My 13 year old son was recently diagnosed with CRPS after multiple ankle fractures and surgery last September. It's mild and in the early stages, although I know it has the potential to progress. He just started pool therapy three times a week because he can't tolerate the pain of land therapy. He's had two sessions and is doing well with it.

My question is, is it okay to just focus on pool therapy until he makes progress and can tolerate land therapy better? Or do we need to be more aggressive and push him through land therapy as well? We are going to be taking him to a local YMCA that has a therapeutic pool to give him lots of extra pool exercise time, in addition to the regularly scheduled physical therapy.

Thanks for any advice and input.

Welcome Swimtime,

I am so sorry for what your family is going through. The prognosis is more positive for children and adolescents who are afflicted with CPRS. Their Nervous systems are so plastic it is perhaps easier to get them back on track. The pool is a great place to start. You want to be sure the therapy is not painful. Pain DOES NOT equal gain in his case. This is not a weightlifting competition. You want range of motion, swelling reduction, etc. He will build up to weight-bearing. After three foot and ankle procedures I can tell you from experience how important it is to get the foot stretched and supple without tearing the humpteen ligaments before you go back to bearing full weight. I strongly recommend a video currently on http://rsds.org If you scroll down on the rsds.org site you will se a video by Dr. Pradeep Chopra. It is recent, very insightful and has some specific sections dealing with youth and therapy. Lots of tips on nutrition and supplements and what NOT to do. He is a respected specialist and his advice is reasonable and not aggressive. Good place to start. For someone your son's age Mirror Box therapy might be helpful. Like I said , the plastic brain. I do mine with one leg behind a mirrored closet door.
Hang in there and DO NOT GIVE UP. Recovery is a process, it takes time, love and devotion. He is young so the odds are more in his favor. Dr. Stanton Hicks of Cleveland clinic says many people improve over time. I am banking on your son to be one of them. Also don't forget ankle injuries have their own aches and pains that are normal as the foot is re-acclimated. Not all pain is pathological. Remember that your are not alone. when you are fearful or need to vent come here. Your strength and confidence will help him immensely as you know. I will be saying prayers for your family.
Sending Healing Love,
Littlepaw

One more thought....Dr. Chopra makes a comment to be very careful of nerve entrapment mimicking CPRS. So true and also so possible after ankle surgery. Another thing I can personally attest to. If your son has not had a nerve conduction done it might be worth pursuing. You don't want to leave a contributing cause untreated. Your son's orthopedist can refer out for this.
Littlepaw

The key with CRPS is to keep moving...so as long as he is doing that he will be fine. The GOAL should be to get him into therapy out of the pool (or in combination with the pool)...but you don't want to push TOO hard too fast and cause him to have a setback where he can't do anything. When I did pool therapy I started with 3 pool days, then it moved to 2 pool days and 1 gym day, then 1 pool day and 2 gym days, until we moved out of the pool completely. This took place over the course of a few months.

There are likely at least some non weight bearing exercises he could try while seated...these are what I was started with when I was in the gym. The exercises were important because they were focused on getting me to move the right way, with very precise, deliberate movements aimed at getting me walking better on land vs the pool. I would discuss this with the doctor and physical therapist and see what they think is the best plan for your son.

You want to be aggressive with CRPS...but not so much that you cause setbacks. It's a delicate balance...but the important thing is to keep moving. That's why those seated exercises are so great...I was able to do them even when I was having a bad day and ensure that I kept moving...even when I was far past that in therapy. In fact...when I have a flare up even now I do those exercises to make sure I'm not immobilizing and making things worse by not moving.