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Part of Ankle sprain

Ankle sprain return to sport: the criteria that matter

Ankle sprain return to sport is judged on what the ankle can do rather than on a date, and the honest starting point is that nobody has published a tested set of criteria for it. A systematic review searching seven databases found no study that had ever applied a criteria-based ankle sprain return to sport process, and concluded that there are currently no published evidence-based criteria to inform the decision (Tassignon and colleagues, 2019). A review of 11 expert opinion papers found agreement on only one of eight assessment domains, sport-specific movement, and no agreement at all on any cut-off number (Wikstrom and colleagues, 2020). What does exist is a consensus framework, PAASS, agreed by 155 health professionals working in elite field and court sports, and one validated score, the Ankle-GO, which a clinician has to administer (Smith and colleagues, 2021; Picot and colleagues, 2024). Most of the framework's 16 items need a clinician to measure or interpret. The one you can judge for yourself is whether you can complete a full training session, and that is the most useful line on this page. If you have had ankle surgery, your surgeon's protocol sets what you may do and when, and it comes before anything written here.

Warning signs, and when to get help

When can you go back to sport after a sprained ankle?

Not on a date, and not when the swelling goes down. The thing you would reasonably expect to exist here, a tested list of what has to be true before you play, does not.

Tassignon and colleagues searched seven databases up to November 2018 looking for exactly that. Their result, in their own terms, is that no study was identified which used a criteria-based return to sport decision-making process in patients with a lateral ankle sprain, and their conclusion is that there are currently no published evidence-based criteria to inform the decision (Tassignon and colleagues, 2019). One limit on that review matters: it is about the lateral sprain only, and it excluded people recovering from an ankle fracture, a high ankle sprain, a medial sprain, chronic ankle instability or a complex ankle injury.

Nor has it dated. A 2025 systematic review of 20 papers found no standard approach to this established in the literature (Jiang and colleagues, 2025), and a 2026 comparison of six elite teams' own protocols found large variation in phases, progression and assessment, with only one assessment domain checked by all six of them (Wagemans and colleagues, 2026).

So what gets quoted instead are figures describing what people did. The US physical therapy guideline reports that a full return to participation can be expected anywhere from 1 day to a little more than 3 weeks after a sprain depending on what the activity demands, while full recovery with no symptoms or limitations may take months or years and cannot be expected in everyone (Martin and colleagues, 2021). The NHS advises avoiding strenuous exercise such as running for up to 8 weeks. Those answer the question how long, not the question am I ready, and the first of them is on sprained ankle recovery time.

If you have had an operation on the ankle, none of this applies to you: your surgeon's protocol sets the stages and the limits. The same goes if the injury was to the ligament joining the two shin bones above the joint, which is covered on high ankle sprain and runs a longer course.

What the PAASS framework asks

With no tested criteria available, the best thing published is a consensus about what to assess. Smith and colleagues ran a three-round Delphi with 155 health professionals working in elite field and court sports and reached agreement on 16 assessment items in five domains, with 98 percent of the panel endorsing the final framework (Smith and colleagues, 2021). They called it PAASS, and the five domains are the useful part for a patient.

Pain, both during sport and over the previous 24 hours.

Ankle impairments: how far the ankle moves, and the strength, endurance and power of the muscles around it.

Athlete perception: how confident and reassured you feel about the ankle, how stable it feels to you, and whether you are psychologically ready.

Sensorimotor control: how well the ankle senses its own position, and how you control your balance while moving.

Sport or functional performance: hopping, jumping and agility, sport-specific drills, and the ability to complete a full training session.

The pattern in that list is obvious once you read it as a patient. Almost all of it needs somebody else: strength and movement have to be measured, balance has to be tested properly, and the hopping and agility work belongs in a session with a physio rather than in a back garden. The ankle sprain program lists who needs to check with a clinician before any hopping at all, and that gate applies before anybody tests you on it.

One item is yours. Whether you can get through a full training session, and how the ankle is the next morning, is something you can judge without any equipment, and it is the single most useful question on this page. A player who cannot complete training has answered the match question already.

Two items that usually get skipped deserve a mention, because the elite protocol study found them deficient in practice: psychological readiness, and the ability to complete a full training session (Wagemans and colleagues, 2026). Feeling unready is not a soft finding. It sits inside one of the five domains the consensus panel agreed on.

Is there a test that says the ankle is ready?

One score has been developed and validated, and it is administered by a clinician rather than by you.

