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Ankle sprains and when to return to sport?

Lateral ankle sprains or rolled ankles are the most common injuries in sport and also a very common injury with the general public. Most individuals in their lifetime have experienced an ankle sprain; the severity of which, and potential recovery or return to sport timelines may vastly differ however.



So you’ve landed awkwardly in a game and hobbled off the field, what’s the next few days/weeks supposed to look like to get you back playing asap? In regards to immediate management POLICE (see muscle strains); then an appropriate gradual rehabilitation with manual and exercise therapy should be applied with consultation with your physiotherapist. A summary of your rehabilitation and how Our Physio can facilitate your return to sport ASAP include: POLICE and swelling management, restoring range of motion, balance, strength and any deficits in your movement or core stability that may have contributed to the cause of injury.


One of the biggest issues surrounding ankle sprains is individuals rushing back sport too early; or some continuing to play through 24hrs later at tournaments, 3 days later at training or week-to-week competition with ongoing swelling, stiffness and weakness following the initial injury. Such rapid return to sport timelines likely fail to provide adequate healing time. People whom have had an ankle sprain have a high probability of recurrent sprains and re-injury if not rehabilitated correctly, return to sport timeframes likely playing a large part. An estimated 40% of individuals who have their first ankle sprain can develop ongoing deficiencies or chronic ankle instability; effecting strength, balance and proprioception which may also lead to conditions such as post-traumatic osteoarthritis. Recent evidence [2] supports these beliefs with ankle sprain patients having increased ligamentous laxity, limitations in self-reported function, limited dorsiflexion range of motion, and impaired dynamic postural control on their injured limb/leg, relative to their uninvolved leg, when they were cleared to return to activity. The clearance occurred on average 12.7 ± 10.0 days following the injury. Given the rapid return to sport timelines and residual deficits still present, sporting ankle sprain injuries appear to be cleared to return too soon.


So when should you return to sport? How do you know if you’re ready?


The criteria for return to sport that should be considered are:

  • Pain and swelling (ie. reduced/ free of pain and swelling)

  • Range of motion (ie. full range)

  • Strength (ie. 90% of uninjured leg)

  • Static balance (ie. balance without pain, = balance to uninjured leg)

  • Dynamic balance (ie. = to uninjured leg)

  • Running (ie. nil pain, full/max effort sprint)

  • Sport-specific movements (eg. Hop test)

  • Self-reported outcomes (eg. individual’s confidence)


“ Based on the expert consensus obtained, practitioners should assess sport-specific movement when determining athlete readiness and return to sport following a lateral ankle sprain. Based on the partial agreement noted, practitioners should use a hop test to assess sport-specific movement. Self-reported function, strength, range of motion, and balance should also be assessed when determining athlete return to sport readiness following lateral ankle sprain.” [1]


Assessment and diagnosis for each individuals injury should always be conducted prior to developing a treatment plan with exercise prescription and appropriate progressions. Should you have any further questions or would like to discuss your ankle injury rehabilitation and when is the appropriate time to return to sport or activity with a physiotherapist, please contact Our Physio Central Coast (02) 4339 4475.


References

[1] Wikstrom, E. A., Mueller, C., & Cain, M. S. (2020). Lack of consensus on return-to-sport criteria following lateral ankle sprain: a systematic review of expert opinions. Journal of Sport Rehabilitation, 29(2), 231-237.

[2] McCann, R., Kosik, K., Terada, M., & Gribble, P. (2018). Residual impairments and activity limitations at return to play from a lateral ankle sprain. International Journal of Athletic Therapy and Training, 23(2), 83-88.


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