Return-to-Play After Ankle Sprain
A 19-year-old recreational basketball player sustained a lateral ankle inversion sprain 12 days ago. There was no fracture on X-ray. He still has mild swelling over the lateral malleolus, can bear weight fully, and has 5 degrees less dorsiflexion on the injured side than the uninjured side. Single-leg hop for distance is 70 percent of the uninjured side, and he reports pain of 3 of 10 when landing on one leg. He wants to play in a game this weekend and asks whether he can tape the ankle and play limited minutes. He has completed no balance or strengthening work so far.
1. Assess readiness to return to sport using the information provided, and state whether limited minutes with taping is an acceptable plan.
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Taping and limited minutes do not make an athlete ready; they are adjuncts once readiness criteria are met. The data here indicate he is not ready.
Key findings:
- Residual swelling and a 5-degree dorsiflexion deficit indicate the joint is still recovering and that landing mechanics will be altered.
- Single-leg hop at 70 percent of the uninjured side is well below the commonly used benchmark of about 90 percent for limb symmetry before return to sport.
- Pain of 3 of 10 on single-leg landing is a clear stop signal. Pain-free, confident landing is a basic criterion, not a bonus.
- No balance or strengthening work has been done, so proprioceptive and peroneal deficits have not been addressed.
Limited minutes with taping would expose a deconditioned joint to game-speed cutting and landing. The defensible answer is no game this weekend; begin a structured rehabilitation progression and re-test in 1-2 weeks, using the same hop and dorsiflexion measures to track progress.
2. Outline the rehabilitation progression you would use over the next two weeks and the criteria you would require before clearing him.
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The progression should move from restoring range of motion and swelling control, to strength and balance, to running and cutting, then to sport-specific contact.
Days 1-4: Elevation and compression as needed, ankle range-of-motion drills, pain-free calf stretching, and isometric peroneal and calf work. Goal: restore dorsiflexion to within 1-2 degrees of the other side.
Days 5-9: Progressive resistance for the calf and peroneals, single-leg balance on firm then unstable surfaces, and double-leg to single-leg hopping with attention to quiet landings. Keep pain at or below 2 of 10 during and after.
Days 10-14: Straight-line jogging, then lateral shuffles, then controlled cutting and single-leg hop for distance. Re-test hop symmetry.
Clearance criteria: No swelling, dorsiflexion within 1-2 degrees, single-leg hop at 90 percent or more of the uninjured side, pain-free landing, and completion of at least two full practice sessions at game intensity without symptoms. Taping can then be used as a precaution, not as a substitute for these criteria.