Article Text

Download PDFPDF

036 Criteria-based return to sport decision-making following lateral ankle sprain injury: a relevant part of the prevention – performance paradox for secondary and tertiary injury prevention?
  1. Bruno Tassignon1,
  2. Jo Verschueren1,
  3. Eamonn Delahunt2,3,
  4. Michelle Smith4,
  5. Bill Vicenzino4,
  6. Evert Verhagen5,
  7. Romain Meeusen1,6
  1. 1Human Physiology and Sports Physiotherapy Research Group, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
  2. 2School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
  3. 3Institute for Sport and Health, University College Dublin, Dublin, Ireland
  4. 4Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
  5. 5Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
  6. 6Strategic Research Program Exercise and the Brain in Health and Disease: the added value of Human-Centered Robotics, Vrije Universiteit Brussel, Brussels, Belgium


Background Lateral ankle sprain (LAS) injury is one of the most frequently incurred musculoskeletal injuries and shows high recurrence rates in individuals participating in sports. This increased re-injury risk is hypothesised to be mainly caused by the persistence of sensorimotor impairments and premature return to sport (RTS) clearance. Therefore, it is indicated to develop and implement evidence-based criteria to guide RTS decisions for LAS patients in order to minimize re-injury risk and maximise performance.

Objective To identify prospective studies that used a criteria-based RTS decision-making process for LAS patients.

Design Systematic review.

Setting Secondary and tertiary injury prevention.

Patients LAS patients.

Main Outcome Measurements Studies were included if they prospectively applied a criteria-based RTS decision-making process for LAS patients.

Results No relevant studies could be identified. However, we retrieved 47 relevant questionnaires, as well as 45 clinical and functional assessments commonly used in studies during the search process.

Conclusions There are currently no published evidence-based criteria to inform RTS decisions for LAS patients. It seems that RTS decisions following LAS injury are still generally time-based. We propose seven variable categories that could be used to develop a criteria-based RTS decision paradigm. These categories were generated in accordance with our results (i.e. questionnaires and tests) and the latest scientific insights. In summary, RTS decisions should acknowledge both preventive and performance criteria. Finding the right balance between these two divergent purposes within the rehabilitation process, is essential in order to minimize the athlete’s re-injury risk and maximise performance. It is thus of paramount importance that all relevant stakeholders (e.g. athlete, medical staff, coaching, staff) take part in the RTS decision-making process. Future research should aim to reach consensus on these variables and apply them to actual RTS decisions within prospective study designs to evaluate re-injury risk and successful return to performance.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.