Kinematics of ankle taping after a training session

This study aimed to test the effectiveness of ankle taping on the limitation of forced supination during a change of direction, as well as the losses of effectiveness after a 30-minute training session. Fifteen young men with no ankle injury volunteered for the study. The static and dynamic ranges of movement (ROM) were measured before and after a training session. The dynamic measurements were recorded using high-speed 3D photogrammetry. The differences between static and dynamic measures of ankle supination and plantar flexion were significant. The losses of effectiveness during supination and ankle plantar flexion restriction were 42.3 % and 47.6 %, respectively. Ankle taping was effective in restricting the maximal static ROMs before a training session, but the effectiveness decreased after 30 min of training. The present study shows the necessity of performing dynamic ROM analysis of sports techniques involved in the ankle sprain mechanism in order to determine the degree of tape restriction after a training session, because there were differences between static and dynamic ankle ROMs. The lack of effects on the restriction of the dynamic plantar flexion would bring into question the necessity of ankle taping in subjects without previous injuries.     

The effects of ankle braces and taping on lower extremity running kinematics and energy expenditure in healthy,non-injured adults

Ankle braces and taping are commonly used to prevent ankle sprains and allow return to play following injury, however, it is unclear how passive restriction of joint motion may effect running gait kinematics and energy expenditure during exercise. The purpose of this study was to determine the effect of different types of ankle supports on lower extremity kinematics and energy expenditure during continuous running. Thirteen healthy physically active adults ran at self-selected speed on the treadmill for 30 min in four different ankle support conditions: semi-rigid hinged brace, lace-up brace, tape and control. Three-dimensional lower extremity kinematics and energy expenditure were recorded every five minutes. The semi-rigid hinged brace was most effective in restricting frontal plane ankle motion. The lace-up brace and tape restricted sagittal plane ankle motion, while semi-rigid hinged bracing allowed for normal sagittal plane ankle kinematics. Kinematic changes from all three ankle supports were generally persistent through 25–30 min of exercise. Only tape influenced knee kinematics, limiting flexion velocity and flexion-extension excursion. Small but significant increased in energy expenditure was found in tape and semi-rigid hinged brace conditions; however, the increases were not to any practically significant level (<0.5 kcal/min).     

Ankle injuries in basketball: injury rate and risk factors

OBJECTIVES: To determine the rate of ankle injury and examine risk factors of ankle injuries in mainly recreational basketball players. METHODS: Injury observers sat courtside to determine the occurrence of ankle injuries in basketball. Ankle injured players and a group of non-injured basketball players completed a questionnaire. RESULTS: A total of 10 393 basketball participations were observed and 40 ankle injuries documented. A group of non-injured players formed the control group (n = 360). The rate of ankle injury was 3.85 per 1000 participations, with almost half (45.9%) missing one week or more of competition and the most common mechanism being landing (45%). Over half (56.8%) of the ankle injured basketball players did not seek professional treatment. Three risk factors for ankle injury were identified: (1) players with a history of ankle injury were almost five times more likely to sustain an ankle injury (odds ratio (OR) 4.94, 95% confidence interval (CI) 1.95 to 12.48); (2) players wearing shoes with air cells in the heel were 4.3 times more likely to injure an ankle than those wearing shoes without air cells (OR 4.34, 95% CI 1.51 to 12.40); (3) players who did not stretch before the game were 2.6 times more likely to injure an ankle than players who did (OR 2.62, 95% CI 1.01 to 6.34). There was also a trend toward ankle tape decreasing the risk of ankle injury in players with a history of ankle injury (p = 0.06). CONCLUSIONS: Ankle injuries occurred at a rate of 3.85 per 1000 participations. The three identified risk factors, and landing, should all be considered when preventive strategies for ankle injuries in basketball are being formulated.     

