Author(s): ZHENG, T., Institution: BEIJING RESERACH INSTITUTE OF SPORTS SCIENCE, Country: CHINA, Abstract-ID: 2623

INTRODUCTION:
The aim of this case report was to describe the rehabilitation process and return-to-competition timeline of a 29-year-old professional volleyball player who sustained a distal left fibular fracture and an avulsion fracture of the posterior malleolus during competition in the National Women’s Volleyball League. The athlete underwent external fixation surgery for the distal fibula after injury and competed in the National Games eight months post-surgery.
METHODS:
Based on the athlete’s injury profile and competitive objectives, an 8-month, three-phase rehabilitation and conditioning program was implemented, integrating Mulligan’s mobilization techniques, blood flow restriction training, and velocity-based strength training. Ankle joint range of motion, lower limb muscle girth, Visual Analog Scale (VAS) pain ratings, core stability, lower limb strength and power were assessed at predefined time points to objectively monitor rehabilitation progress and program efficacy.
RESULTS:
After the first stage (13 weeks post-surgery), the athlete’s ankle dorsiflexion range of motion returned to normal, with no interlimb difference; thigh circumference also showed no asymmetry. After the second stage (21 weeks post-surgery), peak torque increased by 57% in the left quadriceps and by 12% in the right quadriceps; hamstring peak torque increased by 22% on the left and by 8% on the right. Interlimb asymmetry in hamstring peak torque decreased from 9% to 4%, and in quadriceps peak torque from 38% to 2%. After the third stage (32 weeks post-surgery), upper and lower limb muscle strength and vertical jump height had all returned to pre-injury levels. The athlete resumed court-based training at 4 months and competitive matchplay at 8 months post-surgery. She performed outstandingly in competition, averaging 5.22 points per set in volleyball matches.
CONCLUSION:
In the early stage of rehabilitation, the application of Mulligan's mobilization methods combined with BFR training can effectively improve the range of motion of the ankle joint, enhance the strength and circumference of the lower limb muscles, and this program has a small pain stimulus and high compliance among athletes. It is feasible to conduct isokinetic training for the knee and ankle joints at 14 weeks post-surgery, but continuous monitoring using the VAS is necessary throughout the training process. Isokinetic training of the lower limbs during the mid-rehabilitation phase can significantly increase athletes’ lower limb muscle strength, laying a solid foundation for subsequent sport-specific strength training. This case study also provides valuable insights to guide personalized rehabilitation and fitness programs for patients with ankle fractures, contributing to the growing body of literature on interventions for ankle injuries in athletes.