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High ankle sprains are an injury that affects our fantasy football rosters every season. And chances are, if you’ve been playing fantasy football for any length of time now, you’ve rostered a player who either missed a chunk of the season because of a high ankle sprain or whose performance suffered when they returned to the field. But just how much did it affect performance and how many games should we plan for our stars to miss? This article’s aim is to answer these questions from a data-driven approach and then provide some actionable advice, especially for in-season roster management and DFS. Let’s get to it!

Before we dive into the data, it’s important to understand the injury itself. A high ankle sprain refers to an injury to the ligament that attaches the two lower leg bones together, just above the actual ankle joint. It may also include an injury to the ligaments on the inside of the ankle joint and at times, it can be accompanied by a fracture of one of, or both, of the lower leg bones, the fibula, and the tibia. Because the NFL is a contact sport, these injuries often occur with contact, usually during a tackle as seen in this Saquon Barkley injury.

In the vast majority of cases, this injury is caused by forceful rotation of the foot and ankle laterally when the foot is planted on the ground, as shown in the graphic below. It’s worth noting that this study is specifically designed to look at high ankle sprains and high ankle sprains only. Lateral ankle sprains, in which the foot turns inwards, are a completely different injury and carries its own recovery and rehab requirements. The graphic below¹ helps to differentiate the mechanism of injury for each type of ankle sprain.

These high ankle sprains can be graded on a scale of I to III, with grade III injuries being the most severe and grade I injuries being milder. I’ll spare you the nerdy details, but these grades refer to the degree of ligament injury associated with the sprain. While we do have general rehab timelines in the physical therapy world, it’s important to note, that these injuries don’t always follow a black and white timeline, and there are many factors that can determine how long it might take for an athlete to get back on the field. It’s certainly a wide spectrum of recovery that can take days to weeks and at times, even months to fully recover, and that’s not considering the possibility of surgery for the most severe injuries.

Immediately following the injury, pain, and swelling are the primary limiting symptoms. You’ll typically see these players in a walking boot and on crutches immediately following the injury, which usually lasts for a few days to a week. From there, the primary short-term rehab goals are to reduce swelling and regain mobility of the ankle in an effort to normalize the ability to walk without crutches. Once this is accomplished, lower body strengthening, balance training, and general conditioning are slowly progressed until eventually, the athlete is ready to begin sport-specific training. It sounds straightforward, but I promise you, it’s much more complicated and setbacks are definitely possible – Michael Thomas, anyone?.

Now that that’s out of the way, let’s dive into the data. That’s why you’re reading this after all! For this study, here are the inclusion criteria I used:

Across all positions (excluding season-ending injuries)

This data clearly shows players are affected following high ankle sprains, but when you look at the players included in this sample, the vast majority are running backs and wide receivers. Let’s look more specifically at how those players performed because as you’ll see, the QBs especially weren’t affected nearly as much as the RBs and WRs.

To quantify this, I simply split these players into two groups. ‘Early returners’ were those who returned to the field in 3 games or fewer while ‘later returners’ were considered players who took at least 4 weeks to return. Here’s what the data showed. Again, I excluded players whose injury was considered season-ending.

That was a lot of numbers and data, so let’s tie this thing together and give some actionable advice. In other words, what do you, the fantasy player, need to know about high ankle sprains, especially in season? Before we get to that, I want to take a minute to acknowledge a few things about this study. The first is that this study includes a relatively small sample size. I struggled with this because I didn’t want to go too far back into NFL history to avoid looking at data that was no longer relevant. The other reason for excluding older data is that injury reporting is much more difficult to find as the years go by, and so in an effort to solely focus on high ankle sprains, I chose to focus on the data I could find, which admittedly, let to a small sample size including the last three regular seasons.

The other thing to acknowledge about the study is that there are some inherent flaws with looking at fantasy performance as a measurement of success upon returning to the field. No doubt, the injury plays a big role in how players perform later in the season, but it’s possible that some of this data is a bit skewed. What I mean by this is that it’s also possible (likely) that how a player functions after a lengthy injury could be affected by other circumstances outside of just the injury. For example, a WR may now be dealing with a new QB or a scheme change, or a running back may have lost snaps and reps to other backs on the depth chart who may have performed well in the injured players’ absence. This type of stuff was really difficult to quantify, so I just excluded it, but I think it is worth considering.

Alright, now that that’s all out of the way, here’s what I took home from this study:

1. Players who suffer a high ankle sprain, regardless of position are unlikely to meet pre-injury performance levels in their first game back.

2. Running backs and wide receivers, but especially running backs, struggle to return to form compared to other positions.

3. When players return too quickly from the injury, their chance of returning fantasy value is significantly reduced compared to players who rehab for longer than four weeks.

4. Similarly, when players return in less than three weeks, they’re more likely than their counterparts to fail to ever meet their pre-injury performance levels.

In general, this study didn’t really provide me with too much new information as far as the understanding that players who come back too quickly from an injury struggle. As a physical therapist, that’s easy to understand, and it’s probably pretty easy for all of you to understand as well. But what I really found interesting here is that in the NFL, where time is one of the most valuable things, these players don’t necessarily have the ability to properly rehab without trying to rush to get back on the field. Maybe that’s due to pressure from coaching staffs or fans, etc. or maybe it’s because of the need to win and perform well for contract incentives, or maybe it’s for another reason, but either way, this data is conclusive that returning in less than three weeks is a major issue for skill position players.

From a fantasy perspective, after doing this study, I’m certainly more willing to move on from a player who is coming off a high ankle sprain, especially if they play RB or WR. In season-long leagues, this means I’m looking to trade away players who still have value, even if it means I have to sell for 75 cents on the dollar. The data is conclusive that the vast majority of players struggle after a high ankle sprain, and while this approach may lead to some later season “misses” in terms of guys who do actually perform well, it might not truly matter. What I mean here is that if a player finally returns to form 8 weeks after their injury, are you even in a position to make a run at a fantasy title or are you on the outside of the playoff picture looking in?

I also think this data can be useful in DFS, primarily because of the fact that a lot of the numbers I used in this study show that the overwhelming majority of players struggle in their first game back on the field. In DFS tournaments, we’re shooting for upside and top-end outcomes. Based on my study, it seems less likely we’ll get that top 10% performance in players who are just re-entering the lineup for the first time, and that’s especially true if players return in less than three weeks.

So, in conclusion, high ankle sprains lead to a significant amount of games missed and reduced performance in most skill position players. As a result, trading away these players coming off their injury or avoiding them in daily fantasy lineups probably makes sense as this data is relatively conclusive that players struggle to return to form upon stepping back onto the field in the same season.

Let me know your thoughts on this data via Twitter or drop a comment down below!

¹https://www.ultraankle.com/2016/09/16/the-difference-between-high-low-ankle-sprains/

As usual, great article! Although hard to capture scheme changes quantitatively, couldn’t you compare/quantify fantasy points per opportunity pre-injury vs post injury to measure performance? Certainly not perfect as quality of the opportunity may have changed, but may yield more data. However, I suspect the conclusion will be the same. Thanks again!

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