“Where there is a will, there is a way” goes the old adage which remains as relevant even today. It takes only firm determination and grit to find your way and your wish shall come true. My patient Jahnvi (Name changed for patient’s privacy) proved it in real life. This is about our journey of her Rehab from Pain to Gain.
Dancing & trekking were simple joys of life for the fun-loving Jahnvi. Mid 2014, she met with an accident while driving a motorbike and all of these favorite activities came to a total halt for her.
The accident caused fracture of her tibial plateau (part of the bone of lower leg that forms our knee joint) along with complete avulsion of her ACL ligament & tear of her MCL ligament.
For the uninitiated, ACL is one of the four main ligaments of the knee, and contributes to about 90% of total knee joint stability making it crucial for stabilizing the knee when turning. The MCL is a band of tissue on the inside of the knee. It connects thighbone to the bone of lower leg. The MCL keeps the knee from bending inward.
This kind of acute injury usually needs surgery. In response to her hesitation for surgery, Jahnvi’s Orthopedic doctor advised her to try Physiotherapy rehab failing which she would have to go under the knife.
Jahnvi was surely relieved to discover this non-surgical alternate.
I still recall meeting her for the first consultation at ReLiva clinic – She had acute pain in her knee & had a lot of swelling too even 1 month after the accident. 4 weeks of immobilization (plaster) had stiffened her knee. She could not even bend her knee.
A detailed initial assessment revealed that her knee flexion (bending movement) was only 45 degrees vs. a normal range of 130-135 degrees. She also had an extension lag of 10 degrees which means she could neither bend her knee completely nor straighten it !!! She was incapable of even bearing any weight on her leg to stand !!! At this stage getting her back to dancing & trekking were totally out of question !
The most immediate goal for her Orthopedic rehab was to GET HER BACK TO FEET and train her to STAND STRAIGHT and perhaps the next – WALK properly.
But she is one heck of a girl who just wanted to jump/dance/trek & do everything that she did before the accident… her answer to the goals for physiotherapy was very SIMPLE !!!
I felt “WOW” looking at her enthusiasm. A 22 year old girl with tibial plateau fracture & complete avulsion of tibial attachment of ACL & MCL tear – and she was determined to dance…. That too within the next 2 months . After all Navratri Garba will not wait for her to recover !!
I took this up as a challenge & began Physiotherapy to help her get back to her fun filled life again. Preparing a well planned, comprehensive Orthopedic rehab Programme for her recovery was only a part of the battle won. The unique ReLiva approach involves patients in their treatment and so most of the success of my rehab Plan depended upon its compliance.
The journey towards returning to pre-injury activities was not so easy for Jahnvi.
With effective manual therapy techniques; we could achieve her knee flexion range to 98 degrees (an improvement of 35-40 degrees) with just a 2 degrees extension lag remaining and all of this in just 5 sessions!
But as chance would have it – we remained stuck at 98 degrees for the next 4 consecutive sessions. At the end of each session, we would gain 2-5 degrees in movement but would be back to 95-98 degrees by the next day on assessment. This was the most painful phase for Jahnvi & the most challenging phase for me as a therapist.
I decided to go for a mid-therapy reassessment for her afterwhich I gave her a rest period to let her muscles recover from the soreness. Finally the wall caved in and on the 12th session I could manage to take her knee flexion from 98o to 109o. The smile on both our faces was such a magnificent one!
It was so gratifying to see that happiness on her face. She still calls it the “MOMENT OF MAGIC” !!!
By now, we had developed a very strong bond treading through her journey together from Pain to Gain. I would challenge & bet her to not cry through the process & if she did, she would have to get me a chocolate!!!
So committed was she to her Rehab Programme that she never cried despite the rigor !
It took 30 sessions in all to achieve her goals. Not only did she avoid the then looking imminent surgery but she also managed to get back to dancing. She actually went for Garba that Navratri! Infact, she even rehearsed her steps with me at the clinic so that she felt more confident in the actual event.
Unfortunately, nothing could be done for her complete avulsed fragment of tibial attachment of ACL. So some pain still remained during extreme knee flexed postures.
But in the end, she felt lucky to be treated at ReLiva & I am happy I could help her achieve her goals to the best of my abilities.
Jahnvi would always remain one of my most memorable patients till date & I still relish the taste of the chocolate she gifted to me after Garba, in the same consult room of RELIVA where we had first met…
Contributed by Dr. Anuradha Mandalekar (PT), consultant Physiotherapist at ReLiva Physiotherapy & Rehab. She specializes in Cardio-Thoracic Physiotherapy and AHA accredited Healthcare provider. Her smile is infectious and soon spreads to her patient’s face too. You can reach her at ReLiva clinic or write to her at firstname.lastname@example.org
** Disclaimer: The photograph used here is only for representational use and is not of the Patient in subject here.