The Ankle-GO is a 25-point composite of four functional tests and two questionnaires. It was built and tested in 30 healthy participants and 64 patients at two and four months after a lateral ankle sprain. Its internal consistency was good, a Cronbach alpha of 0.79, and its test-retest reliability excellent, an intraclass correlation of 0.99 with a minimum detectable change of 1.2 points. Scores were 7.7 plus or minus 4 at two months, 13.9 plus or minus 4.6 at four months, and 19.6 plus or minus 3.4 in the healthy group, and its ability to predict a return at the same or a higher level at four months was fair, an area under the curve of 0.77 (Picot and colleagues, 2024, the development and validation paper).

Three papers report that work, and they are one cohort of 64 patients rather than three independent studies, so they should not be stacked as though they were.

The follow-up is the part that matters for this decision. Of 54 of those patients followed for two years, 18 had a reinjury, which is 33.3 percent. The ones who went on to reinjure had scored 5.4 plus or minus 2.8 at two months against 9.1 plus or minus 4.5 in those who did not, and patients scoring under 8 points had an odds ratio of 8.6 for reinjury, with a confidence interval running from 2 to 37.2 (Picot and colleagues, 2024, the two-year cohort). That interval is wide because the study is small, 54 people with 18 events, and the paper's own title rounds the finding up to a nine-fold risk. The odds ratio with its interval is the figure to carry, not the headline.

A third paper from the same cohort reports that only 17 of 54 patients, 31 percent, had become copers at one year, which in this literature means somebody who has got back to activity without the ankle giving way or the symptoms returning (Picot and colleagues, 2024, the one-year cohort).

What none of that gives you is a threshold to clear at home. No percentage of your other leg, no number of hops and no balance time has been published as a criterion for this injury, because the expert opinions reviewed by Wikstrom and colleagues reached no agreement on any cut-off at all (Wikstrom and colleagues, 2020). Comparing sides is what physios do in practice and it is a sensible habit, but it is practice rather than a tested rule, and the home version of those comparisons is on ankle proprioception exercises.

What happens if you go back too early?

Nobody has run the trial, and the observational numbers are not encouraging.

In the Ankle-GO cohort, a third of the patients reinjured the ankle within two years, and the ones who did had scored lower on the readiness measure two months in (Picot and colleagues, 2024). A systematic review of the clinical course of acute ankle sprains puts the risk of a repeat sprain between 3 and 34 percent across its 31 studies (van Rijn and colleagues, 2008). The International Ankle Consortium's evidence review describes recurrence rates as high after a first sprain, with a large share of people going on to lasting instability, lower physical activity and a greater chance of ankle arthritis later (Gribble and colleagues, 2016).

None of that proves that going back early caused those reinjuries, because the figures are observational rather than a trial of one decision against another. What they do describe is the size of the risk this decision is managing, and that is the argument for finishing the balance work instead of stopping when the ankle stops hurting. If the ankle is already giving way during sport, the next page is chronic ankle instability, and the things that lower the odds of the next sprain are on how to prevent ankle sprains.

When can I run again?

Earlier than you can play, and still not on a date.

Running in straight lines on even ground asks far less of the ankle than turning, landing or stepping on somebody's foot, which is why it usually comes back first. The NHS figure, avoiding strenuous exercise such as running for up to 8 weeks, is the clearest national marker, and the guideline's own return to activity recommendation is about structure rather than timing: a planned return to work, a brace early in rehabilitation, and training that matches what the job or the sport will ask of the ankle (Martin and colleagues, 2021).

In practice that means building the demands back in an order, which is what the running protocols set out: straight line jogging, then pace, then changes of direction, then the sport itself. Those are on return to running protocols and a return to running plan, and the general testing question is on return to sport test battery.

The brake on all of it is the same one as everywhere else in ankle rehabilitation. Swelling the next morning, or an ankle that feels unreliable rather than sore, means the last step was too big.

What to say to a coach

Take the PAASS list with you, or at least the shape of it, because a conversation about criteria goes differently from a conversation about weeks.

Name the specific demand you cannot meet yet, not a general level of readiness: cutting off the left foot, landing from a jump, playing on grass. Name who is going to judge it, and when, so there is a date for a decision even though there is no date for the ankle. Then ask for training that rebuilds the demands instead of being held out of everything, which is what the guideline's return to activity recommendation describes.

Then be straight about the one thing you can judge yourself. If you cannot get through a full training session, the match is not the next step, whatever the fixture list says. That item is in the consensus framework for a reason, and it is the one nobody needs a clinic to measure.

