Dec. 6, 2000 -- Ankle sprains are one of the most common and debilitating injuries for an athlete. We have all seen professional athletes wearing braces of some kind or walking around the playing field with taped-up ankles. But do these really work to prevent sprains? Researchers in the Netherlands have sifted through eight clinical studies on the subject and come up with their own conclusions, which are published in a recent issue of the Clinical Journal of Sports Medicine.
According to the authors, both tape and braces do work -- but with some caveats. If a sprain is going to happen, either is beneficial to lessen the severity. Both, as well, can prevent them from happening in the first place. But braces may have an edge, at least for certain people. The researchers found that only those with previous ankle injuries actually benefited from preventative bracing. Not true with tape. Other findings: Shoe height is a less-important factor in preventing ankle sprains than shoe newness. Proprioception -- your ability to know where your body parts are (in this case, your ankle) -- is also very important. The authors say that proprioceptive training, which heightens an athlete's sensitivity to the possibility for an ankle injury (so they can avoid it), benefits everyone.
What do practitioners say? In general, it takes good muscular strength and strong and proper shoes to prevent ankle sprains. And if they happen anyway, they shouldn't be ignored. "The most important thing is to strengthen the muscle groups that support and surround the joint," says Marje Albohm, MS, a certified athletic trainer at Orthopedics Indianapolis in Indiana.
Some of this might even be achieved using household items, says Al Green, MEd, former athletic trainer at the University of Kentucky and now with the Kessler Rehabilitation Centers. "Putting a weight of some type in a towel and curling it with the toes; picking up sticks or marbles with the toes increases dexterity and strength of the ankle."
But Albohm says there is still a problem. "The muscle groups [in the ankle] are relatively small. So the potential to really protect that joint is compromised," she says. "Even with the best strength-training, sprains do occur."
The next thing, she says, is to make sure the footwear is appropriate. "And that means appropriate to the surface you're playing on. Lots of research has looked at injury related to the shoe-surface interface. For a sport involving jumping, running, cutting ... you want a fairly sturdy shoe," says Albohm. "You're not concerned with it being lightweight or having a sole appropriate for outdoor terrain. You want something very sturdy and secure." Obviously, that creates a problem for the athlete with many interests. "If you're saying, 'I can't buy six pairs of shoes,' a well-made cross-training shoe is an excellent choice."
"Shoes do make a tremendous difference," says Perry Julien, DPM, of the Atlanta Foot and Ankle Center. "When shoes are worn out, they lose some of their inherent stability. So replacing the shoes regularly is important. Also, getting the specific shoe for the specific sport [is key]. What often happens is people will go on vacation and take just one pair of shoes. But running shoes lack lateral stability." No lateral stability means that you run the risk of an ankle sprain should you hit the basketball or tennis court wearing them. According to Julien, high-tops don't necessarily offer higher protection, but they do provide a degree of proprioception that will allow the ankle to react to potential injury. Studies on high-tops, however, have been mixed.
"The bottom line is: The shoe construction does not significantly decrease the incidence of ankle sprains," says Albohm.
So what about a brace or taping? Albohm says there's a bottom line there, too. "If you're dealing with healthy ankle joints with no previous injuries -- and ones that have been properly strengthened -- then you don't need any preventative measures externally," she says. But for those with a history of ankle sprains -- especially ones that have kept them out for 2-3 weeks -- it's a different story. "Then you've compromised the ligaments in that joint and created some instability that will not return to normal," Albohm says. "For those individuals, external protection is recommended and highly suggested."
Julien warns that some 'bracing' is ineffective. "The elastic braces provide very little stability," he says. "Some proprioception, some bracing -- but not a significant amount of stability."
Albohm prefers the lace-up type of braces but says that nothing works better externally than a good taping. 'Good,' she warns, does not mean 'amateur.' "Taping must be applied by a trained, skilled practitioner who knows what he's doing," she says. Otherwise, more damage can be done -- especially if the ankle gets fixed in the wrong position and the athlete plays on it.
Green notes that taping is not a substitute for strength -- just an enhancement. "There's a little bit of controversy -- if I'm taped or braced does it make the ankle weaker? There is a feeling among some athletes and coaches that it might. But I feel if you have [enough strength to begin with], it gives [added] support," he says.
Some sports may be harder on the ankles than others. Basketball, soccer, and football, for instance, place more strain on the joint. But Green says that nearly every athlete is vulnerable to an injury because they engage in "dry-land conditioning."
All the experts agree that ankle injuries shouldn't be taken lightly because one can more easily lead to another. "It's important to be evaluated. You might have torn a ligament or fractured something," Julien says. But before heading to the doctor, there may be a couple of things that can be done at home. "Get it on ice -- 15-20 minutes every couple of hours," he says. "Limit weight bearing as much as possible; apply some medium compression, such as an ACE wrap. Start from the toes and wrap upward" to avoid more swelling in the foot.
"Don't treat it as a minor injury," says Julien. "Most ankle sprains are undertreated, and people tend to have problems down the road."