Return-to-Play Judgement After Ankle Sprain
A 19-year-old basketball player sustains a lateral ankle sprain during a landing. Nine days later she reports mild pain of 2 out of 10 at rest, no swelling visible, full weight-bearing without limp, and can hop on the affected leg 20 times without pain. However, single-leg balance with eyes closed is held for 8 seconds on the injured side versus 25 seconds on the other, and she is hesitant to change direction at speed. She has a playoff game in four days and asks to play. The coach wants her available.
1. Assess her readiness using the information given, and identify which findings carry the most weight.
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Symptoms and simple function look reassuring: low resting pain, no visible swelling, normal gait, and pain-free hopping suggest the acute tissue irritation has largely settled.
The findings that carry most weight are the ones that predict reinjury risk rather than the ones that feel reassuring. The large side-to-side deficit in single-leg balance (8 versus 25 seconds) indicates impaired proprioceptive and neuromuscular control, which is a recognised risk factor for recurrent sprains. Her hesitation on rapid change of direction reflects the same deficit under sport-specific conditions. Basketball demands repeated cutting, landing, and contact, so these are exactly the situations where the deficit would be exposed.
Conclusion: she is not ready for unrestricted playoff play. Pain-free hopping is necessary but not sufficient, and the balance and directional-control deficits are the deciding evidence.
2. The coach pressures you to clear her. Propose a compromise and explain how you would justify it.
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A reasonable compromise is restricted participation with a clear progression gate, not an all-or-nothing clearance.
Proposal: use the four days for targeted balance and proprioceptive work plus progressive change-of-direction drills, and set an explicit criterion such as balance within a small margin of the uninjured side and confident, pain-free cutting. If she meets it, allow limited minutes with taping or bracing and a warm-up, and remove her if she shows hesitation, pain, or giving-way. If she does not meet it, she does not play.
Justification to the coach: the restriction is not caution for its own sake. The balance deficit is measurable and modifiable within days, so the gate gives her a realistic route to playing while reducing the chance of a recurrence that would cost far more of the season than one game. Framing it as a short, testable pathway is more persuasive than a flat refusal.