Passive stability characteristics of ankle braces and tape in simulated barefoot and shoe conditions

BACKGROUND: Ankle sprains are among the most common injuries in barefoot sport activities such as dance, gymnastics, or trampoline. At present, the use of external ankle devices for prevention of ligament injuries for barefoot activities remains unclear. HYPOTHESIS: External ankle devices have a significant loss of passive stability when used without a shoe in barefoot activities. STUDY DESIGN: Controlled laboratory study. METHODS: Twenty-five healthy subjects participated in the project (mean age, 26.2 +/- 3.3 years; mean body mass, 71.2 +/- 10.3 kg; mean height, 178 +/- 7 cm). Passive range of motion measurements were performed with 3 different ankle stabilizers (a stirrup brace, a lace-up brace, and tape), as well as 2 different shoe conditions (cutout shoe [simulated barefoot] and normal shoe). RESULTS: In the simulated barefoot condition, a significantly reduced stabilizing effect for inversion and eversion (19% and 29%, respectively) was found for the stirrup ankle brace. Small decreases were noted with the soft brace and tape, but these were not statistically significant. CONCLUSION: The passive stability characteristics of ankle braces depend to a great extent on being used in combination with a shoe. This is especially true for semirigid braces with stirrup design. Therefore, it is recommended that soft braces (like the one tested in the present investigation) be used in barefoot sports for restricting passive range of motion of the foot and ankle complex. CLINICAL RELEVANCE: This study provides useful information for clinicians to select or recommend an external ankle stabilizing device in barefoot sports to restrict passive range of motion of the foot-ankle complex most effectively.     

The prevention of ankle sprains in sports. A systematic review of the literature

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.     

A systematic review on the effectiveness of external ankle supports in the prevention of inversion ankle sprains among elite and recreational players

Epidemiological studies have shown that 10–28% of all sports injuries are ankle sprains, leading to the longest absence from athletic activity compared to other types of injuries. This study was conducted to evaluate the effectiveness of external ankle supports in the prevention of inversion ankle sprains and identify which type of ankle support was superior to the other. A search strategy was developed, using the keywords, ankle supports, ankle brace, ankle tapes, ankle sprains and athletes, to identify available literature in the databases (MEDLINE, PubMed, CINAHL, EMBASE, etc.), libraries and unpublished papers. Trials which consider adolescents and adults, elite and recreational players as participants were the study of choice. External ankle supports comprise ankle tape, brace or orthosis applied to the ankle to prevent ankle sprains. The main outcome measures were frequency of ankle sprains. Two reviewers assessed the quality of the studies included using the Joanna Briggs Institute (JBI Appraisal tool). Whenever possible, results were statistically pooled and interpreted. A total of seven trials were finally included in this study. The studies included were of moderate quality, with blinding as the hardest criteria to fulfill. The main significant finding was the reduction of ankle sprain by 69% (OR 0.31, 95% CI 0.18–0.51) with the use of ankle brace and reduction of ankle sprain by 71% (OR 0.29, 95% CI 0.14–0.57) with the use of ankle tape among previously injured athletes. No type of ankle support was found to be superior than the other.     

Volleyball injuries presenting in casualty: a prospective study.

During 1986, all sports injuries (n = 5222) were prospectively recorded at the two casualty departments in Arhus, Denmark. Volleyball injuries (n = 278) accounted for 5.3% of all sports injuries. An evaluation of the rehabilitation period and the consequences of the injuries was undertaken by questionnaire three years after the injury. The injury incidence was 1.9 injuries/1000 inhabitants/year. Hand, finger, and ankle sprains were the most frequent injuries. Female players had significantly more hand/finger injuries than male players, who incurred more ankle/foot injuries. Knee (6%) and ankle injuries (31%) were responsible for the longest duration of absence from sports participation. There were relatively few chronic injuries. The study suggests the need to enhance prophylactic measures with regard to blocking and overhand pass techniques, in order to reduce the number and extent of ankle and hand/finger injuries.     

Study of aeroball injuries.

