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AITFL Rehabilitation protocol for chronic injury

Rehabilitation phases

Phase 1 — Settle symptoms and restore comfortable motion (roughly weeks 0–2 of this programme)

Goals: Comfortable gait, controlled swelling/pain and non-provocative ankle mobility.

• Ankle pumps in pain-free range: 2–3 sets of 15–20 repetitions, 2–3 times/day.
• Gentle active dorsiflexion and plantarflexion; avoid forcing end-range dorsiflexion or external rotation.
• Ankle isometrics in four directions (dorsiflexion, plantarflexion, inversion, eversion): 5–10 second holds, 8–10 repetitions each.
• Gentle calf stretching only if it does not reproduce pain over the distal tibiofibular joint.
• Walking in a supportive shoe/brace as tolerated; shorten distance if pain or limp increases.

Progress when: Walking is improving, swelling is controlled and exercises do not cause a next-day flare.

Phase 2 — Strength and sensorimotor control (roughly weeks 2–4)

Goals: Restore lower-limb strength and balance without provoking syndesmotic pain.

• Theraband ankle dorsiflexion, plantarflexion, inversion and eversion: 2–3 sets of 10–15 repetitions.
• Bilateral calf raises progressing to supported unilateral calf raises: 2–3 sets of 8–12 repetitions.
• Closed-chain mini-squats and sit-to-stand; keep foot progression comfortable and avoid twisting.
• Supported single-leg balance on a firm surface: 3 rounds of 20–30 seconds.
• Progressive walking on level ground; increase distance gradually if gait remains normal.

Progress when: Near-normal walking, improving calf strength and stable single-leg balance without syndesmotic pain.

Phase 3 — Functional strengthening (roughly weeks 4–6)

Goals: Build confidence and capacity for routine daily activities.

• Progress calf raises, resistance-band work and functional strengthening.
• Step-ups and controlled step-downs: 2–3 sets of 8–12 repetitions.
• Progress single-leg balance; add gentle reach tasks only if pain-free and controlled.
• Progress squats and low step tasks while avoiding pivoting or rotational loading.
• Increase walking duration and introduce gentle inclines only if level walking is comfortable.

Progress when: Stairs and usual daily activities are comfortable, with no giving-way and no increase in focal syndesmotic pain.

Phase 4 — Return to usual activity (roughly weeks 6 onward)

Goals: Return to the patient's required level of daily function.

• Continue calf, peroneal and whole-limb strengthening 2–3 times/week.
• Progress walking speed, distance and uneven-ground exposure gradually.
• For a low-demand patient, running, hopping and cutting drills are not required unless needed for their lifestyle.
• If higher-impact activity is desired, introduce it only after clinical review and successful pain-free functional progression.

Progress when: Comfortable normal gait, functional strength and balance close to the opposite side, and no pain with the activities required by the patient.