our care we wouldn't be employed! I know that I feel like my efforts are futile sometimes (and of course improvements won't be made if they put themselves at risk when you have specifically told them not to do something!) but really, what more can you do!
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