HomeBlogReturn to Sport after a Soccer Ankle Injury: How soon is too soon?
Return to Sport after a Soccer Ankle Injury: How soon is too soon?
February 11, 2025
An ankle injury on the soccer field can be a devastating setback for an athlete at the top of their game. Not only does the athlete suffer, but the entire team takes a hit, and even the coach stands to face career issues if a key player goes down in mid-season. Needless to say, there is a lot of pressure for an athlete to return to play (RTP) as soon as possible.
However, returning to sport without adequate recovery and rehabilitation is risky. Not only does premature RTP put an athlete at risk for re-injury of the same ankle, but it also sets them up for compensation injuries as they redistribute force loads to protect the injured appendage. In other words, something else gets injured as the athlete, consciously or subconsciously, strives to prevent re-injury.
Criteria for Determining Readiness for RTP
One reason athletes often return to sport prematurely is lack of objective and reliable criteria for physicians, therapists and coaches to evaluate their readiness. Even in the case of a fracture whose degree of healing can be discerned more or less objectively through imaging technology, the soft tissue structures surrounding the injury that produce force and provide stability must also be fully rehabilitated and strengthened.
In some cases, doctors and coaches rely on a timetable to determine when an athlete is ready for RTP. Taking into account the type of injury, be it a sprain, fracture, multiple ligament injury or a combined fracture and ligament injury, they guesstimate when an injury has had adequate time to heal.
Most ankle fractures take approximately six to eight weeks to heal
After surgery, patients can usually return to full weight-bearing activities after six to eight weeks
Once the ankle has been rehabilitated, RTP is usually approved after 10 to 12 weeks
The problem with a timeline approach is that every injury has unique characteristics, and every athlete has a unique anatomy and capacity to heal.
Other factors that affect RTP time include:
The athlete’s training status, both prior to and post injury
The skill, experience and expertise of the physical therapist
The athlete’s compliance with the rehab protocol
The level of sport (recreational, competitive, professional)
Age of the athlete
Gender of the athlete
In addition to physical readiness, the athlete must be mentally prepared to go back onto the playing field. There is a great deal of psychology in sports performance, and mental readiness is imperative for RTP. After an injury, the athlete may fear re-injury and hold back during play. Yet in aggressive high-velocity sports like soccer, holding back can cost you, setting you up for collisions with other players. The athlete may also use protective compensation mechanisms that set them up for injury.
Functional Testing for RTP
There are a number of functional tests that can be used to determine an athlete’s readiness for RTP. While not wholly objective, they give clinicians some means of measuring the degree of healing and rehabilitation of an athlete’s ankle.
Athletes should be evaluated for balance and proprioception, strength, range of motion, and agility, along with a psychological assessment to determine readiness for RTP.
Common tests for ankle function include:
Lateral hop test
Single leg stance
Heel rocker test
Ankle joint dorsiflexion
Test for joint laxity
Stair run
While clinical measures are useful, clinicians must also rely on experience and instinct. Furthermore, the athlete should be included as a stakeholder in determining their readiness for RTP.
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Range of Available Unique Physical Therapy Treatments at Nydnrehab
About the Author
Dr. Lev Kalika is a world-recognized expert in musculoskeletal ultrasonography, with 20+ years of clinical experience in advanced rehabilitative medicine. In addition to operating his clinical practice in Manhattan, he regularly publishes peer-reviewed research on ultrasound-guided therapies and procedures.
Dr. Kalika is an esteemed member of the International Society for Medical Shockwave Treatment ((SMST), and the only clinician in New York certified by the ISMST to perform extracorporeal shockwave therapy. He is also an active member of the American Institute of Ultrasound in Medicine (AIUM), and has developed his own unique approach to dynamic functional and fascial ultrasonography.
In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.
Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.
The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.
Dynamic ultrasonography examination demonstrating the full thickness tear and already occurring muscle atrophy due to misdiagnosis and not referring the patient to proper diagnostic workup
Demonstration of how very small muscle defect is made and revealed to be a complete tear with muscle contraction under diagnostic sonography (not possible with MRI)
Complete tear of rectus femoris with large hematoma (blood)
Separation of muscle ends due to tear elicited on dynamic sonography examination
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