An effective physical therapy to the patient with CRPS type 1: A case report

We report a case of complex regional pain syndrome (CRPS), involving the lower extremity. Physical therapy was performed as a part of a pain management program. A 62-year-old female had left leg pain since 9/2003. The pain was not controlled with NSAIDs and the gradually increased. She had to use axillary crutch. One month later, osteochondral fracture of the talus was found. Arthroscopic resection of the fracture was done in 11/2003. But the pain got stronger, especially after physical therapy which was focused on the contracture of ankle and gait. She was diagnosed as CRPS in 12/2003. The unbearable pain made her depressive, and after discharge to home at 2/2004, she committed a suicide. She was transported to ER, and a week later she went to psychiatric ward. The energizer and sympathetic nerve block reduced 50% of the pain, but she still refused to walk. She was consulted to our department in 5/2004. Physical therapy was started without touching her painful leg. We focused on building a therapeutic relationship. Then, partial weight bearing exercise was started using a soft and elastic ball to facilitate a sense of pressure loading. After the exercise she had a pain in her leg, but she didn't need painkillers. In 10/2004, she was able to walk by herself with a T-cane, and her activities of daily living (ADL) became independent. At the discharge, her pain was 20% of the admission. Treatment of CRPS must be focused on not only pain, but also functional activity.