DOB: 10/10/97 Affiliation: BHSN Football 9/16/13 S: Pt. was a 16 y.o. male football player.

He was hit f/ the lateral side during play on 9/14/13, forcing the foot into eversion. Pt. c/o p! 10/10 on distal 1/3 of the leg. The pt. attempted to stand after the play and heard a pop. O: Pt. was down on approach. After removal f/ the field, pt. had significant swelling @ lateral malleoli. Pt. also had a possible deformity @ the distal 1/3 of the fibula, near the malleoli. There was significant p! w/ palpation of lateral malleoli & approx. 2 above on the fibula. Minor deformity felt upon palpation. AROM, PROM, and RROM not tested due to pt. p! level & possibility of fx. On-field tests, Squeeze Test & Bump Test were positive for p! but negative for increase p!. A: Diff. Diagnosis: fibular fx, ankle sprain/strain. STG: Stabilize inj., minimize p!, & refer. LTG: RTP p! free. P: Pt. removed f/ play, treated w/ ACE wrap and a boot. Pt. is non-weight bearing & referred to orthopedic specialist 9/16/13. X-ray imaging confirmed bimalleolar fx & surgery was scheduled for 9/19/13. Pt. underwent an ORIF surgery on this date. Loriann D. Mathews, ATS Rehabilitation Plan Injury Diagnosis Diagnosis: Bi-malleolar fracture (16 y.o. male, high school football player) Phase Specific Rehabilitation Problems/ Impairments Phase I Rehabilitation Problems/ Impairments 1. 2. 3. 4. 5. Pain with movement Swelling Loss of ROM Loss of proprioception/ normal neuromuscular control Decreased cardiovascular fitness

Overall Primary Functional Limitations 1. Inability to perform ADL (activities of daily living) that require both feet to bear weight, such as standing or walking, and putting on pants easily. 2. Inability to move through full range of motion (ROM)

3. Inability to run 4. Inability to play competitive sports, including football, wrestling, and baseball Overall Functional Goals (The patient) Returned to full participation in competitive sports, including football, wrestling, and baseball, with the ability to perform activities such as running, on all surfaces (turf, mat, etc.) pain-free within 15 weeks. Phase-Based Rehabilitation Plan: Phase #1 Functional Goal #1: (The patient) Decrease swelling by 15% as defined by girth measurements within 7 days of cast removal to improve ROM for performing ADLs such as walking and putting on and taking off clothing. Modalities/ Treatment Selected Ice bag and NSAIDs General Indications/ Settings Pain/ Swelling Comments Patient should ice multiple times 30 on/ 2 hours off as able, daily. Patient prone with knee flexed to allow gravity to assist in fluid clearance. Clinician will apply pressure as tolerated and perform massage techniques to move fluid into the lymphatic system.

Manual Therapy/ Milk Massage

Swelling

Exercise Passive ROM, assisted by LAT

Sets N/A

Reps N/A

Comments Pt. supine with foot off the treatment table. Clinician applies light pressure in INV,EVE, PLANTARFLEXION, and DORSIFLEXION directions. All activities should be measured by patients tolerance for pain.

Phase 1 Functional Goal #2:

Improve patients CV fitness to pre-injury levels, using the HR max scale, and using activity to reach a 65- 85% max HR to prepare for RTP in competitive activities. Exercise Sets Reps/ Time Comments (Progression/ Purpose/ Other) Frequency: 5-6 days per week Intensity: 132-163 bpm based on HR max

Stationary Arm Bike

30 minutes