MANUAL THERAPY CASE STUDY: FFT APPLIED TO

PRESENTATION History of present complaint A 40 year old female patient sustained an inversion injury to her right foot four months previously, while jogging in the park. She felt immediate pain and an inability to weight bear. She attended her local accident and emergency department where an X ray did not reveal a fracture. She was diagnosed with a local sprain, issued with a compressive support and advised to use rest, ice, compression, elevation and appropriate analgesics to relieve the pain.

She then gradually improved such that after six weeks she felt well enough to return to exercise. This was limited by a return pain and subsequent stiffness in her ankle both during and after exercise. At this point she visited her

GP and was referred to physiotherapy.

Initial presentation (Day 1) On initial presentation the patient described her ankle as ‘non functional'. She was experiencing pain anterior and lateral ankle pain during walking (especially up a gradient), descending stairs, squatting and walking on uneven surfaces. In addition, her ankle felt stiff in the morning which resolved as the day went by. She reported no neurological symptoms.

Previous activity The patient was normally quite active and had performed two 30-minute runs and attended two fitness classes that week.

General health Her general health was good and she did not report any history of previous injuries.

PHYSICAL EXAMINATION Range of movement In non-weight bearing dorsiflexion on the right was full but accompanied by a tightness in the Achilles posteriorly. Plantar-flexion was limited by 5 degrees with anterior ankle pain. In standing dorsiflexion was limited in the ‘knee to wall’ test with the right ankle reduced to half (unable to touch her knee to the wall) compared with the left ankle (1st toe three finger breathes from the wall with no pain) and pain reported to be 8 out of 10 on a visual analogue scale (VAS).

Knee to wall test This is a quick test for weight bearing dorsiflexion. The patient stands with their toes touching the wall and the foot straight with the normal medial arch maintained. The patient then takes

TREATMENT 1 Initially traditional treatment in the form of soft tissue mobilisations and ultrasound were applied, the knee to wall test was then repeated. Movement had increased so she could touch her knee to the wall but after five repetitions pain increased and range returned to the previous level. It was then decided to apply FFT®. Digital distraction in a medial to lateral direction anteriorly gave most pain relief during the test. The skin was prepared and three layers of rigid tape were applied over a hypoallergenic adhe- sive underwrap. The first layer was applied with the ankle in neutral, the second tape was applied with minimal ten- sion with the patient in the test position, the third tape was applied at end of range with moderate tension. On reassessment her knee touched the wall with a 1 out of 10 pain and Achilles tightness, further

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range reproduced her intial pain but only 3 out of 10 (see Figure 1). This was consis- tent on repetition. A layer of hypoaller- genic tape was placed over the taping to prevent lift. Further advice was given (see below) but no exercises were given.

ADVICE GIVEN Any burning sensations or feelings

indicative of skin irritation (eg. red- ness, itching) - remove tape

If the condition becomes worse - remove tape

If ankle feels achey - loosen tension for 30-90 minutes or remove completely

You may develop new symptoms in short duration within the first 24 hours – leave tape on if manageable

You may shower with the tape on

TREATMENT 2 (DAY 3) The patient reported she had felt other aches and a feeling of

instability but

these had subsided within two hours. Knee to wall had deteriorated slightly but the patient was very positive with the improvement. Removal of the tape result- ed in no change in range but an increase in pain from 1 to 4 on a VAS. Plantarflexion in supine was full.

Figure 1: Fascial taping a sprained ankle

Local soft tissue treatment and electrotherapy were applied as before but with no improvement in range. FFT® was reapplied as day 1, however as the patient had also reported a sensation above the lateral malleolus a second area of taping

sportEX dynamics 2007;12(Apr):10-13