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How Patrick Mahomes will rehab his injured ankle before Sunday’s AFC title game

Playing with a high ankle sprain just a week after the injury won’t be easy. What could the quarterback’s rehab entail?

NFL: JAN 21 AFC Divisional Playoffs - Jaguars at Chiefs Photo by Scott Winters/Icon Sportswire via Getty Images

The legend of Patrick Mahomes continues to grow.

The Kansas City Chiefs’ quarterback came up limping after a hit in the first quarter of Saturday’s 27-20 Divisional Round playoff victory over the Jacksonville Jaguars.

Despite appearing to be in significant pain, Mahomes returned to the field after X-rays on his injured ankle were negative. While clearly lacking his signature mobility, he was able to gut it out — and helped lead Kansas City to its fifth consecutive AFC Championship game.

The injury appeared to be a high ankle sprain, which commonly occurs with twisting or rotation — that is, when the foot is planted and turned in relation to the leg. The injury involves damage to the syndesmosis, which are the high ankle ligaments connecting the two lower leg bones: the fibula and the tibia.

This injury would normally sideline a player for several weeks — as we have seen with running back Clyde Edwards-Helaire, who hasn’t played after suffering a similar injury in Week 11.

Mahomes reportedly underwent an MRI on Sunday, which was said to confirm the suspected high ankle sprain. Even so, there is little doubt in fans’ minds that the star quarterback will be ready to suit up on Sunday to face the Cincinnati Bengals in the AFC Championship.

A full week of rehab will be added to Mahomes’ championship game preparation. Let’s take a look at what could be involved.

Mahomes’ rehab week

Since we don’t know the severity of the sprain, the extent of tissue damage or the specifics of how his body reacted in the 24-48 hours immediately after the injury, the precise rehab timeline is impossible to determine. With reports that X-rays were negative, however, we do know there are no fractures present. This is why Mahomes was able to return during Saturday’s second half — and why he could play in Sunday’s AFC Championship.

High ankle sprains (and the typical inversion ankle sprain) have a tendency to swell and stiffen — especially in the acute phase. So Mahomes will certainly be battling pain and swelling throughout the week. Managing these issues has already begun — and will a huge factor in how well he is able to recover before Sunday.

To minimize pain and stiffness — and reduce swelling — the first order of business will be to maintain and improve the ankle’s range of motion. Everything will be kept as light and pain-free as possible. We can expect that Mahomes’ practice participation will be limited throughout the week, because too much weight-bearing, cutting or planting will only serve to irritate and inflame the injury.

As the week progresses, Mahomes will move toward specific strengthening exercises for his ankle and leg, likely using an underwater (and/or anti-gravity) treadmill to strengthen the lower leg and ankle and facilitate weight bearing — but without stressing the soft tissue, which could instigate a further inflammatory response.

Finally, Mahomes will need some specific functional football training. Balance and stability training will be used to build confidence in the limb and strengthen the joint. We should also expect him to work on planting his right foot, using some light multi-directional mobility exercises to simulate moving within the pocket.

AFC Divisional Playoffs - Jacksonville Jaguars v Kansas City Chiefs Photo by Cooper Neill/Getty Images

What can we expect in the AFC Championship?

It takes longer for players to recover from high ankle sprains than inversion ankle sprains, creating a longer timeline for regaining full mobility. Lateral rotation of the tibia will be very uncomfortable. And as we saw with Mahomes during Saturday’s second half, planting, cutting and running on the injured limb is painful — and is therefore limited.

Mahomes will not be at 100% before Sunday. Considering his apparent pain (and lack of mobility) during Saturday’s second half, it’s likely that he wouldn't be playing if a Super Bowl appearance wasn’t on the line.

So while it’s hard to know exactly how his ankle will be feeling by kickoff, it is likely that Mahomes will not have his signature mobility; maintaining the improvisational nature of his play is going to be difficult.

There is good news, though: Mahomes has made a career out of throwing from inconvenient, unorthodox and non-weight bearing platforms. Even in the worst case, it’s likely he could do more than many other quarterbacks in similar circumstances.

Kansas City employs one of the league’s best medical and athletic training staffs. Mahomes will have every available rehab tool and aid at his disposal. There is reason to have confidence that by Sunday, he will be as far along in his recovery as can be reasonably expected.

And as Mahomes has proven over and over again in his career, he is the ultimate competitor. This injury will probably limit his normal style of play — and to some extent, change the offensive game plan. But Mahomes will still be... Mahomes.

So while the road to Super Bowl LVII has become more complicated, the Chiefs’ quarterback should be up to the challenge.

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