- Journal List
- Sports Health
- v.7(3); 2015 May
- PMC4482303
As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsem*nt of, or agreement with, the contents by NLM or the National Institutes of Health.
Learn more: PMC Disclaimer | PMC Copyright Notice
Sports Health. 2015 May; 7(3): 267–269.
PMCID: PMC4482303
PMID: 26131306
Jason M. Denton, PT, DPT, MS,*† Andrew Waldhelm, PT, PhD, LAT, CSCS,† Jonathon D. Hacke, PT, MA, OCS, ATC,‡ and Michael T. Gross, PT, PhD, FAPTA§
Author information Copyright and License information PMC Disclaimer
Associated Data
- Supplementary Materials
Abstract
Background:
Little information is available regarding the ankle braces orthopaedic sports medicine clinicians recommend or clinicians’ concerns that may influence their decisions to recommend use of an ankle brace.
Hypotheses:
(1) Clinicians most frequently recommend lace-up braces with straps. (2) Clinicians who are concerned about potential adverse side effects from ankle brace use are less likely to recommend an ankle brace to prevent ankle sprain injuries.
Study Design:
Descriptive survey study.
Level of Evidence:
Level 3.
Methods:
Surveys were sent via e-mail to 1000 randomly selected members of the Orthopaedic Section of the American Physical Therapy Association (APTA) and 1000 randomly selected members of the National Athletic Trainers’ Association (NATA). A total of 377 individuals responded to the survey.
Results:
Lace-up braces, specifically lace-up braces with straps, were the most frequently recommended type of ankle brace. Regression analyses indicated that the only perceived adverse side effect significantly related to frequency of ankle brace recommendation was a potential negative influence on ankle strength.
Conclusion:
Based on our sample, clinicians recommend lace-up ankle braces with straps most frequently to prevent ankle sprain injuries. Clinicians who are concerned about weakness of ankle musculature may be less likely to recommend use of an ankle brace.
Clinical Relevance:
Clinicians may effectively reduce the number of ankle sprain injuries by recommending an ankle brace use after an initial ankle sprain injury.
Keywords: ankle sprain, ankle bracing, prevention, clinician recommendation
Ankle sprain injuries are common during sporting activities.1,9,10,16 The risk for additional ankle sprain injury increases after the initial injury.14,17 Multiple studies indicate that wearing an ankle brace can reduce the incidence of ankle sprains in sporting activities such as football,8 basketball,7,14 volleyball,4,11 and soccer.13-15 The reduction in the incidence of ankle sprain injuries has been demonstrated for lace-up braces,12,13 semirigid ankle braces,14,15 and rigid braces.4,11 Two recent studies describe a reduced incidence of ankle sprains for individuals who wore a lace-up brace with straps.7,8 While more recent studies have included multiple brace types, studies examining recovery from acute ankle sprain that include ankle bracing as part of the management typically use a semirigid ankle brace.2,5,6
The purposes of this study were to address the following research questions: (1) Which ankle brace do clinicians recommend most frequently to prevent ankle sprain injuries? (2) Is ankle brace recommendation related to clinicians’ concerns about potential side effects?
Methods
Data Collection
The study was approved by the Biomedical Institutional Review Board at the University of North Carolina at Chapel Hill. The survey instrument was formatted based on the Total Design Method by Dillman.3 The initial survey was piloted with 10 local clinicians and faculty in the University of North Carolina–Chapel Hill Movement Science Program. Participant feedback was implemented into the final survey, which was used for this study. An initial e-mail with a link to the survey website was sent inviting subjects to participate in the survey. Informed consent was obtained on the first page of the survey. A follow-up e-mail was sent to all subjects after 2 weeks if they had not participated.
Survey Sample
The e-mail invitation to participate in the survey was sent to 1000 randomly selected members of the National Athletic Trainers’ Association (NATA) and 1000 randomly selected members from the Orthopaedic Section of the American Physical Therapy Association (APTA). A total of 377 subjects responded to some portion of the survey, for a response rate of 20.2%. The survey is provided in Appendix 1 (available at http://sph.sagepub.com/content/by/supplemental-data).
