“Each phase needs to be time-based and criterion-focused”

“What should I do to get my 15-year-old high school soccer player back to sport in 6 weeks after a grade 1 ankle sprain? There are several components to managing this case and I wanted to share them.

Most clinicians would start with outlining the perfect session, creating the home exercise program for the next week, and progressing week to week based on progress. I call this the “let’s see how it goes” approach which is okay but not ideal if there is a timeline and/or if the athlete wants to know specifics on the exact return progression.

If the athlete wants to return to sport in 6 weeks, that means that they need to be back in practice at week 5 with modified contact. At week 4 they need to be able to perform linear jogging and multi-directional movements without pain. At week 3, they need to introduce linear and/or vertical impact drills and lateral non-impact activities. At week 2 they need to be performing linear strengthening without flare-ups. I would have them in my “go-to” ASO ankle brace during this process to minimize flare-ups. 

Here is my outline (with the ASO brace during all waking hours):

  • Week 0-1: linear ROM, balance, and WB as tolerated; hip and core work; cardiovascular fitness in a pool or bike
  • Week 1-2: linear ROM and strengthening, lateral WB exercises as tolerated, progress dynamic balance; hip and core work; progress fitness in pool or bike
  • Week 2-3: linear and vertical impact activities, lateral and multidirectional ankle strengthening; hip and core work; rower, elliptical, or stair climber
  • Week 3-4: practice without contact, lateral and multi-directional impact activities; bike as a primary fitness
  • Week 5-6: practice with modified contact
  • Week 6-7: return to sports
  • Weeks 7-10: continue with rehabilitation and wellness sessions to ensure the athlete does not experience flare-ups

Is this possible? Yes, but these athletes need specific direction and a clear roadmap on what a full recovery looks like. Each phase of the process needs to be time-based and criterion-based to advance to the next phase. Additionally, it’s critical that the athlete, parent, and coach know the markers of success at every stage AND, more importantly, it’s critical that the physical therapist can manage the recovery process and outline it along the way. This is where I see a lot of physical therapists struggle.

Below is a podcast I created for physical therapists to improve communication with athletes, parents, and coaches to ensure everyone is on the same page at all times:

If you have any questions, please email me at drchris@drchrisgarcia.com.

Keep those ankles healthy,

Dr. Chris Garcia, PT, DPT, SCS, CSCS, USAW

P.S. If you’re more of a visual learner, check out my video on managing youth injuries and getting parents and coaches on the same page below.

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