Earning The Right To Return To Play; Ankle Sprain Case Study

Here is a slightly different blog post…

This a REAL WORLD clinical reasoning case study from one of the therapists working in my own clinic who I am helping mentor as he looks after a professional rugby league team.  This particular therapist is a sports therapist who recently stepped out of his comfort zone and stepped up to take the lead.

We will be going through one of his first hand-overs to the coaches and performance staff.

(*Note; Since the time of this handover, the therapist has soared in confidence and competence and it is really pleasing to see.)

Here was one of his first hand-overs to the coaches and performance staff below for a particular patient:

Handover Example:

“ATFL sprain *date*, progressing well with rehab, yet to progress to contact with him, said he is willing to play sunday if needs be and told the coach that. I think there is a risk if he does play and I have informed the player and coach of this”

When I read this email handover, there were alarm bells ringing in my ears straight away…

And also some major pitfalls that the therapist could fall down on if not careful.

And you too may find yourself in these situations when you are working in sport and you have a player the day after a game that has rolled their ankle.

Will He/She Be Ok For The Weekend?

You get the question will he be able to play at the weekend? You find yourself replying ‘erm..yeh or erm…

You find yourself replying “erm..yeh or erm… yeh, he should be fine” and on reflection, you are thinking what have I said?

And you end up putting youself under massive pressure and maybe even making decisions that you are not entirely comfortable with later on in the week.

The point I am trying to get across is based on the above handover YOU have absolutely NO IDEA if the play is going to be ready or not…

The player has not done contact yet and ,we do not know if the player is able to move with ‘thoughtless fearless movement’…

So we really don’t know what the patient’s confidence is like yet in an unpredictable environment.

And now, if you’ve found yourself or are finding yourself in those situations either in the sporting setting or even in private practice, I’d urge you to start clinically reasoning your answers.

Even to yourself, just start today and hold yourself accountable to YOU!

And just justify every step you take with the athlete during the rehab and return to play progressions.

I personally cannot justify how this particular patient can return to play if he hasn’t done any key progressions.

There are no right or wrong in regards key progressions but I’d just urge you to be able to clinically reason every single one on the way back to playing.

I share my own return to play checklists in The New Age Sports Physio Community to help therapists develop their own but once you can justify and clinically reason each step, then your winning 🙂

Towards the back end of the week or rehab even, I am personally looking for the athlete to be able to tolerate high level running, and have the ability to accelerate, decelerate, change direction, and take and give contact.

Once the athlete ticks those boxes I have the confidence that he is ready to go back playing and training with the rest of the team.

Why Is This Really So Important?

Let’s say that the player did play in that game and then their ankle swelled massively after the game again…

There’s nothing that will pi$$ coaches off more than sending a player/patient back to play and then getting injured for the following match, and the blame may sometimes naturally point towards you.

Moral of this story is that you have to have a very structured and logical return to play protocol yourself.

If that player gets a little bit of bad luck and something happens in the game you can look the coach in the eye and justify yourself that he was right to play.

Whereas if you just do the above and not have gone through each progression, then you are leaving yourself open to criticism from both patients and coaches.

I hope this shows you the importance of clinical reasoning all of your decisions and helps you avoid all those mistakes!

Thanks for your time,


P.S If you haven’t picked up your free copy of my free ebook The Successful Discharge Blueprint below, click on the button and I’ll get it straight to you so you can start learning more about this way of looking at the body, which I’ve used in professional sport and private practice consistently over the last nine years…