The Prevention of Ankle Sprains in Sports

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. Ten citations of studies involving athletes in basketball, football, soccer, or volleyball compared alternative methods of prevention. Methods tested included wrapping the ankle with tape or cloth, orthoses, high-top shoes, or some combination of these methods. Most studies indicate that appropriately applied braces, tape, or orthoses do not adversely affect performance. Based on our review, we recommend that athletes with a sprained ankle 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. Both coaches and players must assume responsibility for prevention of injuries in sports. Methodologic limitations of published studies suggested several areas for future research.

[1]  A. Caraffa,et al.  Prevention of anterior cruciate ligament injuries in soccer , 1996, The Journal of orthopaedic and sports physical therapy.

[2]  Jesse A Berlin,et al.  Does blinding of readers affect the results of meta-analyses? , 1997, The Lancet.

[3]  R. Bahr,et al.  A twofold reduction in the incidence of acute ankle sprains in volleyball after the introduction of an injury prevention program: a prospective cohort study , 1997, Scandinavian journal of medicine & science in sports.

[4]  R. Bahr,et al.  Incidence of acute volleyball injuries: a prospective cohort study of injury mechanisms and risk factors , 1997, Scandinavian journal of medicine & science in sports.

[5]  M. Callaghan Role of ankle taping and bracing in the athlete. , 1997, British journal of sports medicine.

[6]  D. D. Clercq,et al.  Ankle Bracing in Running: The Effect of a Push® Type Medium Ankle Brace Upon Movements of the Foot and Ankle During the Stance Phase , 1997 .

[7]  M. T. Gross,et al.  Effect of ankle orthoses on functional performance for individuals with recurrent lateral ankle sprains. , 1997, The Journal of orthopaedic and sports physical therapy.

[8]  J. Ashton-Miller,et al.  The Effect of Exercise, Prewrap, and Athletic Tape on the Maximal Active and Passive Ankle Resistance to Ankle Inversion , 1997, The American journal of sports medicine.

[9]  B. Beynnon,et al.  Ankle Injury Risk Factors in Sports , 1997, Sports medicine.

[10]  D. De Clercq Ankle bracing in running: the effect of a Push type medium ankle brace upon movements of the foot and ankle during the stance phase. , 1997, International journal of sports medicine.

[11]  M. Ricard,et al.  The effects of spatting and ankle taping on inversion before and after exercise. , 1997, Journal of athletic training.

[12]  J. Ashton-Miller,et al.  What Best Protects the Inverted Weightbearing Ankle Against Further Inversion? , 1996, The American journal of sports medicine.

[13]  I. Olkin,et al.  Improving the quality of reporting of randomized controlled trials. The CONSORT statement. , 1996, JAMA.

[14]  D. McKeag,et al.  Practical methods of preventing ankle injuries. , 1996, American family physician.

[15]  B. Nigg,et al.  The effect of an ankle orthosis on ankle range of motion and performance. , 1996, The Journal of orthopaedic and sports physical therapy.

[16]  P Huston,et al.  Cochrane Collaboration helping unravel tangled web woven by international research. , 1996, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[17]  J. Verbrugge The effects of semirigid Air-Stirrup bracing vs. adhesive ankle taping on motor performance. , 1996, The Journal of orthopaedic and sports physical therapy.

[18]  W. Mosterd,et al.  Injuries in Male Soccer Players: Team Risk Analysis , 1996, International journal of sports medicine.

[19]  C. Reinschmidt,et al.  Lateral stability in sideward cutting movements. , 1996, Medicine and science in sports and exercise.

[20]  A. Watson Sports injuries in footballers related to defects of posture and body mechanics. , 1995, The Journal of sports medicine and physical fitness.

[21]  S. Robbins,et al.  Ankle taping improves proprioception before and after exercise in young men. , 1995, British journal of sports medicine.

[22]  R. Shapiro,et al.  The Effect of Ankle Stabilizers on Athletic Performance , 1995, The American journal of sports medicine.

[23]  V. Vardaxis,et al.  Ankle ranges of motion during extended activity periods while taped and braced. , 1995, Journal of athletic training.

[24]  Judith F. Baumhauer,et al.  A Prospective Study of Ankle Injury Risk Factors , 1995, The American journal of sports medicine.

