The Effect of Lace-up Ankle Braces on Injury Rates in High School Basketball Players
McGuine TA, Brooks A, and Hetzel. Am J Sports Med. 2011 July27. [Epub ahead of print]
Ankle injuries are the most common musculoskeletal injury sustained by basketball athletes. Long-term effects of ankle injuries can include chronic ankle instability, as well as early onset of osteoarthritis. While previous research has explored the effectiveness of ankle braces in reducing ankle injuries among adult or college level athletes, no study had exclusively looked at the high school population. Therefore, McGuine and colleagues conducted a randomized controlled trial, to determine whether using lace-up ankle braces reduced the number and severity of acute, first-time and recurrent, ankle injuries in high school basketball players. Secondarily, the study also sought to determine whether or not the use of lace-up ankle braces affected the incidence of other lower extremity injuries. The researchers divided 46 high schools into either a control (not braced) or a braced group, which received McDavid Ultralight 195 lace-up ankle braces. A self-reported questionnaire regarding the athlete’s demographic and injury history was also completed during pre-season. The braced group was instructed on proper application and fitting of the braces. Patients were instructed to wear their braces at all team-organized events throughout the entire season. All participating school’s athletic trainers maintained daily exposure calendars and recorded all injury details through the course of the season. Also recorded by the athletic trainers were days lost to injury; this was later used to determine injury severity. A total of 78 acute ankle injuries were reported among control participants, compared to 27 sustained by subjects in the braced group. The overall, first-time and recurrent incidence rates for ankle sprains were lower in the braced group than in the control group but injury severity was comparable between groups. Secondarily, the authors reported no significant difference in the lower extremity injury rates when comparing the two groups.
Overall, this study highlights the effectiveness of lace-up ankle braces in reducing the incidence, but not severity of ankle injuries among high school basketball players. These findings concur with other previous research of rigid (hard-shell) braces. The authors suggest that future research may want to examine the relationship between ankle motion and lower extremity kinematics. This is due to the belief that if the ankle’s ROM is limited the force would be transferred up the kinetic chain causing lower extremity injuries. However, logical this concept seems, the data presented in this study does not seem to present a strong case for it. Limitations for this study included variations in shoe types, as well as the possibility of a selection bias due to participants being made aware of the intervention, or lack thereof, prior to the participants’ decision to take part in this study. Overall, this study supports the use of lace-up ankle braces to minimize the incidence of ankle injuries in high school basketball players. Clinically, this may be a method of injury prevention that athletic trainers may want to consider, depending on their individual budgetary situation. Bracing has been shown to be more cost effective than ankle taping (Olmsted and colleagues, 2004). What have you found in your everyday practice? Is this prevention method something you have tried? If not, is it due to budgetary difficulties?
Written by: Kyle Harris
Reviewed by: Jeffrey Driban
Last year in my internship, their was a strong push from the coaches for preventive taping for some of the players. Due to budget constraints we chose rather tape only those who were evaluated and determined to need tape (or tape and brace). We also gave them the option to purchase braces through us. Several of the players purchased the braces and I feel that we ended up with fewer ankle injuries than we had the previous year. Additionally, those that purchased the braces tended to like them better than tape anyway.
Timothy Boerger, LAT
I think that your experience is something more and more athletic trainers are seeing. In the end, we are in a world of ever shrinking budgets and need to be conscious of how we use our supplies. I inform my athletes of the types of braces, things they should look for, and places where they can purchase the brace. The article in question does make a great case for the use of lace-up ankle braces. One advantage which I tell my athletes regarding ankle braces, is the ability to re-tie, and adjust the brace throughout practices or activity. This, in my personal experiences, seem to be something that athletes really like and respond to.
While the question is posed "Haven't We Heard This Question Before?", I think this study adds four very important pieces of evidence to the ankle sprain prevention literature that can help us to better answer this question.
1) To my knowledge, this is the first randomized control trial to study lace-up ankle braces. The previous randomized control trials looking at the effect of ankle bracing on ankle sprain prevention examined semi-rigid braces (specifically the Aircast Sport Stirrup). This is important because lace-up braces represent a very large portion of the ankle brace market.
2) McGuine et al's findings of signicant reduction of both first time and recurrent ankle sprains is unique. The previous randomized controlled trials mentioned above have only shown significant reduction of recurrent ankle sprains. This calls into question, recommendations made by previous authors that a priority should be given to bracing athletes with a previous history of ankle sprain over athletes with no previous history.
3) This is the first randomized controlled trial that has evaluated the prophylactic effects of ankle braces in female athletes. Enough said.
4) Lastly, McGuine et al's study represents what is perhaps the largest randomized controlled trial of an injury prevention initiative conducted in the high school athletic training setting. There are very few examples of Level 1 evidence that stems directly from traditional athletic training practice settings. This is of critical importance in the creation of a body of evidence specific to athletic training interventions.
As an ATC who has performed ankle instability research for over 15 years, this study represents one of the most impressive clinical studies that I have seen in sports medicine. Kudos to McGuine and his colleagues for their execution of this excellent study.
As a seasoned ankle instability researcher its great to hear from you and get some more insight into a very interesting study which I think has a lot of clinical value.