Ankle Sprains in Netball: Why They Keep Coming Back
It is tempting to skip the rehab component for the common ankle sprain.
If you play netball, there's a good chance you've rolled your ankle at some point — maybe more than once. You strapped it, iced it, and got back out on court within a week or two. For a lot of players, that's the whole treatment.
The problem is, that approach often isn't enough. Lateral ankle sprains are the most common musculoskeletal injury in athletic populations, and netball has the highest incidence of any sport. Many people who sprain an ankle never seek proper treatment — and a significant number go on to develop ongoing instability that may impact later in life.
Why ankle sprains keep coming back
Around 85% of ankle ligament injuries involve the lateral ligaments — most commonly from an inversion and internal rotation mechanism (where your ankle rolls out away from your midline and the sole of your foot faces up), whether from contact with another player or simply landing awkwardly. It's a quick, common injury. But "common" doesn't mean "low stakes." Ankle sprains carry real long-term consequences for your health and function if they're not properly rehabilitated, and the fact that so many go untreated is part of why chronic ankle instability is so widespread.
It's not just the ligament
When an ankle sprain doesn't fully resolve, what's left behind is usually described as chronic ankle instability (CAI), CAI is a big issue because we don’t have many ways of fixing it. Ankle surgery is notoriously complex and (unlike hip and knee replacements and reconstructions) isn’t always associated with satisfying outcomes for patients.
CAI is made up of three separate things, not just "a weak ankle":
The mechanical side: Ligament laxity and anatomical changes in the joint itself.
The physical side: Reduced strength, balance, and motor control around the joint.
The psychological side: Fear of re-injury and reduced confidence in the ankle — often underestimated, but it plays a real role in whether someone returns to full function.
Rehab that only addresses one of these three — usually just "get the swelling down and build some strength back" - is a big part of why sprains recur.
How we know you're actually ready to return
Historically, there hasn't been a great way to decide when someone's ready to get back on court. More recent frameworks assess readiness across five areas, often referred to by the acronym PAASS:
Pain — how much you're experiencing during sport and in the 24 hours after
Ankle impairments — your range of motion, strength, endurance, and power
Athlete perception — how confident and psychologically ready you actually feel
Sensorimotor control — your balance and proprioception
Sport and functional performance — hopping, jumping, agility, and sport-specific movement, right up to a full training session
Practical tests that feed into this include single-leg stance, hop tests, and patient-reported measures of function. Psychological readiness matters here too — athletes who score low on measures of psychological readiness to return to sport have a meaningfully higher risk of a repeat sprain within the first couple of months back. This is exactly why "does it feel okay to walk on?" isn't a sufficient return-to-play test on its own.
Preventing the next one
If you've had one ankle sprain, you're at higher risk of another — but the evidence points to some genuinely effective prevention strategies:
Taping or bracing has been shown to meaningfully reduce recurrence
Neuromuscular and balance-based exercise also reduces recurrence, though to a lesser extent than taping or bracing
Footwear — despite what you might have heard, there isn't good evidence that specific shoes prevent ankle sprains
None of these are about wrapping your ankle in cotton wool. They're about giving an already-vulnerable joint some extra support and better control while it continues to build strength and confidence.
What this means for you
We know that a previous ankle sprain is the biggest predictor of future ankle sprains. We also know that multiple ankle sprains with incomplete rehabilitation can lead to Chronic Ankle Instability. The goal is to work hard to avoid CAI, as the treatment and future outcomes for CAI are poor.
Ready to get back on court with confidence? Book an appointment with our team for a proper ankle assessment and a return-to-play plan built around you.
References
Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C. The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports Medicine. 2014. PubMed
Rowe PJ, et al. Prevalence and impact of chronic ankle instability in female sport: a cross-sectional study. BMC Sports Science, Medicine and Rehabilitation. 2025. Article — this is Patrick Rowe's own research, and the source of the netball incidence finding.
Return to sport decisions after an acute lateral ankle sprain injury: introducing the PAASS framework — an international multidisciplinary consensus. ResearchGate
Martin RL, Davenport TE, Fraser JJ, et al. Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021. Clinical Practice Guidelines, Academy of Orthopaedic Physical Therapy, APTA. Journal of Orthopaedic & Sports Physical Therapy. 2021. JOSPT
Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis. British Journal of Sports Medicine. 2017. PubMed
Neuromuscular training is effective to prevent ankle sprains in a sporting population: a meta-analysis translating evidence into optimal prevention strategies. Journal of ISAKOS. 2021. Article
National Athletic Trainers' Association Position Statement: Conservative Management and Prevention of Ankle Sprains in Athletes. Journal of Athletic Training. PMC
Hoch MC, et al. The ankle ligament reconstruction-return to sport after injury (ALR-RSI) is a valid and reproducible scale to quantify psychological readiness before returning to sport after ankle ligament reconstruction. PMC