Table 1.

Integration of BFR with Rehabilitation for Ankle Instability

Phase	Description	Goals	Therapeutic Exercises
Phase 1	Initial strengthening and range of motion progressions	Reduce pain	•4-way band exercises (ankle) •Straight leg raise variations •Ankle pumps •Seated heel raises •Intrinsic foot muscle activation, toe scrunches •Resisted manual ROM •Double and single leg bridge variations
		Establish functional movements
		Initiate resisted activities
		Ensure adequate motion is available in all planes
Phase 2	Static stability and closed-kinetic chain strengthening	Enhance proprioceptive ability	•Standing heel raises (double to single leg) •Four-way hip with elastic resistance •Drop step squats •Lateral slide steps •Dynamic stabilization exercises (unstable surface) •Multi-directional lunge variations (e.g. furniture slider)
		Enhance neuromuscular control
		Improve lower extremity strength under dynamic conditions
Phase 3	Multi-planar balance and reactive series	Increase degrees of freedom during functional activities	•Plyo-toss on unstable surface •Visual light reactive drills in double and single-leg stance •Manual perturbations to surface with upper extremity activities (catch and throw, wall taps, ball dribble, jab steps)
		Elicit adaptive reactive strategies with external attention cueing

* Phase progressions should include consideration of: tissue healing parameters, quality of movement, and demonstration of adequate strength

•BFR applied to the involved extremity at 60-80% arterial occlusion for all exercises

•Standard repetition scheme of 30/15/15/15 with 30 second rest periods in between sets should be used for isotonic exercises

•Balance/stability exercises can utilize 30:30 second repetition:rest ratio x4 sets