[25]  R. Burnham,et al.  Prophylactic ankle bracing vs. taping: effects on functional performance in female basketball players. , 1995, The Journal of orthopaedic and sports physical therapy.

[26]  Joyce A. Mitchell,et al.  Methods of Randomized Controlled Clinical Trials in Health Services Research , 1995, Medical care.

[27]  J. Ashton-Miller,et al.  Basketball Shoe Height and the Maximal Muscular Resistance to Applied Ankle Inversion and Eversion Moments , 1995, The American journal of sports medicine.

[28]  S. Thacker,et al.  Public health surveillance in child-care settings. , 1995, Public health reports.

[29]  M. Horodyski,et al.  Effects of a semirigid and softshell prophylactic ankle stabilizer on selected performance tests among high school football players. , 1995, The Journal of orthopaedic and sports physical therapy.

[30]  D. Sanderson,et al.  The role of external nonrigid ankle bracing in limiting ankle inversion. , 1995, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[31]  K. Bennell,et al.  The differential effects of external ankle support on postural control. , 1994, The Journal of orthopaedic and sports physical therapy.

[32]  R. Bahr,et al.  Incidence and Mechanisms of Acute Ankle Inversion Injuries in Volleyball , 1994, The American journal of sports medicine.

[33]  B. Vicenzino,et al.  Leuko and Nessa Ankle braces: effectiveness before and after exercise. , 1994, Australian journal of science and medicine in sport.

[34]  M. Schwellnus,et al.  A Fivefold Reduction in the Incidence of Recurrent Ankle Sprains in Soccer Players Using the Sport-Stirrup Orthosis , 1994, The American journal of sports medicine.

[35]  R. Arciero,et al.  The Efficacy of a Semirigid Ankle Stabilizer to Reduce Acute Ankle Injuries in Basketball , 1994, The American journal of sports medicine.

[36]  K. M. Chan,et al.  An epidemiological survey on ankle sprain. , 1994, British journal of sports medicine.

[37]  M. Sitler,et al.  Effects of Two Semirigid Prophylactic Ankle Stabilizers on Speed, Agility, and Vertical Jump , 1994 .

[38]  T J Koh,et al.  Effect of an Ankle Orthosis and Ankle Ligament Anesthesia on Ankle Joint Proprioception , 1994, The American journal of sports medicine.

[39]  R. E. Johnson,et al.  Comparative study of ankle support devices. , 1994, Journal of the American Podiatric Medical Association.

[40]  M. Shapiro,et al.  Ankle Sprain Prophylaxis: An Analysis of the Stabilizing Effects of Braces and Tape , 1994, The American journal of sports medicine.

[41]  J. Scott Effect of the Active Ankle[TM] brace in controlling ankle plantarflexion, inversion stress before and after exercise , 1994 .

[42]  M. T. Gross,et al.  Comparison of DonJoy ankle ligament protector and subtalar sling ankle taping in restricting foot and ankle motion before and after exercise. , 1994, The Journal of orthopaedic and sports physical therapy.

[43]  J. Lau,et al.  Meta-analytic stimulus for changes in clinical trials , 1993, Statistical methods in medical research.

[44]  T. Yamamoto,et al.  Effectiveness of functional ankle taping for judo athletes: a comparison between judo bandaging and taping. , 1993, British journal of sports medicine.

[45]  W. Sebastianelli,et al.  A Comparison of Ankle-taping Methods , 1993 .

[46]  R. Harter,et al.  Comparison of inversion restraint provided by ankle prophylactic devices before and after exercise. , 1993, Journal of athletic training.

[47]  M. Verstraete,et al.  Reusable Prophylactic Ankle Support: A Review of the Literature , 1992 .

[48]  J. Karlsson,et al.  The effect of external ankle support in chronic lateral ankle joint instability. An electromyographic study. , 1992, The American journal of sports medicine.

[49]  L M Bouter,et al.  Aetiology of handball injuries: a case--control study. , 1992, British journal of sports medicine.

[50]  M. T. Gross,et al.  Comparison of DonJoy® Ankle Ligament Protector and Aircast® Sport-Stirrup™ Orthoses in Restricting Foot and Ankle Motion before and after Exercise , 1992 .

[51]  J. W. Alves,et al.  A comparison of the passive support provided by various ankle braces. , 1992, The Journal of orthopaedic and sports physical therapy.

