Table 2:

PHASE II: Light Strengthening (begin after meeting Phase I criteria, approximately 3-4 weeks following surgery).

Category	Information
Phase II Appointments	Rehabilitation appointments are 1 time per week on average
Phase II Rehabilitation Goals	Lower extremity circumference within 1 cm of uninvolved side
	Incision is well healed
	Minimize muscle atrophy and flexibility deficits in anterior/involved compartment
	Single leg stance control with eyes open on unstable surface for 30-60 seconds
	Full flexibility of gastrocnemius (ankle DF with knee extended): 15-20 degrees
	Maintain motion and strength of uninvolved muscle groups, as well as cardiovascular endurance, as able
	Perform active or gentle resisted exercises of the hip of the operated lower extremity and resistance exercises of the upper extremities
	Proper lower extremity control and alignment with no pain during functional double leg squats
	Non-antalgic gait on level surface with full weight bearing and no assistive device, >3mph with equal step length bilaterally
	8 point (or greater) improvement on FAAM (ADL portion)
Phase II Precautions	Avoid over-stressing new scar formation by avoiding any friction over tissue (as per Phase I)
	Avoid post-activity swelling by limiting prolonged weight bearing activity as appropriate. If swelling occurs, manage with rest, ice, elevation and compression (as per Phase I).
	Avoid eccentric loading with any impact activity.
Phase II Suggested Therapeutic Exercise	Scar massage/mobility and desensitization (once incision is healed). Begin with 3-5 minutes, 1-2x/day and modify as needed.
	Gentle stretching and nerve mobilizations to tissue in involved compartment. Stretch holds for 30-60 seconds, 2-3x/day. Nerve mobilizations begin with 5-8 reps, 3-5x/day; progress number of reps as tolerated. For nerve mobilizations, begin with supine positioning with the lower extremity in a straight-leg raise position; ankle plantarflexion with inversion places tension on the common peroneal tract. (Figure 4a and 4b) Progress by adding hip adduction or internal rotation while doing the straight-leg raise to increase tension on the nervous system. Passive neck flexion will also pull the spinal cord superiorly and places the entire nervous system on a stretch.
	Progress open kinetic chain ankle strengthening. 2-3 sets of 10; progress resistance, sets and reps as tolerated.
	Balance and proprioception exercises: initiate a progression of bilateral to unilateral balance activities first on a level, firm surface, then on a soft/unstable surface, such as dense foam or Bosu ball, and then on a balance board. Begin with eyes open; progress with head turns and eyes closed as able. Goal of 30-60 second holds; 2-3 repetitions, 1-2 times/day.
	Gait drills: begin with sagittal plane and progress to frontal and transverse planes. Examples include forward and backward marching (sagittal plane, Figure 5), sidestepping or side marching (frontal plane), and carioca/grapevine walking (transverse plane). Begin with 10-20 steps, 2-3 repetitions, 1-2 times/day. Progress as tolerated.
Phase II Cardiovascular Exercise	Upper body circuit training, upper body ergometer (as per Phase I)
	May begin stationary biking if wound is healed; begin with 5-10 minutes at a low resistance (for example, level 1-2 on a bike with 10 levels), and low cadence (for example 60-80 revolutions per minute). Progress time, cadence, and resistance as able.
	Begin treadmill or track walking if wound is healed; begin with 5-10 minutes at 2-3 mph and progress time and speed as able.
	May swim or water walk if wound is FULLY healed (do not risk infection); begin with 10-15 minutes and progress time and speed as able.
Progression Criteria to Phase III	Patient may progress to Phase III if they have met the above stated goals