Data Analysis
Descriptive statistics were used to analyze which ankle braces clinicians recommended most frequently to prevent ankle sprain injuries, while multivariate regression analyses were employed to answer whether ankle brace recommendations were related to clinicians’ concerns about potential side effects. The independent variables included clinicians’ concerns for the following potential side effects of using an ankle brace: reduced strength, compromised proprioception, compromised dynamic balance, and risk of injury to the knee joint.
Results
Descriptive statistics of the survey participants are provided in Appendix 2 (available at http://sph.sagepub.com/content/by/supplemental-data). Overall, clinicians recommended an ankle brace to individuals with recurrent ankle sprains more than patients with an initial ankle sprain (64.1% to 48.1%). Preliminary data analysis indicated that professional status (athletic trainers [ATs], physical therapists [PTs], both) was highly correlated with the percentage of patients for whom clinicians recommended use of an ankle brace. Lace-up braces with straps were recommended by more clinicians than any other brace type (Table 1). The top 5 braces by estimated frequency of recommendation are listed in Table 2.
Table 1.
Number of clinicians who identified brace as the most frequently recommended
| Bracea | n | Percentage |
|---|---|---|
| Lace-up braces with straps | 116 | 41 |
| Ankle Stabilizing Orthosis (ASO) | 102 | 36 |
| RocketSoc | 14 | 5 |
| Lace-up (subtype not specified) | ||
| McDavid Sports Medical Products lace-up | 36 | 13 |
| Rigid braces | 35 | 12 |
| T2 Active Ankle Support | 28 | 10 |
| Universal Ankle Stirrup | 7 | 2 |
| Lace-up brace | ||
| Swede-O Ankle LoK | 27 | 10 |
| Semi-rigid brace | ||
| Aircast Air-Stirrup (Aircast) | 26 | 9 |
Open in a separate window
aAll other braces selected by ≤2% of respondents.
Table 2.
Frequency of recommendation for 5 most frequently recommended braces
| No. of Times Brace Recommended in Past 12 Monthsa | ||||||
|---|---|---|---|---|---|---|
| Brace | 51+ | 26-50 | 16-25 | 11-15 | 6-10 | 1-5 |
| Ankle Stabilizing Orthosis (lace-up with straps) | 10 | 12 | 19 | 19 | 25 | 41 |
| T2 Active Ankle Support (rigid brace) | 4 | 4 | 4 | 5 | 10 | 36 |
| McDavid (lace-up subtype not specified) | 3 | 2 | 5 | 4 | 17 | 48 |
| Swede-O Ankle LoK (lace-up) | 2 | 2 | 4 | 6 | 13 | 48 |
| Aircast Air-Stirrup (semirigid brace) | 2 | 0 | 2 | 6 | 15 | 54 |
Open in a separate window
aEntries in each column indicate the number of clinicians who have recommended the corresponding braces at the indicated frequency.
Clinicians reported concern about each of the side effect variables, but only the side effect of reduced ankle strength was significantly related to the percentage of patients for whom clinicians recommended an ankle brace (P < 0.05). Clinicians’ concerns about compromised ankle joint proprioception, compromised dynamic balance, and risk of injury to knee joint structures were not significantly related to whether clinicians recommended an ankle brace after an initial ankle sprain (P > 0.05). None of the factors were related to recommendation frequency after a recurrent ankle sprain (P > 0.05, all tests).
Discussion
A reduction of ankle sprain injuries using the lace-up with straps brace type has been established.7,8 Clinicians who were concerned about reduced ankle musculature strength were less likely to recommend an ankle brace to patients after an initial ankle sprain. Insufficient evidence exists in the literature to support or dismiss clinicians’ concerns about potential reductions in ankle muscle strength. The bulk of the literature indicates that an individual with 1 or more ankle sprains is at greater risk for a subsequent ankle sprain compared with individuals without a history of ankle sprain injury.9,14,16
Because of the low response rate (20.2%), the findings of this study may not be generalizable to all ATs and PTs. Another limitation is that the term ankle sprain was not defined within the survey. The potential reduction in strength on wearing an ankle brace long term requires investigation.
Conclusion
Lace-up braces with straps were recommended by a considerable number of clinicians. Clinicians were concerned about a reduction in ankle muscle strength from ankle brace use and were less likely to recommend ankle braces to patients after an initial ankle sprain.
Supplementary Material
Supplementary material:
Click here to view.(124K, pdf)
Acknowledgments
The authors would like to thank Angela Rosenberg, PT, DPH, for her assistance with developing the survey instrument.