OBJECTIVE: To present the risks of aeroball, a new sport played by either two or four players on a trampoline court surrounded by specially constructed fabric walls, and to propose ways to increase awareness and reduce the incidence of injury, in particular, ankle injury. METHOD: A study was carried out to document the nature of aeroball related incidents, between 1991 and 1995, at Lancaster University Sports Centre. Lace-up ankle supports were introduced in April 1992, and their effect on the incidence of ankle injury was recorded. RESULTS: The lower limb received most injuries (90%), followed by the upper limb (6%), then the face (3%) and cervical spine (1%). The most common category of injuries was sprains (83%), followed by fractures (8%), contusions (5%), and dislocations (4%). The most common site of injury was the ankle (73%). It is during doubles play that injury is most likely to occur. Since the introduction of ankle supports, there has been a gradual decline in the incidence of ankle injury, 31 in 1991 to nine in 1995. CONCLUSION: Aeroball has become a popular sport, but it is not without risks. Leaflets have been produced to promote the objectives, rules, and safety of the game. Trained full-time staff should be present to explain the nature of the game. The use of prophylactic ankle stabilisers in aeroball is strongly recommended.     

Ankle injuries in basketball players

We carried out a retrospective study of the frequency of ankle sprains in basketball players. A questionnaire about previous ankle injuries, time off after such injuries, current ankle problems, personal data, number of practice hours and the use of prophylactic measures was sent out to 102 basketball players in a second division league in Sweden. Ninety-six players answered. 92% of them had suffered an ankle sprain while playing basketball, and of these 83% reported repeated sprains of one ankle. In the last two seasons, 78% of the players had injured at least one ankle. The injury frequency in the investigation was 5.5 ankle injuries per 1000 activity hours. 22% of the players used some kind of prophylactic support of their ankle joints. Because of the great number of ankle sprains and the disability in terms of time away from sports that they cause, prevention of these injuries is essential.     

The effect of ankle bracing on athletic performance

Ankle braces in sports are used for prevention of ankle sprains. Besides restricting inversion and eversion, it is possible that an ankle brace also reduces the functional range of motion of the ankle joint. Consequently, their use could also impair athletic performance. It is unlikely that prophylactic ankle bracing will gain wide acceptance if bracing hinders athletic performance. The purpose of this paper is to review the literature on the effect of ankle bracing on vertical jump height, running speed, agility and broad jump performance. In 2 studies, 2 ankle braces negatively affected vertical jump height. Other studies did not find a significant effect on vertical jump performance when wearing an ankle brace. One study found a negative effect on running speed and broad jump performance when wearing a lace-on brace. In other studies, no effects on running speed and broad jump were found. In 1 study, agility was negatively affected when wearing an ankle brace, although agility was not significantly affected in other studies. The effect of prolonged use of an ankle brace is un-known, but could possibly influence ankle musculature and ligament function. Further research is necessary to study the effect of prolonged ankle bracing on performance.     

Magnetic resonance imaging findings of chronic lateral ankle instability

The ankle inversion injury is one of the most common types of injury that is encountered in athletes and active individuals. There are a wide variety of acute injuries associated with ankle inversion, including peroneal tendon tears, osteochondritis dessicans of the talus, anterior talofibular ligament avulsion, peroneal retinaculum avulsion, and calcaneofibular ligament tears. Chronic sequelae include impingement, posttraumatic degenerative arthritis, and an attenuated peroneal retinaculum. Most inversion injuries to the ankle have multiple associated injuries and isolated ligament injuries are uncommon. Chronically, the injured ankle usually demonstrates the injuries found at the time of the initial injury. Subsequently, there is a high frequency of these injuries in patients evaluated for symptoms of chronic lateral ankle instability. A high index of suspicion for the specific types of injuries associated with ankle inversions may result in a higher rate of injury detection and more expeditious and accurate diagnoses. Given the persistence of these injuries seen in patients with chronic posterolateral instability, injury patterns of ankle inversion are important to recognize even in the absence of acute trauma. We review the various types of injuries with their associated magnetic resonance (MR) imaging characteristics seen in patients with chronic lateral ankle instability.     

