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Phase I- Maximum Protection (Weeks 0 to 4 as directed by the physician)

  • Ice and modalities to reduce pain and inflammation
  • Compression wrap to reduce swelling
  • Crutches, splint, boot or cast as instructed
  • Elevate the ankle above the heart
  • Active range of motion PF/DF gentle inversion/eversion as instructed
  • Stationary bike and pool program

Phase II- Progressive Range of Motion and Early Strengthening (Weeks 4-6)

  • Continue with modalities to reduce swelling and control pain
  • Wean off crutches as instructed
  • Normalize gait mechanics
  • Continue with splint or boot as instructed
  • Full active range of motion – emphasize end range dorsiflexion
  • 4 plane ankle TB – emphasize eversion strengthening
  • 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 6 – 8)

  • Continue with modalities to reduce swelling
  • Restore full range of motion all planes
  • Open and closed chain ankle and foot intrinsic strengthening
  • Progress difficulty of proprioception drills
  • Increase intensity of pool running progression to dry land and lateral agilities as tolerated

Phase IV- Advanced Strengthening – Return to Sports (Weeks 8-12)

  • Progress strengthening and proprioception
  • Advance to sprinting and agility drills as tolerated; braced or tape.
  • 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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