Brostrum-Gould Procedure Rehab Protocol

Brostrum-Gould Procedure Rehab Protocol

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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 
  • Age
  • Males
  • Females
  • 20-29
  • 30-39
  • 40-49
  • 50-59
  • 60-69
  • 70-79
  • 80-89
  • 37
  • 32
  • 28
  • 23
  • 19
  • 14
  • 10
  • 30
  • 27
  • 24
  • 21
  • 19
  • 16
  • 13