Phase 1: Acute Phase week 1
Goals:
- Decrease swelling
- Decrease pain
- Protect from injury
- Maintain appropriate weight bearing status
- Increase pain free ROM
- Limit muscular inhibition
Treatment: (RICE) REST‐ICE‐COMPRESSION‐ELEVATION
- Modalities‐ electrical stimulation, ultrasound, phonophoresis,
- Iontophoresis
- Taping/compression wrap/ankle bracing, crutches if needed
- Active range of motion in all planes (alphabet, circles, calf pumping)
- Gentle isometric strengthening in all planes
- Begin non‐weight bearing proprioception‐ seated BAPS
Phase 2: 1‐3 weeks
Goals:
- Full pain free range of motion
- Pain free strengthening
- Progress to weight bearing exercises
- Begin proprioceptive training
- Resume normal gait pattern
Treatment:
- Continue with phase 1 exercises
- Stretching in non‐weight bearing and weight bearing positions
- Strenghening: 4 plane ankle Theraband
- Towel sweeps
- Foot Intrinsics‐towel crunches, tissue or marbles pickup)
- Heel and toe raises
- Trampoline (weight shifting and balance activities)
- Quarter squats
- Joint mobilization‐ dorsiflexion and plantarflexion
- Proprioceptive training‐ seated BAPS, wobble board, single limb stance,
- rocker board
- Stationary bike
- Modalities to reduce pain and inflammation
- Aqua‐jogging in pool if available
- Continue cold therapy
Phase 3: week 3‐5
Goals:
- Progress strengthening
- Progress proprioceptive training
- Increase endurance
Treatment:
- Initiate Elliptical
- Treadmill walking to jogging ( can incline treadmill)
- Increase eccentric work
- Leg press
- Advance balance and proprioception exercises: single leg balance activities from stable to unstable surfaces with and without distractions ,standing BAPS with/without weights, wobble board, lateral shuffles, toe walk, heel walk, dynadisc, single leg trampoline ball catch, body blade, 5 point star, single leg squat
- Agilities: begin lateral agility work Sportscord
- Carioca
Phase 4: 5 weeks +
Goals:
- Regain full strength
- Full Range of motion
- Full balance/proprioception
- Prevent future injuries
- Return to participation in sport activity
Treatment:
- Jogging progression
- Advance single leg balance and proprioceptive exercises: single leg
- squat on dynadisc, BOZU, dynadisc 5 point star
- Agilities‐ grid hops, double hops, single hops, diagonals
- Double leg hops, forward/backward/side to side
- Single leg hops, forward/backward/lateral hops
- Plyometrics: multidirectional jump drills
Note: As with all protocols, the designated time frames and exercises are for guidance only and should not limit the patient’s progress or make them worse.