1ankle sprain rehabilitation

8/13/2019 1Ankle Sprain Rehabilitation

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Ankle Sprain Rehabilitation Program Missouri Sports Medicine

Ankle Sprain Rehab il itation Progr amMissouri Sport s Medicin e

University of Missouri-Columbia

The physical therapy program employed following an ankle sprain will vary in lengthdepending on such factors as:

1. Severity and type of ankle sprain2. Acute vs. chronic injury3. Performance/activity demands

The rehabilitation program consists of three phases. These phases may overlapdepending on the individual progress of each patient. The goals of Phase I include painmodulation, inflammatory control, full range of motion and early weight bearing astolerated. Phase II rehabilitation consists of advanced strengthening, lower extremityflexibility, and normal ambulation. The focus of Phase III is a functional return to pre-injury activities.

Phase I

1. The application of ice bags or immersion in ice buckets should beperformed a minimum of three to four times per day. The patient may

receive an ankle cryocuff if swelling is moderate to severe. Modalitiessuch as high volt galvanic stimulation and Jobst pump are beneficial in thisphase of rehabilitation. Anti-inflammatory medication may also beprescribed at this time.

2. Early range of motion is very important in the beginning phase ofrehabilitation. The patient will perform active plantar/dorsiflexion andinversion/eversion through a pain free range of motion. Gentle passivedorsiflexion is performed through towel stretches. This exercise will helpimprove heel cord flexibility and allow normal gait when ambulating.

3. The patient may be given a Aircast. They will be instructed to wear it at alltimes the first one to two weeks following injury. An ace wrap and felt

horseshoe may be worn under the Aircast for compression.4. The patient is encouraged to begin weight bearing as soon as possibleafter the injury. The Aircast will provide the needed support for relativelypainfree gait without antalgia. The patient is encouraged to use crutchesuntil ambulation is normal Retro walking on a slightly inclined treadmillmay be beneficial in allowing the patient to improve weight bearing withoutdiscomfort which will lead to an improved gait pattern. Small quick laterallunges in both directions can be helpful to regain confidence and ankle




proprioception.5. Cross-friction massage may be initiated over the injured ligaments to

reduce the unorganized alignment of scar tissue, which will guide thereturn to full pain-free range of motion. The massage should be performedfor 5-10 minutes one time per day.

Phase II

1. Ice treatments are continued but on a less frequent basis. Cryotherapy twotimes per day following their exercise program is adequate at this phase ofthe rehabilitation.

2. The patient should have achieved full range of motion by this time. Thepatient will now concentrate on improving heel cord flexibility. Wall stretch,chair stretch, and slant board are all good exercises for improvinggastrocnemius and soleus flexibility. General lower extremity flexibility shouldalso be addressed at this time.

3. Ankle strengthening exercises are started in phase II. The patient will beginwith bilateral heel raises, progressing to unilateral exercise as tolerated.Small knee bends (bilateral progressing to unilateral) help to increase lowerextremity strength, proprioception, and dorsiflexion range of motion.Exercise tubing will be added for inversion/eversion strengthening. Standingperoneal strengthening can also be performed. The exercise is performed byactively elevating the heel and lateral side of the foot while rolling weight ontothe first metatarsal head.

4. Proprioception training is a very important part of the ankle rehabilitationprogram. The patient should be instructed to stand in a modified Rhombergposition, attempting to maintain this position for 30 seconds to one minute.The patient should progress to performing this exercise with their eyesclosed. Quick lateral and forward lunges can be used to regain confidenceand proprioception in the injured ankle. BAPS board training can be used toimprove balance and proprioception.

5. Cardiovascular training can be started in this phase. This includes biking,swimming, StairMaster, and treadmill exercise. The initial bike workouts willbe ten to 15 minutes duration with minimal resistance, progressing to thirtyminutes at moderate resistance. Twenty to 30 second sprints are performedevery five minutes during the bike workouts to improve anaerobicconditioning. Freestyle and flutterkick swimming in initiated in Phase II. Calfraises, walking and eventually running in chest-deep water are encouraged.StairMaster workouts should begin when the patient can perform the exercisewithout discomfort. Treadmill workouts should include a decreased inclinewith retro walking, progressing to forward walking as tolerated withoutantalgia.

6. By the end of Phase II the patient should have full range of motion, minimalswelling, and nearly full strength of the ankle musculature. The patient shouldbe full weight bearing with a normal gait pattern.




Phase III

1. The focus of Phase III rehabilitation is a functional return to pre-injuryactivities. These activities include running, jumping, and agility drills.

2. Strengthening, flexibility, and proprioceptive exercises are continued if deficitsremain.3. Implementation of a sports specific functional progression is appropriate in

this phade.4. The patient will be discharged back to unrestricted activity once he has

successfully completed the functional progression. The patient may berequired to wear a Swedo-brace for return to athletic activities as prescribedby the physician.

1ankle sprain rehabilitation

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