Phase I- Maximum Protection (Weeks 0 to 1)
- Ice and modalities to reduce pain and inflammation
- Compression wrap to reduce swelling
- Crutches as instructed
- Elevate the ankle above the heart
- Begin active range of motion all planes as directed by physician
- Stationary bike/non-impact and pool program
Phase II- Progressive Range of Motion and Early Strengthening (1-2 weeks)
- Continue with modalities to reduce swelling and control pain
- Wean off crutches as instructed
- Continue with active range of motion with light terminal stretching
- Begin 4 plane ankle TB
- Foot intrinsic strengthening
- Begin closed chain progression bilateral progressing to unilateral (squats, calf raises, toe raises)
- Proprioception drills
- Bike, elliptical, treadmill walking
- May begin shallow water pool jogging
Phase III- Progressive Strengthening (Weeks 2-3)
- Continue with modalities to reduce swelling
- Restore full range of motion all planes
- Continue with open and closed chain ankle and foot intrinsic strengthening
- Progress difficulty of proprioception drills
- Begin straight plane dry land running
- Begin controlled lateral agility work
Phase IV- Advanced Strengthening – Return to Sports (Weeks 3-6)
- Continue with modalities as needed
- Continue with end range stretching
- Progress strengthening and proprioception
- Advance to sprinting and agility drills; braced or tape.
- Simulate return to sport activity with field or court drills
- Must demonstrate a negative clinical exam and pass a strength and agility test with greater than 90% efficiency for physician release.