Retrospective comparison of taping and ankle stabilizers in preventing ankle injuries

The effectiveness of taping and the effectiveness of wearing a laced stabilizer in preventing ankle injuries and reinjuries over six seasons of collegiate football practices and games were assessed retrospectively. For 1 1/2 years the players all had taped ankles, and for the remaining 4 1/2 years the players chose their type of ankle support. Over the entire period, the players chose high-top or low-top shoes as preferred. During 51,931 exposures to injury (46,789 practice-exposures and 5,142 game-exposures), the 297 players sustained 224 ankle injuries and 24 reinjuries. Tape was worn during 38,658 exposures to injury (233 players), stabilizers during 13,273 exposures (127 players). Tape had been worn when 159 of the injuries and 23 of the reinjuries occurred; a stabilizer had been worn when 37 of the injuries (P = 0.003) and one of the reinjuries occurred. The combination allowing the fewest injuries overall was low-top shoes and laced ankle stabilizers.     

Assessing performance,stability, and cleat comfort/support in collegiate club soccer players using prophylactic ankle taping and bracing

Soccer athletes at all levels of play are keenly aware of their equipment needs including cleat wear, and want to be protected from injury but without impeding on-field performance. Ankle injury is a common disorder that is prevalent in the sport of soccer and recent improvements in ankle prophylaxis interventions have proven effective. The aim of this study was to determine if the use of elastic taping or a neoprene sleeve alters performance, stability, and cleat comfort/support in soccer players compared to wearing a soccer cleat without any external support. Twenty male collegiate club soccer players were recruited and randomly assigned to the three conditions (untaped control, taped, neoprene sleeve). Performance testing and comfort/support assessment for each condition took place in one on-field test session, while stability testing was completed during a separate laboratory session. The only significant finding was improved inversion/eversion stability in both the tape and sleeve conditions as compared to the cleated condition. The addition of tape or a sleeve did not have an adverse effect on performance or comfort during functional and stability testing, and should therefore be considered as a method to decrease ankle injuries in soccer athletes as external supports provide increased stability in inversion/eversion range of motion.     

A systematic review on ankle injury and ankle sprain in sports

This article systematically reviews epidemiological studies on sports injury from 1977 to 2005 in which ankle injury was included. A total of 227 studies reporting injury pattern in 70 sports from 38 countries were included. A total of 201,600 patients were included, with 32,509 ankle injuries. Ankle injury information was available from 14,098 patients, with 11 847 ankle sprains. Results show that the ankle was the most common injured body site in 24 of 70 included sports, especially in aeroball, wall climbing, indoor volleyball, mountaineering, netball and field events in track and field. Ankle sprain was the major ankle injury in 33 of 43 sports, especially in Australian football, field hockey, handball, orienteering, scooter and squash. In sports injuries throughout the countries studied, the ankle was the second most common injured body site after the knee, and ankle sprain was the most common type of ankle injury. The incidence of ankle injury and ankle sprain was high in court games and team sports, such as rugby, soccer, volleyball, handball and basketball. This systematic review provides a summary of the epidemiology of ankle injury in sports.     

The influence of shoe aging on children running biomechanics

Athletic children are prone to overuse injuries, especially at the heel and knee. Since footwear is an extrinsic factor of lower limb injury risk, the aim of this study was to assess the influence of shoe aging on children running biomechanics. Fourteen children active in sports participated in a laboratory biomechanical evaluation. A new pair of shoes was provided to each participant at an inclusion visit. Four months later, the participants performed a running task and their kinematics and kinetics were assessed both with their used shoes and with a new pair of shoes identical to the first. Furthermore, mechanical cushioning properties of shoes were evaluated before and after in-vivo aging. After 4 months of use, the sole stiffness increased by 16% and the energy loss capacity decreased by 18% (p < 0.001). No ankle or knee kinematic adjustment was found at foot strike in used shoes but changes were observed later during stance. Running with used shoes produced a higher loading rate of the vertical ground reaction force (+23%, p = 0.016), suggesting higher compressive forces under the heel and placing children at risk to experience impact-related injuries. Nevertheless, the decreased peak ankle and knee power absorption in used shoes (−11%, p = 0.010 and −12%, p = 0.029, respectively) suggests a lower ankle and knee joints loading during the absorption phase that may be beneficial regarding stretch-related injuries.     

