Sports Medicine Research: In the Lab & In the Field: Save the Ankles by Bracing or Balance Training: Either is Better than Nothing (Sports Med Res)


Wednesday, August 22, 2018

Save the Ankles by Bracing or Balance Training: Either is Better than Nothing

The Effect of Bracing and Balance Training on Ankle Sprain Incidence among Athletes: A Systematic Review with Meta-Analysis

Bellows R., Wong CK. Int J Sports Phys Ther. 2018 Jun;
Text Freely Available

Take Home Message: Ankle braces and balance training can reduce the risk of ankle sprains among competitive athletes.

Ankles sprains are common, lead to prolonged disability, and lead to a high risk of recurrence. Health care professionals are eager to implement prophylactic interventions; however, it is unclear how to select the most effective approach. Hence, the authors conducted a systematic review to compare the effect of an ankle brace or balance training on reducing the risk of ankle sprains among competitive athletes. The authors conducted a standardized literature search of four databases to find randomized clinical trials from 2005 to 2016 that reported the incidence of ankle sprains among competitive athletes who completed balance training, received a brace, or were assigned to a control group. They found 8 studies that included 7,195 (36% female) high school to professional athletes across multiple sports (basketball, football, volleyball, and soccer). Incidence of ankle sprains were not limited to lateral sprains, but also included medial, high, and syndesmotic sprains. Based on 3 studies, athletes wearing ankle braces had a 64% reduced risk of sustaining an ankle sprain compared to athletes receiving no-treatment. Similarly, athletes who completed balance training had a 46% reduction in risk of injury compared to controls. The authors were unable to control for history of ankle sprains subsequently limiting the conclusion of these methods at reducing the risk for a recurrent sprain or first-time occurrence.

This systematic review highlights the impact prophylactic approaches can have on reducing the risk of ankle sprains among competitive athletes. The balance training protocols included in this analysis were very different but used a similar progression of major components (double limb to single limb; eyes open to eyes closed; stable to unstable surface, and perturbations to upper extremity motion). While differences in protocols may have affected the overall relative risk assessment in this study, it is realistic. Clinicians often adopt different protocols depending on their athletes and setting/equipment. If a clinician feels their setting does not have enough time for a balance training program, then they may consider using ankle braces but this is a more costly approach. Unfortunately, the effectiveness of incorporating both balance training and ankle braces were not examined in this systematic review. Overall, clinicians should consider implementing a balance training program or requiring ankle braces for their athletes if they wish to see a reduction in ankle sprains.

Questions for Discussion: Do you require athletes to wear ankle braces or complete balance training, regardless of ankle sprain history? What is your preferred method for preventing ankle sprains among athletes?

Written by: Danielle M. Torp
Reviewed by: Jeffrey Driban

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Unknown said...

Thank you for this article, it was a great read. I am currently an athletic training student and I found this very interesting and clinically applicable when I will be working as a clinician.

Throughout my clinical experiences as a student I have only witnessed athletes being required to wear bi-lateral ankle
braces. Specifically, I have only seen basketball athletes being required to wear them.

I think my preferred method for preventing ankle sprains among athletes would be the use of a balance training program. I feel that this approach is more beneficial and realistic toward athletes. One aspect athletes complain about with the ankle braces is they effect their performance level, resulting in some athletes just choosing not to wear them. Which brings me to my next point, athlete compliance. It is difficult to ensure an athlete will always wear their ankle braces during both practices and games. Yes, it may be difficult to get athletes to have compliance with their balance training programs but at least you can require them to do these at specific times when you are present to hold them accountable or they can even be incorporated into practice plans. Also, some athletes may not be able to fit an ankle brace in their cleats. I am thinking specifically of soccer players. Lastly, does an ankle brace provide adequate protection in all directions of instability? Through the use of a balance training program you can individualize it for each athlete ensuring balance training is met multi-directional, or as needed on an individual athlete basis.

Danielle Torp said...


I am glad you were able to relate this read to your clinical experience and already begin to think about how you wish to conduct your prevention strategies. During my clinical experience (primarily collegiate women’s basketball) it was my policy any athlete with a previous ankle sprain was required to wear a brace/or tape AND finish at least 4 weeks of a balance training program. I was able to implement this program with 100% athlete compliance because I presented my case (and the research supporting it) to my head coach and she bought into the importance of prevention of ankle sprains. I understand this will not be the case for every team and every coach, but I found this to be the best way to combat athlete compliance.

You make a great point regarding ankle braces and soccer cleats- there is research to support similar effectiveness between tape and braces, meaning those athletes would benefit from taping.

I am sure many clinicians will support your decision to implement balance training, and again if you can present the research to your coaches they will buy into your policies and assist you in compliance.

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