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Boot Rehab and Protocols for Cheer

Boot Rehab and Protocols for Cheer
Written By Brian Finn ATC, CSCS
Purpose behind the Boot:
Rehabilitative boots are a form of lower extremity bracing.  The job of the boot is to restrict the movement of the joint.  The movement restriction allows the injured structures to heal and prevents jostling and unnecessary stress.  The boot also serves as a mental reminder to the athlete to take it easy on the injured limb and be conscious of the injury while going about daily activities.
Boot Removal:
While these structures are healing, atrophy (muscle weakening) takes place in the muscles around the injured area.  Range of motion begins to diminish as a result of the immobilization of the lower leg.  These muscles and range of motion need to be retrained and strengthened after boot use to help prevent a recurring injury.
If the ankle/lower leg is not strengthened after boot removal the muscles will not fire quickly or have the strength to sustain the repetitive trauma that occurs during repeated impact from jumping and landing.  A methodical application of exercise should be used to integrate the athlete back into performance.  When the boot is removed the athlete is not ready to compete and should be placed on restricted participation.  The athlete is more likely to reinjure the same area again if not properly progressed through rehab.
Risks of practicing/competing with a boot:
Athletes with a boot can pose a risk during activities such as stunting.  The brace is a hard splint that will not flex.  The athlete wearing the boot has extremely limited mobility which can increase the likelihood of injury to the athlete in the boot or the athletes being supported by them.   There are two particular high risk matters to address:
If an athlete wearing a boot were to lose her balance while stunting and fell awkwardly the splint can act as a fulcrum causing a fracture to occur in the lower leg.  
If another player were to fall and make contact with the boot it can also injure the falling athlete.    
Below is a progression for a return to play protocol for an ankle injury after boot removal.  Progression is based off of pain and symptoms.  This is not standardized for all athletes.
Ankle range of motion and strengthening exercises 
Ankle Biomechanics and Balance exercises
Advance ankle strengthening: bands and body weight
Introduction of sport specific movements
Ankle Proprioception: double and single leg
*Involved in team activities: can mark and stunt with supportive taping (No impact/Jumping)*
Continued ankle strengthening and proprioception work
Jumping and landing biomechanics
Reintroduction of impact drills
Advanced Sports Specific Training
Modified Tumbling 
Full return to Play