Ankle distorsion part IV; When can players participate in games/matches again?

A very knowledgeable physiotherapist named Richard Dahan lectures widely on the topic of return to practice and games. His vast experience and knowledge has created what he calls The Rehab Staircase. The last step of The Rehab staircase is a whole weeks participation in regular training, and only after this step the athlete is approved for game playing.

This is an excellent rule; for the speed, intensity and the increased mental and physical stress affects the players. To be able to perform well, the player must be able to trust his/her body to actually play; this also reduces the risk of injury if we know the player can perform fully without being hindered by the foot.

Should this rule apply in all cases? And to all ages?

This can be discussed till the end of time. What do we need to take into consideration?

Age? Obviously. A youth player who isn’t finished growing and still can’t control the body from the start, should definitely not enter the playing field.  Still, a lot of players feel the pressure to participate even thought the foot is hurting, maybe due to this player being an important player, or the star of the team.

Level? Is it the playoffs for a senior team where the player has 20 years of experience and a sports career - then maybe it's not that bad. The player knows his/her body, and can adapt the movements to a foot that doesn’t feel completely well yet. They are, after all, paid for this job. But what if it ultimately leads to osteoarthritis of the ankle? Is it still OK to expect them to play?

As you can imagine, it is not easy to make decisions or generalize, it must be decided individually.

So, what could happen then?

If the ankle isn’t ready to be loaded, even if it’s minimally damaged, the healing will be affected. The swelling never goes down properly and the foot remains stiff and with reduced mobility compared to the other foot for a very long time. Does that matter if you can still play sports, walk, and so on? Yes, it does, because stiffness = less spring in the joint = other structures such as the Achilles tendon becomes more loaded, as all movements are shortened. Other joints are affected as well, the knee for example experiences greater load - so also the tendons around it.

The player is also exposed to danger; doing sports with an unsteady foot can lead to falling or movements that weren’t planned. This can cause damage to other joints. What if that ankle injury that wasn’t allowed to recover will lead to ankle osteoarthritis at age of 40? (You can’t replace the ankle joint as easy as the knee or hip joint.) Another scenario is that after a few years not being able to run or jump any longer due to a painful ankle which no one can find a reason to?

Sad scenario ... And still; this is "just" an ankle sprain.

All of you who work in the club teams, national teams, and so on - you have no easy job ...