The Effect of Lace-up Ankle Braces on Injury Rates in High School Football Players.
McGuine TA, Hetzel S, Wilson J, Brooks A. Am J Sports Med. 2011 Sep 16. [Epub ahead of print]
Ankle injuries are common in high school sports and it has been estimated that 24% of all ankle injuries among high school athletes are sustained by football players. Lace-up braces are commonly used with the goal of preventing ankle injuries. Unfortunately, there is limited data about the efficacy of lace-up braces among adolescent football players. Therefore, McGuine et al assessed whether using a lace-up ankle brace reduced the number and severity of acute first-time and recurrent ankle injuries sustained by high school football players during one football season. Furthermore, they assessed if using lace-up ankle braces influence the incidence and severity of other lower extremity injuries. The researchers randomly divided 51 high schools (1 dropped out) into either control (not braced; ~1100 athletes) or braced group (~1000 athletes), which received the Donjoy Ankle Stabilizing Brace. Prior to the season, athletes completed a questionnaire that included questions about their demographics, level of competition (freshman, junior varsity, and varsity), expected playing position, and history of injury/surgery. The research staff measured each athlete to ensure proper brace fit and instructed them on how to wear the brace. Athletes were told to wear their braces at all team-organized events throughout the season. All participating school’s athletic trainers maintained daily exposure calendars, recorded all injury details throughout the season, and noted the use of any external support (taping or bracing). Also recorded by the athletic trainers, were the days lost due to injury; this was later used to define injury severity. After adjusting for athletes’ sex, history of previous ankle injuries, grade level, competition level, body mass index, shoe height (mid top or low top), and cleat type (molded or detachable); the incidence of acute ankle injury was 61% lower in the braced group compared to the control group. A benefit of bracing was found for athletes with and without a history of ankle injuries. The number needed to treat (click here for a second definition) with bracing to prevent 1 first-event acute ankle injury was 28.3 athletes. Acute ankle injury severity was not different between groups. Furthermore, the rate and severity of other lower extremity injuries was not different between the braced and control groups.
This article complements a previous SMR post that summarized similar findings by these authors when they evaluated lace-up ankle braces among high school basketball players. Among high school football players, we can estimate from this study that approximately 2 to 3 acute ankle injuries could be prevented among a team of 60 players during one season (based on the number needed to treat). Furthermore, if we apply this study’s data to the number of high school football players in the United States the authors estimate that lace-up braces may reduce the number of acute ankle injuries among high school football players by 39,000. The authors propose the lace-up braces represent a cost-effective strategy compared to the costs of tape or not doing anything at all, to prevent acute ankle injuries. This type of research is critical to help demonstrate the benefit of injury prevention strategies. It is a positive sign that this group has evaluated the benefit of prophylactic ankle bracing in two populations. We need more research like this for other braces as well as a better understanding of the factors that influence implementation and compliance. If the athletes won’t wear the brace or participate in the injury prevention program then it doesn’t matter how effective the treatment may be. Do these new findings persuade you to recommend more ankle braces? Are you currently using any prophylactic bracing in your sports medicine clinic?
Written by: Jeffrey B Driban
Reviewed by: Kyle Harris

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McGuine TA, Hetzel S, Wilson J, & Brooks A (2011). The Effect of Lace-up Ankle Braces on Injury Rates in High School Football Players. The American journal of sports medicine PMID: 21926383