Return to sport after a lateral ankle sprain is decided on 16 items in five domains
Pain, ankle impairments, athlete perception, sensorimotor control and sport performance — not on a number of days
Key Findings
Sixteen assessment items in five domains reached consensus for the return-to-sport decision after a lateral ankle sprain; no time-based criterion and no numeric cut-off is given.
Three-round Delphi with 155 health professionals working in elite field or court sports; consensus set at more than 70% agreement.
The authors state there were no guidelines to inform return-to-sport decisions after acute lateral ankle sprain.
Sixteen assessment items reached consensus, mapped to five domains with 98% agreement (the PAASS framework): Pain (during sport and over the last 24 hours); Ankle impairments (range of motion; strength, endurance and power); Athlete perception (confidence, stability, psychological readiness); Sensorimotor control (proprioception, dynamic postural control); Sport performance (hopping, jumping and agility; sport-specific drills; ability to complete a full training session).
Practical Application
Progress a sprained ankle by criteria, in order: walking without pain and none over the previous 24 hours; movement and calf strength back; steady single-leg balance and confidence in the ankle; pain-free hopping; then easy running; then strides, hills, uneven ground and turns; the last gate is a full normal session.
If a step brings back pain, swelling or giving way, go back one step; if that persists, refer to a clinician or physiotherapist.
The consensus gives no numeric cut-offs (no days, no hop-symmetry percentage, no pain score): any number offered is practice and must be said as practice.
Limitations
Expert opinion, not validated against outcomes; no thresholds in the abstract (abstract only was read).
A companion consensus on clinical assessment (Delahunt 2018, DOI 10.1136/bjsports-2017-098885, 14 experts) notes that a high proportion of people develop long-term symptoms and chronic ankle instability after a first sprain.