Look at the bigger picture

In my rural placement, I had a 16 year old patient who had undergone an ACL repair about 8 weeks ago and is now attending outpatient rehab classes. He did his ACL while playing cricket for the school team. Each time he came to rehab, his only question is when can I start cricket again. He was someone who is not really vigilant with HEP and is really desperate to get back to his games. I explained to him that his knee needs time to heal and returning to cricket has to be a gradual process. Each time he came he complained of a knee pain but subjectively reported no change of his activities over the week. His progress was much slower than you would expect for someone at that age who had undergone an ACL repair. His muscle was still weak, he still had poor proprioception, some swelling around the knee and his range had plateud.

After the second session with him, I had a discussion with my supervisor as I suspected something just did not quite add up to the picture. I gave the mum a call and asked her some clarifying questions and all she said is that he still doesn’t do much. Just few days after that, I had another patient who goes to the same school as him asked how is his knee and I told him I can’t really discuss other patient with him. Then he responded jokingly, it must be doing well because he plays cricket now but he plays like a looser. Immediately the picture added up. So the next time he attended rehab, I asked him in an appropriate manner not to make him feel like I am accusing him. He eventually admitted that he started cricket about 3 weeks ago and since then he’s been having the knee pain. I then gave him an intensive education session and told him that if he does not back off from his sport he is going to damage the repairs and potentially not able to ever return to his sport again. He seemed like he had understood me as he said he is going to try and be a bit more active in his rehab. From then on, his swelling reduced and his knee range started improving.

This encounter had highlighted the importance of looking at things at the bigger picture and making sure that it all adds up. It is important to realize that when a patient is not progressing, we have to try and seek the barrier to this so that we are able to achieve better outcomes in the rehabilitation process and prevent any potential risk of further injury.