The ankle sprain is one of the most common sporting injuries that we’re presented with. Chances are you or someone you know has experienced one at some point in your life. The mechanism varies: landing on someone’s foot, coming down from a rebound, quick changes in direction. Ultimately, everyone ends up asking us the same question:
“When can I return to sport?!”
We know the severity of the sprain can directly influence when you can return to the sport you love. Not only this, but your history of ankle injuries and the physical nature of sport can all impact the time needed for rehabilitation.
Whilst these factors can give us an approximate ‘window’ of when you’ll likely be able to return – a specific injury timeline is often varied. Unfortunately, this leaves us physios with a very unsatisfying response to that question of: ‘it depends’.
No, that’s not just us covering our bases. Whether an acute ankle sprain, or a persistent ankle problem from years ago, the underlying concept on how we manage these presentations is very similar. Outside of an approximate window, a return to sport should be heavily dependent on a criteria-driven approach to rehab.
Let me explain…
In the past, there has been a great emphasis on rigid timelines that dictate the rehabilitation process. For example, at week 3 they should be able to complete a single leg calf raise and at week 5 they should be able to run. This packages the rehab process into a nice, easy bundle- which may be why it has been widely employed by many physios.
In recent times, there has been a shift to more criteria-based progressions in the rehabilitation of not only ankle sprains, but musculoskeletal conditions in general. This allows for the vast variability seen in people with musculoskeletal injuries. For example, it takes into account the severity of the specific injury as well as problems with other areas that may be contributing to their injury and rehabilitation progress.
However, it should be said that strict time frames in the rehabilitation process still have a place in injury management. We are aware that that healing times for a Grade 1 ankle sprain will be significantly less than a Grade 3 ankle sprain, and we absolutely need to tailor our rehabilitation to respect this healing process.
So bringing it back to our old friend the ankle sprain. We follow certain criteria incorporating functional milestones in order to determine whether or not one can progress to the next, more challenging activity.
Why is this important?
Imagine someone trying to get fit for the first time, has sprained their ankle a few times in the past, who can only run 2km before ankle pain stops them. Looking at them hop reveals they can barely get off the ground, and can only manage 10 hops before they start getting sore. This scenario could have been avoided by following criteria based progression in exercise, rather than beginning at a 2km run for an inexperienced individual.
For example – before running one should go through the following progressions:
- Double leg calf raise
- Single leg calf raise
- Double leg jumping
- Hopping greater than 40 times with good propulsion.
- Return to running
Running has a flight phase and so is essentially a series of hops with a lot of forward momentum. So if you are unable hop on the spot more than a few times, your chances of being able to run without issue are compromised. By using this series of checkpoints to ensure the individual is physically ready, it should give them much more confidence in their ability to run and ultimately reduce risk of further injury.
If you or someone you know still has that niggling ankle problem, get in touch with the experts at Thrive Physio Plus (you can book online here). We can ensure you are following the right steps in your rehabilitation program, and help you back to what you love a whole lot sooner.