In this Masterclass in dealing with lateral ankle sprains, Ep 385 of The Physical Performance Show, host Brad Beer sits down with fellow physiotherapist Lewis Craig for a lateral ankle sprain masterclass. Drawing on material the pair recently presented at a Gold Coast orthopedic evening, Brad and Lewis cover the burden and prevalence of lateral ankle sprains, the three-part clinical assessment process, key differential diagnoses, rehabilitation phases, and preventative strategies including bracing and taping.
The episode explores why lateral ankle sprains — despite their reputation as a minor injury — carry a significant risk of chronic ankle instability, and why a thorough, structured assessment is essential to a smooth recovery. Brad and Lewis unpack the different ligament and tendon structures that can be involved, the red flags practitioners need to rule out, the impairment categories drawn from Jay Hertel’s model of chronic ankle instability, and how rehabilitation should progress from protection through to return to sport and long-term prevention.
Show Sponsor:
Pogo Physio also offers online Telehealth Consultations for endurance athletes managing bone, tendon, or joint issues — book online at https://www.pogophysio.com.au.
And…
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One of their newest releases is Collagen Repair, developed in collaboration with Gelita Laboratories and featuring the clinically trialled collagen peptide TENDOFORT. For 15% off your first purchase, head to pillarperformance.shop or, for North American listeners, thefeed.com and use the code PHYSICALPERFORMANCE at checkout.
Pillar Performance continues to lead the way in sports nutrition through micro-nutrition innovation, now expanding into the Performance Health range. One of their newest releases, Collagen Repair, was developed with Gelita Laboratories (Germany) using a clinically trialled collagen peptide (Tendofort) to support tendon and ligament health in conditions like hamstring tendinopathy, Achilles tendonitis, shin splints, and patellofemoral pain.
Head to Pogo Physio also offers online Telehealth Consultations for endurance athletes managing bone, tendon, or joint issues — book online at https://www.pillarperformance.shop (or https://www.thefeed.com for North American listeners) and use code PHYSICALPERFORMANCE for 15% off your first purchase.
Partners / links mentioned:
Ortho Tools (Cumberland Ankle Instability Tool / CAIT): mentioned in-episode as the online questionnaire resource
Contact: Lewis Craig — [email protected]
In this episode, you’ll hear:
Episode context: Lewis Craig’s return to the show after being last on around episode 109, and his progress toward finishing his Sports Masters through the University of Queensland
The burden of lateral ankle sprains: why they’re the most common musculoskeletal injury in sport across field and court sports, contact and non-contact alike
Recurrence risk: why roughly 40% of people who sprain their ankle go on to develop chronic instability, and why the one-year mark is a key risk-reduction milestone
Early predictors of chronic ankle instability: the Doherty 2016 study on single-leg landing and drop-jump testing at two weeks post-injury
The three priorities of assessment: ruling out red flags and fractures, forming an accurate diagnosis, and identifying impairments
Screening for fractures: mechanism of injury, the Ottawa ankle rules, weight-bearing ability, and key bony landmarks to palpate
Differential diagnosis: ATFL and CFL sprains (70–80% of ankle sprains), peroneal tendon injuries, bifurcate ligament sprains, deltoid ligament tears, syndesmosis injuries, and talar dome injuries
Why getting a clear mechanism of injury from the athlete is critical to an accurate diagnosis
Identifying impairments: the ROAST consensus and Jay Hertel’s updated model of chronic ankle instability — pathomechanical, sensory-perceptual and motor-behavioural impairments
Clinical and objective testing: balance progressions, calf raise endurance and strength benchmarks, and power tests including triple hop, crossover hop and timed lateral hop
The role of patient-reported outcome tools: the Cumberland Ankle Instability Tool (CAIT) and FAAM, and why they’re useful for tracking progress and motivation
Rehabilitation framework: protection and appropriate early loading, followed by strength, stability and mobility phases
Managing specific injury types: use of moon boots, orthotics, low-dye taping and ASO ankle braces depending on the structures involved
Addressing dorsiflexion loss: why regaining ankle range of motion is often one of the hardest parts of rehab, and the Torillin infographic on identifying the source of restriction
Late-stage rehab and return-to-sport: hopping, change of direction, and integrating exercises into an athlete’s normal training week for ongoing prevention
Bracing and taping as secondary/tertiary prevention strategies to reduce recurrence
Long-term consequences of poorly managed ankle sprains, including links to post-traumatic osteoarthritis and eventual ankle surgery
The biggest mistake athletes make: assuming rehab is “done” once they can run, despite still having deficits in power, change of direction and stability
Lewis’s top tip: get every ankle sprain properly assessed, no matter how minor
Quotes / takeaways:
“It’s just a simple lateral ankle sprain… and then someone who goes missing for months at a time.”
