Download PDF to print
The goal of this protocol is to provide a clinical guideline for the post-surgical course of physical therapy for a patient who has had a Brostrom Procedure or similar surgical procedure for repair of chronic lateral ankle instability. This is not intended to substitute clinical decision making regarding the patient’s proper progression based on evaluation findings, individual progress, and if/when post-operative complications arise. If a clinician requires assistance in the progression of a post-surgical patient the surgeon should be consulted.
GENERAL GUIDELINES:
- Limit active and passive range of motion for 1-2 months, especially inversion and eversion
- The physician may change the time guidelines for immobilization
- Supervised physical therapy takes place for 4-6 months
- Return to run and sport activities starting after 3 months with bracing
GENERAL PROGRESSION OF ACTIVITIES OF DAILY LIVING (ADLs)
- Non-weight bearing with crutches for 3 weeks or until first follow up with surgeon.
- Driving: 1 week for automatic cars, left leg surgery
- 6 weeks for standard cars, or right leg surgery
Rehabilitation Progression
PHASE I: Week 0 – 6:
Goals:
- Manage swelling, check incisions for proper healing
- Increase hip strength and motor control
- Begin gentle AROM
Precautions:
- Protect the surgical site
- Avoid all inversion and eversion motion
Weight Bearing Status:
- Non-weight bearing until advised by surgeon to initiate progression to toe-touch and partial weight bearing
Exercises:
- 4 way straight leg raise
- clam shells
- Nerve glides and hamstring flossing
- Hip flexor and Quadriceps mobility
- Aquatic Therapy when cleared my MD for PWB
- Seated/modified upper body strengthening
- Seated/modified CV training
- Modified bridging
- Seated knee extension
PHASE II: Weeks 6-9:
Criteria to advance to Phase II:
- Minimal signs of inflammation and pain
- Clearance from surgeon for weight bearing progression
Goals:
- Increase ROM
- Increase weight bearing tolerance
- Train proper gait pattern
- Continue to avoid all inversion motion
Weight Bearing Status:
- Progress from boot to full weight bearing in shoe and aircast
Exercises:
- Hip strengthening
- Hip and knee mobility
- Ankle isometrics progressing to light and moderate resistance in
Functional Performance Test:
- Single Leg Balance
- Heel Elevated Squat without lateral shift
Phase III: Week 9 to 12:
Criteria to advance to Phase III:
- Normalized gait without pain
- Hip strength in all directions
Goals:
- Full active range of motion in all directions
- Full strength in all directions
Exercises:
- WB exercises: squats and dead lifts
- Single leg balance
- Resisted ankle strengthening in all planes
Functional Performance Test:
- Single leg heel raises within 10% contralateral
Phase IV: 3 to 6 Months:
Criteria for advancement to Phase IV:
- 5/5 strength in all planes in ankle
- Full active range of motion in all directions
Goals:
- Begin running and return to sport progressions
- Establish equal bilateral lower extremity strength and coordination
- Restore explosive strength
- Improve reaction speed and response time
Exercises:
- Single limb stance strengthening: multi-planar dead lifts and lunges
- Plyometrics
- Agility
Functional Performance Test:
- Hayden Plyometrics (for athletic population)
- Fast walking/jogging (for general population)
- Single Leg heel raise within 5% of contralateral
|
|
|
- 20-29
- 30-39
- 40-49
- 50-59
- 60-69
- 70-79
- 80-89
|
|
|