Athletic Training and Sports Health Care

Quick Questions in Sports Medicine 

What Effect Does Prophylactic Bracing and/or Taping Have on Reducing Lateral Ankle Sprain Risk?

Timothy A. McGuine, PhD, ATC

Abstract

For many years, providers have had to rely on taping and bracing research that consisted of laboratory studies that detailed measures of ankle biomechanics and athletic performance as proxy measures of efficacy rather than prospective trials conducted in athletic populations.

Despite its widespread use, ankle taping has not been well studied prospectively in athlete populations. The limited data do show that athletes with a history of previous injury benefited from prophylactic ankle taping. On the other hand, several large well-controlled studies have reported that both semirigid and lace-up braces are effective in reducing the incidence of ankle sprains in adolescent and college-age athletes. Noteworthy are the findings that bracing reduced the risk of injury in athletes without a previous injury and did not increase the risk for other lower-extremity injuries.

There is good evidence to support the use of prophylactic bracing to prevent ankle sprains. Less clear is the evidence to support the use of prophylactic taping. Providers should consider the efficacy and attributes of taping and bracing within the context of a specific athletes to determine which method of external support to use.

Prophylactic taping and bracing have been used extensively by sports medicine providers for decades to prevent ankle sprain injuries in youth, adolescent, and adult competitive and recreational athletes. While no numbers actually exist to document the use of prophylactic ankle support, it is safe to assume that sports medicine providers use these measures more than any other injury-prevention mechanism.

Historically, tape and braces were used to provide a mechanism to limit excessive foot and ankle motion. In recent years, sports medicine providers have often cited the growing body of thought that these external support measures enhance neuromuscular function through tactile stimulation equal to or greater than an effective mechanical restriction of foot and ankle motion.1

Despite the widespread use of taping and bracing to prevent ankle sprains, the question often posed by many sports medicine providers is simply this: Will taping or bracing actually prevent ankle sprains in my athletes? This may seem to be a straightforward question, but in reality, it can best be answered in the context of secondary questions that include the following: (1) Why consider taping or bracing? (2) Are there advantages/disadvantages of these methods? (3) Will athletes without any history of ankle sprain benefit from taping or bracing? (4) Will taping or bracing increase the risk for other injuries to the knee or lower leg?

The primary rationale for using taping or bracing to prevent ankle sprains is that their preventive effect is noticed immediately when used by an athlete. On the other hand, traditional lower-leg neuromuscular training programs develop their protective effect over an 8- to 10-week time period.1 Taping and bracing both offer specific advantages and disadvantages. The main advantage for ankle tape is that it can be tailored to the specific shape of an athlete's lower leg, ankle, and foot, providing appropriate and varying support as necessary for the athlete. The disadvantages to taping include (1) a traditional tape job, using anchor strips, stirrups, heel locks, and figure eights, requires the time and expertise of a trained provider, (2) it loosens in as little as 20 to 30 minutes of activity, possibly negating some of its protective effect, and (3) it costs several dollars per application, translating to several hundred dollars spent per ankle over an entire sport season.

The advantages of braces include the facts that they can be (1) applied by the athletes themselves, (2) tightened periodically throughout the session to provide continuous support to the ankle, and (3) reused throughout the entire season. A disadvantage…

For many years, providers have had to rely on taping and bracing research that consisted of laboratory studies that detailed measures of ankle biomechanics and athletic performance as proxy measures of efficacy rather than prospective trials conducted in athletic populations.

Despite its widespread use, ankle taping has not been well studied prospectively in athlete populations. The limited data do show that athletes with a history of previous injury benefited from prophylactic ankle taping. On the other hand, several large well-controlled studies have reported that both semirigid and lace-up braces are effective in reducing the incidence of ankle sprains in adolescent and college-age athletes. Noteworthy are the findings that bracing reduced the risk of injury in athletes without a previous injury and did not increase the risk for other lower-extremity injuries.

There is good evidence to support the use of prophylactic bracing to prevent ankle sprains. Less clear is the evidence to support the use of prophylactic taping. Providers should consider the efficacy and attributes of taping and bracing within the context of a specific athletes to determine which method of external support to use.