[52]  S. Hunyor,et al.  Accuracy of Borg's ratings of perceived exertion in the prediction of heart rates during pregnancy. , 1992, British journal of sports medicine.

[53]  P. Hamer,et al.  The influence of ankle strapping on wobbleboard performance, before and after exercise. , 1992, Australian Journal of Physiotherapy.

[54]  D. L. Paris The Effects of the Swede-O, New Cross, and McDavid Ankle Braces and Adhesive Ankle Taping on Speed, Balance, Agility, and Vertical Jump. , 1992, Journal of athletic training.

[55]  G. Wilkerson Comparative biomechanical effects of the standard method of ankle taping and a taping method designed to enhance subtalar stability , 1991, The American journal of sports medicine.

[56]  S. Thacker,et al.  A meta-analysis of the effect of estrogen replacement therapy on the risk of breast cancer. , 1991, JAMA.

[57]  C. Milgrom,et al.  Risk Factors for Lateral Ankle Sprain: A Prospective Study Among Military Recruits , 1991, Foot & ankle.

[58]  M. T. Gross,et al.  Comparison of Swede-O-Universal® Ankle Support and Aircast® Sport-Stirrup™ Orthoses and Ankle Tape in Restricting Eversion-Inversion Before and After Exercise , 1991 .

[59]  A. Klein,et al.  Structural measures as predictors of injury basketball players. , 1991, Medicine and science in sports and exercise.

[60]  R. Marcus,et al.  Analysis of athletic performance with prophylactic ankle devices , 1991, The American journal of sports medicine.

[61]  M. T. Gross,et al.  Comparison of Swede-O-Universal® Ankle Support and Aircast® Sport-Stirrup orthoses and ankle tape in restricting eversion-inversion before and after exercise , 1991 .

[62]  S. Hillman,et al.  Comparison of support provided by a semirigid orthosis and adhesive ankle taping before, during, and after exercise , 1990, The American journal of sports medicine.

[63]  S. Walter,et al.  Application of Epidemiological Methodology to Sports ana Exercise Science Research , 1990, Exercise and sport sciences reviews.

[64]  T. A. Greene,et al.  A comparative isokinetic evaluation of a functional ankle orthosis on talocalcaneal function. , 1989, The Journal of orthopaedic and sports physical therapy.

[65]  J. Garrick,et al.  The epidemiology of foot and ankle injuries in sports. , 1989, Clinics in podiatric medicine and surgery.

[66]  S N Garn,et al.  Kinesthetic awareness in subjects with multiple ankle sprains. , 1988, Physical therapy.

[67]  J. Hamill,et al.  Exercise moderation of foot function during walking with a re-usable semirigid ankle orthosis. , 1988, Clinical biomechanics.

[68]  G. Rovere,et al.  Retrospective comparison of taping and ankle stabilizers in preventing ankle injuries , 1988, The American journal of sports medicine.

[69]  A. Saxena,et al.  Footwear and ankle stability in the basketball player. , 1988, Clinics in podiatric medicine and surgery.

[70]  J. Nunley,et al.  Effects of ankle taping on the motion and loading pattern of the foot for walking subjects , 1988, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[71]  C. Buncher Statistics in Sports Injury Research , 1988, The American journal of sports medicine.

[72]  A. Arthornthurasook,et al.  Study of the infrapatellar nerve , 1988, The American journal of sports medicine.

[73]  T. Bauer THE EFFECTIVENESS OF ANKLE TAPING AND CONSIDERATIONS FOR ALTERNATIVES , 1988 .

[74]  M. G. Owen,et al.  Effect of the AirStirrup in Controlling Ankle Inversion Stress. , 1987, The Journal of orthopaedic and sports physical therapy.

[75]  M T Gross,et al.  Effects of recurrent lateral ankle sprains on active and passive judgements of joint position. , 1987, Physical therapy.

[76]  M. T. Gross,et al.  Comparison of support provided by ankle taping and semirigid orthosis. , 1987, The Journal of orthopaedic and sports physical therapy.

[77]  A. Stacoff,et al.  A Biomechanical Study of the Stabilization Effect of the Aircast Ankle Brace , 1987 .

