Return to Sport Criteria After Ankle Sprains

4 min read. Posted in Ankle/foot
Written by Physio Network info

A recent study aimed to determine a set of return to sport criteria for individuals following lateral ankle sprains.

We reviewed this study in the latest issue of our Research Reviews – where industry experts break down the most recent and clinically relevant studies, for immediate application in the clinic.

What you’ll read below is a snippet from the review.

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Back to the study!


STUDY TITLE: Return to sport decisions after an acute lateral ankle sprain injury: introducing the PAASS framework – Smith et al (2021)

Study reviewed by Dr Teddy Willsey in the August 2021 issue of the Research Reviews


Key points from the study

  • Less than 50% of individuals seek medical treatment following lateral ankle sprains.
  • Up to one-third of individuals go on to experience chronic ankle instability after ankle sprains.
  • This paper provides a framework for clinicians to use to better determine athlete readiness for return to sport.


Background and Objective

Lateral ankle sprains are the most common injury seen in sport. Although the majority of ankle sprains initially seem non-serious and do not limit sport participation, up to one third of individuals who suffer an ankle sprain go on to experience symptoms of chronic ankle instability over the next 12 months.

The goal of this paper was to develop a return to sport criteria for lateral ankle sprains to help inform clinicians on how to make return to play recommendations.



The authors of this paper created an evidence based multidisciplinary international consensus by interviewing 155 sports rehabilitation experts who routinely treat lateral ankle sprains and advise on return to play. Three rounds of online surveys were sent out over a 14-month period. The final result was 16 agreed upon items to include in the return to sport decision-making process.



16 specific items were identified by the panelists, which were used to form the ‘PAASS’ framework: an acronym standing for pain, ankle impairment, athlete perception, sensorimotor control, and sport/functional performance. See Figure 1 below for details.




This study is limited by the generalizability of items included in the consensus. Furthermore, the paper does not inform clinicians on how to specifically assess the consensus items.


Clinical Implications

The results of this study point toward a battery of items clinicians should take into account when making return to sport decisions. As with most pathologies and diagnoses, there is never just one or two perfect tests that can cover all the variables worth considering.

This current study, along with other similar research, illuminates the importance of including psychological readiness testing in addition to physical measurements in the return to sport process. Clinicians should consider using psychometric analysis screening in order to identify athletes with potentially maladaptive psychological responses to injury.

Finally, it has become clear that clinicians would be prudent to educate their athletes on the potential benefit of holding out a bit longer before returning to sport. It appears that the culture of quick returns following ankle injuries may be contributing to high rates of chronic ankle instability.



Here’s what this review looks like in our August issue.


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Here are the 11 other studies we’ve reviewed in our August issue just published:

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  • Patellofemoral Pain Prevention in Runners
  • Treatment of Acromioclavicular Joint Injuries
  • Exercise and Axial Spondyloarthritis
  • Surgical vs Non-Surgical Treatment of Achilles Ruptures
  • Treatment of Rotator Cuff Disorders
  • Impact of Patellar Tendinopathy on Strength/Jumps
  • Diagnosis of Hip-Related Pain
  • Timed Up From Floor Test for Older Adults
  • Best Practice Management of Knee Osteoarthritis
  • Orofacial Musculoskeletal Pain

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