Background

Prophylactic taping and bracing have been used extensively by sports medicine providers for decades to prevent ankle sprain injuries in youth, adolescent, and adult competitive and recreational athletes. While no numbers actually exist to document the use of prophylactic ankle support, it is safe to assume that sports medicine providers use these measures more than any other injury-prevention mechanism.

Historically, tape and braces were used to provide a mechanism to limit excessive foot and ankle motion. In recent years, sports medicine providers have often cited the growing body of thought that these external support measures enhance neuromuscular function through tactile stimulation equal to or greater than an effective mechanical restriction of foot and ankle motion.1

Despite the widespread use of taping and bracing to prevent ankle sprains, the question often posed by many sports medicine providers is simply this: Will taping or bracing actually prevent ankle sprains in my athletes? This may seem to be a straightforward question, but in reality, it can best be answered in the context of secondary questions that include the following: (1) Why consider taping or bracing? (2) Are there advantages/disadvantages of these methods? (3) Will athletes without any history of ankle sprain benefit from taping or bracing? (4) Will taping or bracing increase the risk for other injuries to the knee or lower leg?

Attributes of Taping and Bracing

The primary rationale for using taping or bracing to prevent ankle sprains is that their preventive effect is noticed immediately when used by an athlete. On the other hand, traditional lower-leg neuromuscular training programs develop their protective effect over an 8- to 10-week time period.1 Taping and bracing both offer specific advantages and disadvantages. The main advantage for ankle tape is that it can be tailored to the specific shape of an athlete's lower leg, ankle, and foot, providing appropriate and varying support as necessary for the athlete. The disadvantages to taping include (1) a traditional tape job, using anchor strips, stirrups, heel locks, and figure eights, requires the time and expertise of a trained provider, (2) it loosens in as little as 20 to 30 minutes of activity, possibly negating some of its protective effect, and (3) it costs several dollars per application, translating to several hundred dollars spent per ankle over an entire sport season.

The advantages of braces include the facts that they can be (1) applied by the athletes themselves, (2) tightened periodically throughout the session to provide continuous support to the ankle, and (3) reused throughout the entire season. A disadvantage to bracing is that braces are essentially designed to fit every ankle in the same manner. This can translate to various levels of tension, support, and stress depending on an athlete's specific lower-leg, ankle, and foot shape.

Evidence

The majority of research supporting the effectiveness of taping and bracing to prevent ankle sprains actually consists of small laboratory studies that detail measures of ankle joint motion, lower-limb biomechanics, and athletic performance in collegiate and adult subjects.2 A number of studies reported the efficacy of both methods in preventing recurrent ankle sprains in recently injured subjects or measured their effectiveness prophylactically in adult athletes.1,2 While these studies do provide useful information, they often do not offer the level of evidence sports medicine providers need to fully evaluate their effectiveness in a young athlete population. There are, however, a limited number of prospective studies that have reported the effect that prophylactic taping or bracing has on reducing the incidence of ankle sprains in young athlete populations.

Taping

Despite the widespread use of prophylactic ankle taping, only one large randomized controlled trial of collegiate intramural basketball players supports the use of a traditional taping method (applying anchor strips, stirrups, heel locks, and figure eights) to prevent ankle sprains. Garrick and Requa3 reported that nontaped college-aged intramural basketball players were twice as likely to sustain an ankle sprain than the taped subjects while competing. The protective effect was most pronounced in players with a history of previous ankle injury, with the numbers needed to treat (NNT) equal to 26 versus subjects with no previous history (NNT = 143). The NNT is the expected number of athletes a clinician would need to treat to prevent one injury and can be used to gauge the benefit of a treatment. The limited taping evidence indicates that, while prophylactic taping reduced the risk of ankle sprains, those with a history of ankle sprains benefited greatly compared to those with no history.

Unfortunately, the limited evidence available indicates that there is a need for well-designed randomized clinical trials to examine the effect of traditional ankle taping on the incidence of ankle sprains. Needed as well are well-controlled trials that compare the effectiveness of taping to bracing methods in actual athletic populations over an entire season of multiple practice and competition sessions.