“Four out of ten people who have an ankle sprain go on to develop a chronic instability.”
“The better quality of the assessment, the more likely there’s an accurate diagnosis.”
“It’s really hard to sprain your ankle when it’s really well strapped or with an appropriate brace.”
“Once someone gets running… you can run in a straight line really well and have really considerable deficits still.”
“Get it assessed. Understand what you’ve done and understand what impairments you might have.”
Time Stamps:
00:17 – Episode introduction and breakthrough experience
00:23 – Episode 385 introduction: lateral ankle sprain masterclass with Lewis Craig
00:50 – Sponsor: PILLAR Performance and Performance Health
01:15 – Collagen Repair: formulation, TENDOFORT and collagen health
01:44 – 15% PILLAR Performance discount with code PHYSICALPERFORMANCE
02:19 – Welcoming Lewis Craig back to the show
02:48 – Lewis’s tenure at Pogo Physio and progress on his Sports Masters at UQ
03:45 – Introducing today’s topic: lateral ankle sprains
04:37 – How common and burdensome are lateral ankle sprains?
05:36 – The “she’ll be right” attitude and why it’s changing
07:02 – Lewis’s personal history with recurrent ankle sprains
08:02 – Impact on Lewis’s own running and trail running
08:28 – The one-year mark and recurrence risk statistics
09:26 – Predictors of chronic ankle instability: single-leg landing and drop jump
09:53 – The Doherty 2016 study explained
10:51 – The three priorities of assessment
11:21 – Ruling out red flags and fractures
12:45 – Why assessment quality drives rehab outcomes
13:14 – Screening for fractures: mechanism, Ottawa ankle rules, bony landmarks
14:39 – Deciding on imaging: x-ray or MRI
15:06 – Differential diagnosis: the many subcategories of ankle sprain
15:35 – ATFL and CFL: the most common ligament sprains
16:35 – Peroneal tendon injuries
17:04 – Bifurcate ligament sprains
18:04 – Deltoid ligament tears with lateral ankle sprains
18:33 – Syndesmosis injuries and mechanism differences
19:31 – Clinical tests for syndesmosis
20:01 – Talar dome injuries and other easily missed diagnoses
20:30 – Why getting a clear mechanism from the athlete matters
21:29 – Identifying impairments: what it means and why it’s important
22:51 – Jay Hertel’s model of chronic ankle instability
23:48 – Balancing patient education without causing fear
24:17 – Motor outcomes: strength, power and kinetic chain
24:43 – Assessment time and thoroughness at Pogo Physio
25:08 – Objective testing: dynamometers, balance and calf tests
25:38 – Balance test progressions as return-to-sport criteria
26:37 – Strength testing: inversion, eversion and calf raise endurance
27:07 – Power testing: triple hop, crossover hop and lateral hop tests
27:33 – Using objective markers to guide return-to-sport decisions
28:01 – Patient questionnaires: Cumberland Ankle Instability Tool (CAIT) and FAAM
28:57 – Coping vs non-coping athletes and objective scoring
29:25 – Moving into rehabilitation: individualised management
29:54 – Protection and appropriate early loading
30:20 – Moon boots and protecting specific structures
31:16 – ASO ankle braces for lower-grade sprains
31:45 – The strength, stability, mobility rehab framework
32:14 – Early loading phase: range of motion, balance and strength
32:43 – Addressing dorsiflexion loss
33:13 – The Torillin infographic on restriction sources
33:40 – Progressing balance and strength exercises
34:10 – Preventative efforts and integrating rehab into training
34:40 – Late-stage rehab and return-to-play criteria
35:39 – Bracing and taping to prevent recurrence
36:08 – Long-term consequences: osteoarthritis and ankle surgery risk
37:34 – Lewis’s own experience with taping and bracing
38:02 – The biggest mistake athletes make in managing ankle sprains
39:29 – Lewis’s top tip: get every ankle sprain assessed
40:27 – Where to reach Lewis Craig for questions
40:52 – Episode close and sponsor reminder
41:20 – Pogo Physio Telehealth Consultations and closing details
THE TEAM:
Join the The Physical Performance Show LEARNINGS membership through weekly podcasts here: https://www.patreon.com/TPPShow
Our goal is to get you back to your Physical Best. Find out more about Telehealth Consultations and book online.
Your Hosts:
🏃 Brad Beer – Instagram & X @Bradbeer and YouTube on @PogophysioAu
💪 Lewis Craig – Physiotherapist and Clinical Lead, Pogo Physio Instagram: @_lewiscraig_
The Physical Performance Show can be found at: Facebook: facebook.com/thephysicalperformanceshowpodcast X: @tppshow1 Instagram: @physicalperformanceshow
Please direct any questions, comments, and feedback to the above social media handles.
COLLAGEN REPAIR
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