What is the recommended timeline for returning to sports after an ankle sprain?

Return to Sports After Ankle Sprain

For most ankle sprains, athletes can return to full sports participation within 3-4 weeks for simple distortions and 6-8 weeks for partial or complete ligament ruptures, provided they complete supervised exercise therapy focusing on proprioception, strength, coordination, and sport-specific function. 1

Timeline Based on Injury Severity

The British Journal of Sports Medicine provides specific return-to-sport timelines that should guide your decision-making 1:

Grade I Ankle Sprain (Simple Distortion)

• 3-4 weeks: Return to full sports depending on task requirements 1
• This assumes mostly sitting work initially with phased rehabilitation focusing on sport-specific tasks 1
• Athletes should not exceed 10 kg of lifting during the initial 2-week period 1

Grade II/III Ankle Sprain (Partial or Complete Ligament Rupture)

• 6-8 weeks: Return to full sports depending on task requirements and physiotherapy results 1
• Initial 3-6 weeks should involve mostly sitting work with limited standing/walking on uneven surfaces 1
• Progressive weight-bearing should be initiated as tolerated 2

Post-Surgical Cases

• 12-16 weeks: Return to physically demanding sports 1
• Non-weight-bearing cast and crutches for first 2 weeks 1
• Weight-bearing as tolerated from weeks 3-6 1
• Cast replaced by brace after 6 weeks 1

Critical Treatment Components That Accelerate Return

Supervised exercise therapy is superior to unsupervised training and leads to faster return to sport 1. The evidence strongly supports immediate functional treatment over immobilization, which can reduce return-to-sport time by approximately 5 days 1.

Essential Rehabilitation Elements

• Proprioception training: Addresses central nervous system disturbances that occur above the spinal reflex level 1
• Strength training: Targets peroneal muscle response time deficits and eversion muscle weakness 1
• Coordination exercises: Restores motor-unit function that becomes insufficient after ankle sprains 1
• Sport-specific functional drills: Must be incorporated before full return 1

Bracing Strategy

Use a semi-rigid or lace-up ankle brace rather than elastic bandage, as this accelerates return to sport by approximately 4.2 days 1. The brace should be worn during the initial return-to-sport phase and then phased out over time 1.

Return-to-Sport Assessment Framework (PAASS)

Before clearing an athlete for full return, assess these five domains systematically 3:

1. Pain Assessment

• Pain during sport participation 3
• Pain levels over the last 24 hours 3

2. Ankle Impairments

• Range of motion (use dorsiflexion lunge test) 3, 4
• Muscle strength, endurance, and power 3

3. Athlete Perception

• Perceived ankle confidence and stability 3
• Psychological readiness to return 3, 4

4. Sensorimotor Control

• Proprioception testing 3
• Dynamic postural control/balance (use star excursion balance test) 3, 4

5. Sport/Functional Performance

• Hopping, jumping, and agility tests (agility T-test, vertical jump test) 3, 4
• Sport-specific drills 3
• Ability to complete a full training session 3

Common Pitfalls to Avoid

Never immobilize for more than 10 days, as prolonged immobilization significantly delays recovery and leads to worse functional outcomes compared to immediate functional treatment 1, 2. Functional treatment shows 1.86 times better return-to-sport rates than immobilization 1.

Do not use ultrasound, laser therapy, or electrotherapy, as these modalities have no proven benefit for acute ankle injuries 1, 2.

Avoid premature return without adequate rehabilitation, as this substantially increases recurrence risk 2. Exercise therapy reduces recurrence by 62% (RR 0.38 for athletes) 1, making it essential rather than optional.

Do not rely solely on time-based criteria—functional assessment using the PAASS framework is critical 3. Self-reported functional measures combined with ambulation status explain approximately one-third of the variance in return-to-sport timing 5.

Recurrence Prevention Strategy

Once the athlete returns to sport, implement these evidence-based prevention measures:

• Continue prophylactic bracing or taping during sports participation, as this reduces recurrent injury risk by 47% (RR 0.53) 1
• Maintain exercise therapy integrated into regular training activities, particularly balance and coordination exercises 1
• Recognize emotional aspects of the injury and involve appropriate support when needed 1

The key distinction is that exercise therapy prevents recurrence in athletes with previous ankle sprains but lacks evidence for preventing first-time injuries 1.