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Rehabilitation Protocol For Ankle Sprain

This document outlines a rehabilitation protocol for lateral ankle sprains in 4 phases. Phase 1 focuses on protection, decreasing pain and edema within 1-2 weeks. Phase 2 emphasizes normalizing gait and improving range of motion from 3-6 weeks. Phase 3 aims to optimize strength and balance from 7-10 weeks. Phase 4 involves returning to sports and full activities from 11-16 weeks through plyometrics and agility drills. Each phase provides sample exercises and progress criteria based on timelines and clinical evaluation.

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42 views3 pages

Rehabilitation Protocol For Ankle Sprain

This document outlines a rehabilitation protocol for lateral ankle sprains in 4 phases. Phase 1 focuses on protection, decreasing pain and edema within 1-2 weeks. Phase 2 emphasizes normalizing gait and improving range of motion from 3-6 weeks. Phase 3 aims to optimize strength and balance from 7-10 weeks. Phase 4 involves returning to sports and full activities from 11-16 weeks through plyometrics and agility drills. Each phase provides sample exercises and progress criteria based on timelines and clinical evaluation.

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manu gonzalez
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Rehabilitation Protocol for Lateral Ankle Sprain: non-operative

management
This protocol is intended to guide clinicians through non-operative management of lateral ankle sprain. This protocol is
time based (dependent on tissue healing) as well as criterion based. Specific intervention should be based on the needs
of the individual and should consider exam findings and clinical decision making. The timeframes for expected outcomes
contained within this guideline may vary based on referring physician preference, severity of ankle instability, number of
involved ligaments, additional impairments, and/or complications.

The interventions included within this protocol are not intended to be an all-inclusive list of exercises. Therapeutic
interventions should be included and modified based on the progress of the patient, and under the discretion of the
clinician.

Diagnosis Lateral Ankle Sprain


Considerations • Mechanism of Injury
• Degree of ecchymosis and edema
• Tenderness to palpation over lateral ankle ligaments
• Anterior drawer and reverse anterior drawer test
• Ottawa ankle rule to rule out fracture
Differential • Foot and ankle fracture
Diagnosis • Syndesmotic injury
• Osteochondral lesion
• Talar bone contusion
• Deltoid ligament sprain
• Peroneal tendon strain
• Achilles tendon strain
• Midfoot sprain
• Epiphyseal plate injuries

PHASE I: PROTECTION AND OPTIMAL LOADING (1-2 WEEKS AFTER INJURY)


Rehabilitation • Decrease pain
Goals • Decrease edema
• Improve weight bearing
• Protect healing structures
Brace • Brace or protective tape should be worn during weight bearing activities.
• Immobilization is recommended for 10 days for severe ankle sprain.
Intervention Range of motion/Mobility
• Foot and ankle PROM
• Ankle pumps
• Ankle circles
• Ankle alphabet
• Seated heel raises
• Seated toe raises
• Towel crunches/toe curls
• BAPS board
Manual therapy
• Grades I-II to talocrural, subtalar, and mid foot for pain control

Gait training
• Normalize stance time, weight bearing, and promote heel to toe gait pattern

Motor control/Balance
• Initiate Tandem or single leg balance on firm surface if non-painful

• Ice, compression, elevation, NSAIDS (if appropriate)


Criteria to • Ability to fully weight bear on involved lower extremity
Progress • Decreased pain
• Minimal swelling

PHASE II: INTERMEDIATE/SUB-ACUTE (3-6 WEEKS AFTER INJURY)


Rehabilitation • Decrease pain
Goals • Normalize gait pattern
• Improve ankle ROM
• Improve single leg stance stability
• Maintain or improve proximal muscle strength
Brace • Continue to wear brace for weight bearing activities.
Additional Range of motion/Mobility
Intervention • Knee to wall closed chain dorsiflexion mobilization
*Continue with • Gastroc stretch
Phase I • Soleus stretch
interventions
Manual Therapy
• Grades I-IV to talocrural, subtalar and midfoot for pain control and mobility

Strengthening
• Resisted dorsiflexion, resisted eversion, resisted plantar flexion, resisted inversion
• Double leg heel raises
• Single leg heel raises
• Standing toe raises
• Open and closed chain knee, hip, and core strengthening

Motor control/Balance
• Tandem stance: Firm and unstable surface
• Tandem walking
• Single leg stance: Firm and unstable surface
• Rocker board / Wobble board
Criteria to • Non-antalgic gait pattern
Progress • Equal single leg stance time and quality bilaterally
• Full ankle PROM and AROM
• 5/5 ankle strength with MMT

PHASE III: LATE/CHRONIC (7-10 WEEKS AFTER INJURY)


Rehabilitation • Optimize strength
Goals • Optimize balance
• Initiate plyometric activities
• Initiate return to running
Brace • Utilize lace up brace for functional activities as needed
Additional Strengthening
Intervention • Closed chain strengthening and endurance for entire lower extremity
*Progress established strengthening exercises with increasing resistance and repetitions
Massachusetts General Brigham Sports Medicine 2
*Continue with
Phase I-II Motor control/Balance
Interventions • Single leg multidirectional reach: Firm and unstable surface
• Dual task balance exercises: Ball toss with decreased base of support or unstable surface

Plyometrics/Agility
• Double leg hopping
• Lateral bounding
• Initiate agility ladder drill
Criteria to • Able to perform 25 single leg heel raises or equal number compared to uninvolved side
Progress • 80% or better performance on involved lower extremity compared to contralateral side with
Star balance / Y-balance excursion test compared to uninvolved side
• Appropriate scores on patient reported outcome measure (e.g. Cumberland Ankle Instability
Tool or FAAM)

PHASE IV: RETURN TO SPORT/FUNCTIONAL ACTIVITIES (11-16 WEEKS AFTER INJURY)


Rehabilitation • Full strength of foot and ankle
Goals • Improve motor control with higher level activities
• Return to normal activities
Additional Plyometric/Agility
Intervention • Single leg agility drills
*Continue with • Single leg hopping
Phase I-III • Change in speed and change in direction drills
interventions
Return to sports/function
• Interval sports training
• Return to running progression
• Compound strengthening exercises
Criteria to • 90% or better performance on involved lower extremity on Star balance / Y-Balance excursion
Progress test
• 90% or better performance on involved lower extremity on single leg hop for distance, triple hop
for distance, 6m timed hop, and/or cross over hop for distance
• Appropriate scores on patient reported outcome measure (e.g. Cumberland Ankle Instability
Tool or FAAM)
• No increase in pain or swelling with plyometric and return to sports activities
Revised 9/2021

Contact Please email *** with questions specific to this protocol


References:

1. Petersen, W., Rembitzki, I.V., Koppenburg, A.G. et al. Treatment of acute ankle ligament injuries: a systematic review. Arch Orthop
Trauma Surg 133, 1129–1141 (2013). https://doi.org/10.1007/s00402-013-1742-5

2. RobRoy L. Martin, PT, PhD; Todd E. Davenport, DPT; John J. Fraser, DPT, PhD; Jenna Sawdon-Bea, PT, PhD; Christopher R. Carcia,
PT, PhD; Lindsay A. Carroll, DPT; Benjamin R. Kivlan, PT, PhD; Dominic Carreira, MD
J Orthop Sports Phys Ther. 2021;51(4):CPG1-CPG80. doi:10.2519/jospt.2021.0302

3. Struijs PA, Kerkhoffs GM. Ankle sprain. BMJ Clin Evid. 2010;2010:1115. Published 2010 May 13.

Massachusetts General Brigham Sports Medicine 3

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