Ankle Sprains and Braces

WMO was my first tournament since a bad ankle sprain suffered at the end of the 2005 season. With my current set of braces splitting at the seams, I need to take stock...

I sprained each ankle pretty badly numerous times playing high school basketball. High tops provide ZERO support, in my experience. I've probably done each ankle six times unbraced. However, when wearing McDavid lace-up braces I made it through 17 years of Ultimate without a sprain (until my first Nationals - wouldn't you know it?). So now I have to decide if I should buy another pair of McDavids, or if I should switch to Active Ankle braces. I hesitate to give up my McDavid's as they served me so well for 17 years, but I don't want rare ankle sprains, I want zero ankle sprains. Theoretically the Active Ankle braces provide more support, or so says "a major university." But which major university? What study? And what of all the anecdotal stories you hear about ankle sprains and bracing? Some examples:

  • Braces don't prevent sprains (false, if my experience has anything to say about it. Give me a few months braceless and I'll give you a sprain the size of a goose egg. With braces, one sprain in 17 years).
  • Braces will make your ankles weak and dependant, so you can never go braceless again (seems like hogwash to me, provided your brace allows a normal range of motion while preventing an abnormal range of motion).
  • Braces will slow you down (not sure).
  • Braces transfer the stress further up your leg, making you more prone to knee injury (this one just seems silly, unless the brace is seriously compromising your normal range of motion).
  • Braces are not the answer, proper rehab is (maybe, but again, not in my experience. Sprain 'em enough, and no amount of rehab is going to tighten them all the way up again. Interestingly, a NMT friend of mine recently told me that there are lots of proprioceptors in the ligaments themselves, so when you sprain an ankle and damage the ligaments, it is not only the ligament looseness that makes you more prone to sprains, but the decreased proprioception down there as well).

Anyway, I went a huntin' for some studies. My initial Google search (university study "active ankle" inversion tape) turned up a few things, but clicking through on the Scholarly articles for university study "active ankle" inversion tape gets you the good stuff. Without further ado, various sources with interesting excerpts (note that I'm not qualified to judge the validity of these studies):

The Prevention of Ankle Sprains in Sports - A Systematic Review of the Literature by Stephen B. Thacker, MD, MSc, Donna F. Stroup, PhD, MSc, Christine M. Branche, PhD, Julie Gilchrist, MD, Richard A. Goodman, MD, MPH, and Elyse A. Weitman

To assess the published evidence on the effectiveness of various approaches to the prevention of ankle sprains in athletes, we used textbooks, journals, and experts in the field of sports medicine to identify citations. We identified 113 studies reporting the risk of ankle sprains in sports, methods to provide support, the effect of these interventions on performance, and comparison of prevention efforts. The most common risk factor for ankle sprain in sports is history of a previous sprain. [emphasis added]

How incredibly awesome. If someone could arrange for a team of experts to summarize available literature whenever I set out to research something, that'd be grand.

Using a variety of tools, these investigators have demonstrated that inversion of the ankle is substantially restricted with these interventions. Slowing the speed of inversion, however, does not provide the peroneal muscles time to contract to prevent injury, and the torque generated by braces will not counteract the inversion movement that typically leads to injury. Moreover, such restriction is reduced after exercise, especially in persons using tape or cloth wrapping. Although the effectiveness of orthoses is reduced by exercise, these devices can be tightened easily to provide effective deterrents to extreme inversion, and may also protect the ankle by preventing inversion movement by preloading and maintaining the ankle in proper anatomic position at impact. [Tighten those braces after you've been exercising a bit!]
Although the majority of studies indicate that appropriately braced or taped ankles do not adversely affect performance, several studies report a small, but statistically significant, decrease in performance.
a randomized controlled trial of 2562 U.S. intramural basketball players observed for 2 years demonstrated a protective effect of high-top shoes. This study also demonstrated the protective effect of taping, reporting a reduction from 32.8 sprains per 1000 participant-games to 14.7 sprains per 1000 participant-games. Indeed, the protective effect of shoes was due primarily to taping, although the use of high-top shoes enhanced that protective effect. [emphasis added]
In a randomized controlled trial of 1601 U.S., male, college-aged intramural basketball players with no history of recent ankle sprain, a semirigid orthosis had a significant protective effect compared with the unprotected ankle (1.6 ankle sprains per 1000 athlete-exposures versus 5.2 sprains per 1000 athlete-exposures).
The trial of soccer players in Sweden suggests that training that focuses both on agility and flexibility decreases the risk for ankle injury. Similar results are seen in a study of knee injuries among soccer players in Italy.
For decades, taping the ankle has been the preventive method of choice for coaches and trainers in many sports. Data from one randomized controlled trial indicate that taping can prevent ankle sprains, despite the fact that tape loosens in approximately 10 minutes and provides little or no measurable support to the inverting ankle within 30 minutes. [interesting paradox - click through for more]
Despite these research needs and unanswered questions, on the basis of this review, we can make one clear recommendation to coaches, trainers, and athletes: athletes with a sprained ankle should complete supervised rehabilitation before returning to practice or competition, and those athletes suffering a moderate or severe sprain should wear an appropriate orthosis for at least 6 months. Research suggests that the benefit of the orthosis persists up to 1 year after injury.

