Ankle braces help prevent injury by restricting motion, but those restrictions don’t necessarily result in negative effects on athletic performance. Evidence suggests that while agility may be affected with use of an ankle brace, vertical jump and balance skills may not.
By Jatin P. Ambegaonkar, PhD, ATC, OT, CSCS; Nelson Cortes, PhD; and Shruti J. Ambegaonkar, MS, PT
Ankle injuries, particularly sprains, are the most common injuries sustained during physical activity, accounting for 15% to 30% of all injuries;1-3 85% of these injuries are ankle sprains.2,3 An estimated 23,000 ankle sprains occur per day in the US alone, equaling one sprain per 10,000 people daily.4
Ankle taping and bracing are used extensively to enhance ankle joint stability, prevent injury occurrence, and mitigate severity.5 Both taping and bracing are intended to prevent ankle medial and lateral ligamentous and capsular trauma by limiting excessive anatomical ankle motion, enhancing cutaneous feedback and ankle muscle activity, and helping secure protective pads, dressings, and splints.5-7 Ankle taping and bracing reduce ankle sprain incidence,8 especially in individuals with a history of recurrent ankle injuries.9-12
Taping vs bracing
Ankle taping has been used widely as a prophylactic measure for injury prevention for many years.13 Gibney reported using strapping as a means of treating ankle sprains as early as 1895.14 Research has shown that the convention of ankle taping with adhesive tape offers protection against ankle sprains during physical activity.1 Prophylactic ankle taping has also been reported to reduce the likelihood of reinjury to a previously sprained ankle by approximately two thirds.14
Although there are demonstrated advantages, ankle taping also has several disadvantages. Although taping initially restricts ankle range of motion, the tape loosens within 30 to 60 minutes of application,5,15-18 cannot be reused, and requires training and time to apply properly.19,20 Ankle braces are an appealing alternative to taping, as they too restrict ankle motion but can be tightened as needed, are reusable, require minimal training to apply, and can be applied more quickly than tape.18,20-22
Ankle brace types
The relatively high incidence of ankle sprains has led to the design of various ankle external supports.22 One of the earliest noncommercially available semirigid prophylactic ankle stabilizer was described in 1974.23 The first commercially available semirigid prophylactic ankle stabilizer was the Aircast Air Stirrup.23 Soft-shell prophylactic ankle stabilizers, such as lace-on braces, were first introduced in the early 1980s and made of a variety of materials, including canvas and neoprene rubber.18 Most current ankle brace designs are either soft-shell braces, which often are laced-up, or semirigid braces that have semirigid thermoplastic shells and inner air cell linings.6,18,24
Ankle braces and athletic performance
Although injury prevention is the primary objective for using any ankle support,20 athletes and their coaches and trainers often have concerns about possible decreases in athletic performance associated with the use of ankle braces.20 Vertical jump ability, agility, and dynamic balance are among the most important abilities required for an athlete to perform successfully.25
The vertical jump test is used widely for measuring lower body power and is a determinant of athletic performance.26,27 Agility is required for rapid changes in direction of the body or parts of the body25 and is an important ability in many sport activities.28 Balance is the ability to maintain the body’s center of gravity within its base of support with minimal postural sway.29 Static balance allows a person to hold a stationary position28 while dynamic balance maintains one’s balance during movement;28 both are important in athletic performance.30
Ankle bracing and vertical jump
The primary functions of ankle braces are restricting inversion and eversion ranges of motion5 and protecting the ankle’s medial and lateral structures. Because vertical jumping primarily requires ankle motion in the sagittal plane (dorsiflexion and plantar flexion), it seems logical that ankle braces would not hinder performance given that ankle braces do not primarily restrict sagittal motion.
Previous researchers have examined effects of ankle bracing on vertical jump performance. Some researchers have reported that soft-shell lace-up braces19 reduced vertical jump performance. Others17,21 have found conflicting results, reporting that braces did not hinder vertical performance. Several other researchers have noted that several types of semirigid or soft-shell lace-up ankle braces18,20,21,31,32 have no effect on vertical jump performance.
In our study,23 published in 2011 in Foot & Ankle Specialist, we examined whether four ankle stabilizer conditions (a soft-shell lace-up ankle brace, a semirigid brace, a closed basket weave with heel locks taping technique, and control nonsupport condition) affected vertical jump performance in 10 healthy participants (aged 25.6 ± 2.8 years, 6 women) as measured by the Sargent Chalk Jump test. In this test participants stood with the dominant side toward the wall with the heels together, reached upward as high as possible, and made a base mark using a one-inch piece of chalk on the wall at the highest point he or she could reach when standing. Then participants crouched, jumped as high as possible, and made another mark on the wall at the apex of the jump. The difference between the standing reach and jump apex reach was measured as the vertical jump. None of the ankle stabilizing conditions negatively impacted vertical jump performance.
