Ankle sprains are extremely common in sports. In fact it’s estimated that ankle sprains account for around 30% of all sports related injuries (most are lateral ankle sprains).

Ankle sprains are common in athletes between the ages of 10-20 and involve different structures depending on the mechanism of injury, as well as the severity of the injury. Most acute sports ankle sprains need to be evaluated by a professional right away to rule out fractures or other conditions depending on the signs and symptoms.

Rather than talking about the injury mechanism itself and the structures are involved, I would like to specifically explain the management and physical therapy rehabilitation program of ankle sprains and return to sport after these type of injuries.

First off, a thorough evaluation of the ankle must take place after the injury and throughout the rehabilitation program. This is to monitor progression and avoid misdiagnosing injuries to other structures. In addition, these evaluations will help the physical therapist tailor the rehabilitation program according to the individual’s progression.

Rehabilitation time will depend on several factors but primarily on the severity of the injury sustained (depending on whether the sprain is classified as grade I, II or III). It can last from one week with grade I sprains to 16 weeks with grade III sprains.

The rehabilitation program is divided into three different stages according to the healing processes that take place with the body’s natural ability to recover.

The three stages are:

  1. Acute stage – the inflammatory stage itself that takes place right after the injury. Symptoms include – pain, swelling, redness and decrease in function.
  2. Subacute stage – the beginning of tissue repair with decreased signs of inflammation.
  3. Maturation stage – tissues become stronger although not completely normal due to scar formation. This stage can last more than a year.

Progression through these stages in rehabilitation will vary from one athlete to another and therefore signs and symptoms, as well as functional limitations should always be considered more carefully than the time since the injury. This way the physical therapist will be able to decide whether the athlete can progress to the next stage of rehabilitation safely or may even occasionally need to regress.

Regardless of rehabilitation progression the athlete must keep training his/her strength and endurance throughout the rehabilitation program.

A quick summary of the primary goals of each of the rehabilitation stages:

  1. Acute stage – protect the injured tissue from additional injuries, stimulate tissue healing, limit pain, swelling and spasm, and maintain function of the surrounding non-injured ankle tissues.
  2. Subacute stage – in this stage the goals of the first stage are maintained and additional goals are added – to restore motion and flexibility in the ankle, restore strength, endurance and neuromuscular control, restore balance, agility and coordination.
  3. Maturation stage – in this last stage of rehabilitation the goals from both earlier stages are maintained, with the addition of the goal of improving sport-specific skills. As this is the last stage of rehabilitation the athlete must regain/increase all sport specific skills that are needed in his/her sport. For example, this may include vertical jump drills for basketball players, varying in ground contact times, landing positions, weight held, surfaces used, single or bilateral leg use, increased fatigue etc, to resemble as close to real play time scenarios as possible.

Lastly, the ultimate goal of all stages of rehabilitation is to return the athlete to sport/play. This is appropriate only after the following goals are met:

  1. All movements are pain free.
  2. Ankle is not swollen, before or after activity.
  3. Full range of motion is restored/improved (specific to the athlete’s sport).
  4. Reestablished strength, endurance and power (specific to the athlete’s sport).
  5. Reestablished balance, agility and coordination  (specific to the athlete’s sport).
  6. Last but not least, the athlete is psychologically ready to return to activity (athlete’s readiness to return to sport).