If somebody quotes you a figure about how quickly athletes come back, it is probably the one the guideline reports from high school athletes after a first sprain: roughly a 75 percent chance of being back within 3 days and 95 percent within 10 days, with no difference between first and repeat sprains (Martin and colleagues, 2021). That is a record of what players with an athletic trainer on hand actually did. It is not a recommendation, and the reinjury figures on this page are the reason to treat it as a warning rather than a target.

Related exercise programs

Warning signs

Get emergency help now

  • Emergency: the ankle or foot looks deformed or out of place, you heard a crack when you were injured, or the foot is numb, tingling, cold, pale or blue. Go to an emergency department straight away, and do not drive yourself.
  • Emergency: if you faint while exercising, call emergency services, even if you feel fine again quickly.

Get help today

  • Same day: you could not take 4 steps right after the injury and still cannot, or the back edge or tip of either ankle bone is tender to press. Keep your weight off that foot as much as you can, leave the exercises out, and get it checked for a fracture the same day. These are part of the Ottawa ankle rules, explained on the ankle sprain page.
  • Same day: the pain is in the middle of your foot, and the bony bump halfway along the outer edge of the foot or the bony bump on the inner side of the midfoot is tender to press. Keep your weight off that foot as much as you can, leave the exercises out, and get it checked for a fracture the same day, even if you can still walk on it.
  • Same day: you felt a pop or snap at the back of your heel or lower calf, or it felt as if someone kicked you there, even if you can still walk and push off. Stop, take the weight off that leg carefully, and go to an urgent care center or emergency department the same day, as this can be a torn Achilles tendon rather than a sprain.
  • Same day: the pain is severe and getting worse, or the swelling or bruising is very large. Get medical advice the same day.
  • Same day: the ankle or foot is hot, red and swollen, or you have a fever or feel unwell. Get medical help the same day, and go to an emergency department if you feel very unwell. If you have a very high or very low temperature, shivering you cannot control, you are breathing very fast or finding it hard to breathe, you are confused or your speech is slurred, your skin, lips or tongue look blue, gray, pale or blotchy (on brown or black skin this can be easier to see on the palms of the hands or soles of the feet), or you have a rash that does not fade when you press it, call emergency services, as this can be sepsis.
  • Same day: a calf or thigh that is newly swollen or getting more swollen, warm, tender, red or darker than usual, has swollen veins that are sore to touch, or has a throbbing or cramping pain that does not fit your injury or condition, or that feels different from normal muscle soreness after exercise. This can be a sign of a blood clot (deep vein thrombosis), especially after surgery, an injury, time in a cast or boot, a long trip or a spell of being much less mobile than usual. Get medical advice the same day. If you are also short of breath or have chest pain, call emergency services.

Book an appointment

  • Within a week or two: the ankle keeps giving way or rolling over, even on flat ground, weeks or months after the sprain. This is not an emergency, but book an assessment with a physio or doctor in the next week or two.

Common questions

Is there a test that tells me my ankle is ready?

There is one validated score and you cannot run it on yourself. The Ankle-GO is a 25-point composite of four functional tests and two questionnaires, developed in 30 healthy participants and 64 patients and administered by a clinician (Picot and colleagues, 2024). It also comes from a single cohort of 64 people, which is one study reported in three papers rather than three separate pieces of evidence. Beyond that, a review of expert opinions found no agreement on any cut-off threshold at all (Wikstrom and colleagues, 2020). So no page can honestly give you a number of hops or a percentage of your other leg as a published criterion, and anyone who does is quoting something that has not been established.

When can I run again after a sprained ankle?

The NHS advises avoiding strenuous exercise such as running for up to 8 weeks after a sprain, which is the clearest national figure and is an outer edge rather than a target. No running-specific criterion for this injury has been published, so what physios do instead is build from straight lines on even ground to turning and changing direction, judging each step by swelling and by how the ankle feels the next morning. The protocols for the running side of it are on return to running protocols and a return to running plan.

Should I wear a brace when I go back to sport?

The guidelines say yes for the period after a sprain, and the trials support it. The US physical therapy guideline recommends a brace early in rehabilitation as part of returning to activity, and separately recommends a preventive brace together with balance focused exercise after a first sprain (Martin and colleagues, 2021). In the head to head trial, the brace group wore a semi-rigid brace during all sports for 12 months and reported fewer repeat sprains than the group doing the exercise program (Janssen and colleagues, 2014). What a brace does not do is improve how steady the ankle feels or how well it senses its position, which is why it goes alongside the balance work rather than instead of it. The detail is on how to prevent ankle sprains.

