Carrying the Load Together: The Role of the Therapeutic Alliance in a Patient With Bilateral Achilles Tendon Repair With Unilateral Failure and Subsequent Infection: A Case Report

Abstract

BACKGROUND: Adverse events can complicate the rehabilitation process. In complex clinical situations, the therapeutic alliance can aid the therapist and patient in navigating clinical challenges and facilitate a successful outcome. CASE PRESENTATION: A 38-year-old male presented to physical therapy after sequential bilateral Achilles tendon repairs following a 2-year history of chronic bilateral Achilles tendinopathy that did not respond to limited conservative care. The patient subsequently experienced traumatic failure and infection of the left Achilles tendon repair, necessitating prolonged medical management and physical therapy care over 56 weeks. His goals were to return to high-level physical activity and collegiate basketball officiating. OUTCOME AND FOLLOW UP: Approximately 80 weeks following initial physical therapy evaluation, the patient had returned to collegiate basketball officiating and was fully participating in high-intensity interval-based circuit training, including strength training, plyometric training, and sprint training, 3 times per week. DISCUSSION: The primary physical therapist in this case sought to intentionally develop the therapeutic alliance with the patient through use of core components of the therapeutic alliance and components of psychologically informed practice. Specific strategies were utilized to develop the therapeutic alliance and leverage it in ways that positively influenced outcomes. This case report demonstrates the theories of the therapeutic alliance in practice and serves as an example to clinicians managing complex clinical cases. JOSPT Cases 2023;3(4):235-244. Epub 13 October 2023. doi:10.2519/josptcases.2023.11557