1. Ankle Rehabilitation By: Luke Kasper & Dave Schuber

2. Ankle Anatomy ► Bony  Tibia (medial malleolus)  Fibula (lateral malleolus)  Talus  Calcaneous  Cuboid  Cuneiforms  Navicular

3. Ankle Anatomy (continued) ► Ligaments  Lateral ► Anterior Talofibular Ligament (ATF)  Most commonly injured ligament ► Calcaneofibular Ligament (CF) ► Posterior Talofibular Ligament (PTF)  Medial ► Deltoid Ligament  Anterior ► Anterior Tibiofibular Ligament

4. Ankle Anatomy (continued) ► Lateral Ligaments ► Medial Ligaments

5. Common Mechanisms of Injury (MOI) ►I►I►I►Inversion DDDDamages the lateral ankle ligaments MMMMost common type of ankle injury ►E►E►E►Eversion DDDDamages the medial ankle ligaments ►E►E►E►Extreme Dorsiflexion DDDDamages the anterior ankle ligaments

6. Rehabilitation Sequence ► Range of Motion (ROM) Range of Motion (ROM) Range of Motion (ROM)  Passive (PROM)  Active (AROM) ► Strengthening Strengthening  Basic to advanced  Isometric to Isokinetic  Open versus Closed kinetic chain ► Next Stages Next Stages Next Stages

7. Rehabilitation Sequence (continued) ►P►P►P►P rrrr oooo pppp rrrr iiii oooo cccc eeee pppp tttt iiii oooo nnnn BBBBalance CCCCoordination AAAAgility ►P►P►P►P llll yyyy oooo mmmm eeee tttt rrrr iiii cccc ssss ►F►F►F►F uuuu nnnn cccc tttt iiii oooo nnnn aaaa llll E E E E xxxx eeee rrrr cccc iiii ssss eeee ssss ►R►R►R►Return to Play

8. ROM ► Decreased ROM following injury ► Must increase ROM to prevent any gait abnormalities.  Exercises ► Towel Stretch ► ABC’s Ankle Alphabets Ankle AlphabetsAnkle Alphabets ► Slant Board ► Stationary Bike ► Back to Sequence Back to Sequence Back to Sequence

9. Strengthening ► Increase strength to help with stability of joint and return to prior strength levels  Exercises ► 4 way Theraband ► 4 way ankle weights ► BAPS board ► Towel curls ► Marble Pickups ► Calf Raises ► Back to Sequence Back to Sequence Back to Sequence

10. Proprioception ► Proprioception is lost due to the damage to the sensory nerves in the ankle. ► Body loses the ability to determine where it is without sight  Exercises ► Single leg balance ► Single leg balance on different surfaces ► PNF patterns ► Jogging on trampoline ► Back to Sequence Back to Sequence Back to Sequence

11. Plyometrics ►I►I►I►Incorporates strength and proprioception ►P►P►P►Power, quick movements EEEExercises ►H►H►H►Hopping ►B►B►B►Box jumps ►D►D►D►Dot Drills E E E E E xxxx aaaa mmmm pppp llll eeee V V V V iiii dddd eeee oooo ►B►B►B►B aaaa cccc kkkk t t t t oooo S S S S eeee qqqq uuuu eeee nnnn cccc eeee

12. Functional Exercises ► These drills should mimic the athletes sport, but in a controlled environment. ► Drills should be sports specific.  Examples ► Football- running, cutting, blocking ► Volleyball- agility, jumping, sliding ► Soccer- running, cutting, kicking ► Return to Play Return to Play Return to Play

13. Return to Play ► Once the athlete has been cleared by the physician and team athletic trainer they are able to return to play. ► They may have to wear some support or brace once they have returned.  Donjoy  Mueller  Ankle Tape