Ankle sprain recovery: When can I play again?

• by Dr. Dev Mishra , Sep 24, 2020

People are coming into my clinical office again with ankle sprains, and this makes me happy. No, I’m not happy because they’re hurt, but I am happy because it means that folks are slowly finding a way to safely navigate our COVID restrictions and get back to sports.

An ankle sprain is an injury that’s typically brushed off as a minor inconvenience by the athlete. Most athletes will try to power through and keep playing. But this is a classic injury where early proper management will speed recovery and reduce a chance for a re-injury. Conversely, ignoring it can lead to more severe sprains and chronic problems

Treating the Injury

The treatment phase involves healing of the injured part. For an ankle sprain, this may involve a brace, sometimes crutches, and typically “RICE”: rest, ice, compression, and elevation. Ankle sprains are classified by physicians in “grades”, ranging from Grade 1 (mild) to Grade 3 (severe, with a complete ligament tear).

Rehabilitating the Injury

Once the treatment for the injury has started, the next phase of recovery begins. Self-directed exercises (trace the alphabet with your foot, no running, no jumping) for a week or two can be adequate for mild injuries. But for Grade 2 or 3 injuries I’ll involve referral to a qualified physical therapist or working with your athletic trainer. The physical therapist and athletic trainer are highly trained in techniques to restore function of the injured ankle, develop a plan for sport-specific training, or suggest equipment modification such as bracing. For many injuries we’ve learned over the years that early involvement by an athletic trainer or physical therapist speeds up return to play.

For guidelines and best practices for WHEN AND IF your local authorities have deemed it safe to return to the play, check out U.S. Soccer's PLAY ON home page HERE.

Conditioning the Injured Athlete for Return to Play

Here’s the part that can take some time, often much longer than you initially realize. Let’s say you’ve had a significant ankle sprain. You were treated in a brace for 2-4 weeks, and then you started getting some movement skills back for another 2-4 weeks. Now we’re up to 4-8 weeks from the time of your injury, and you know what you haven’t been doing- practicing or playing sports. Getting yourself fit will take a few more weeks (or even months, if you’ve been out a long time). In this phase we will usually rely on the trainer to start sport specific conditioning drills designed to safely return you to play.

Putting it All Together: How Long Until You Can Play Again?

I’ve broken the process into “phases” above, but the reality is that there’s a lot of overlap between the phases. For example, treatment and rehabilitation will be going on at the same time and will overlap, and rehabilitation and conditioning will also overlap. Additionally, each person responds differently to injury and healing. So each situation can vary quite a bit with the specifics of your injury, but here are some very rough guides based on real world experience from my orthopedic practice.

“Mild” or Grade 1 ankle sprain:

Brace or Ace wrap for 3-5 days
Return to play with ankle brace 1-2 weeks

“Moderate” or Grade 2 ankle sprain:

Brace 2 weeks
Rehab and conditioning 2 weeks
Full return to training 4-5 weeks after injury

“Severe” or Grade 3 ankle sprain:

Boot or brace 3 weeks
Rehab and conditioning 4-6 weeks
Full return to training 7-9 weeks after injury
“High Ankle” or syndesmosis sprain (highly variable return times):
Boot or cast 3 weeks, possibly crutches as well
Rehab and conditioning 6-12 weeks
Full return to training 9-15 weeks after injury

Key Points:

• Recovery and return to play after ankle sprains will vary depending on the severity of the injury, and the injured athlete’s unique healing response.

• Sport specific reconditioning after an ankle sprain often takes much longer than you think.

• For the common Grade 1 sprain, I typically see return to play with a brace at 1-2 weeks after injury.

• For the common Grade 2 sprain, I typically see return to play with a brace at 4-5 weeks after injury.

Dr. Dev Mishra is in private practice at the Institute for Joint Restoration in Menlo Park, California, and Medical Director of Apeiron Life. He is the creator of the SidelineSportsDoc.com online injury management course and the Good to Go injury assessment App for coaches, managers, parents and players. Mishra writes about injury recognition and management at SidelineSportsDoc.com blog, where this article originally appeared.