Steven J. Anderson, MD

Practice Essentials Series Editors:
Kimberly G. Harmon, MD; Aaron Rubin, MD

THE PHYSICIAN AND SPORTSMEDICINE - VOL 30 - NO. 12 - DECEMBER 2002

An ankle sprain may not seem like a big deal, but returning to play without proper rehabilitation will increase your chances of injuring your ankle again—maybe even more seriously. Taking the time to fully recover will actually put you back in the game faster. The checklist on the other side of this page will take the guesswork out of knowing when you are ready to return to play safely.

After the diagnosis of ankle sprain has been confirmed by your physician, your rehabilitation will be done in four phases. Phase 1 requires patience and rest. In phase 2 you can begin to move the ankle more and gradually build up the muscles in your lower leg. Phase 3 concentrates on regaining your balance and overall strength. When you reach phase 4, you will be almost back to your preinjury level.

It is important to follow your doctor's or physical therapist's instructions and do the prescribed exercises correctly. Doing too much, too soon can cause more damage. Not doing enough will also lengthen the time it takes to recover. If moving on to the next phase causes pain, you may have to go back to an earlier phase. Ask your doctor if you have questions or concerns about how fast you are progressing.

This chart (figure 1) will help you figure out when you can return to play. By marking the number of days since injury as you complete each phase of rehabilitation, you can make a rough estimate of when you will be ready to return to play. By knowing the number of days at the completion of phase 4, you can find your actual return-to-play date.

Remember: This information is not intended as a substitute for medical treatment. Before starting an exercise program, consult a physician.

For more on specific exercise for ankle rehabilitation see the article "Rehabilitating Ankle Sprains" by Richard Sandor, MD and Scott Brone, PT, CSCS

Ankle Rehabilitation Checklist

Note: All items on this list should be checked before returning to play.

Name: __________________________

Date of Injury: ________________

Phase 1: Ready to Start Rehabilitation
    A. I am wearing the protective tape, brace, or wrap that my doctor prescribed.
    B. I can stand on the injured leg without pain.
    C. Pain and swelling have gone down.

Phase 1 complete. Date __________________

Days after injury __________

Phase 2: Beginning Level
    A. My ankle does not feel too stiff to draw the letters of the alphabet with my toes.
    B. Strength in my calf and ankle muscles is back to normal.
    C. I know when I need to wear an ankle brace or taping and how to apply it.
    D. Neither low-impact aerobic exercise nor weight lifting causes pain or swelling.

Phase 2 complete. Date __________________

Days after injury __________

Phase 3: Intermediate Level
    A. Balance when standing on the injured leg is as good as the uninjured leg.
    B. Increasing my aerobic exercise or weight lifting does not cause pain or swelling.
    C. My general strength is back to preinjury level.

Phase 3 complete. Date __________________

Days after injury __________

Phase 4. Advanced Level
    A. My return-to-running program has been completed without pain or limitation.
    B. I can do sport-specific movements and skills without pain or limitation.
    C. My coach or physical education teacher knows about my special needs for gradual return to play and my long-term needs to prevent future injury.

Phase 4 complete. Date __________________

Days after injury __________

Cleared for full participation.
Date __________________	by Dr ______________________________________
	(signature)

Downloadable PDF Version of Ankle Rehabilitation Checklist

Dr Anderson is a clinical professor in the Department of Pediatrics at the University of Washington in Seattle.

© 2002, by The McGraw-Hill Companies, Inc. Permission to photocopy is granted for educational purposes.