Our observation of no effect for braces or taping on vertical jump performance is in consensus with the majority of previous studies, but in contrast to some research that reported negative effects of a soft-shell lace-up brace or taping19,32 on vertical jump performance, which were described as secondary to restriction in ankle ranges of motion. Still, we feel comfortable with our findings since ankle stabilizers are designed primarily for restricting inversion and eversion ranges of motion5 and vertical jumping requires primarily ankle dorsiflexion and plantar flexion. Because sagittal ranges of motion are only minimally affected when using ankle braces, it is reasonable that ankle brace use would not hinder vertical jump performance.
Overall, our findings are in consensus with the majority of previous work, which notes that semirigid5,18,20,21,33 and soft-shell bracing31,33 do not impair vertical jump performance.22 Consequently, our research and that of others suggest that concerns among athletes and coaches24,35 about decreased vertical jump performance are unwarranted.33
Ankle bracing and agility
Previous researchers have also examined the effects of ankle bracing on agility.17,19,21,31-34 While some researchers report that using ankle bracing negatively affected agility,34 most17-19,21,31-33,35 noted ankle bracing did not affect this ability.
In our 2011 study23 we also examined whether ankle braces or taping affected agility as measured by the Right-Boomerang Run test. The agility course was set up using cones (see figure). Participants were allowed to familiarize themselves with the agility course pattern and then were instructed to run as fast as possible to the finish line without touching any cones. Specifically, participants ran to the center station, made a quarter right turn, ran to and around the first outside station, returned to the center, made another quarter turn, and continued through the course. The agility score was the run time to complete the course (touching a cone resulted in a 0.1-second penalty).
We noted that, compared with not wearing any ankle stabilizer, the use of the lace-up or semirigid ankle braces or taping negatively affected agility performance.23 We feel reasonably confident in our results because ankle braces restrict inversion and eversion ranges of motion.5 Agility requires individuals to rapidly plant-cut and change directions, which requires movements in multiple planes of motion, including inversion and eversion. All ankle stabilizer braces restrict inversion and eversion ranges of motion, which may make it somewhat difficult to change directions rapidly,34 as often required in the agility tests.
Given that our observations conflict with some prior research, examinations of the range of motion restrictions provided by ankle braces may be warranted in future work.
Ankle bracing and dynamic balance
We also noted in our recent study23 that ankle braces did not affect dynamic balance. These findings are consistent with a previous study by Paris that found no effect of ankle bracing on static or dynamic balance.31 One reason for our observation of no negative effects of ankle braces on dynamic balance may be related to our choice of the test used for this measure, the Modified Bass Test of Dynamic Balance. This test has a stepping component and a balancing component, neither of which require quick direction changes. Similarly, the Paris study31 utilized the Nelson test of static and dynamic balance, which also does not involve quick changes of direction. While the literature is still unclear about the preferred test for examining dynamic balance, some other tests include the Star Excursion Balance Test36 and its modification, the Plisky inverted Y-test.37
Still, whether using different balance tests influences findings is unclear, with some researchers noting that ankle taping and bracing negatively affected clinical measures of static balance (using the Balance Error Scoring System) but not computer-based balance measures.38 These researchers suggested that the actual tests used to measure balance may influence interpretation of the effects of ankle braces on balance.38 Future research should examine dynamic balance using a test requiring quick direction changes to determine whether such an assessment results in different findings with regard to ankle brace use and balance performance.
Individuals with a history of previous ankle sprains are at risk for future ankle sprains, and their clinicians may prescribe ankle braces as part of rehabilitation and recovery protocols.9,10 Because ankle braces resist ankle motion they can potentially influence athletic performance, yet the question of whether wearing ankle braces consistently affects performance remains unclear.17-19,32-34,39-42 Thus, clinicians should be aware of the potential effects on performance when prescribing ankle braces.
Our findings, consistent with most prior work, indicate that ankle braces do not impede vertical jump or dynamic balance but may impede agility to some degree. Research suggests that, with this exception, there are no differences among ankle brace types with regard to effects on performance. With these findings in mind, clinicians can prescribe the ankle stabilizer that provides their patients with the best protection, comfort, and cost-efficiency and be confident that the choice of stabilizer is not likely to affect their patients’ athletic performance.
One possible progression of ankle brace use after an ankle sprain is to begin using a semirigid ankle brace postinjury, as this type of brace restricts ankle ranges of motion more than lace-up braces, and as the patient improves, prescribe a lace-up brace to allow for greater range of motion.
The constant stream of new advanced ankle brace designs, which are introduced yearly, mean there is a continuing need for research to examine the effects of these novel braces on athletic performance.
Jatin P. Ambegaonkar, PhD, ATC, OT, CSCS, is associate professor of athletic training, codirector of the Sports Medicine Assessment, Research, and Testing (SMART) Laboratory, and coordinator of the Exercise, Fitness, and Health Promotion Program at George Mason University in Manassas, VA. Nelson Cortes, PhD, is assistant professor of kinesiology, a researcher in the SMART Laboratory, and a faculty member in the Exercise, Fitness, and Health Promotion Program at George Mason. Shruti J. Ambegaonkar, MS, PT, is an instructor in the Athletic Training Education Program at George Mason and a physical therapist with The Jackson Clinics in Manassas, VA.
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