WEEK 3 - EARLY REHAB OF ACUTE ANKLE KNEE INJURIES

Question 1

Explain the key tenets of the primary (1º) injury prevention model

Answer 1

Key features of primary prevention

• big picture prevention
• bio-psycho-social approach
• whole person
• whole group
• whole organisation - e.g supportive culture
• workload management
• recovery e.g sleep
• nutrition and fuelling
• whole group primary prevention programs

Question 2

Explain the key tenets of the secondary (2º) injury prevention model

Answer 2

Secondary prevention programs

• Screening, risk factor identification and preventative rehabilitation (prehab) (+/- load management)
  
  • more individualised treatment

Question 3

Explain the key tenets of the tertiary (3º) injury prevention model

Answer 3

Tertiary prevention programs

• rehab of an injured athlete
  
  • highly individualised rehabilitation
• prevent de-training
• restore full function for return to sport
• return to performance (better athlete)

Question 4

RTS continuum - acute injury management + key elements

Answer 4

Acute injury management

• As it states – means the optimum management
  of the acute stage of the disorder in accordance with the;
  
  • Nature and severity of the injury
  • The tissue type(s) involved
  • Available evidence about best practice care for the injury/disorder

Acute injury management - key elements

• Diagnostic triage and screening is successfully implemented
  
  • Such that diagnostic clarity is achieved as well as the need for onward referral for medical imaging and/or opinion (where indicated)
• Acute injury Rx and Mx strategies are successfully implemented
• Acute stage, temporary, activity modifications are successfully implemented
  
  • What your patient SHOULD NOT be doing
  • What they SHOULD be doing (including S&C maintenance)
• Factors that could facilitate progression towards persistent pain and/or disability are identified and addressed

Question 5

What are the entry criteria (or KPI’s) for the RTS phase of rehab?

Answer 5

• Diagnostic clarity achieved
• Disorder is no longer pain-dominant (the farm has been calmed)
  
  • “Calm” or “quiet” ankle, knee, hip etc.
  • Acute inflammatory responses settled
• Competent and successful execution of the acute injury Mx plan
• Initial activity modifications successfully implemented
• Patient is “on board”
• Timeframe for the acute injury Mx phase?
• Highly variable and dependent
  
  • Injury severity
  • Previous history of same/similar injury
  • Tissue type(s) – bone versus muscle versus ligament versus tendon etc.

Question 6

Describe high-value evidence-based care as it relates to the management of common lower limb traumatic injuries

Answer 6

High value care

• care that delivers most value for the patient and the clinical benefits outweigh the costs to the individual or system providing the care
  
  • unnecessary imaging or surgery
  • overloading
  • prolonged + unnecessary reduction in activity (immobilisation)
    
    • AMI
  • non-specific treatment (tissue massage, needling for a LAS?, arguably high or low valued care)

Question 7

care strategies relevant to the acute stage for common lower limb traumatic injuries

Answer 7

PEACE & LOVE Acronym

Exercises to maintain function and restore stability

• Active-assisted ankle inv/eversion - resistance band, facing plantar surface of foot in and out
• Active-assisted ankle dorsi/plantar - rolling over a soccer ball
• intrinsic muscle exercises - scrunch up a towel

Splinting and bracing:
- depends on severity - low grade (1-2) requries minimal protection (tape, compression) for initial protection, but early mobilisation is desired

• high severity (grade 3 + fracture) usually requires splint or brace for 1-6 weeks with imaging
• slower return to function