Point-Counterpoint: Preventive Bracing For Ankle Sprains: Is it Legitimate?

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Author(s): 
Doug Richie, DPM, FACFAS, and Lisa M. Schoene, DPM, ATC, FACFAS

Yes. Doug Richie Jr., DPM, FACFAS says evidence-based medicine is overwhelmingly in favor of preventive bracing and notes that the literature discounts perceived negative
effects on athletic performance.

No. Lisa M. Schoene, DPM, ATC, FACFAS argues that clinicians should consider other modalities and be wary of a hasty return to play with bracing as a lack of follow-through with appropriate rehabilitation may lead to compromised tissue repair and recurrent sprains.

Yes.

This author says evidence-based medicine is overwhelmingly in favor of preventive bracing and notes that the literature discounts perceived negative
effects on athletic performance.

Preventive bracing for ankle sprains is legitimate and this position is clearly supported by the highest level evidence-based medicine. Preventive ankle bracing has consistently shown a protective benefit for the athlete with no sequelae for long-term use on a regular basis.

   So why is there any debate on this subject? Perhaps it is because parents, coaches, athletic trainers and physicians still cling to myths and misconceptions about preventive bracing of the ankle. Therefore, the facts of this debate deserve review and discussion.

   An ankle sprain is the most common injury in sport, comprising approximately 25 percent of all injuries reported for any part of the body.1-3 In terms of sport, basketball has the highest incidence of ankle sprain, followed by volleyball and soccer.1,2,4-7 These three sports have received the most intense focus of studies on preventive ankle bracing.

   The two classic studies showing positive effects of preventive bracing of the ankle were published in the 1990s and clearly show protective benefits in two different sports. Sitler and Horodyski performed a prospective study of over 1,600 basketball players at the United States Military Academy over a two-year period.7 Players who wore an Aircast type ankle stirrup (DJO) averaged 1.6 sprains per 1,000 games played while unbraced players suffered 5.2 sprains for the same amount of games. There was no difference in benefit whether the athletes had suffered a previous sprain.

   In a randomized prospective study of over 500 senior club soccer players, Surve and colleagues reported that the Aircast type stirrup ankle brace prevented sprains only in athletes who had suffered a previous sprain.8

   Later, Pedowitz and co-workers conducted an important seven-year study of female volleyball players at the University of Pennsylvania.9 This study showed a significant decrease in the incidence of ankle sprain in comparison to data published from the NCAA for female volleyball players during the same time period.

   Therefore, three prospective studies of three sports (basketball, soccer and volleyball) show significant benefit of preventive ankle bracing. Is any more data needed?

   If so, one only needs to evaluate today’s gold standard of evidence-based medicine: the systematic review of this subject published by the Cochrane Database Review.10 Here, the evidence becomes even more overwhelming supporting the notion that preventive bracing of the ankle is effective and safe. Overall, the review included 14 randomized trials with data for 8,279 participants. The main finding was a significant reduction in the number of ankle sprains in people who had external ankle support. This reduction was greater for those with a previous history of ankle sprain but still possible for those without a prior sprain. There was no apparent difference in the severity of ankle sprains or any change to the incidence of other leg injuries.

   Other systematic reviews of the large body of published research on preventive ankle bracing have shown similar results and conclusions. Kaplan recently published a review of 19 randomized, controlled trials consisting of a total of 12,233 participants.11 The studies showed a significant reduction in the number of ankle sprains in individuals in an external ankle support group. This reduction was greater for those with a previous history of ankle sprains. Braces appeared to be more effective than tape in preventing ankle sprains.

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Doug Richiesays: September 10, 2011 at 1:29 pm

Lisa,
Excellent overview of treatment options for the ankle sprain! My question: Why can't the practitioner utilize all of your suggestions AND implement preventive bracing? Does it have to be "either/or"? I have never seen any credible evidence that ankle bracing impedes any of the treatment measures you recommend.

Best Wishes,
Doug Richie

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