Dr Mak Protocol™

Ankle Rehabilitation Protocol (Athlete Version)

Phase 1 — Protection & Inflammation Control

Timeframe: Day 0 – Day 5

Goals:

reduce pain & swelling

protect injured ligament

prevent muscle inhibition

Clinical Focus:

lymphatic activation

pain modulation

early neuromuscular activation

Interventions:

Manual Therapy

gentle lymphatic drainage

talocrural joint grade I–II mobilization

soft tissue release (peroneal, calf)

Mobility

pain-free dorsiflexion / plantarflexion AROM

ankle circles (pain-free range)

Activation

isometric inversion / eversion (sub-maximal)

isometric plantarflexion

intrinsic foot activation (short foot)

Support

compression wrap

ankle brace if needed

Criteria to progress:

swelling ↓ at least 50%

able to weight bear without severe pain

no sharp pain at rest

⸻

Phase 2 — Mobility Restoration & Early Strength

Timeframe: Day 5 – Week 2

Goals:

restore full ROM

initiate strength

re-establish proprioception

Exercises:

ROM

full dorsiflexion mobilization

knee-to-wall ankle mobilization

calf stretch (gastrocnemius, soleus)

Strength

resisted plantarflexion (band)

resisted eversion (band)

resisted inversion (band)

heel raises (bilateral)

Neuromuscular

single leg stance (stable surface)

balance with perturbation

Manual Therapy

talus posterior glide (important for dorsiflexion)

fibular head mobilization if needed

Criteria to progress:

full pain-free ROM

able to single leg stand 30 sec

able to walk normally

⸻

Phase 3 — Strength & Neuromuscular Control

Timeframe: Week 2 – Week 4

Goals:

restore strength symmetry

restore joint stability

prepare for dynamic loading

Exercises:

Strength

single leg heel raises

eccentric heel raises

weighted calf raises

Dynamic Stability

single leg balance (unstable surface)

BOSU balance

perturbation training

Movement Control

step-ups

step-downs

lateral weight shift

Manual Therapy

full talocrural mobility restoration

Criteria to progress:

pain-free single leg heel raise × 20

no instability feeling

no swelling after exercise

⸻

Phase 4 — Plyometric & Return to Running

Timeframe: Week 4 – Week 6

Goals:

restore elastic function

restore explosive stability

Exercises:

Plyometric

double leg jumps

single leg hops (progressive)

lateral hops

Running Progression

jog → run → sprint

Sport-specific

cutting drills

change of direction

⸻

Phase 5 — Return to Sport ( volleyball approach )

Timeframe: Week 6 – Week 8

Goals:

full sport return

prevent re-injury

Exercises:

spike approach jumps

lateral shuffle

reaction drills

landing mechanics training

⸻

Return to Sport Criteria (Dr Mak Standard)

Athlete must achieve:

full ROM

strength ≥ 90% contralateral side

pain-free jumping

pain-free cutting

no swelling after training

⸻

Critical Clinical Notes (Important)

Most important factors preventing recurrence:

talus mobility restoration

peroneal strength

proprioception

calf strength symmetry