03/21/2026
Ankle sprain 1 week progression:
Days 1-3: Inflammatory phase—diagnostic imaging (if necessary), immobilize, WB modification, come out of boot 3x per day to do ankle isometrics, foot intrinsic activations; we don’t do any modalities for 48hrs.
Days 3-5: End of inflammatory phase—grade the sprain, effleurage swelling, grade I-II talocrual jt mobs, gait mechanics, PROM ankle & foot, base balance & prop work, work uninvolved musculature, stationary bike, gentle AROM, dynamic TB isometrics, NWB hip, core & UE endurance work. Contrast foot baths with epson salt.
Day 6: Sub-Acute/proliferation Phase: Achieve full ROM & swelling is out, gait normalized, Grade II-IV talocrual jt mobs, Elliptical & bike, light reactive mechanics (sag & frontal), BFR Quads, hams & calf, Active ankle TB work (focus on peroneals), eccentric heel lowering to tolerance, low grade Y-balance work. Continue contrast foot bath with epson salt to flush any swelling from work loads.
Day 7: Allow for remodeling phase, Deep tissue work, functional mobilizations ie: DF MWM, Light GP IV-V distraction talocrual distraction manip, normalize jog gait, dynamic arch loading, functional flexibility loading ie: uphill RDLs, continue with LE conditioning, ankle brace or tape able with uneven surfaces.
Day 8: Return to 50% practice with minimal pain, continue multi-planar balance & prop progressions, functional loading peroneal & glute med mechanics, DF moment progressions ie: bottom position squat holds, DF band MWM.
Continue to condition out of the brace or tape, but be in the brace with dynamic environments until remodeling phase ends (6 weeks). Graduated return back to full play. Dynamic balance & prop, restore normal lifting loads, absolutely no limping with walking or jogging, Y balance clearance, speed & agility recovery. Modalities to promote increased blood flow, inflammation management as necessary.
