Return to Sport After Ankle Sprain
Athletes should return to sport based on objective functional criteria rather than time alone, though most can resume play within 12 weeks if they complete supervised rehabilitation and meet specific performance benchmarks. 1
Timeline by Injury Severity
The return-to-sport timeline depends critically on injury grade:
- Simple distortions (Grade 1): Full return within 3-4 weeks with supervised exercise therapy 2
- Partial or complete ligament ruptures (Grade 2-3): Full return within 6-8 weeks depending on physiotherapy results and sport demands 2
- Post-surgical cases: Return to physically demanding sports within 12-16 weeks 2
- Overall success rate: 60-90% of athletes resume sports at pre-injury level by 12 weeks 1
Mandatory Functional Criteria Before Clearance
Do not clear athletes based on time alone—they must demonstrate all of the following objective criteria: 1
Range of Motion
- Full or near-full ankle dorsiflexion must be restored, as limited dorsiflexion significantly increases reinjury risk 1
Neuromuscular Function
- Normalized peroneal muscle response time (delayed response increases instability risk) 1
- Adequate eversion muscle strength 2
Balance and Proprioception
- Dynamic postural control demonstrated on both stable and unstable surfaces 1
- Successful completion of proprioceptive testing 3
Functional Performance
- Ability to complete jumping and landing tasks (inability to do so within 2 weeks after first-time sprain predicts chronic instability) 1
- Successful completion of hopping, jumping, and agility tests 3
- Completion of sport-specific drills 2, 3
- Ability to complete a full training session 3
Psychological Readiness
- Athlete reports adequate confidence, perceived stability, and psychological readiness 3
Pain Assessment
- Minimal pain during sport participation and over the preceding 24 hours 3
Critical Rehabilitation Components
Supervised exercise therapy must begin immediately and continue for the full 4-6 week program—this is non-negotiable: 1
- Proprioception training addresses central nervous system disturbances 2
- Strength training targets peroneal muscle deficits and eversion weakness 2
- Coordination exercises restore motor-unit function 2
- Sport-specific functional drills must be incorporated before full return 2
- Manual joint mobilization combined with exercise therapy provides superior outcomes 2
Supervised therapy is superior to unsupervised training and reduces return-to-sport time by approximately 5 days compared to immobilization 2
Bracing Strategy
Use semi-rigid or lace-up ankle braces rather than elastic bandages: 1, 2
- Accelerates return to sport by approximately 4.2 days 2
- Should be worn during initial return-to-sport phase, then phased out gradually 2
- Continue prophylactic bracing during sports participation to reduce recurrent injury risk by 47% 2
Critical Pitfalls That Delay Recovery or Cause Reinjury
Premature Discontinuation of Rehabilitation
Stopping exercises once pain subsides dramatically increases reinjury risk—the full 4-6 week supervised program must be completed regardless of symptom improvement. 1 This is the most common error leading to chronic instability.
Excessive Immobilization
- Immobilization beyond 10 days significantly delays recovery and worsens functional outcomes 2
- Functional treatment shows 1.86 times better return-to-sport rates than immobilization 2
Time-Based Rather Than Criteria-Based Return
- Premature return without meeting functional criteria substantially increases recurrence risk (3-34% experience recurrent sprains at 1-4 year follow-up, 33-55% report ongoing instability) 1
- Young males in high-level sports face particularly elevated risk 1
Incomplete Rehabilitation Leading to Chronic Instability
- Up to 40% develop chronic ankle instability despite initial treatment, usually from incomplete rehabilitation 1
- Athletes with persistent deficits in dynamic postural control, altered hip kinematics, or mechanical instability at 8 weeks are at high risk for chronic problems 1
Ineffective Modalities
Do not waste time on ultrasound, laser therapy, or electrotherapy—these have no proven benefit for acute ankle injuries. 2
Optimal Clinical Assessment Timing
- Initial assessment: Clinical examination is most accurate 4-5 days post-injury (84% sensitivity, 96% specificity for ligament rupture detection) 1
- Mid-rehabilitation checkpoint: Reassess ankle strength and stability at 4-6 weeks 1
- Pre-return assessment: Athletes with Ankle-GO score <8 points at 2 months are unlikely to return to pre-injury level 4