Ankle Sprain: When can I play again?

By Dev K. Mishra, M.D.

There's never a good time to be injured. As we come up to the end of many winter sports, players often have their eyes on championships or important tournaments. When an injury happens one of the most important questions the young athlete wants to know is “when can I play again?”

Usually their point of reference is the newsfeed on some professional athlete’s injury, and the answer from the news media is almost always “2-3 weeks.” The reality, however, is that full recovery as I outline below can often take much longer than that. Let me outline the general phases for injury recovery, and finish with some rough timelines for return to play after ankle sprains.

Treating the Injury

The treatment phase involves the 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 complete ligament tear).

Rehabilitating the Injury

Once the treatment for the injury has started, the next phase of recovery begins. This will often 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.

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 K. Mishra, a Clinical Assistant Professor of orthopedic surgery at Stanford University, is the creator of the SidelineSportsDoc.com online injury-recognition course, now a requirement for US Club Soccer coaches and staff members. Mishra writes about injury management at SidelineSportsDoc.com Blog, where this article first appeared.)