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Phases of rehabilitation and objectives

Phase 1: Acute Phase

  • Timing
    • Grade 1 sprain: 1-3 days.
    • Grade 2 sprain: 2-4 days.
    • Grade 3 sprain: 3-7 days.
  • Goals
    • Decrease swelling, and pain.
    • Protect from re-injury for a rapid return to sports and pain-free function.
  • Protection Options
    • You will be placed in a boot or a cast initially and then wear an ankle brace after that as you recover.
    • Rest is essential for rapid recovery and to reduce swelling. Crutches should be used to assist with ambulation without gait deviation.
    • Ice packs, frozen peas or cold gel packs can be used for 20-30 minutes with 30 minutes off to avoid freeze injury (frost-bite).
    • A loosely applied ACE wrap will help control swelling. Remove it and rewrap every 6-12 hours to avoid excessive compression.
  • Elevation
    • Elevate your foot above your heart with a downhill slope from toes→ankle→knee→hip→heart to allow swelling to flow out of your ankle.
    • Ankle and toe active motion will pump swelling out as well.

Phase 2: Week 2

  • Goals
    • Decrease swelling and pain.
    • Increase pain-free ROM.
    • Begin strengthening.
    • Begin non-weight-bearing proprioceptive training (alphabet exercises).
  • Modalities to Decrease Pain and Swelling during PT or at home.
    • Ice baths.
    • Electrical stimulation (Acti-patch or at PT).
    • Ultrasound (at PT).
  • Weight Bearing
    • Progressive weight-bearing with pain as your guide.
    • Partial weight-bearing to full weight-bearing if minimal pain.
  • Therapeutic Exercises
    • Active ROM exercises
      • Dorsiflexion.
      • Inversion.
      • Foot circles.
      • Plantar flexion.
      • Eversion.
      • Alphabet.
      • Use of cold water for gentle strengthening and ROM.
    • Strength exercises
      • Toe curls with towel (place weight on towel to increase resistance).
      • Pick up objects with toes (tissues, marbles).
    • Proprioceptive training.
      • Seated biomechanical exercises.
      • Wobble board.
    • Stretching
      • Passive ROM- doing only Dorsi-flexion and Plantar-flexion in pain-free range, not eversion or inversion.
      • Achilles stretch (gentle).

Phase 3: 2-4 weeks

  • Goals
    • Complete pain-free ROM
    • Strengthening
    • Progressive proprioceptive training.
    • Pain-free full weight-bearing and uncompensated gait.
  • Therapeutic Exercises
    • Stretching.
      • Calf and Achilles stretch.
      • Joint mobilization (dorsiflexion, plantar flexion, eversion and inversion).
    • Strengthening
      • Weight bearing exercises.
        • Heel raises.
        • Toe raises
        • Stair steps.
        • Quarter squats.
        • Eccentric and isotonics (Theraband and ankle cuff weights)
          • Inversion.
          • Eversion.
          • Plantar flexion.
          • Dorsiflexion.
          • Peroneal strengthening.
          • Isokinetics.
      • Proprioceptive training (progress from non-weight-bearing/controlled weight-bearing stage to full weight-bearing.
        • Standing wobble board.
        • Single-leg balance activities (stable to unstable surfaces, without to with distractions).
      • Continue modalities as needed, specifically after exercises to prevent recurrence of pain and swelling.
      • Supportive taping, bracing, and orthotics used as needed. Avoid re-injury.

Phase 4: 3-6 Weeks

  • Goals
    • Obtain full strength.
    • Normal biomechanics.
    • Return to participation in sports and avoid re-injury.
    • Protection and strengthening of any mild residual joint instability.
  • Therapeutic Exercises
    • Continue progression of ROM and strengthening exercises.
    • Sport-specific strengthening and training are imperative.
  • Running Progression
    • Alternate jog-walk-jog on smooth, straight surfaces.
    • Alternate sprint-jog-sprint on smooth, straight surfaces.
    • Figure-of-eights.
    • Zig-zag cutting.
  • Agility Drills
    • Back pedaling.
    • Side stepping.
  • Plyometrics specific to each sport.
    • Return to Competition
      • When above skills are accomplished at full speed, athlete may return to practice.
      • When full practice is tolerated, competition can be resumed.
      • Some type of ankle support should be used for the first several months of sports.

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