This case involves a 38 year old adult female who presented, to this author and therapist, with a chronic
nd degree left ankle sprain. It had occurred in November 2002 when she stepped awkwardly off of a
street curb and twisted it 11 months prior to this therapeutic experience. This patient is a successful
trial attorney who enjoys running as a stress-relieving, leisure activity. She is an intelligent, selfproclaimed “left brain, linear thinker” who deals in facts and statistics. She was a recently divorced
mother of two at the time of her initial visit. Although her job does confine her to a desk at times, it also
requires a lot of activity as well, which includes standing for long periods of time. She presented in
excellent health, with no other significant medical history, nor previous ankle injury. Except for the
Caesarean births of both of her children, she had never undergone any previous surgical procedures.
The patient reported being happy and content in her life, and stated that she enjoys an active lifestyle
that involves sports, cooking and travel.
Upon initial onset of the injury, the patient stated that pain and swelling of her left ankle had occurred
immediately and that she was initially unable to bear weight on her left foot. She sought medical
attention at a local hospital emergency room. X-rays were negative and physical assessment
determined soft tissue damage to the lateral aspect of her ankle. She was initially treated with ice, an
ace wrap, crutches and mild pain medications (Tylenol with codeine). She was instructed to continue ice
applications, elevate when possible and two weeks later was referred to physical therapy. Traditionallybased physical therapy was conducted for 2 months, three times per week consisted of ice, whirlpool
bath, ultrasound treatments, exercise and ambulation skills. The patient progressed, was eventually
able to ambulate without an assistive device and regained some of her ankle range of motion, but
continued to complain of ankle tightness and intermittent pain when engaging in activities such as
running, stair climbing and prolonged periods of standing. These activities could also produce minor
ankle swelling on occasion if she did any of them to an extreme or repetitively. She would ice her ankle
when this occurred although she had stopped the prescribed medication after the initial two week