Ankle Joint – From Rehab To Return To Play

Through the mentorship and return to play courses I go in depth on how to build your own graded exposure plan.

If you don’t have confidence and clarity to do this then ultimately you won’t get the results your patient needs to get back on the field. You need to get this right.

Today I’ll share how to logically build your step-by-step progressions for your own return to play rehab.

The End Goal

You always want to begin with your end goal. The final stage should be a good change direction and a full range of motion especially for the calcaneus.

These tissues are going to be stressed when our athlete sprints or changes direction so we need to eliminate protective tone and prepare them to take high level loads.

Key Performance Indicators

In the last article we discussed the key performance indicators for our assessments. Test, re-test and use your KIPs. All you need to do is fill in the gaps and progress your patient from these to your end goal and return to play.

Lunge

Using some kind of lunge to work on accepting weight will ultimately be feeding into change of direction and deceleration. We can use a variety of different types of lunges to stress the calcaneus, the ankle joint range of motion and different fibres of the tissue in a controlled way.

Ankling

Using an ankling technique we can check the peroneals ability to brace and assess midfoot stiffness both of which are vital for your athletes top end speed and accelerations.

Hopping Progressions

To get towards our final goal we need to check the athletes ability to run. I use different levels of hopping exercises to ensure my patient is loading correctly and has the ability to get back out on the field.

This stage should be used to overload the tissues before your patient needs to run. We want to put these tissues through stress before getting back to the training ground. You must take note here, are there any changes as a result of doing these exercises? Is there any reaction? If the athlete comes back the next day and all of your KPIs are okay then you can move on to the next logical progression.

Sessions

Below is a rough breakdown of how your step-by-step play may take shape over each session. Remember, this is not concrete, every patient reacts differently, some may be quicker whilst some with more acute injuries may take a little more time. It does not matter how long it takes as long as they have earned the right to progress.

Sessions 1-2

Range of motion
Calf raises
KPIs

Sessions 3-4

Lunges
Ankling

Sessions 5-6

Hopping progressions

Sessions 7-8

Higher level hopping
Return to play

Make sure you have good intent through each of these progressions. The gastroc and hamstrings need to work together so one isn’t overloading the other.

This is what you want with ankle progression. You need to use a step-by-step system and ensure every step you take is the next logical progression. Through each step your patient should earn the right to progress. By the time your athlete is back to running you both know they will be able to tolerate the loads they need to.

Throughout this whole process you need to bear in mind the 80/20 rule. 20% of your time and attention will be spent on settling the symptoms and 80% on finding the true stressor, addressing it and getting your athlete back to where they need to be.

If you’re still confused on any of this information then I’d encourage you to click here, go back and review the fundamentals we have already covered.