PT Treatment Question from SPT w/ case

[kellerac]

Case (NOT real patient): 48 y.o. 3 wk s/p L ankle ORIF. Patient is NWB for 3 more weeks. Cleared for ROM and strengthening by MD. Pt has swelling and 5/10 pain w/ activity. Wants to return to work.

Here's the initial (first visit) treatment plan I'm thinking. Let me know if this progression makes sense:

1) Ice OR HVPC E-stim to reduce swelling/pain (is one better than the other for this pt?)
2) Stretching OR Joint mobs (are joint mobs contraindicated 3 wks s/p a bone repair?)
3) strengthening (not sure if I should do isometric or regular concentric/eccentric strengthening)
4) Seated AROM on BAPS board
5) Ice @ end of treatment

Total tx time: ~ 1 hour

What are you're thoughts PT's? We're not getting a lot of guidance from our professors. They want us to come up with things and present them in class. Does this progression make sense?

Thank you,

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[truthseeker]

Ice and elevate. stim may not have much effect. if there is lots of dependent edema and that is the cause of the pain, try some distal to proximal effleurage (milking) manual therapy to physically reduce the dependent edema. AROM and stretching is best and should be tried before you consider joint mobilizations. (see what goes away with things that they can do themselves) As for strengthening, I would do the seated BAPS, seated supination pronation, windshield wipers, big toe extensions to prepare the peroneus longus to stabilize the first ray when they are able to bear weight. If the incision is closed and the surgeon will allow it, walking in deep water would accomplish a lot of these things. in chest deep water you weigh 30% of what you do on dry land. Chin deep, 10%