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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.

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