This is a protocol I have used for a player that had a screw fixation of the navicular. The timeline was outlined by the surgeon and I have filled in some of the key milestones and treatment objectives without going into to the day by day scheduling detail.


0-2 weeks


Relative rest

Game ready – ice and compression every 2-3 hours

Elevate as much as possible

Mobilise non-weight bearing with 2 elbow crutches

Exogen 20 mins twice daily

Hyperbaric chamber 30-60 mins twice daily

Soft tissue release lower limb

Appointment with nutritionist – slight calorie reduction due to decreased exercises, bone healing nutrients in diet.

Appointment with sports psych – mental emotional demands of being out injured


2-4 weeks


Reduction of dressings to double tubigrip at 2 weeks post-op with trimming of sutures

Ankle/midfoot range of motion exercises to commence

Continue to mobilise non-weight bearing

Exogen 20 mins twice daily

Hyperbaric chamber 30 mins twice daily

Pool work to commence when stitches removed and wound clean and dry – NWB – swimming with pool bouy, arm fin work, aqua jog

Upper body fitness – seated boxing, arm bike to progress to upper body weights where no loading of the foot occurs.


4-6 weeks


Commence compex and theraband work

PWB for 2 weeks

Continue pool work PWB –pool jogging / power walk progressed to swimming,

Light bike work building up to 20 mins daily

Continue upper body fitness and weights

Commence walking in alter G gravity treadmill preferably in hypoxic chamber

Outpatient appointment to see Surgeon at 6 weeks post-operatively with x ray

No non-steroidal anti-inflammatories to be used until bony union has been confirmed


6 to 12 weeks


Commence proprioception work progressing static to dynamic

Reduce upper body fitness and weights and pool work

Progress bike fitness work to intervals and Tabata, progress this to X trainer fitness work

Progressive weight bearing in the alter G with the aim to be running at 12weeks as long as surgeon happy

Progressive gym strengthening lower limbs – calf, quads, hams, glutes

Low level controlled environment functional loading

12 week outpatient appointment with CT scan


12 to 16 weeks


Functional court rehab and fitness work with fitness coach

Progressive gym strengthening upper and lower body

Continued bike fitness work


16 weeks


Gradual return in to full training – manipulating session length and complexity