Bracing and taping in an office sports medicine practice

Braces can be divided according to their use: rehabilitative, functional, or prophylactic. Rehabilitative braces are used following injury or surgery to allow protection of the injured part while rehabilitation is taking place. Functional braces are used following injury or surgery to allow an individual player to return to athletic activities while protecting the injured part from further damage. Prophylactic braces are used in an attempt to prevent injury to a normal area while engaged in athletic endeavors. Braces are available for the neck, back, and both the upper and lower extremities. There are many commercially available braces that are quite useful and effective. It is still controversial whether or not prophylactic braces prevent knee injuries in contact sports. However, prophylactic braces and/or taping have proved to be quite effective in preventing ankle injuries. It should always be kept in mind, however, whether one is using rehabilitative, functional, or prophylactic braces, that a good rehabilitation program and conditioning should be instituted along with their use to strengthen the involved area and prevent further injuries.     

Acute inversion injury of the ankle without radiological abnormalities: assessment with high-field MR imaging and correlation of findings with clinical outcome

Background  

Acute inversion injuries of the ankle are the most common sports accidents, accounting for approximately 10% of emergency room admissions. In up to 85%, an injury of the lateral collateral ligaments is observed. Classically, the assessment of these injuries has relied on clinical examination and radiographs, including stress views. The aim of our study was to correlate prospectively the findings of high-field 3 T MRI in acute ankle distortion with clinical outcome.     

Is it possible to prevent sports injuries? Review of controlled clinical trials and recommendations for future work.

Sports injuries are one of the most common injuries in modern western societies. Treating sports injuries is often difficult, expensive and time consuming, and thus, preventive strategies and activities are justified on medical as well as economic grounds. A successful injury surveillance and prevention requires valid pre- and post-intervention data on the extent of the problem. The aetiology, risk factors and exact mechanisms of injuries need to be identified before initiating a measure or programme for preventing sports injuries, and measurement of the outcome (injury) must include a standardised definition of the injury and its severity, as well as a systematic method of collecting the information. Valid and reliable measurement of the exposure includes exact information about the population at risk and exposure time. The true efficacy of a preventive measure or programme can be best evaluated through a well-planned randomised trial. Until now, 16 randomised, controlled trials (RCT) have been published on prevention of sports injuries. According to these RCT, the general injury rate can be reduced by a multifactorial injury prevention programme in soccer (relative risk 0.25, p < 0.001, in the intervention group), or by ankle disk training, combined with a thorough warm-up, in European team handball [odds ratio 0.17; 95% confidence interval (CI) 0.09 to 0.32, p < 0.01]. Ankle sprains can be prevented by ankle supports (i.e. semirigid orthoses or air-cast braces) in high-risk sporting activities, such as soccer and basketball (Peto odds ratio 0.49; 95% CI 0.37 to 0.66), and stress fractures of the lower limb by the use of shock-absorbing insoles in footwear (Peto odds ratio 0.47; 95% CI 0.30 to 0.76). In future studies, it is extremely important for researches to seek consultation with epidemiologists and statisticians to be certain that the study hypothesis is appropriate and that the methodology can lead to reliable and valid information. Further well-designed randomised studies are needed on preventive actions and devices that are in common use, such as preseason medical screenings, warming up, proprioceptive training, stretching, muscle strengthening, taping, protective equipment, rehabilitation programmes and education interventions (such as increasing general injury awareness among a team). The effect of a planned rule change on the injury risk in a particular sport could be tested via a RCT before execution of the change. The most urgent needs are in commonly practised or high-risk sports, such as soccer, American football, rugby, ice hockey, European team handball, karate, floorball, basketball, downhill skiing and motor sports.     

