Treatment recommended and rehabilitation process

The treatment and rehabilitation process are very important in deciding the athlete’s return to sport. “The aim of the game … is to do no further damage. Inadequate first aid may aggravate the injury and lengthen the amount of time the player needs before being able to return to play” (Cromie, p17).

Treatment/ Rehabilitation process
(0-48 hrs)
· First 48 hours are very important!
· Consider the basic life support flow chart, DRABCD (Danger, Response, Airways, Breathing, Circulation and Defibrillation)
· STOP regime would be used by stopping the sport (S), talking to injured person (T), observing the injury (O) and preventing further injury (P).
· Use of RICER regime by resting (R), ice (I), compression (C), elevation (E) and referral (R). The injured athlete should be in a comfortable position, use of ice to reduce swelling and pain and compression bandages with the leg elevated above heart to reduce swelling or bleeding. Refer the injured athlete to a qualified professional, for a diagnosis.

· Medical practitioner will examine the injury and request an X-ray. Salter-Harris type 2 fracture to the distal fibula is seen. This will not require surgery.
· Back slab/splint is fitted to immobilise the leg and will stay on until swelling has reduced.

Day 3- week 6
· Swelling has reduced so a full plaster cast is fitted.
· The athlete is not able to put any pressure on the fractured leg and will use crutches.
· The foot should be elevated as much as possible to reduce swelling.

Week 6
· Another X-ray is taken to show the progress of some healing (not complete).
· Plaster cast is removed and air cast boot fitted.
· Gradually more and more pressure should be placed on the injured ankle as this speeds up the recovery process and also will help to loosen the unused joints. The athlete must be careful not to overuse the ankle.

Week 7-10
· Continue to wear air cast boot.
· Rehabilitation begins with a physiotherapist to strengthen the muscles around the ankle (twice weekly visits).
· Physiotherapist will give the athlete soft tissue massages surrounding the fibula such as the ankle gutters, calf and soleus and give stretching exercises, to increase strength and mobility.
· Initial stretches will be simply pointing toes down, towards you, inwards and outwards. These stretches also used with resistance called a theraband, which increases the plantarflexion, dorsiflexion and eversion of the foot.
· In week 9, when the athlete is getting some strength back, heel lift exercises begin. These include bilateral (both legs), single leg and eccentric heel (single and both legs on edge of step) lifts.
· Whilst doing single heel lifts the athlete will use proprioception by trying to use a cushion or trampoline at home to increase strength. Closing eyes will help to develop co-ordination.

· Another x-ray to check that healing is taking place and indicates that there is evidence of healing.
Air cast boot is no longer required

Week 10-15
· The athlete continues to see the physiotherapist and continues with stretching exercises and commences running. This will start with 60% intensity in a straight line, progressing to 80%.
· Once the athlete can reach 80% intensity running, the athlete begins agility running by changing direction at 60% intensity. This will include snake running, zigzag running and figure of 8 running.
· By week 13 the athlete should be capable of hopping and landing comfortably on the fractured leg.

Week 15
· The athlete should be capable of returning to sport but this will be dependant on the physiotherapist and also rate of recovery. The athlete should be able to play on the injured ankle even if it has not healed completely.
· No longer required to visit physiotherapist.
Week 17
·Another x-ray is taken which indicates that the fracture appears to be healing with some slight new bone formation but the fracture line is still noticeable

· Even though the fracture has not completely healed the athlete should now be able to participate in a full range of activities.
· Exercises should be continued.

Injury Management Procedure

Full Plaster cast

Air cast boot
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Heel raises