Returning to Sport following an Ankle Sprain
By Hannah Violet, Senior Physiotherapist
This blog is a little different to my previous blogs in that it is a review of the latest literature. If you would like to receive more posts like these, please use the sign up box above. Thank you very much for reading.
This is a continuation from my previous blog post "Ankle Instability - when a sprain is more than a sprain.."
Take Away Points
BACKGROUND & OBJECTIVE
The most common injury seen in sport is lateral ankle sprains (1). Of the individuals that sustain a lateral ankle sprain, 50% do not seek a formal medical assessment, and 70% return to playing sport within 3 days. Most ankle sprains don't seem serious initially as they do not limit a person's ability to participate in sport, however up to 30% of people go on to experience chronic ankle instability over the following 12 months! (2)
Repeated ankle sprains can lead to permanent alterations to the joints stability and structure (3). It is believed that by returning to sport early following an ankle sprain, individuals are contributing to the high rates of chronic instability.
This paper's aim was to develop a return to sport guideline for individuals following a lateral ankle sprain, and to assist clinicians on making recommendations for return to play
"Over 70% of people with lateral ankle sprains return to sport in 3 days or less which may increase the risk of chronic ankle instability"
155 sports rehabilitation experts who routinely treat lateral ankle sprains and advised on return to sport were interviewed by Physiotherapists, Sports medicine physicians and athletic trainers.
Three surveys were sent out over a 14-month period with the initial survey having 35 questions and was gradually narrowed down in order to establish a 70% agreement across the panel. The final result was 16 agreed items to include in the return to sport decision making process.
After three surveys, 16 specific items were identified by the interviewers to assist in the return to sport decision making. This helped to create the PAASS framework - an acronym for Pain, Ankle Impairment, Athlete Perception, Sensorimotor Control and Sport/Functional Performance.
This framework is outlined in detail in the image below. A range of clinical tests can be used to assess each item.
This study provides clinicians with a range of tools that they can refer to when assessing a patients ability upon returning to sport.
As identified in other musculoskeletal pathologies, it is important to assess the individuals psychological readiness as well as their physical readiness prior to returning to sport. This has also been supported in other research (4). Having psychologically maladaptive behaviours in response to an injury may influence a poor outcome when returning to sport.
Smith et al (2021) Return to sport decisions after an acute lateral ankle sprain injury: introducing the PAASS framework—an international multidisciplinary consensus
Epidemiology of Ankle Sprains and Chronic Ankle Instability.
Clinical assessment of acute lateral ankle sprain injuries (ROAST): 2019 consensus statement and recommendations of the International Ankle Consortium.
Understanding and treating lateral ankle sprains and their consequences: a constraints-based approach.
Psychometric Analysis and Effectiveness of the Psychological Readiness of Injured Athlete to Return to Sport (PRIA-RS) Questionnaire on Injured Soccer Players.
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