[78]  L. B. Cooper,et al.  Systematic ankle stabilization and the effect on performance. , 1986, Medicine and science in sports and exercise.

[79]  Eli Isakov,et al.  Response of the Peroneal Muscles to Sudden Inversion of the Ankle during Standing , 1986 .

[80]  J. Hamill,et al.  Evaluation of two ankle appliances using ground reaction force data. , 1986, The Journal of orthopaedic and sports physical therapy.

[81]  F. Handelberg,et al.  Comparative radiological study of the influence of ankle joint strapping and - - taping on ankle stability*. , 1985, The Journal of orthopaedic and sports physical therapy.

[82]  D A Nawoczenski,et al.  Objective evaluation of peroneal response to sudden inversion stress. , 1985, The Journal of orthopaedic and sports physical therapy.

[83]  T. Loos,et al.  The Effect of Ankle-tape on Lower Limb Muscle-activity , 1984 .

[84]  C. Vaughan,et al.  The effects of ankle guards and taping on joint motion before, during, and after a squash match , 1984, The American journal of sports medicine.

[85]  E. Larsen Taping the ankle for chronic instability. , 1984, Acta orthopaedica Scandinavica.

[86]  H Tropp,et al.  Stabilometry in functional instability of the ankle and its value in predicting injury. , 1984, Medicine and science in sports and exercise.

[87]  H. H. Morris,et al.  The effect of taping on ankle mobility following moderate exercise. , 1983, The Journal of sports medicine and physical fitness.

[88]  J. Ekstrand,et al.  Prevention of soccer injuries , 1983, The American journal of sports medicine.

[89]  M. Möller,et al.  Incidence of soccer injuries and their relation to training and team success , 1983, The American journal of sports medicine.

[90]  J A Zelisko,et al.  A comparison of men's and women's professional basketball injuries , 1982, The American journal of sports medicine.

[91]  Brandell Br,et al.  An EMG analysis of the effectiveness of external ankle support during sudden ankle inversion. , 1981 .

[92]  R. M. Fumich,et al.  The measured effect of taping on combined foot and ankle motion before and after exercise , 1981, The American journal of sports medicine.

[93]  B. Brandell,et al.  An EMG analysis of the effectiveness of external ankle support during sudden ankle inversion. , 1981, Canadian journal of applied sport sciences. Journal canadien des sciences appliquees au sport.

[94]  E. Chao,et al.  Three-dimensional kinematics of the taped ankle before and after exercise , 1980, The American journal of sports medicine.

[95]  Delacerda Fg Effect of underwrap conditions on the supportive effectiveness of ankle strapping with tape. , 1978 .

[96]  F. Delacerda Effect of underwrap conditions on the supportive effectiveness of ankle strapping with tape. , 1978, The Journal of sports medicine and physical fitness.

[97]  R. Gordon,et al.  The prevention and treatment of ankle injuries , 1976, The American journal of sports medicine.

[98]  G. McCluskey,et al.  Prevention of ankle sprains , 1976, The American journal of sports medicine.

[99]  D Dowson,et al.  A biomechanical approach to the design of football boots. , 1976, Journal of biomechanics.

[100]  R. W. Godshall The predictability of athletic injuries: An eight-year study , 1975, The Journal of sports medicine.

[101]  R J Ferguson,et al.  Synthetic turf and grass: A comparative study , 1974, The Journal of sports medicine.

[102]  B M Cameron,et al.  The swivel football shoe: A controlled study , 1973, The Journal of sports medicine.

[103]  J. Garrick,et al.  Role of external support in the prevention of ankle sprains. , 1973, Medicine and science in sports.

[104]  D. Libera Ankle taping wrapping and injury prevention , 1972 .

[105]  S. Bramwell,et al.  High school football injuries: a pilot comparison of playing surfaces. , 1972, Medicine and science in sports.

[106]  B. Simpson The measurable support given to the ankle joint by conventional methods of ankle taping , 1966 .

[107]  A. Ryan Prevention of sports injuries. , 1963, The New physician.

[108]  R. Malina,et al.  Effect of Exercise upon the Measurable Supporting Strength of Cloth and Tape Ankle Wraps , 1963 .

[109]  R. Malina,et al.  The measurable support of the ankle joint by conventional methods of taping. , 1962, The Journal of bone and joint surgery. American volume.