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
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
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