October 2011

Tackling ankle sprains

In the moment: Sports medicine

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Braces reduce risk in football players

Research e-published last month by investigators at the University of Wis­consin-Madison suggests prophylac­tic lace-up braces are a cost-effective method of reducing the incidence of ankle sprains in high school football players without increasing the risk of knee and other lower extremity injuries.

By Emily Delzell

The same group also found similar results in high school basketball players in a study originally presented in May at the World Conference on Prevention of Injury & Illness in Sport and later published in the September issue of the American Journal of Sports Medicine. Players who wore lace-up braces had a significantly lower rate of ankle injuries than unbraced players; the benefit was seen in athletes with and without a history of ankle sprain (see “Lace-up ankle braces reduce risk of sprain in basketball players regardless of history”).

“Although we expected to find a reduced injury rate in athletes with a previous ankle sprain—previous research supports this—I was surprised when the data from both studies showed lace-up braces lower injury risk in players without a history of ankle injury,” said Timothy McGuine, PhD, ATC, senior scientist, UW-Madison School of Medicine and Public Health, Department of Orthopedics and Rehabilitation, and lead author of both studies.

In the football study, McGuine and colleagues assigned 2081 players from 50 high schools to a control group or a group that wore front-lacing braces with Velcro straps on each ankle for all practices and competitions during the 2010 football season. The incidence of ankle injuries was significantly lower in the braced group than in the control group (p=.003).

Among players in the braced group, the ankle injury rate was 70% lower in players with an ankle injury in the previous 12 months (p=.004) and 57% lower in those without previous injury (p=.010). There were no significant differences in knee or other lower extremity injuries between the braced and nonbraced groups.

The findings, e-published by AJSM in mid-September, contrast with earlier work that found an increased incidence of ankle sprains in high school football players who used braces. That study, published in 2006 in AJSM and conducted by researchers at the Nicholas Institute of Sports Medicine and Athletic Trauma (NISMAT), Lenox Hill Hospital, NY, found that the incidence of sprains was 0.5 per 1000 athlete exposures in players who didn’t use a brace or tape compared with 3.9 for players using a brace, tape, or a combination.

Malachy McHugh, PhD, lead author of the NISMAT study, said, “Our study wasn’t designed to study the effect of taping or bracing. We didn’t document compliance or look at the type of braces used or whether players were properly fitted [in McGuine’s study research staff measured all players to ensure proper fit]. I doubt taping or bracing increased risk in the players in our study. There were probably some confounding factors, such as functional ankle instability, increasing risk.”

Like McGuine, McHugh was surprised the recent studies found a protective effect in players with no history of ankle sprain and said he’d like to see the results replicated.

“Currently the only indication for bracing is for players with functional ankle instability,” he said.

McGuine noted that, ideally, injury prevention efforts should focus on neuromuscular training programs. McHugh agreed the most effective intervention is for coaches to make such programs a routine part of training.

The UW-Madison findings also suggest that bracing is cost effective.

“If we extrapolate our data to nationwide ankle sprain incidence, providing lace-up braces to all high school football players has the potential to decrease the number of ankle sprains by 39,000 events and lower the overall economic cost by millions of dollars,” McGuine said.

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