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Note: Exercise prescription is dependent upon the tissue healing process and individual functional readiness in all stages. If any concerns or complications arise regarding the progress of any patient, physical therapy will contact the orthopedist.
PHASE I: ACUTE CARE PHASE: (Generally last 24-72 hours)
- Exercises should be performed 2-3 times each day.
- Gait Training: emphasize heel/toe gait
- Weight Shifting Activities (2-3 minutes)
- Motion and Stretching
- Bike for ROM (5-10 minutes)
- Seated Wobble Board (2-3 minutes)
- Seated Achilles Towel Stretch (2-3 minutes)
- Alphabet, Circles, Calf Pumping with ankle elevated (2-3 minutes)
- Ice with elevation (15-20 minutes)
- CRUTCHES-PWBAT - (Heel-Toe Gait Emphasized). D/C when non-antalgic gait
- BRACE/SUPPORT:Compression Tape (Open Gibney)
- DOCUMENTATION:
- Pain Level (each eval/re-eval)
- Neurovascular status
- Swelling - Ecchymosis
- Gait status - Functional Level
- ROM
- Status of Ankle Ligaments
Criteria for Progression to Phase II:
- Full Weight Bearing on Affected Lower Extremity Without Pain
- Swelling and Pain Controlled
PHASE II: BEGINNING FUNCTIONAL PHASE:
- CRUTCHES:WBAT - (May D/C Crutches when Gait is Near Normal)
- EXERCISE:
- Bike –May progress to Nordic Track (10-20 minutes)
- Gait Training
- Functional Training /Lateral Shuffles, Carioca, Heel and Toe Walk.
- Cone Walking, etc. (3-5 minutes)/Treadmill walking progression
- Motion and Stretching, Gastroc and Soleus Stretching - Wedge Board
(3-5 minutes)
- Alphabet, Circles, Calf Pumping with ankle elevated (as needed)
- Strengthening
- Eversion in Plantar Flexed Position (3 sets of 30)
- Heel Raise Progression (3 sets of 30)
- Proprioception / Balance Training
- Standing Wobble Board (BAPS) - (3-5 minutes)
- One Legged Standing Exercises - (3 exercises for 2-3 minutes each)
- Stork Stand, Airplane, Opposite Leg Sports Cord,
- Body Blade, Plyoball, Trampoline Ball Catch
- Ice with elevation (15-20 minutes)
- BRACE/SUPPORT:Ankle Taping For Support (only as needed)
NOTE:Criteria for Progression to Phase III:
- Single Leg Hopping is Pain Free
- Ankle has Full ROM
PHASE III: INTERMEDIATE FUNCTIONAL PHASE:
- EXERCISE:
- Warm-up on bike or stairmaster and do general LE stretching (5-6 minutes)
- Functional Training Progression (4 Exercises - 2-3 minutes each)
- Lateral Shuffles, Carioca Jog, Figure 8 Jog, Zigzag Jog
- Plyoball hop, Trampoline hop, Cone Hop, Jumping Rope
- Strengthening
- Eversion in Plantar Flexed Position to Muscle Failure (3 sets of 20)
- Proprioception / Balance Training
- BAPS (3-5 minutes)
- Body Blade, Sports Cord, Airplane - Eyes Closed (3-5 minutes total)
- Jogging Progression
- Ice as needed (10-15 minutes)
- BRACE/SUPPORT:Ankle Taping For Support (only as needed)
- DOCUMENTATION:
- Pain Level
- Swelling - Ecchymosis
- Gait status - Functional Level
- ROM
- Strength
- Status of Ankle Ligament
NOTE: Criteria for Progression to Phase IV:
- Lateral Hop is > 80% contralateral side
- Ankle has Full Strength
- Jog 1-2 miles without limp/pain
PHASE IV: ADVANCED FUNCTIONAL PHASE:
- EXERCISE:
- Warm-up on bike or stairmaster and do general LE stretching (5-6 minutes)
- Functional Training Progression (4 Exercises - 2-3 minutes each)
- Grid Hop, Carioca run, Figure 8 Run, Crossover Cut, Zigzag Hop,
- Plyometric Directional Hop, Straight Cut, Side to Side Hop
- Proprioception / Balance Training
- BAPS (3-5 minutes)
- Body Blade, Sports Cord, Karate Stand – Eyes Closed (3-5 min total)
- BRACE/SUPPORT:Ankle Taping For Support (only as needed)
GOALS: Functional Testing - Lateral Hop > 90% contralateral side
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