Ankle sprain in volleyball: 5 return-to-play tests

Three weeks ago she landed under the block on the middle blocker's foot. The swelling is gone, she walks normally and she wants to play on Saturday. Everywhere you read "four to six weeks", but that number says nothing about this particular ankle. What you need is not a calendar but a test — five tests, to be precise, and you can run all of them yourself on the sideline.

What actually tears: grade I, II and III

Almost every volleyball sprain happens the same way: the foot rolls inward and the ligaments on the outside of the ankle stretch further than they can take. Bahr and Bahr described the ankle sprain in Scandinavian Journal of Medicine & Science in Sports (1997) as the most common acute injury in volleyball, with the net as the scene of the crime: landing on a blocker's or a hitter's foot. Remember that mechanism, because it decides where your return-to-play ends.

Sports physicians roughly divide a sprain into three grades. You don't determine the grade — a doctor or physiotherapist does — but it is still worth knowing, because the three behave very differently on the sideline:

• Grade I: the ligaments are overstretched, not torn. Little swelling, the player can usually stand on it straight away and walks reasonably normally within a day. This is the sprain teams treat far too casually.
• Grade II: part of the ligament fibres has torn. Clear swelling within a couple of hours, often a bruise that drops down into the sole of the foot after a day or two, and walking hurts.
• Grade III: the ligament is completely ruptured. Heavy swelling, the ankle feels loose or unstable, weight-bearing barely works or not at all. Always see a doctor.

What you do with this in the gym is modest: you write down what you saw (the moment, whether the player could still stand, how fast the swelling came) and you refer on. What you don't do is decide the grade yourself and attach a number of weeks to it. The grade is only a rough predictor anyway: there are grade II ankles that pass everything after four weeks and grade I ankles still wobbling after eight.

The first 48 hours: what you do and what you leave alone

In the hour after the sprain you have two jobs. The first is deciding whether this needs a doctor straight away. Refer immediately if the player cannot take four steps — not in the gym and not an hour later — or if there is pain on the bone itself, on the tip or the back edge of either ankle bone. Those are the signals from the Ottawa ankle rules, the rule of thumb used in emergency departments to decide whether an X-ray is needed. Also refer for an ankle that is visibly out of line, for numbness or tingling in the foot, and for a player whose ankle is the size of a tennis ball within half an hour.

The second job is making sure nothing stupid happens over the next two days. Sports medicine has moved away from "rest and ice until it's over". Dubois and Esculier summarised the current approach in British Journal of Sports Medicine (2019) as PEACE & LOVE: protect for the first few days, elevate, use compression, but after that load and move again as fast as the pain allows. Translated into what a coach actually says and does:

• Do: shoe off, ankle up, a pressure bandage or compression sock if you have one, and let the player walk as much as they can pain-free — even if that is three metres to the bench.
• Do: get an appointment booked with a GP or physiotherapist that same evening. The first week is the cheapest week to get something right.
• Don't: hand out painkillers. That is not a coach's job, and pain is your only measuring instrument at this stage.
• Don't: "walk it off to see if it loosens up", or test the ankle by pulling on it. You are not a diagnostician.
• Don't: prescribe two weeks of complete rest. An ankle that does nothing gets stiff and weak.

If it happens during a match, the referee has their own protocol: recovery time, substitutions and the exceptional substitution are described in injury during a match. Never let the scoreline tempt you into a player who "wants to give it a go" — an ankle that has just been sprained gets sprained again in the same set.

Why "four to six weeks" is the wrong answer

A time frame sounds reassuring and is practically useless to a coach, for three reasons. First, you rarely know which day to count from: most players only report a sprain once it fails to settle on its own. Second, tissue doesn't heal on a schedule, it heals in response to load. And third, a date doesn't measure what you want to know. You don't want to know whether the ligaments have healed — you want to know whether this ankle can take a single-leg landing while somebody shoves into the shoulder.

So replace the question "how many weeks?" with "which test hasn't been passed yet?". That changes the conversation with the player too. "You're not allowed yet" is a verdict they will argue with; "you're not passing the single-leg landing yet, so that's what we train this week" is a task they can get to work on — and that matters with a player whose first injury has knocked their confidence, see rebuilding a player's confidence.

The five tests you run yourself on the sideline

These are five checks that need no equipment and take five minutes together. They measure exactly what volleyball asks of an ankle: strength, control, balance and change of direction. Run them at the end of a session, not at the start — a fresh ankle passes things a tired ankle cannot, and it is the tired version you need to see.

