Ankle Sprain Protocol

Phase 1: Acute Phase

Timing
> Grade 1 sprain: 1-3 days
> Grade 2 sprain: 2-4 days
> Grade 3 sprain: 3-7 days
Goals:
> Decrease swelling
> Decrease bleeding
> Decrease pain
> Protect instability
> Starting healing process
PRICE:
Protection
> Aircast, Taping, Brace, Bandage
> Stabilize ankle (ligament healing)
> Crutches if necessairy
Rest
Ice
As analgesia application for
> 10 min
> 10 min rest
> 3 times x 3 sets a day
Compression
Elevation
> Elevate as much as possible
> Higher than the waist
> Elevation during sleeping
Phase 2: Subacute Phase

Timing
> Grade 1 sprain: 2-4 days
> Grade 2 sprain: 3-5 days
> Grade 3 sprain: 4-8 days
Main goals:
> Decrease pain
> Increase circulation/decrease swelling
> Increase pain-free ROM
> Strengthening exercises
> Improve neuromuscular control (proprioception)
> Stretching
> Progressive weight-bearing
Decrease pain
> Ice
> Electro Therapy
> Ultrasound
Increase circulation/decrease swelling
> Ankle pump
> Compression
> Hot/Cold contrast baths
> Lymphopress
Increase pain-free ROM within limits of pain:
Passive mobilisation
> Talo crural joint
> Sub talar joint
> Proximal and distal tibiofibular joint
> Foot
Autopassive
> Towel
Active joint mobilisation
 > Dorsi-flexion/Plantar-flexion
> Eversion
> Foot circles
> Alphabet
Strengthening exercises
> Isometric in pain-free range/eversion+++
> Toe curl with towel (weight on towel to increase
resistance)
> Pick up objects with toes (tissues, marble)
Improve neuromuscular controle (proprioception)
Progress from 2 legs to one leg and from closed eyes to
open eyes

Mat
> Wobble board
> Ankle disc
> Trampoline
> Biodex balance system
Stretching
> Passive ROM only dorsi flexion and plantar
flexion in pain free-range
> NO: inversion
> Achilles tendon
Weight-bearing
> Progress weight bearing as symptoms permit
> Partial weight-bearing to full weight-bearing if no
signs of antalgic gait are present
Hydrotherapy
> Stretching
> Active mobilization
> Improve gait pattern
> Proprioception
Criteria to progress to the next phase
 > Full active ROM
> Minimum or no swelling
> Normal gait pattern
> Adequate proprioception on a stable surface
Single leg stand 30sec

Phase 3: Rehabilitative Phase

Timing
> Grade 1 sprain: 1 wk
> Grade 2 sprain: 2 wk
> Grade 3 sprain: 3 wk
Goals:
> Full passive ROM
> Progress strengthening
> Progress proprioceptive training
> Increase pain-free activities of daily living
> Slowly increase stress on ligaments (painfree)
> Full weight-bearing and uncompensated gait
Increase painfree ROM
> Continue active joint mobilization
Strengthening
Weight bearing ex
> Heel raises
> Toe raises
> Stair step
> Mini squats
Isotonic Eccentric/Concentric:
> Theraband and cuff weights
Peroneal
Calf
Leg press
Isokinetics : ecc evertors +++
 Stationary bike
Active Stretching
Soleus
Gastrocnemius
Tibialis posterior
Plantar fascia

Proprioception
Standing toes
Trampoline
Single leg balance activities
Criteria to progress to the next phase
Full passive ROM
Full strength
Normal biomechanics
Normal muscle length
Good dynamic proprioception

Phase 4: Functional phase

Timing
Grade 1 sprain: 1-2 wk
Grade 2 sprain: 2-3 wk
Grade 3 sprain: 3-6 wk
Goals
Return to participation
Protection and strengthening of any mild residual joint
instability
Sport Specific Strengthening and training
Running progression
Jogging
Running
 Theraband running
Trampoline running/jumping
Alternate jog-walk-jog on smooth surface
Alternate sprint-jog-sprint
Figure of eights
Zig-zag cutting
Plyometrics specific to each sport
Multidirectional balance board activities
To prevent reinjury
Criteria to Return to competition
When above skills are accomplished at full speed, athlete
may return to practice
When full practice is tolerated, competition can be
resumed
Proprioception test is within normal on BBS
Isokinetic test and functional tests are normal

Prevention
Proper shoes
Decent warming up
Decent stretching
Flat surface Prevention
Taping
Consider orthotics if necessary