The influence of foot positioning on ankle sprains by I.C. Wright, R.R. Neptune, A.J. van den Bogert, and B.M. Nigg

First of all, the entire introduction is fascinating. Go read it. On to the excerpts:

This meant that the more plantarflexed the foot was at touchdown, the greater the incidence of excessive supination. This result was further supported by the findings presented in the literature. Inversion sprains often occur when the foot is plantarflexed (Leonard, 1949; Renstrom and Kontradsen, 1997), and the ATF ligament, which is loaded when the foot is plantarflexed and supinated, is the most frequently sprained ligament of the ankle (Leonard, 1949; Saunders, 1980). Therefore, it appears that susceptibility to sprains is increased by initial plantar flexion.
Ankle taping and bracing may influence the position of the unloaded foot, decreasing the tendency of the foot to be plantarflexed. Taping and bracing stiffen the ankle in dorsi/plantar flexion as well as supination/pronation (Bruns et al., 1996; Siegler et al., 1997). Siegler et al. suggested that `the largest effects of the ankle braces on the passive flexibility of the ankle complex occurred near the neutral position of the ankle. Therefore the braces not only limit the range of motion, but may return the unloaded ankle to a neutral position. Since the foot was initially plantarflexed an average of 10° at touchdown during the simulated side-shuffle movements (Neptune et al., 1999), returning the foot to a neutral (zero dorsiflexion position) would tend to decrease the sprain frequency. Both ankle taping and bracing have been shown to improve foot position awareness in the unloaded foot (Heit et al., 1996). Therefore, in addition to passive ankle repositioning, taping and bracing may improve active ankle repositioning (by the muscles) in response to proprioceptive signals, thereby reducing the occurrence of excessive plantar flexion at touchdown. The findings of the current study would therefore suggest that repositioning of the foot prior to touchdown may be the means by which taping and bracing reduce ankle sprain frequency.

Very interesting. I wonder if that's how my McDavid's served me so well for 17 years? Clearly, since I sprained my ankle while wearing them, they don't provide enough support to prevent sprains Although, who knows how much worse the sprain would have been without them (it was bad enough). Also, I wasn't in the habit of tightening the braces after 10 minutes or so.

The Effects of Kinesio™ Taping on Proprioception at the Ankle by Travis Halseth, John W. McChesney, Mark DeBeliso, Ross Vaughn and Jeff Lien

I've written about Kinesio tape before. I imagine the Kinesio folks weren't too happy with the findings:

The application of Kinesio™ tape does not appear to enhance proprioception (in terms of reproduction of joint position sense (RJPS)) in healthy individuals as determined by our measures of RJPS at the ankle in the motions of plantar flexion and 20° of plantar flexion with inversion.


It is important to note, however, since the present study did not specifically measure changes in cutaneous sense, that kinesio™ tape cannot be ruled out as a contributor to increasing cutaneous sense. We can only speculate on the role cutaneous sense may or may not play in RJPS. It may be that kinesio™ tape does contribute to increasing cutaneous feedback, however it appears that it plays only a minimal role in RJPS.

Peroneus Longus Stretch Reflex Amplitude Increases After Ankle Brace Application by ML Cordova and CD Ingersoll

Wow! Here's a study that speaks directly to the two products I'm considering:

A 3 X 3 X 2 factorial design guided this study. The first independent variable (within-subjects factor) was the test condition with three levels: control (no brace), semi-rigid (Active Ankle training brace; Active Ankle Systems, Inc, Louisville, Kentucky, USA), and lace up (McDavid 199; McDavid Knee Guard, Chicago, Illinois, USA).

Figures this study would be the hardest to understand. Is it desireable that the peroneus longus amplitude increase? It sounds like it is. Thank goodness for the one-line "take home message":

External ankle support may enhance the sensorimotor response of the peroneus longus muscle.


We attempted to investigate the effects of long term use of ankle braces on the amplitude of the peroneus longus stretch reflex. The neuromuscular function of this muscle is critical to the dynamic support of the ankle/foot complex and the prevention of inversion injuries. As a result, peroneus longus reaction time (latency) during a simulated ankle sprain has been predominantly studied comparing normal and chronically unstable ankles,7 9-13 whereas the effect of ankle support on peroneus longus function has not been as thoroughly investigated.
There is no question that the semi-rigid style is more restrictive than the lace up style because of its inherent construction. The restrictive properties of the ankle braces play a role as the physiological limit of joint motion is reached. However, the peroneus longus muscle is firing well before the physiological limit is reached. This may provide more evidence that the external ankle support offered may enhance cutaneous feedback in addition to the mechanical properties of the devices.
Another important finding of this study is that, after acute application, the lace up brace resulted in greater stretch reflex amplitude of the peroneus longus than the semi-rigid and control conditions. We hypothesise that this is due to increased afferent information provided to the central nervous system primarily by cutaneous mechanoreceptors, and perhaps other joint mechanoreceptors, although no other data exist on the influence of ankle bracing on peroneus longus reflex amplitude. Because the lace up brace covers more area than the semi-rigid brace, more receptors may be being stimulated.

So the lace up (McDavid) provides for improved proprioception as soon as you put it on, but the semi-rigid (Active Ankle) doesn't improve proprioception until eight weeks go by? Not sure I'm interpreting that right, but that's what it sounds like. Here's the conclusion:

This study was designed to determine if long term ankle bracing affects peroneus longus neuromuscular response. The data provide evidence that peroneus longus amplitude in response to sudden inversion perturbation immediately after the application of a lace up style ankle brace is facilitated. It was also observed that peroneus longus amplitude was increased after an eight week application of a semi-rigid style ankle brace. The increased reflex response with an immediate application and extended use of external ankle support is a positive finding, as the neuromotor response from the primary musculature dynamically stabilising against lateral ankle sprain is enhanced. Although these results are encouraging, more studies are needed to understand the mechanisms by which these neurophysiological characteristics of the peroneus longus stretch reflex are effected. These results provide support for clinicians who advocate the use of prophylactic ankle support for extended periods of time, perhaps over the course of a sport season, in healthy subjects and in subjects who suffer from chronic ankle instability.

All very interesting stuff, but it doesn't bring me any closer to a decision! Damn.