Case Study June 2014


A 31 year old man, working as a storeman for up to 50 hours per week sustains an ankle injury when slipping off the last step of a ladder. It is initially diagnosed as an ankle sprain with an MRI scan later diagnosing a grade 3 ligament sprain. He had 5 weeks off work. However, he continued to experience chronic pain in his ankle and foot and required a cam boot and crutches for mobility.

The client was referred for an exercise programme as an alternative to the Physiotherapy treatment he was receiving three times per week. Upon examination the client showed a heavy reliance on his walking aid and cam boot to move around. He experienced consistent bouts of pain and unable to bear weight for sustained periods. He was diagnosed with chronic pain regional disorder with further investigations required by an Orthopaedic Surgeon. The client was also recently diagnosed with type 2 Diabetes.

Based on both the referral and initial assessment performed by Absolute Balance, hydrotherapy was deemed appropriate as a starting point to help promote range through his lower limbs and overall body activity to aid the management of his type 2 Diabetes. The first hydrotherapy session, with the aid of a pool noodle in deep water proved unsuccessful as the
client experienced foot pain throughout the session even from the water current. The client’s reliability on his cam boot made access and egress to the pool quite difficult.

An upper body gym programme was proposed to the Insurer and General Practitioner, to promote upper body conditioning and help manage the client’s comorbidities, providing further benefits to overall mood and well-being.

The client was prescribed a progressive upper body cardiovascular and strengthening programme. The programme was designed to be efficient and be performed in an efficient
manner to reduce the repetitive sitting and standing to accommodate his ankle but he was encouraged to progressively increase his weight bearing around the gym. The client showed good compliance to his programme, reaping the benefits through increased strength, cardiovascular tolerance and confidence in his weight bearing capabilities. The specific pathology of his injury was determined and surgical intervention is to be performed in the near future.

What we learned?


This case indicated that although a person has sustained an injury to a certain body region, exercise can be adapted and flexible to physician requirements so as to provide benefits to
the person whilst undergoing treatment for their specific intervention such as surgery. This situation demonstrates the importance of exercise physiologists being flexible and understanding pathology therefore, conducting a modified exercise programme. The benefits include increased cardiovascular activity which elicits weight management and reducing the risk factors associated with physical inactivity including chronic disease.

From a chronic disease perspective the programme has helped managed the condition by aiding weight loss and improved insulin sensitivity. From a psychological perspective, the programme benefits mood, general well-being and diversion of focus from the injury.

Daniel Anderson
(B.Sc. – Sports Science, Exercise
and Health – Hons, ESSAM)
Accredited Exercise Scientist