Return to sport decisions after an acute lateral ankle sprain injury: introducing the PAASS framework - an international multidisciplinary consensus

Review written by Dr Teddy Willsey info

Key Points

  1. Less than 50% of individuals seek medical treatment following lateral ankle sprains.
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Lateral ankle sprains are the most common injury seen in sport (1). Up to 50% of individuals who sustain a lateral ankle sprain do not seek formal medical treatment, and over 70% of people with lateral ankle sprains return to sport in 3 days or less. 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 (2).

It has been suggested that recurrent lateral ankle sprains may lead to permanent alterations to joint structure and stability (3). It has been hypothesized that a widespread culture of early return to sport following ankle injuries may be contributing to high reported rates of chronic instability. 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.

Over 70% of people with lateral ankle sprains return to sport in 3 days or less.
This paper illuminates the importance of including psychological readiness testing in addition to physical measurements in the return to sport process.


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. The panel was comprised of physiotherapists, sports medicine physicians, and

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