Ankle sprains are treated as minor injuries more often than almost anything else in sport, which is part of the problem. Most people are walking normally within days and back at light training within a couple of weeks, long before the ankle has actually regained the strength and control needed to land, cut, or change direction without giving way again. A single-leg hop test is one of the more practical ways to check that control has genuinely returned before an athlete finds out the hard way.
WHAT THE TEST ACTUALLY MEASURES
The test itself is straightforward: standing on one leg, the athlete hops forward as far as possible and lands under control on the same foot, without the free leg touching down or the landing foot needing to step to regain balance. Distance is measured and compared side to side, and the quality of the landing, whether it’s stable and controlled or wobbly and compensated, is assessed alongside the raw number.
A 2009 study by Caffrey, Docherty, Schrader, and Klossner, published in the Journal of Orthopaedic and Sports Physical Therapy, examined four different single-limb hopping tests in people with functional ankle instability and found that hopping tests were able to detect functional performance deficits that simpler balance and range-of-motion measures missed. The general benchmark used across the hop testing literature, consistent with lower limb testing more broadly, is a Limb Symmetry Index of at least 90% between the injured and uninjured ankle before returning to unrestricted sport.
WHY TESTING BEATS GUESSING
Because ankle sprains are so common and usually resolve pain quickly, they’re one of the injuries most likely to be self-managed without any formal testing before return to sport. That’s exactly why they’re also one of the most likely injuries to recur, with a well-established pattern where an initial sprain, especially if returned to sport too early, tends to be followed by a second and third, eventually settling into what’s recognised clinically as chronic ankle instability.
The broader evidence for objective testing over time-based clearance is consistent across joints. A 2016 Delaware-Oslo cohort study by Grindem and colleagues found an 84% lower reinjury rate in athletes cleared using objective discharge criteria rather than time alone, and a related study by Kyritsis and colleagues found a fourfold higher reinjury risk in athletes who didn’t meet full discharge criteria before returning to sport. A hop test applies exactly that principle to the ankle: confirm the capacity is actually there, rather than assuming it from the absence of pain.
THE KINETIC CHAIN COST OF CUTTING CORNERS
An ankle that returns to sport with reduced control rarely stays an isolated ankle problem. Athletes with chronic ankle instability commonly develop compensatory movement patterns up the chain, altering knee and hip mechanics during landing and cutting to protect the unstable ankle, which shifts injury risk upward rather than removing it. This same load-redistribution pattern is well documented after other undertested joints return to sport: a 2016 systematic review by Wiggins and colleagues found that athletes returning to sport after ACL reconstruction reinjured the same knee and the opposite knee at almost identical rates, illustrating how an underprepared joint changes the loading pattern of everything connected to it, not just itself.
Each recurrent ankle sprain also tends to leave the joint a little less stable than before, compounding the risk of the next one and increasing the long-term likelihood of chronic instability and early degenerative change in the joint. Confirming hop test performance before return to sport is one of the more effective ways to break that cycle rather than let it repeat every season.
WHAT WE DO AT PRAXIS
We use single-leg hop testing alongside balance and proprioception assessment and sport-specific cutting drills to confirm an ankle is genuinely ready for full training, not just pain-free at walking pace. If you’re recovering from an ankle sprain, or you’ve had more than one, book a return-to-sport assessment with our team.
Until next time, Praxis What You Preach…
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References
Caffrey E, Docherty CL, Schrader J, Klossner J. The ability of 4 single-limb hopping tests to detect functional performance deficits in individuals with functional ankle instability. Journal of Orthopaedic and Sports Physical Therapy. 2009;39(11):799-806.
Grindem H, Snyder-Mackler L, Moksnes H, Engebretsen L, Risberg MA. Simple decision rules can reduce reinjury risk by 84% after anterior cruciate ligament reconstruction: the Delaware-Oslo ACL cohort study. British Journal of Sports Medicine. 2016;50(13):804-808.
Kyritsis P, Bahr R, Landreau P, Miladi R, Witvrouw E. Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture. British Journal of Sports Medicine. 2016;50(15):946-951.
Wiggins AJ, Grandhi RK, Schneider DK, Stanfield D, Webster KE, Myer GD. Risk of secondary injury in younger athletes after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. American Journal of Sports Medicine. 2016;44(7):1861-1876.