Footnotes
The authors report no potential conflicts of interest in the development and publication of this article.
This research was completed in partial fulfillment of Mr Denton’s Master of Science degree in the Program in Human Movement Science, University of North Carolina at Chapel Hill.
References
1. Anderson TE, Floerenes TW, Arnason A, Bahr R.Video analysis of the mechanisms of injury in football. Am J Sports Med. 2004;32(1 suppl):69S-79S. [PubMed] [Google Scholar]
2. Boyce SH, Quigley MA, Campbell S.Management of ankle sprains: a randomized controlled trial of the treatment of inversion injuries using an elastic support bandage or an Aircast ankle brace. Br J Sports Med. 2005;39:91-96. [PMC free article] [PubMed] [Google Scholar]
3. Dillman D.Mail and Telephone Surveys: The Total Design Method. New York, NY: Wiley; 1978. [Google Scholar]
4. Frey C, Feder KS, Sleight J.Prophylactic ankle brace use in high school volleyball players: a prospective study. Foot Ankle Int. 2010;31:296-300. [PubMed] [Google Scholar]
5. Lamb SE, Marsh JL, Hutton JL, Nakash R, Cooke MW.Mechanical supports for acute, severe ankle sprain: a pragmatic, multicenter, randomized controlled trial. Lancet. 2009;373:575-581. [PubMed] [Google Scholar]
6. Leanderson J, Wredmark T.Treatment of acute ankle sprain: comparison of a semi-rigid ankle brace and compression bandage in 73 patients. Acta Orthop Scand. 1995;66:529-531. [PubMed] [Google Scholar]
7. McGuine TA, Brooks A, Hetzel S.The effect of lace-up ankle braces on injury rates in high school basketball players. Am J Sports Med. 2011;39:1840-1848. [PMC free article] [PubMed] [Google Scholar]
8. McGuine TA, Hetzel S, Wilson J, Brooks A.The effect of lace-up ankle braces on injury rates in high school football players. Am J Sports Med. 2012;40:49-57. [PMC free article] [PubMed] [Google Scholar]
9. McKay GD, Goldie PA, Payne WR, Oakes BW.Ankle Injuries in basketball: injury rate and risk factors. Br J Sports Med. 2001;35:103-108. [PMC free article] [PubMed] [Google Scholar]
10. Meeuwisse WH, Sellmer R, Hagel BE.Rates and risks of injury during intercollegiate basketball. Am J Sports Med. 2003;31:379-385. [PubMed] [Google Scholar]
11. Pedowitz DI, Reddy S, Parekh SG, Huffman GR, Sennett BJ.Prophylactic bracing decreases ankle injuries in collegiate female volleyball players. Am J Sports Med. 2008;36:324-327. [PubMed] [Google Scholar]
12. Rovere GD, Clarke TJ, Yates CS, Burley K.Retrospective comparison of ankle taping and ankle stabilizers in preventing ankle injuries. Am J Sports Med. 1988;16:228-233. [PubMed] [Google Scholar]
13. Sharpe SR, Knapik J, Jones B.Ankle braces effectively reduce recurrence of ankle sprains in female soccer players. J Athl Train. 1997;32:21-24. [PMC free article] [PubMed] [Google Scholar]
14. Surve I, Schwellnuw MP, Noakes T, Lombard C.A fivefold reduction in the incidence of recurrent ankle sprains in soccer players using the Sport-Stirrup orthosis. Am J Sports Med. 1994;22:601-606. [PubMed] [Google Scholar]
15. Tropp H, Askling C, Gillquist J.Prevention of ankle sprain. Am J Sports Med. 1985;13:259-262. [PubMed] [Google Scholar]
16. Verhagen EAL, Van der Beek AJ, Bouter LM, Bahr RM, Van Mechelen W.A one season prospective cohort study of volleyball injuries. Br J Sports Med. 2004;38:477-481. [PMC free article] [PubMed] [Google Scholar]
17. Yeung MS, Chan KM, So CH, Yuan WY.An epidemiological survey on ankle sprain. Br J Sports Med. 1998;28:112-116. [PMC free article] [PubMed] [Google Scholar]
Articles from Sports Health are provided here courtesy of SAGE Publications