My coach wants me back this week. What do I say?

Give them a demand rather than a date. Something like: straight line running is fine, cutting off that foot is not yet, and the plan is to test it at training before a match. That is a sentence a coach can work with, and it keeps the decision with the person doing the testing rather than with the fixture list. It helps to know what the figures behind the pressure actually are: the guideline reports high school athletes getting back into sport within days of a first sprain, with about a 75 percent chance inside 3 days, which is a description of what teenagers did rather than evidence that it was wise (Martin and colleagues, 2021). The reinjury figures on this page are the other half of that story.

References

  1. Tassignon B, Verschueren J, Delahunt E, Smith M, Vicenzino B, Verhagen E, Meeusen R. Criteria-Based Return to Sport Decision-Making Following Lateral Ankle Sprain Injury: a Systematic Review and Narrative Synthesis. Sports Medicine. 2019;49(4):601-619. https://doi.org/10.1007/s40279-019-01071-3
  2. Wikstrom EA, Mueller C, Cain MS. Lack of Consensus on Return-to-Sport Criteria Following Lateral Ankle Sprain: A Systematic Review of Expert Opinions. Journal of Sport Rehabilitation. 2020;29(2):231-237. https://doi.org/10.1123/jsr.2019-0038
  3. Smith MD, Vicenzino B, Bahr R, et al. Return to sport decisions after an acute lateral ankle sprain injury: introducing the PAASS framework-an international multidisciplinary consensus. British Journal of Sports Medicine. 2021;55(22):1270-1276. https://doi.org/10.1136/bjsports-2021-104087
  4. Picot B, Lopes R, Rauline G, Fourchet F, Hardy A. Development and Validation of the Ankle-GO Score for Discriminating and Predicting Return-to-Sport Outcomes After Lateral Ankle Sprain. Sports Health. 2024;16(1):47-57. https://doi.org/10.1177/19417381231183647
  5. Picot B, Fourchet F, Lopes R, et al. Low Ankle-GO Score While Returning to Sport After Lateral Ankle Sprain Leads to a 9-fold Increased Risk of Recurrence: A Two-year Prospective Cohort Study. Sports Medicine Open. 2024;10(1):23. https://doi.org/10.1186/s40798-024-00693-w
  6. Picot B, Fourchet F, Rauline G, et al. Ankle-GO score is associated with the probability of becoming coper after lateral ankle sprain: a 1-year prospective cohort study. British Journal of Sports Medicine. 2024;58(19):1115-1122. https://doi.org/10.1136/bjsports-2024-108361
  7. Martin RL, Davenport TE, Fraser JJ, et al. Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021. Journal of Orthopaedic and Sports Physical Therapy. 2021;51(4):CPG1-CPG80. https://doi.org/10.2519/jospt.2021.0302
  8. Janssen KW, van Mechelen W, Verhagen EALM. Bracing superior to neuromuscular training for the prevention of self-reported recurrent ankle sprains: a three-arm randomised controlled trial. British Journal of Sports Medicine. 2014;48(16):1235-1239. https://doi.org/10.1136/bjsports-2013-092947
  9. Jiang H, Mei Q, Wang Y, et al. Towards the strategies of return to sport after lateral ankle Sprain: a systematic review. Annals of Medicine. 2025;57(1):2586334. https://doi.org/10.1080/07853890.2025.2586334
  10. Wagemans J, Dingenen B, Tassignon B. Return-to-sport following lateral ankle sprain: Connecting scientific frameworks and real-world protocols of elite sports teams. Physical Therapy in Sport. 2026;78:101899. https://doi.org/10.1016/j.ptsp.2026.101899
  11. van Rijn RM, van Os AG, Bernsen RM, Luijsterburg PA, Koes BW, Bierma-Zeinstra SM. What is the clinical course of acute ankle sprains? A systematic literature review. The American Journal of Medicine. 2008;121(4):324-331.e6. https://doi.org/10.1016/j.amjmed.2007.11.018
  12. Gribble PA, Bleakley CM, Caulfield BM, et al. Evidence review for the 2016 International Ankle Consortium consensus statement on the prevalence, impact and long-term consequences of lateral ankle sprains. British Journal of Sports Medicine. 2016;50(24):1496-1505. https://doi.org/10.1136/bjsports-2016-096189
  13. NHS. Sprains and strains. Page last reviewed 23 April 2024. https://www.nhs.uk/conditions/sprains-and-strains/

Written and checked by the PocketPhysio editorial team. Last updated 2026-11-06.

This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.