Laurence's Step by Step Road to Recovery

Laurence suffered a devastating ankle injury weeks before the start of his 2023 - 2024 rugby season, fracturing both his tibia and fibula and damaging multiple ligaments in his left ankle. After undergoing surgery to insert plates and screws to stabilise the bones, he began a lengthy rehabilitation process. 

Initial Assessment 

When Laurence first came to FORM Athletic for rehabilitation, it was 4 weeks after being cleared by medical staff to return to competitive sport. Despite this, he was still significantly lacking in ankle strength, mobility, and most importantly in confidence. He would overcompensate by putting more weight on his uninjured right leg during exercises and daily activities in order to avoid putting stress on his ankle. His range of motion was still very limited, especially in plantar flexion and inversion. Complex movements like running or side-stepping caused discomfort. Mentally, he didn't fully trust that his ankle was healed enough for competitive sports.

During Laurence’s assessment session, dorsiflexion, plantar flexion, inversion, and eversion were examined. He demonstrated limited dorsiflexion, being unable to fully bend his ankle upwards. He also struggled to plantar flex without compensation from other joints like the knee, swinging the other leg or hiking up his opposite hip. Both inversion and eversion were performed with difficulty, indicating poor ankle control in those planes of motion.

Left ankle struggled to dorsiflex during single leg calf raise, and the right leg can be seen compensating during plantar flexion of the left ankle.

Dynamic assessment involved light bilateral exercises like pogo hops. These tests revealed Laurence had issues controlling his ankle through loaded dynamic movements. He experienced mobility deficits and lacked stability transitioning between dorsi- and plantar flexion during the hopping action.

Notice the different knee angles of both legs during dynamic movements like pogo and vertical jumps, the left leg is unable to bend further, as the ankle lacks range to dorsiflex.

The results pointed to specific functional limitations for Laurence at the ankle. Dorsiflexion was the most restricted movement. Plantar flexion, inversion and eversion also presented challenges when performing the actions in isolation, unassisted by other body parts. Dynamic stability tests further emphasized the ankle control problems Laurence experienced with sport-specific motions. These findings helped identify focus areas for rehabilitation to improve his ankle function.

PHASE 1: Range of Motion, Strength and Stability 

Loaded split squat with a bias of ankle dorsiflexion. Heel elevation was needed in order to perform lateral lunges to a good standard

The initial goal of Laurence's program was to regain as much strength, mobility, and stability as possible in a progressive manner. We started with isolation exercises like calf raises in different positions to work the full range of motion pain-free. Floating heel split squats and single leg Romanian Deadlifts challenged his balance while strengthening the ankle joint. We also incorporated dynamic movements like pogos and small hops to improve his movement patterns and technique early in the process. By having Laurence focus on proper form during these exercises, we could identify and correct any imbalances or compensation patterns early on. 

EXAMPLE OF SESSION:

Prep: Pogos, Single leg balance 

A1 Elevated SL Calf Raise

A2 Kettlebell anterior tibialis raise 

Pauses at bottom and top parts of range of motion

B1 60s Calf raise holds 

B2 60s Tibialis raise hold at end range

C1 Front foot elevated Split Squat Calf Raise - progressed to floating heel Split Squat 

C2 Single leg RDL 

Performing a calf raise in a split squat position to train the soleus muscle.

PHASE 2: Dynamic Movement and Technique

Regular feedback and video analysis allowed us to make minor adjustments to Laurence's movement patterns over time. As Laurence’s ankle gained strength, stability, range of motion and most importantly moved efficiently, we decided to progress his training to phase 2. The focus in this phase was to include more dynamic movements, incorporate more functional lifting and athletic movements. Back squats, lunges, and plyometrics further improved his ankle and lower body’s ability to absorb and produce force. The addition of complex change of direction, deceleration and lateral movements to his running drills challenged his ankle in similar positions he would encounter during rugby. As he became more confident, we were able to gradually increase the intensity, load, and complexities of these exercises.     

We were able to remove the heel elevation during lateral lunges as the ankle mobility improved. While progressing all other movements to continue challenging the left ankle.

EXAMPLE OF SESSION:

Prep: Rebound Jumps, lateral pogos, ankle inversion/eversion ISO

A1 Cossack Squat Holds

A2 Single Leg calf raise 

B1 Heavy Split Squats

C1 Goblet Squat Holds 

C2 Single Leg Calf raise variation

Running 

A1 20m Sprints 

A2 10m shuttles (focusing on quick 180º turns)

B1 20m Sprint to hard deceleration/ Stop

C1 90º Turns 

D1 Curvilinear Running

Stepping off the right leg was a much smoother affair, with a two step deceleration, aggressive shin angles, and a hard push off the right foot to initiate acceleration out of the 90º turn

Stepping off the left leg was much less efficient, with slower entry speeds, three step deceleration, and poor shin angles during the exit of the 90º turn.

PHASE 3: Full speed movements and high intensity training 

After 8 weeks, Laurence had made significant gains in mobility, strength symmetry between both legs, and dynamic control. However, he still experienced occasional soreness or discomfort with unplanned motions like cutting or landing from a jump. So over the next 4 weeks, we continued to target his ankle’s range of motion, and strengthen its ability to invert and evert, slowly progress the intensity and complexity of exercises. Small jumps and hops became bounding and beginning curved running added multidirectional demands. We also introduced sport-specific drills, like change of direction running and place kicking to fully expose his ankle in the contexts of competition.

Improved ankle mobility helped improve Laurence's efficiency during dynamic movements.

EXAMPLE OF SESSION:

Prep: Banded ankle inversion and reversion holds

A1 Vertical Jumps 

A2 Lateral Hurdle Jumps 

B1 Barbell Back Squat 

B2 DB RDL 

Running

A1 20m Acceleration to Hard Stop 

A2 20m acceleration to 180º Turns (progressing to reactive 180º turns)

B1 Back pedal to forward acceleration 

B2 90º Turns

C1 Slalom Sprints 

END STAGE: Successful Rehabilitation and Full confidence

By 12 weeks into the program, Laurence's strength, mobility and confidence had returned to pre-injury levels. He was now squatting with perfect form to depth, comfortably completing lateral plyometric patterns, and sprinting at high speeds with no lingering pain or compensation. Most importantly, he felt fully confident landing and cutting without thinking about his ankle during intense on-field testing. His work with the training specialists at FORM Athletic provided the structured guidance, gradual overload, and objective feedback crucial to his full recovery from a significant ankle injury. Through diligent rehabilitation, Laurence was able to get back to his sport ready to perform at his best.

Two step deceleration, aggressive shin angles and a hard push off the left foot to initiate acceleration out of the 90º turn.

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