Return to Barre Three Weeks After a Lateral Ankle Sprain
A 42-year-old client, Dana, returns to your open-level barre class three weeks after a grade 2 lateral ankle sprain. Her physiotherapist cleared her for low-impact strengthening but not for jumping, running, or end-range pivoting. In class she reports the ankle still swells by the end of a workday and feels unstable when she stands on one leg. The room is full: 12 participants, one instructor, fixed barre, mats, light dumbbells, and mini-bands; no assistant. The planned 50-minute sequence includes relevés in parallel and turned-out first position, single-leg balances at the barre, lateral band walks, and a 90-second jump series. Dana arrives early and says she wants to do everything except the jumps because she has a wedding in five weeks. She has not brought an ankle brace.
1. Before Dana enters the room, what screening and decision steps do you take, and which components of the planned class do you modify or omit? Give the exact substitutes you would use.
Read the worked answer
Screen first, then substitute by load, range, and speed. I would ask Dana three questions before the warm-up: pain now and at worst in the last 24 hours (0–10), whether the ankle is more swollen than yesterday, and whether she can stand on that leg for 10 seconds with fingertips on the barre without the ankle rolling. I would watch her walk and do five slow bilateral heel raises. If pain is ≤3/10, swelling is stable, and the heel raise is controlled, she can stay for a modified class; if not, I would encourage her to observe or do seated upper-body work and contact her physiotherapist.
Modify or omit:
- Omit the 90-second jump series entirely; replace it with slow bilateral calf isometrics and seated toe-spreading drills.
- Replace turned-out first-position relevés with parallel, small-range heel raises with fingertips on the barre, 3 seconds up, 1-second hold, 3 seconds down.
- Replace single-leg balances with double-leg standing weight shifts or single-leg stance with fingertip support and a fixed gaze, no turned-out leg.
- Omit lateral band walks for now: a band around the ankles adds inversion/eversion load and quick lateral direction changes, which are poorly tolerated at three weeks.
- Keep upper-body and seated mat work as planned.
I would tell Dana the goal is to finish with no increase in swelling and no sharp pain, not to get through the class. The wedding deadline is understandable but does not change tissue healing.
2. During single-leg balance she reports sharp lateral ankle pain at 5/10 and you see her ankle roll inward. What do you do in the moment, what do you say, and what follow-up do you document?
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Stop the set, not the class. I would say, 'Sharp pain is a stop signal. Let's take that leg down and check it.' I would have her sit, remove the mini-band if present, compare swelling to the other ankle, and ask her to move the ankle actively through a pain-free range. I would not poke, stretch, or test the ligament. If pain settles quickly and she can bear weight normally, I would offer seated ankle range-of-motion and upper-body work only. If pain remains above 3/10, swelling increases, or she cannot bear weight, I would advise her to contact her physiotherapist and stop weight-bearing exercise for the day.
Documentation: time, exercise, pain score and location, what I observed (ankle rolling inward), immediate action, whether she could bear weight, advice given, and that her physiotherapist was contacted. I would complete an incident note and tell the studio owner. I would not label it a re-sprain; that is a diagnosis.
3. Dana asks when she can return to jumps and deep relevés. How do you answer without overpromising or practicing outside your scope?
Read the worked answer
I would separate the calendar from the criteria. 'Five weeks may be enough, but I can't promise it. The physiotherapist decides return to jumping; my job is to prepare you without a setback.' I would describe general readiness markers: no increase in swelling after class, pain-free single-leg stance with eyes open and closed, equal-quality heel raises, and no giving-way episodes. I would ask her to get written clearance for plyometrics and end-range relevés. If she pushes for a date, I would say the safe answer is not until the criteria are met, and that a five-week wedding is a reason not to rush. I would give her a written modified plan and a symptom log.