When can you return to sports following a lateral (inversion) ankle sprain? Use this framework

Research reviewed: Return to sport decisions after an acute lateral ankle sprain injury: introducing the PAASS framework—an international multidisciplinary consensus; Smith et al, BJSM 2021

Acute lateral (inversion) ankle sprains - when the ankle turns inwards (see pic below) are the most common injury in sports and have a high recurrence rate, even more so without proper rehabilitation and return to sport testing, with possibility for both short-term reinjury and chronic ankle instability. However, the guidelines on making those return to sport (RTS) decision can be murky.

Researchers in this paper sought to solve that problem by creating a multidisciplinary consensus and framework - termed the PAASS framework.

Methods

155 health professionals working globally in elite field or court sports were surveyed on different assessment items needed for proper return to sport (RTS). These assessment items were taken through three rounds of surveys (a “three-round Delphi survey approach”) and an item was deemed to be consensus if greater than 70% of the professionals agreed or disagreed.

Results

16 assessment items reached that consensus level and were synthesized into five different buckets, with 98% panelist agreement. The five domains were:

Pain (during the sport and over the last 24 hours)

Ankle impairments (mobility aka range of motion, muscle strength, endurance, and power)

Athlete perception (perceived confidence/reassurance in the ankle and stability; psychological readiness)

Sensorimotor control (proprioception, dynamic postural control and balance)

Sport/functional performance (jumping, hopping and agility; sport-specific drills; response during a full training session)

PAASS for short.

Interestingly, and contrary to popular belief, swelling of the ankle did not reach the consensus criteria. The underlying rationale was that swelling without pain or dysfunction was not enough to delay RTS, as long as functionality has been restored and impairments resolved.

Key takeaways

Returning to sport following an ankle sprain is a multi-variable process; a process that is well reflected in these PAASS guidelines, from pain to physical and mental impairments to control and functional sports performance.

These guidelines - which can include a variety of tests based on the healthcare provider, the specific sports and context of the patient - give a clear clinician driven direction on what is and isn’t important when evaluating the return to sport process for athletes following acute lateral ankle sprains.

Full article:

https://bjsm.bmj.com/content/bjsports/55/22/1270.full.pdf

Thank you for reading and thank you for your time.  If you need our help with injury recovery, fitness, and/or mindset coaching (we offer virtual & in-person avenues, including online programs) head over to the website.

Dr. Rajpal Brar, DPT has a doctorate in physical therapy from Northern Arizona University, and runs his own in-person and online sports medicine and performance business, 3CB Performance, in West LA and Valencia, CA and partners with Quantum Performance in which he further combines his movement expertise and fitness training background to rehab & train elite athletes. He also works at a hospital — giving him experience with patients in the immediate healthcare setting and neurological patients (post stroke, post brain injury) — and has been practicing for over 6+ years. Brar is additionally training at UCLA’s mindful awareness research center (MARC), has a background in multiple sports both playing and coaching and discusses sports injuries, fitness and performance his own YouTube Channel. You can follow him on Twitter at @3cbPerformance.