I was treating a man in his late 20’s who was 6 months post ACL repair and progressing well. His rehab had progressed to the stage that he was running on a treadmill for short (<5>
At a monthly review the patient reported that he was finding his knee “unstable and mildly painful” when he runs on the treadmill for more than 8 minutes but that he is able to “push through the pain”. He also told me he was planning on going on a snowboarding holiday in 6 weeks time and that he would like a brace to support his knee. When I asked if he had spoken to the doctors about his intentions, he said he had told the registrar at the last review, who was not happy about it but told him it was his choice. He told me that as he felt his knee was doing well he would like to “test it out on some good runs, but have the brace for backup”.
I spent quite a bit of time educating the patient on the need for a graduated rehab program along with the risks of re-injury and the fact that any brace will not make up for a structurally strong and well functioning knee. After taking in this information the patient told me that he was going snowboarding no matter what and that he would be fine.
The question then in my mind was do I not provide a brace and leave the patient exposed to further injury or get the brace and risk the patient over exerting himself due to unfounded confidence in the power of the brace. After discussion with my supervisor and other physios, I decided to provide the brace as the patient was going expose himself to risk and some support was better than none.
I found this situation challenging to understand as the patient had had surgery and had progressed through to a good stage of rehabilitation which had taken 6 months, only to risk this progress for a ride on a snowboard. However it has made me realise that while we may think we know what is best for a patient, they will always be free to choose their actions.
1 comment:
Brett, I currently have a similar situation with a pt with a fractured talar dome who is 4 mths post surg and still has no dorsiflexion. He's going backpacking on an ankle which causes him pain after walking 10 metres.. I guess we just provide all the education to manage the inevitable pain and swelling and perhaps highlight any symptoms which would require swift intervention. You're right, we are here to help, but ultimately pts get to choose whether their priorities lie in rehab or their chosen alternative. I think as long they are making an informed decision, then we should feel like we have done our job.
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