SIMPLE TEST FOR RETURN TO PLAY AFTER ANKLE SPRAINS

By Dev K. Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • Ankle sprains can be surprisingly tricky to recover from; a number of these will have ongoing issues needing therapy
  • A simple way to test for readiness to return to play after an ankle injury is to have the athlete do a sideline functional test: jog, sprint, cut, pivot, jump. Successful completion of the test means they are comfortable, with normal speed and normal form. Pass the test= generally ok to return to play. Don’t pass the test= best to have physician evaluation, these ankles may need rehab.

The poor little ankle sprain just doesn’t seem to get its due as a significant injury. And to jump closeupbe sure, for most first-time sprains the ankle will heal and then allow the athlete to return successfully to play. But a surprisingly large number of these sprains will continue to bother the athlete even after a single sprain, more than a year after the original injury. What’s up with these? What do we do about them? And is there a way to predict who will have problems?

We often think of an ankle sprain as a fairly minor injury, one from which an injured athlete can return successfully to play in a matter of days or weeks. But a surprisingly large number of injured athletes will go on to have ongoing issues with the ankle months or even years after the original injury. The ligament injured in a sprain typically heals, but one underappreciated aspect associated with the injury is the loss of balance and loss of ability to do specific tasks such as jumping or cutting. There is a neurologic factor called “proprioception” which essentially refers to the joint’s ability to know where it is in space. This joint position sense can be lost with an ankle sprain and it often needs to be retrained. These are often the folks you’ll see wearing ankle braces months after their ankle sprain.

A recently published study in the American Journal of Sports Medicine studied athletes with first time ankle sprains and measured ankle instability and loss of function out to a year after the injury. They found that 40% of their patients had criteria that placed them in the chronic instability category- a number that I find remarkably high. The authors then correlated the tests they performed to see if any were predictive for the later development of ankle instability issues. They found that two types of jump tests were strongly predictive: a single-leg drop landing and a drop vertical jump. Inability to properly perform these tests at the 6-month time point predicted instability at 1 year.

Are there tests we can look at early after an injury that can assess readiness for return to play? Yes, I find that a simple sideline functional test is very helpful early in the injury recovery process. Let’s say that one of your players had an ankle sprain during competition and then rested for a week or two from training. I would then recommend that they try a simple functional progression consisting of:

  • Jog comfortably and with good form
  • Then sprint comfortably and with good form
  • Cut left and right with good speed and form
  • Pivot off the injured ankle successfully
  • And finally do a two leg jump with a stable landing

SideLineSportsDocThe entire test takes about a minute or two, max. You want to look for the athlete’s ability to progress the tasks and to do so without a limp, without pain, and with normal form. If they pass the test it’s generally ok to resume play. If not, it would be best to have physician evaluation, as these may be ankles in need of some rehab. Let’s give the ankle sprain some respect!