Once you have returned to straight line running the next aim is to progress to faster paced running and agility based motions.
In this phase the aim is for the injured ankle to achieve at least 95% compared to the uninjured side when performing any test.
Single hop forwards for distance
- Start position: stand on the injured side foot.
- Movement: Hop forwards and land on the same foot.
- Hold: for 1 second on the landing to ensure you have a stable landing.
- Repetitions: aim to complete 2 sets of 15 reps. Return to the same start position after each hop forwards.
- Progression: Attempt to increase the distance that you hop forwards.
Triple hop forwards for distance
- Start position: stand on the injured side foot.
- Movement: Hop forwards 3 times in a direct line. As soon as you land you hop forwards into the next hop.
- Hold: the last landing for 1 second to ensure you have a stable landing and you do not over-balance.
- Repetitions: aim to complete 2×15 reps. Return to the same start position after each hop series.
- Progression: Attempt to increase the overall distance that you hop forwards.
Triple cross over hop for distance
- Start position: stand on the injured side foot and just to the left or right of a straight line.
- Movement: Hop forwards 3 times. On each hop you hop to the other side of the line so that you are hoping forwards in a slightly diagonal direction each time. As soon as you land hop forwards into the next hop.
- Hold: the last landing for 1 second to ensure you have a stable landing and you do not over-balance.
- Repetitions: aim to complete 2 sets of 15 reps. Return to the same start position after each hop series.
- Progression: Attempt to increase the overall distance that you hop forwards.
Maximum side hop for distance
- Start position: stand on the injured side foot.
- Movement: Hop to the left or right as far as you can.
- Hold: the landing for 1 second to ensure you have a stable landing and you do not over-balance.
- Repetitions: aim to complete 2 sets of 15 reps in both directions. Return to the same start position after each hop series.
- Progression: Attempt to increase the distance that you hop to either side.
Maximum side hops in 30secs
- Start position: Set up 2 lines that are 40cm apart. Stand on one leg on the outside of one of the lines. Stand side on to the lines
- Movement: Hop sides and attempt to land on the outside of the other line. Try to land as close to the line as possible without touching it.
- Repetitions: Hop sideways back and forth for 30secs and attempt to complete as many hops as possible in this time. Do not count hops that either touch the line or land on the inside of the lines. Females should aim for 50+ hops and males 55+ hops.
- Progression: Attempt to increase the distance that you hop to either side.
Knee to wall stretch
- Start position: stand near a wall facing it.
- Movement: with the injured foot flat on the ground and placed in front of you, bend your knee, moving it towards the wall and trying to get your knee to touch the wall. Keep the foot flat on the ground. If you can touch the wall with your knee, move your foot backwards. Aim for a stretch at the back of the ankle.
- Hold: hold the stretch for 20-30secs.
- Repetitions: repeat 4 times.
- Progression: Aim to have a distance that is less than 2cm different to the uninjured ankle.
Return to contact sport
Return to contact sport is great to be able to achieve and means the ankle should be feeling really good. This is the time where you can start to utilise the ankle brace or ankle tape to provide additional support.
During this phase it’s all about adding in reactive agility drills where you react to an external cue to decide which direction to cut. This can be as simple as running in a straight line and a partner calling left or right to indicate which direction to go. Progressively build up the speed so you feel you are running 100% speed prior to making the cutting motion. You can also progress the speed of the cutting motion.
Return to play
To make sure the ankle is ready for a return to full sport the following should be achievable:
- No episodes of ankle instability should be experienced,
- All strength and hopping tests should be at least 95% of the uninjured side.
- The ankle muscle invertors and evertors should have a ratio of 1:1,
- Seated heel raises of 1.5x body weight should be able to be completed.
- Standing heel raises of 3x bodyweight should be able to be achieved.