FOUR-SQUARE ANKLE REHABILITATION EXERCISES

With any athletic injury, coordinated function between proprioceptive fibers and motor response is disrupted. Not only is it necessary to redevelop strength and range of motion, but it is important to retrain the proprioceptive fibers. Because impaired proprioceptive coordination is a primary cause of reinjury, rehabilitation should stress proprioceptive function as well as re-establishment of strength.

ADVANTAGES

Four-square ankle rehabilitation exercises are a set of hopping patterns that stimulate sensory feedback and motor response in the lower extremities. the four-square program is uncomplicated. the directions are easy to follow, and no equipment is required. After a short period of supervision the program can be used at home.

Furthermore, the program is functional. It allows athletes to work at the high speeds and stresses encountered in competition. Speeds can be varied by the rate of hopping, and a metronome can be used for pacing. Athletes may increase their leg power by increasing the height of their jumps or by increasing their load with added weight. They may also increase proprioceptive demands by performing the hopping patterns with their eyes closed.

The exercise program may begin one hour after RICE (rest, ice, compression, elevation). However, athletes with first- degree injuries should not begin exercising until the second day:those with second-degree injuries should begin only after pain-free walking has begun. Athletes must have established dorsiflexion at the ankle joint so that the triceps surae will not be strained.

Four-square exercises are useful for rehabilitating other lower-limb injuries or to prevent injuries. Because repeated 30- to 40-second sets are performed, the exercises are appropriate for interval training. Once full range of motion and normal gait have been re-established, the exercises may be used in a cryokinetic program. If swelling occurs after the set, use ice massage for 5-10 minutes. If pain occurs during or following the exercise, wait 3 days before restarting the program, and resume at one step below that at which the pain occurred.

HOPPING PATTERNS

A cross pattern (two lines intersecting at right angles) marked on the floor is all that is needed for the program. The exercises may be performed barefoot on a soft surface such as a wrestling mat or gymnastic pad. Flat- soled athletic shoes should be worn if a hard surface is used.

Athletes hop to and from the different quadrants in varying patterns - slowly and with both feet at first. Athletes may initially support their weight by leaning on a table with both hands. Eventually, they may progress to vigorous single-leg hopping.

The program is composed of eight basic patterns (figure 1). the exercises become progressively more difficult, and athlete should successfully perform one pattern without pain before moving to the next. If necessary, a set of hopping in place can be performed before beginning the program.

Initial emphasis should be on landing in the appropriate quadrant after each hop. Speed and accuracy should be encouraged as athletes progress. Athletes should do each pattern for 30 to 40 seconds. Sets should not be repeated and the rest time between sets should equal the length of a set. Ultimately, a total of 8 to 12 minutes should be spent on the exercises.

The goal is to do these exercises at least twice, preferably three times daily.

References:

1.Fox E., Mathews DK: The Physiological Basis of Physical Education and Athletic. Philadelphia, WB Saunders Co. 1981, pp 129-136.

2. Freeman MA, Dean MR, Hanham IW: The etiology and prevention of functional instability of the foot. J Bone Joint Surg (Br) 1965;47(November);678-685.

3.Knight KL: Ankle rehabilitation with cryotherapy. Phys Sportsmed 1979;7(November):133.

4.Kulund DN: The Injured Athlete. Philadelphia. JB Lippincott Co. 1982, pp 438-440.

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