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Ankle Sprain Rehabilitation Program

Missouri Sports Medicine

Ankle Sprain Rehabilitation Program Missouri Sports Medicine University of Missouri-Columbia The physical therapy program employed following an ankle sprain will vary in length depending on such factors as: 1. 2. 3. Severity and type of ankle sprain Acute vs. chronic injury Performance/activity demands

The rehabilitation program consists of three phases. These phases may overlap depending on the individual progress of each patient. The goals of Phase I include pain modulation, inflammatory control, full range of motion and early weight bearing as tolerated. Phase II rehabilitation consists of advanced strengthening, lower extremity flexibility, and normal ambulation. The focus of Phase III is a functional return to preinjury activities. Phase I 1. The application of ice bags or immersion in ice buckets should be performed a minimum of three to four times per day. The patient may receive an ankle cryocuff if swelling is moderate to severe. Modalities such as high volt galvanic stimulation and Jobst pump are beneficial in this phase of rehabilitation. Anti-inflammatory medication may also be prescribed at this time. Early range of motion is very important in the beginning phase of rehabilitation. The patient will perform active plantar/dorsiflexion and inversion/eversion through a pain free range of motion. Gentle passive dorsiflexion is performed through towel stretches. This exercise will help improve heel cord flexibility and allow normal gait when ambulating. The patient may be given a Aircast. They will be instructed to wear it at all times the first one to two weeks following injury. An ace wrap and felt horseshoe may be worn under the Aircast for compression. The patient is encouraged to begin weight bearing as soon as possible after the injury. The Aircast will provide the needed support for relatively painfree gait without antalgia. The patient is encouraged to use crutches until ambulation is normal Retro walking on a slightly inclined treadmill may be beneficial in allowing the patient to improve weight bearing without discomfort which will lead to an improved gait pattern. Small quick lateral lunges in both directions can be helpful to regain confidence and ankle

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Ankle Sprain Rehabilitation Program

Missouri Sports Medicine

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proprioception. Cross-friction massage may be initiated over the injured ligaments to reduce the unorganized alignment of scar tissue, which will guide the return to full pain-free range of motion. The massage should be performed for 5-10 minutes one time per day. Phase II

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Ice treatments are continued but on a less frequent basis. Cryotherapy two times per day following their exercise program is adequate at this phase of the rehabilitation. The patient should have achieved full range of motion by this time. The patient will now concentrate on improving heel cord flexibility. Wall stretch, chair stretch, and slant board are all good exercises for improving gastrocnemius and soleus flexibility. General lower extremity flexibility should also be addressed at this time. Ankle strengthening exercises are started in phase II. The patient will begin with bilateral heel raises, progressing to unilateral exercise as tolerated. Small knee bends (bilateral progressing to unilateral) help to increase lower extremity strength, proprioception, and dorsiflexion range of motion. Exercise tubing will be added for inversion/eversion strengthening. Standing peroneal strengthening can also be performed. The exercise is performed by actively elevating the heel and lateral side of the foot while rolling weight onto the first metatarsal head. Proprioception training is a very important part of the ankle rehabilitation program. The patient should be instructed to stand in a modified Rhomberg position, attempting to maintain this position for 30 seconds to one minute. The patient should progress to performing this exercise with their eyes closed. Quick lateral and forward lunges can be used to regain confidence and proprioception in the injured ankle. BAPS board training can be used to improve balance and proprioception. Cardiovascular training can be started in this phase. This includes biking, swimming, StairMaster, and treadmill exercise. The initial bike workouts will be ten to 15 minutes duration with minimal resistance, progressing to thirty minutes at moderate resistance. Twenty to 30 second sprints are performed every five minutes during the bike workouts to improve anaerobic conditioning. Freestyle and flutterkick swimming in initiated in Phase II. Calf raises, walking and eventually running in chest-deep water are encouraged. StairMaster workouts should begin when the patient can perform the exercise without discomfort. Treadmill workouts should include a decreased incline with retro walking, progressing to forward walking as tolerated without antalgia. By the end of Phase II the patient should have full range of motion, minimal swelling, and nearly full strength of the ankle musculature. The patient should be full weight bearing with a normal gait pattern.

Ankle Sprain Rehabilitation Program

Missouri Sports Medicine

Phase III 1. 2. 3. 4. The focus of Phase III rehabilitation is a functional return to pre-injury activities. These activities include running, jumping, and agility drills. Strengthening, flexibility, and proprioceptive exercises are continued if deficits remain. Implementation of a sports specific functional progression is appropriate in this phade. The patient will be discharged back to unrestricted activity once he has successfully completed the functional progression. The patient may be required to wear a Swedo-brace for return to athletic activities as prescribed by the physician.