More Than Meets the Eye: Clinical Reflection and Evidence-Based Practice in an Unusual Case of Adolescent Chronic Ankle Sprain

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Adolescents who have chronic pain after common orthopedic injuries such as ankle sprains may present a multidimensional clinical problem stemming from both physical and psychological issues. A traumatic incident such as a motor vehicle accident can produce clinical issues ranging from a specific tissue injury to multisystem complications such as complex regional pain syndrome (CRPS) or posttraumatic stress disorder (PTSD). The purpose of this retrospective case report on an adolescent with chronic ankle pain stemming from a motor vehicle accident is to demonstrate how reflection and the evidence base influenced the modification of the plan of care. Description of the screening methods, clinical findings, interventions, and outcomes of the case may help physical therapists identify and improve the quality of care in cases of suspected CRPS and PTSD. The patient was a 12-year-old girl with a medical diagnosis of recurrent right ankle sprain and with signs of potential CRPS and PTSD. Poor initial response to ankle sprain management led to reflective reconsideration of the diagnosis and plan of care. The revised plan of care supported by the evidence base emphasized empathetic consideration of the traumatic motor vehicle accident and focused on CRPS prevention and management of potential non-physical pain via mirror therapy and motor imagery therapy. Pain was relieved, behavior improved, and functional movement began to normalize after 3 sessions of mirror therapy and motor imagery therapy. Patient symptoms were inconsistent with the medical diagnosis, and the clinical outcome of the original plan of care was unsuccessful. Reflection inspired a more-detailed history and systems review, which led to greater understanding and more-effective care.