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Bulkow, B.; Johnson, S.
Progressive Step Rehab, Milwaukee, WI.
Background & Purpose: Phototherapy is gaining popularity in the practice of physical therapy to address the pain symptoms and limited mobility following a musculoskeletal injury. The investigators desired to study the effects of the application of Superluminous Diodes (SLDS) to a lateral ankle sprain to decrease pain complaints and increase the functional mobility of the patient. Case Description: A 77 year old female experienced a left lateral ankle sprain on May 25, 2005, requiring hospitalization. Patient was hospitalized from May 25th through June 8th for medical management of numerous secondary conditions as well as pain control for the ankle. The patient received an orthopedic consult as well as physical therapy in the hospital, but was limited due to excessive pain and inability to bear weight through the involed left lower extremity. The orthopedic consult recommended conservative treatment, immobilized the ankle in a walking boot, and the patient was referred to a long term care facility. Upon PT evaluation on June 9th, the patient reported 6 out of 10 pain rating in the ankle and was only able to ambulate 3 feet with a walker and moderate assist of one and notable difficulty with weight bearing through the left lower extremity. Outcomes: Phototherapy treatment was initiated on day one in addition to a standard physical therapy plan of care to treat the ankle. Which consisted of gait and transfer training, open chained therapeutic exercise, and range of motion to the ankle. A MedX unit was used to deliver infrared light (870nm) at 2 Joules/min through the SLDs to the left lateral ankle structures. Immediately following the treatment on day one, the patient reported decrease in pain rating to 4 out of 10 for 2 to 3 hours following the treatment. On day 2, the patient reported 5 out of 10 pain at the beginning of treatment and 4 out of 10 again upon completion. The phototherapy protocol was continued 5x/week for 2 weeks. The patient's mobility status increased from ambulation of 3 feet with a walker and moderate assistance on day one, to 12 feet with stand by assistance on day 2 and 100 feet with stand by assistance by day 3. Upon completion of the 2 week course of phototherapy treatment, the patient reported 2 out of 10 pain to the left ankle and was ambulating up to 100 feet with a walker and stand by assistance. In addition to the mobility gains the patient was able tolerate standard shoes, and weight bearing was equal bilaterally. Discussion: This patient had made limited progress during her hospital course and was referred to a long term care facility vs. returning to her home due to limited mobility and increased dependence. The addition of phototherapy appears to have had a significant effect in decreasing the patients pain. This allowed for a rapid increase in weight bearing tolerance and overall mobility. Although case studies lack the scientific controls to draw conclusions, it appears that phototherapy was a contributing factor in the positive outcome for this patient and warrants further investigation.
Copyright © 2005 the Section on Geriatrics of the American Physical Therapy Association
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