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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).
- Active ROM exercises
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.
- Weight bearing exercises.
- Stretching.
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.
- Return to Competition
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