1. Ten single-leg hops, pain-free. On the injured foot, on the spot, ten low hops in a row. Pass: no pain during, no increase the next morning, and no visible hesitation just before landing. Hesitation counts as a fail — the body is protecting something.
2. Ten single-leg jumps with a stuck landing. Maximal jump off one leg, land on that same leg, three seconds dead still. Pass: ten in a row, with comparable height left and right. An extra step, a hand against the wall or clear wobbling is a fail.
3. Toe walk and heel walk, ten metres each. Ten metres out on the toes, ten metres back on the heels. Pass: even tempo, the heel comes up equally high on both sides and the foot doesn't turn outward to spare the sore side.
4. Thirty seconds of balance with the eyes closed. One leg, hands on hips, eyes shut. Measure the healthy leg first: that is this player's standard, not a number from a textbook. Pass: the injured leg holds out just as long with roughly the same number of corrections. If the gap is more than a few seconds, or the player visibly sways more, the control isn't back yet.
5. Sprint-stop-turn, five times. Five metres sprint, brake on the injured leg, turn 180 degrees over that leg, back again. Then one zigzag around four cones at full speed. Pass: no holding back just before the stop and no shortened stride on the affected side.

Important: this is a return-to-training check, not a diagnosis. These five tests tell you whether it is responsible to increase the load. They don't tell you whether the ligament has healed, they don't replace the treating physiotherapist and they say nothing about whether something else is going on. If a player repeatedly fails the same test, or the swelling comes back after a session, that is not a reason to train harder but to refer back.

From test to plan: the return in five phases

The five tests are the gates between five phases. At least one full session per phase, and you only move on once the test has been passed and nothing has increased the next morning. That morning is the real referee: how an ankle feels straight after a session says little, how it feels on the first steps out of bed says everything.

• Phase 1 — pain-free walking. Gate: ten minutes of normal walking without a limp and without a reaction the following day. In the gym: be there, take an observer role, do core and upper-body work. Turning up is not a detail; an injured player who stays away for three weeks often doesn't come back at all.
• Phase 2 — hopping and toe walking (tests 1 and 3). In the gym: setting and passing from a fixed spot, serving, technical work without movement. No jumping yet, no lateral step yet.
• Phase 3 — single-leg jumping and landing plus balance (tests 2 and 4). In the gym: movement at half speed, passing drills with footwork, hitting at their own tempo from a fixed approach, block footwork along the net without an opponent. This is where you weave in the landing technique from learning to land safely, because for this player it is no longer general prevention but the core of the rehab.
• Phase 4 — sprint-stop-turn (test 5). In the gym: full session in game-based drills, at full speed, but not yet in situations where they land near other people's feet.
• Phase 5 — contact at the net. Gate: two full sessions with blocking drills, hitting against a block and play across the centre line, without a reaction the next morning. Only then match minutes, and preferably a limited number of sets in that first match.

Expect phases 1 to 3 to go quickly and phases 4 and 5 to take time. That is also where the corners get cut: the player feels fine again and the team is missing them.

The phase everybody skips

Look back at the mechanism: this ankle broke down landing on somebody else's foot, under the block or across the centre line. Everything you train up to and including phase 4 happens on an empty floor. A player who passes all five tests but has never landed next to somebody again has not been tested on the situation that caused it last time.

So build that situation deliberately: first blocking next to a team-mate with space between them, then blocking against a hitter attacking at full tempo, then game drills across the centre line with a hard agreement that nobody steps through. The conversation about nerve belongs in that same week. A player who visibly turns away from the block in phase 5 is physically recovered but mentally isn't — and you don't fix that by making them train harder.

The year after: the return doesn't end at the first session

The strongest predictor of an ankle sprain is a previous ankle sprain, and that risk is highest in the first few months up to roughly a year afterwards. Tick the player off on the day they return and you have done exactly half the job. Two things should stay in place for a full season after that.

A balance block. Verhagen et al. studied a balance programme among Dutch volleyball players in American Journal of Sports Medicine (2004) and found the number of ankle sprains dropped, with the clearest effect in players who had previously had an ankle injury. In practice: five minutes of balance work, three times a week, for at least three months. One leg with the eyes closed, one leg on an unstable surface, one leg while a team-mate tosses balls at them, and single-leg landings with a stuck finish. Put it in your warm-up as a fixed block rather than sending it home as homework — homework evaporates after three weeks, a block in the template doesn't. Strong calves and thighs help; how to build those is in strength training for volleyball players.

Ankle support for the rest of the season. For players who sprained an ankle during the current season, a brace or tape is worthwhile as recurrence prevention; for players with no history that is a completely different trade-off. Which option fits and for how long is a conversation with the physiotherapist — not a call you make in the gym. The wider prevention story, including net discipline and the agreement about stepping through under the net, is in injury prevention in volleyball.

Finally, watch the first few weeks after a full return. A player who hasn't jumped for six weeks is suddenly back on hundreds of jumps a week; that spike in load is a risk in itself. Increase the number of match sets gradually and expect a spell of heavy legs, which is exactly when recovery after training is worth more than usual.

What you record, and why that isn't bureaucracy

This whole approach stands or falls on four lines per session: date, which phase, which test attempted, and how the ankle was the next morning. That's it. Record that in the player notes in Koach and you can see in black and white whether it is progressing or stalling, you have something more concrete than "it's alright" at the next physiotherapy appointment, and if there is a second sprain you can look back at what worked the first time.

It also produces a decision nobody can argue with. A parent asking why their daughter still isn't playing on Saturday doesn't get a feeling, they get a test that hasn't been passed yet and the week in which it probably will be.

Frequently asked questions