Table 2.
Three-phase rehabilitation program.
| Rehabilitation Phase | Goals, Sample Treatments, and Criteria for Progression |
|---|---|
| Acute | Goal: Joint protection while minimizing pain, inflammation, weakness, and loss of motion. |
| Joint protection: Immobilization in a walking cast, boot, custom orthosis, lace-up ankle brace, or ankle stirrup. External rotation and end-range dorsiflexion are avoided. | |
| Weightbearing: Based on assessment and patient symptoms—varies from nonweightbearing to full weightbearing. | |
| Pain and inflammation control: Compression, elevation, cryotherapy, electrical stimulation, manual therapy, other modalities, and/or alternative therapies such as acupuncture. | |
| Maintenance of strength and mobility: Gentle motion, cycle ergometer, progressive resistance exercise with bands, cords, ankle weights, and/or electrical stimulation. | |
| Progressed when: Able to ambulate in full weightbearing on various surfaces and traverse stairs with minimal discomfort. | |
| Subacute | Goal: Normalize joint mobility, strength, neuromuscular control, and return to basic function in activities of daily living. |
| Mobility: Low-load, long-duration stretching with cords, bands, or towels; repetitive motion through the range of motion; cycle ergometer; joint mobilization; and/or aquatic therapy. | |
| Strengthening: Cords, bands, ankle weights, heel raises, step up/down, calf press with isotonic equipment, and/or neuromuscular training exercises. | |
| Neuromuscular training: Progressive use of air cushions, rocker boards, wobble boards, air-filled domes, trampolines, or other perturbation of support surfaces. | |
| Progressed when: Can jog and hop with minimal discomfort. | |
| Advanced training | Goal: Prepare for return to sports participation. |
| Neuromuscular training: Perturbation of support surfaces. | |
| Functional/agility drills: Running, jumping rope, hopping, shuffling, carioca, and/or figure-8 running with or without use of props such as cones, hurdles, and ladders. | |
| Strength/power: Advanced strengthening, plyometrics. | |
| Sports-specific drills: Dribbling drills, running reception patterns, shooting balls, skating/rollerblading. | |
| Return to sports when: Performs sport tasks at game speed with minimal discomfort and quality movement. |