A systematic review on the treatment of acute ankle sprain: brace versus other functional treatment types

Ankle injuries, especially ankle sprains, are a common problem in sports and medical care. Ankle sprains result in pain and absenteeism from work and/or sports participation, and can lead to physical restrictions such as ankle instability. Nowadays, treatment of ankle injury basically consists of taping the ankle. The purpose of this review is to evaluate the effectiveness of ankle braces as a treatment for acute ankle sprains compared with other types of functional treatments such as ankle tape and elastic bandages. A computerized literature search was conducted using PubMed, EMBASE, CINAHL and the Cochrane Clinical Trial Register. This review includes randomized controlled trials in English, German and Dutch, published between 1990 and April 2009 that compared ankle braces as a treatment for lateral ankle sprains with other functional treatments. The inclusion criteria for this systematic review were (i) individuals (sports participants as well as non-sports participants) with an acute injury of the ankle (acute ankle sprains); (ii) use of an ankle brace as primary treatment for acute ankle sprains; (iii) control interventions including any other type of functional treatment (e.g. Tubigrip?, elastic wrap or ankle tape); and (iv) one of the following reported outcome measures: re-injuries, symptoms (pain, swelling, instability), functional outcomes and/or time to resumption of sports, daily activities and/or work. Eight studies met all inclusion criteria. Differences in outcome measures, intervention types and patient characteristics precluded pooling of the results, so best evidence syntheses were conducted. A few individual studies reported positive outcomes after treatment with an ankle brace compared with other functional methods, but our best evidence syntheses only demonstrated a better treatment result in terms of functional outcome. Other studies have suggested that ankle brace treatment is a more cost-effective method, so the use of braces after acute ankle sprains should be considered. Further research should focus on economic evaluation and on different types of ankle brace, to examine the strengths and weaknesses of ankle braces for the treatment of acute ankle sprains.     

Ankle taping improves proprioception before and after exercise in young men.

Ankle sprains are common sports injuries. Inadequate foot position awareness is thought to be the fundamental cause of these injuries. Ankle taping may decrease risk of injury through improving foot position awareness. The benefit of taping is thought to decrease with duration of exercise because of poor tape adherence to human skin. This study was a randomized, crossover, controlled comparison experiment that tested the hypothesis that ankle taping improves foot position awareness before and after exercise. A sample of 24 healthy young blindfolded volunteers, wearing their own athletic shoes, indicated perceived slope direction and estimated slope amplitude when bearing full body weight and standing on a series of blocks. The top slope of the blocks varied between 0 degree and 25 degrees, in 2.5 degrees increments, to orient the plantar surface with respect to the leg toward pronation, supination, plantarflexion, and dorsiflexion, relative to its position on a flat surface. Foot position awareness, which was considered the reciprocal of surface slope estimate error, varied with testing condition, particularly when surface slope was greater than 10 degrees, presumably the most important range considering ankle injuries. In this higher range absolute position error was 4.23 degrees taped, and 5.53 degrees untaped (P < 0.001). Following exercise, in the higher range absolute position error was 2.5% worse when taped and 35.5% worse when untaped (P < 0.001). These data support the hypothesis that ankle taping improves proprioception before and after exercise. They also indicate that foot position awareness declines with exercise. Compared to barefoot data (position error 1.97 degrees), foot position error was 107.5% poorer with athletic footwear when untaped (absolute position error 4.11 degrees), and 58.1% worse when taped (position error 3.13 degrees). This suggests that ankle taping partly corrects impaired proprioception caused by modern athletic footwear and exercise. Footwear could be optimized to reduce the incidence of these injuries.