Watch the video version of this Q&A episode on YouTube - https://youtu.be/mxKy6s9tWCg

A patient reports to physical therapy for evaluation with a referral that states they had platelet-rich plasma (PRP) injections three days ago. The patient received the injections after several months of failed treatment for Achilles tendinopathy. Which of the following interventions would be the MOST likely for the initial session?

1. Instruction in crutch training and/or use of a walking boot
2. Achilles tendon static stretching and resistance band ankle strengthening
3. Calf raises, bridges, and straight leg raises
4. Single leg balance on even and uneven surfaces

Transcript

Welcome back to the Scorebuilders’ Question and Answer Podcast! This podcast provides members of the Scorebuilders’ team with the opportunity to explore challenging multiple-choice examination questions with students actively preparing for the licensing examination. My name is Scott Giles and I will be your host for today’s journey.

Ready? Let’s go!

A patient reports to physical therapy for evaluation with a referral that states they had platelet-rich plasma (PRP) injections three days ago. The patient received the injections after several months of failed treatment for Achilles tendinopathy. Which of the following interventions would be the MOST likely for the initial session?

1. Instruction in crutch training and/or use of a walking boot
2. Achilles tendon static stretching and resistance band ankle strengthening
3. Calf raises, bridges, and straight leg raises
4. Single leg balance on even and uneven surfaces

Your first thought upon reading this question might be…. Are you kidding me?…..questions about platelet-rich plasma injections on the physical therapy licensing examination.

Yes indeed! In fact, this should not be a surprise to diligent physical therapy students familiar with the current examination blueprint published by the Federation of State Boards of Physical Therapy. 

Remember, the examination blueprint changes significantly every five years and with this change new topics such as regenerative medicine are added while other topics previously on the examination are removed. 

Let me be more specific. The largest Content Outline category on the current licensing examination is called Foundations for Evaluation, Differential Diagnosis, and Prognosis.

Foundations for Evaluation, Differential Diagnosis, and Prognosis.
This category refers to the interpretation of knowledge about diseases/conditions of the musculoskeletal, neuromuscular, and nervous systems according to current best evidence, in order to support appropriate and effective patient/client management for rehabilitation, health promotion, and performance across the lifespan.

One of the subcategories in this broad area is as follows:

The impact of regenerative medicine (e.g., platelet rich plasma, stem cells) on physical therapy prognosis and interventions related to musculoskeletal, neuromuscular, and nervous systems diseases/conditions

Becoming familiar with the current examination blueprint can go a long way toward avoiding unpleasant surprises on test day!  Let’s take a deeper dive into platelet-rich plasma injections.

Platelet-rich Plasma Injections
Platelet-rich Plasma (PRP) Injections have been used predominantly for musculoskeletal sport injuries (e.g., hamstring strain, patellar tendinopathy, Achilles tendinopathy). Since PRP-based therapies are still in their infancy, there is not a consensus rehabilitation protocol that has been established and widely agreed upon. 

Existing protocols often include a period of rest, immobilization, and/or limited weight bearing in the period that immediately follows the procedure (i.e., the first few days or week). This is then followed by a gradual progression of weight bearing, exercise, and activity to progressively load the affected structure.

Let’s explore each of the options:

Option 1 - Instruction in crutch training and/or use of a walking boot 
Since the patient is less than one week post injection, physical therapy intervention would likely be limited at this point. The initial recovery period after the procedure is often characterized by rest, immobilization, and, in some cases, weight bearing restrictions. It would be important to ensure the patient is knowledgeable on how to use crutches and/or a walking boot to help limit stress to the tendon during this stage.

Option 2 - Achilles tendon static stretching and resistance band ankle strengthening 
Range of motion exercise and static stretching may be used early in the rehabilitation process. However, resistance band strengthening would be too aggressive at this stage. Typically, strengthening will not begin for at least two weeks after the procedure.

Option 3 - Calf raises, bridges, and straight leg raises 
It may be important for the therapist to include strengthening (e.g., bridges, straight leg raises) of other muscles and joints in the initial recovery period to prevent deconditioning. However, performing calf raises would be too aggressive at this stage given the Achilles tendinopathy.

Option 4 - Single leg balance on even and uneven surfaces 
Having the patient perform different balance exercises in single leg stance would likely be too aggressive at this stage given the Achilles tendinopathy, especially given that the patient would be balancing on uneven surfaces.

The correct answer is Option 1

Let’s explore the all student data:
62% of students selected Option 1, Instruction in crutch training and/or use of a walking boot, the correct response
18% of students selected Option 2, Achilles tendon static stretching and resistance band ankle strengthening
11% of students selected Option 3, Calf raises, bridges, and straight leg raises
9% of students selected Option 4, Single leg balance on even and uneven surfaces

System Classification
This question is a Musculoskeletal System question which represents approximately 27% of all exam items.

Content Outline Classification
This question is an Interventions question which represents approximately 29% of all exam items.

Level Classification
This question is a Level 3 question since the question requires candidates to systematically analyze and often interpret information to determine an appropriate course of action. Level 3 questions tend to have some degree of subjectivity and candidates are required to assign varying degrees of importance to different variables.

Thanks for joining us on the Scorebuilders Q and A podcast! See you next week!