Bracing

Compared to taping, there is considerably more evidence to support the use of bracing to prevent ankle sprains. One notable well-controlled study by Sitler et al.4 illustrated the effectiveness of semirigid (hard plastic) braces in preventing ankle sprains. Military cadets not wearing braces were 3 times more likely to sustain an ankle sprain while participating in intramural basketball. The protective effect was most pronounced in players with a previous history of ankle sprain (NNT = 18) compared to subjects with a previous injury (NNT = 39). The authors also reported that the incidence of knee injuries was not affected by wearing the braces. In comparison to the taping evidence, bracing appears to be prophylactically beneficial for those with and without a history of ankle sprains.

In most athletic populations, prophylactic bracing involves using less rigid lace-up braces rather than the semirigid braces shown to be effective in collegiate and adult settings. Two recent large randomized trials studies reported on the effectiveness of lace-up ankle braces in high school basketball5 and football6 players. Basketball players not wearing braces were 3 times more likely to sustain an injury than braced subjects, while football players not wearing braces were twice as likely to sustain an ankle sprain than the players wearing braces. In basketball players, the NNT was 15, while the NNT in football players was 29. Unlike the previous studies, the braces were effective for players both with and without a history of previous ankle sprains. Also noteworthy is the finding that the risk for sustaining acute knee and other leg injuries was not increased in subjects wearing the lace-up braces.

Conclusion

There is good evidence to support the use of prophylactic bracing to prevent ankle sprains. Less clear is the evidence to support the widespread use of prophylactic taping. Both ankle taping and semirigid bracing seem to be more effective for athletes with a previous history of ankle sprain. On the other hand, lace-up braces reduced the incidence of ankle sprains in players with and without a previous injury.

Athletes using prophylactic taping or bracing do not have an increased risk of knee or other leg injuries. Sports medicine providers need to consider the efficacy and attributes of both methods within the context of a specific athlete's needs to determine which method to implement.

References

  1. Verhagen E, Bay K. Optimising ankle sprain prevention: a critical review and practical appraisal of literature. Br J Sports Med. 2010;1082–1088. doi:10.1136/bjsm.2010.076406 [CrossRef]
  2. Kaminski TW, Hertel J, Amendola N, et al. National Athletic Trainers' Association position statement: conservative management and prevention of ankle sprains in athletes. J Athl Train. 2013;48:528–545. doi:10.4085/1062-6050-48.4.02 [CrossRef]
  3. Garrick JG, Requa RK. Role of external support in the prevention of ankle sprains. Med Sci Sports. 1973;5:200–203.
  4. Sitler M, Ryan J, Wheeler B, et al. The efficacy of a semi-rigid ankle stabilizer to reduce acute ankle injuries in basketball: a randomized clinical study at West Point. Am J Sports Med. 1994;22:454–461. doi:10.1177/036354659402200404 [CrossRef]
  5. McGuine TA, Brooks A, Hetzel S. The effect of lace-up ankle braces on injury rates in high school basketball players. Am J Sports Med. 2011;39:1840–1848. doi:10.1177/0363546511406242 [CrossRef]
  6. McGuine TA, Hetzel S, Wilson J, Brooks A. The effect of lace-up ankle braces on injury rates in high school football players. Am J Sports Med. 2012;40:49–57. doi:10.1177/0363546511422332 [CrossRef]
Authors

From the Division of Sports Medicine, Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.

The author has no financial or proprietary interest in the materials presented herein.

Reprinted with permission from McKeon PO, Wikstrom EA, eds. Quick Questions in Ankle Sprains: Expert Advice in Sports Medicine. Thorofare, NJ: SLACK Incorporated; 2015:29–33. To purchase: http://www.healio.com/books/at

Correspondence: Timothy A. McGuine, PhD, ATC, 621 Science Drive, Madison, WI 53711. E-mail: TMCGuine@uwhealth.org

10.3928/19425864-20160229-01

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