Grade III Lateral Ankle Sprain


“I like the AlterG because it gives my patients a way of non-painful, controlled weight-bearing early in the recovery period. Studies show that an earlier return to activity prevents atrophy of supporting muscles, decreases swelling, and improves outcomes.”
Dr. Lance Silverman, Orthopedic Surgeon, Silverman Ankle and Foot


Grade III Lateral Ankle Sprain Protocol for Rehabilitation Professionals


General Principles

This protocol for Grade III Lateral Ankle Sprain is designed to provide the rehabilitation professional with a general guideline for patient care with the AlterG Anti-Gravity Treadmill. As such, it should be stressed that this is only a protocol and should not be a substitute for professional clinical decision-making regarding a patient’s progression. Progression should be individualised based upon each patient’s specific needs, pain level, physical examination, functional progress, and presence of any complications.



2x week (Daily treatment may be beneficial for collegiate or professional athletes).

Precautions and Contraindications

  • Increasing pain in the foot or ankle
  • Persistent edema/effusion
  • Numbness or paresthesia to ankle, foot, toes

Phase I (immediate):

Week 1 – Week 3


  • Reduce edema & pain
  • Protection of ligamentous structures

Treatment Options:

  • Non-wt bearing X 3 wks
  • Compression dressing 1st week with posterior
  • splint followed by boot for weeks 2 and 3
  • Modalities:
    • Rest
    • Ice
    • Ice Compression (Ex: Game Ready® or Cryo-Cuff®)
    • Electrical stimulation
    • Elevation
  • Manual Therapy:
    • Gentle effleurage/retrograde massage
    • Gentle dorsiflexion, NO Inversion or Eversion
  • Therapeutic Exercise:
    • Stationary bike
  • Gait Training:
    • AlterG Anti-Gravity Treadmill
      • Walking with boot in AlterG @ 50% BW

Phase II (early post-operative phase):

Week 4 – Week 6

Initiate outpatient Physical Therapy


  • Begin weight-bearing as tolerated (WBAT) in boot, with progression to out of boot
  • Treatment Options:

  • Modalities:
    • Continue with ice compression, elevation, e-stim
  • Manual Therapy:
    • Begin passive ROM, with protected inversion
    • Continue massage for soft-tissue restrictions
  • Therapeutic Exercise:
    • Active ROM with Thera-band® or similar elastic tubing
    • Begin proprioceptive re-training
    • Gentle Closed-Kinetic Chain activities can begin, using AlterG first, then overground when patient tolerates Full Weightbearing
      • Squats
      • Step-Ups
      • Shuttle Leg Press
      • Steamboats
  • Gait Training:
    • Progress to full weight bearing in the boot
    • Discontinue the boot when painfree (usually 4-6 weeks)
    • Use ankle brace/tape for outside activity
    • AlterG Anti-Gravity Treadmill
      • Can weight bear in AlterG at 3 – 6 weeks at 50% – 85% BW
      • Can initiate single-legged strengthening in AlterG
      • Can start ambulating without boot, 0° incline at 3 mph – 6 mph

Phase III (intermediate phase)

Week 7 – Week 12


  • Painfree with activities of daily living
  • Progress with sports and recreational activities (first linear and then lateral)
  • Taping/bracing can be used during functional training, but therapeutic exercises should be performed without support

Treatment Options:

  • Modalities:

    Can add pulsed ultrasound if adhesed capsule or posterior impingement is present

    • Continue as above

Manual Therapy:

  • Improve ROM with advanced mobilization techniques
  • Manual resistance to ankle through range, straight

Therapeutic Exercise:

  • Progress functional rehab, closed-kinetic strength, and proprioception
  • Incorporate plyometrics, agility exercises as appropriate. Can be performed initially in the AlterG, with progression back to overground (Sagittal plane first, then frontal plane, then multi-planar)

Gait Training:

  • AlterG Anti-Gravity Treadmill
    • Continue as above, maintain bracing or taping as needed
    • Continue AlterG for cardiovascular and endurance training purposesBegin a walk/jog progression at 75% body weight and progress to 85 -90%
    • Use body weight support if there is any residual pain with running