superior to neuromuscular training for the prevention of self-reported
recurrent ankle sprains: a three-arm randomized controlled trial

Janssen K, van Mechelen W, &
Verhagen ALM. British Journal of Sports
. Published Online First November 29, 2013 doi:10.1136/bjsports-2013-092947

Take Home Message: Long-term bracing
reduced the incidence of recurrent ankle sprains in comparison with 12 weeks of
neuromuscular training following an ankle sprain.  A combination of bracing and neuromuscular
training also had a mild reduction in comparison with neuromuscular

Ankle sprains are very common in the
athletic and physically-active population. 
We can successfully return individuals to activity after an ankle
injury; however, we need to more closely investigate our long-term treatment
strategies because the risk of a recurrent sprain is doubled after an
individual returns to activity.  The
authors of this randomized clinical trial compared the effectiveness of 3
interventions: 1) an 8 week neuromuscular training program, 2) bracing for 12
months, and 3) a combination of neuromuscular training program with a brace for
8 weeks total. Physically-active
individuals between 18 and 70 years of age with a history of a lateral ankle
sprain within the 2 months prior to screening were eligible for this study. A
total of 340 randomized participants (107 training, 113 brace, 120 combination)
completed 12 monthly follow-up forms that asked a participant to report sport
participation, recurrent ankle sprains, and adherence to treatment.  The authors reported that bracing alone had
fewer self-reported recurrent sprains than the training group: 1) bracing alone
(15%, 0.5 sprains/1000 hours of sport), 2) training group (27%, 2.5
sprains/1000 hours of sport), and 3) combination group (19%, 0.7 sprains/1000
hours of sport). The authors also reported that there were compliance issues
within each group (full compliance: 45% training, 23% bracing, 28% combination)
as well as participants who reported adding either a brace or training to their
assigned intervention program (~15% of participants).           

While this study aims to answer a very
interesting question, the results should be interpreted with caution.  Clinically, it appears that bracing is the
best option post-ankle sprain to reduce the risk of recurrent sprains.  Interestingly enough, I believe this study
highlights a larger underlying issue of patient compliance.  Bracing had the lowest overall compliance,
yet the best outcomes.  Unfortunately, it
is unknown as to what the compliance was over time.  It may have been interesting to look at this
as well as patient reported reasons for non-compliance.  Also, the prescribed training program was
only 2 months in duration, while the bracing was for 12 months.  A 2 month training program is typical
following an ankle sprain; however, perhaps we should consider the value of a
longer-term training program for prevention. 
 The combination group was prescribed
2 months of training and brace wearing only. 
Also, despite a lack of significant findings, the combination
training/brace group had lower ankle sprain recurrence than the training only
group, comparable to the brace for 12 months group.  If the two groups with bracing had high
adherence for the first few weeks that then diminished then protection for a few
weeks after an injury may be critical to preventing recurring ankle sprains. Overall,
this is an interesting study that compares three common treatment strategies
after an ankle sprain and highlights that we need to find ways to promote
adherence/compliance and further optimize our strategies.       

Questions for Discussion:  What
are your thoughts regarding rehabilitation and/or bracing following an ankle
sprain?  What are your recommendations for
clinically managing ankle sprains over a long term? 

by: Nicole Cattano
by: Jeffrey Driban

Related Posts:

Janssen KW, van Mechelen W, & Verhagen EA (2014). Bracing superior to neuromuscular training for the prevention of self-reported recurrent ankle sprains: a three-arm randomised controlled trial. British Journal of Sports Medicine PMID: 24398222