When can an athlete be cleared for sports after a sprain?

Return to Sport After Ankle Sprain

Athletes can be cleared to return to sport after an ankle sprain when they meet specific criteria across five domains: pain resolution, normal ankle function, psychological readiness, restored sensorimotor control, and successful completion of sport-specific performance testing—typically achieved through a progressive, stepwise rehabilitation protocol over 8-14 days for uncomplicated sprains. 1

Stepwise Return-to-Sport Protocol

The return to sport process should follow a graduated progression, with each stage requiring at least 24 hours and advancement only if the athlete remains asymptomatic 2:

Stage 1: Complete Rest

• No physical activity until asymptomatic at rest 2
• Focus on pain and swelling management 1

Stage 2: Light Aerobic Activity

• Walking, swimming, or stationary cycling at 70% maximum heart rate 2
• No resistance exercises or sport-specific movements 2

Stage 3: Sport-Specific Exercise

• Sport-related drills without full intensity 2
• Begin addressing ankle-specific impairments 1

Stage 4: Non-Contact Training Drills

• More complex drills with progressive loading 2
• Incorporate agility and change-of-direction activities 1

Stage 5: Full Contact Practice

• Complete training session participation 1
• Medical clearance required before advancing 2

Stage 6: Return to Competition

• Unrestricted game play 2

PAASS Framework for Clearance Assessment

The consensus-based PAASS framework identifies five critical domains that must be assessed before clearing an athlete 1:

Pain Assessment

• Pain during sport participation: Must be minimal or absent 1
• Pain over the last 24 hours: Should not interfere with function 1
• Note: 65.1% of athletes still report pain deficits at typical return-to-sport timeframes, suggesting many return prematurely 3

Ankle Impairments

• Range of motion: Must achieve 95% knee flexion ROM and full extension (adapted from ACL guidelines, similar principles apply) 2
• Muscle strength, endurance, and power: Should demonstrate symmetry between limbs 1
• No effusion: Trace effusion at most 2

Athlete Perception

• Perceived ankle confidence/reassurance: Athlete must feel stable and confident 1
• Psychological readiness: Critical for safe return, often overlooked 1
• Global rating of function: 86.2% of athletes report functional deficits at typical return timeframes 3

Sensorimotor Control

• Proprioception testing: Must demonstrate restored position sense 1
• Dynamic postural control/balance: Essential for preventing reinjury 1
• Balance testing shows impairment after injury and should be normalized before clearance 2

Sport/Functional Performance

• Hopping and jumping tests: Should achieve >90% limb symmetry index 2, 1
• Agility testing: Must complete sport-specific cutting and pivoting movements 1
• Full training session: Ability to complete without symptom exacerbation 1

Timeline Considerations

Typical return-to-sport occurs around 8 days post-injury 3, though this varies significantly:

• Functional support (taping/bracing) allows return approximately 4.6 days sooner than immobilization 4
• Median clearance time varies by medical facility: urgent care (7 days), hospital (9 days), primary care (10 days), team physician (12 days), neurologist (13 days) 5
• Athletes should not return the same day as injury under any circumstances 2

Critical Pitfalls to Avoid

Premature return is common and dangerous: Research shows that despite self-perceived improvement, most athletes return with persistent deficits in pain (65.1%), function (86.2%), and disability (35.8%) 3. This creates substantial reinjury risk.

Key mistakes to avoid:

• Relying solely on time-based criteria without functional testing 1
• Assuming absence of pain at rest means readiness for sport 1
• Neglecting psychological readiness assessment 1
• Failing to test sport-specific movements under game-like conditions 1
• Not incorporating both taping/bracing AND exercise therapy for recurrent sprain prevention 4

Prevention of Recurrent Injury

Functional support through taping or bracing is essential for athletes returning after ankle sprain, particularly for preventing recurrent injuries (relative risk reduction of 0.70,95% CI 0.57-0.79) 4. However, taping alone without exercise therapy is insufficient—combined approaches show the best outcomes 4.

Medical Clearance Authority

The team physician or qualified healthcare provider must provide final clearance, with documentation of all PAASS criteria being met 1, 5. Athletic trainers frequently serve as initial examiners (71.3% of cases) but medical doctors most commonly authorize final clearance (63.9%) 5.