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.     

Comparison of three preventive methods in order to reduce the incidence of ankle inversion sprains among female volleyball players

BACKGROUND: Ankle sprains are the most common form of acute injury in volleyball. A prevention programme consisting of technical training, proprioceptive training, and external support was previously designed to reduce the rate of ankle sprains in volleyball players. OBJECTIVE: To investigate which of these three interventions is the most effective in preventing ankle sprain in female volleyball players. METHODS: Participants were 52 players who suffered ankle sprains during the season 1998-1999. They were divided randomly into three preventive groups: group 1 (n = 18) followed the technical training programme; group 2 (n = 17) followed the proprioceptive programme; group 3 (n = 17) used orthosis. The players followed their respective programmes for the whole of the 1999-2000 season. Data were collected at the end of the season. RESULTS: The three preventive strategies were all effective in preventive further ankle sprain. Technical training was slightly more effective than the other two methods. Orthosis was not effective in athletes who had suffered ankle sprains more than three times during their careers. Under those circumstances, technical training and proprioceptive training were equally effective at preventive further sprains. CONCLUSIONS: Technical training and proprioceptive training are effective methods of preventing ankle sprain in volleyball players who have suffered this injury four or more times during their career. Orthosis appears effective only in players with fewer than four previous sprains.     

Comparison of 3 preventive methods to reduce the recurrence of ankle inversion sprains in male soccer players

BACKGROUND: Ankle sprains are frequent injuries in soccer. Several strategies can be used to prevent further ankle sprains in athletes: the most common are proprioceptive training, strength training, and orthoses. OBJECTIVE: To investigate which of these 3 interventions is the most effective in preventing ankle sprains in athletes with previous ankle inversion sprain. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS AND MEASURES: Eighty male soccer players (age, 24.6 +/- 2.63 years; height, 175.60 +/- 4.36 cm; weight, 64.26 +/- 8.37 kg) in the first division of a men's league who had experienced previous ankle inversion sprain were randomly selected from an original population of 120 players. The subjects were individually and randomly assigned to 4 study groups: group 1 (n = 20) followed the proprioceptive program, group 2 (n = 20) followed the strength program, group 3 (n = 20) used orthoses, and group 4 (n = 20) was the control group. Data on the frequency of ankle sprain reinjury were collected at the end of the session. RESULTS: There were no significant differences among the groups in the number of exposures. The incidence of ankle sprains in players in the proprioception training group was significantly lower than in the control group (relative risk of injury, 0.13; 95% confidence interval, 0.003-0.93; P = .02). The findings with respect to the strength and orthotic groups in comparison with the control group were not significant (relative risk of injury, 0.5; 95% confidence interval, 0.11-1.87; P = .27 for strength; relative risk of injury, 0.25; 95% confidence interval, 0.03-1.25; P = .06 for orthotic group). CONCLUSION: Proprioceptive training, compared with no intervention, was an effective strategy to reduce the rate of ankle sprains among male soccer players who suffered ankle sprain.     

Wellbeing perception and the impact on external training output among elite soccer players

Objectives

The objective of the investigation was to observe the impact of player wellbeing on the training output of elite soccer players.

Risk factors for noncontact ankle sprains in high school football players: the role of previous ankle sprains and body mass index

BACKGROUND: In a previous study, we noted a possible connection between an athlete's weight and risk of ankle sprain. HYPOTHESIS: A high body mass index and a history of a previous ankle sprain increase the risk of a subsequent noncontact sprain. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: One hundred fifty-two athletes from 4 football teams were observed (2 varsity and 2 junior varsity). Two teams were observed for 3 seasons, and 2 teams were observed for 1 season. Before each season, body mass, height, history of previous ankle sprains, and ankle tape or brace use were recorded. RESULTS: There were 24 ankle sprains, of which 15 were noncontact inversion sprains (11 grade I, 3 grade II, 1 grade III; incidence, 1.08 per 1000 athlete-exposures). Injury incidence was higher in athletes with previous ankle injuries (2.60 vs 0.39; P < .001). Body mass index was also a risk factor (P < .05): injury incidence was 0.52 for players with a normal body mass index, 1.05 for players at risk of overweight, and 2.03 for overweight players. Injury incidence was 0.22 for normal-weight players with no previous ankle sprain compared with 4.27 for overweight players who had a previous sprain. CONCLUSION: An overweight player who had a previous ankle sprain was 19 times more likely to sustain a noncontact ankle sprain than was a normal-weight player with no previous ankle sprain. CLINICAL RELEVANCE: Ankle sprain prevention strategies should be targeted at football players with a high body mass index and a history of previous ankle sprains.     

The effectiveness of a balance training intervention in reducing the incidence of noncontact ankle sprains in high school football players

BACKGROUND: A high body mass index and previous ankle sprains have been shown to increase the risk of sustaining noncontact inversion ankle sprains in high school football players. HYPOTHESIS: Stability pad balance training reduces the incidence of noncontact inversion ankle sprains in football players with increased risk. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Height, body mass, history of previous ankle sprains, and current ankle brace/tape use were documented at the beginning of preseason training in 2 high school varsity football teams for 3 consecutive years (175 player-seasons). Players were categorized as minimal risk, low risk, moderate risk, and high risk based on the history of previous ankle sprain and body mass index. Players in the low-, moderate-, and high-risk groups (ie, any player with a high body mass index and/or a previous ankle sprain) were placed on a balance training intervention on a foam stability pad. Players balanced for 5 minutes on each leg, 5 days per week, for 4 weeks in preseason and twice per week during the season. Postintervention injury incidence was compared with preintervention incidence (107 players-seasons) for players with increased risk. RESULTS: Injury incidence for players with increased risk was 2.2 injuries per 1000 exposures (95% confidence interval, 1.1-3.8) before the intervention and 0.5 (95% confidence interval, 0.2-1.3) after the intervention (P < .01). This represents a 77% reduction in injury incidence (95% confidence interval, 31%-92%). CONCLUSION: The increased risk of a noncontact inversion ankle sprain associated with a high body mass index and a previous ankle sprain was eliminated by the balance training intervention.     

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.     

Interventions for the prevention of first time and recurrent ankle sprains

The uses of external support and balance/coordination training have demonstrated to be effective interventions for the prevention of ankle sprains, especially in those who have a history of ankle sprain. The purpose of this article is to identify areas where evidence has been established to support the use of these interventions for the prevention and enhancement of outcomes of lateral ankle sprain. In addition, areas of deficiency in the evidence are discussed related to these interventions. Finally, future directions for clinicians and researchers as per the use of these interventions are discussed.     

Ankle joint proprioception and postural control in basketball players with bilateral ankle sprains

BACKGROUND: Deficiencies in ankle proprioception and standing balance in basketball players with multiple ankle sprains have been reported in separate studies. However, the question of how ankle proprioceptive inputs and postural control in stance are related is still unclear. HYPOTHESIS: Ankle repositioning errors and the amount of postural sway in stance are increased in basketball players with multiple ankle sprains. STUDY DESIGN: Controlled laboratory study. METHODS: Twenty healthy male basketball players and 19 male basketball players who had suffered bilateral ankle sprains within the past 2 years were examined. Both groups were similar in age. Passive ankle joint repositioning errors at 5 degrees of plantar flexion were used to test for ankle joint proprioception. The Sensory Organization Test was applied with dynamic posturography to assess postural sway angle under 6 sensory conditions. RESULTS: A significant increase in ankle repositioning errors was demonstrated in basketball players with bilateral ankle sprains (P < .05). The mean errors in the right and left ankles were increased from 1.0 degrees (standard deviation, 0.4 degrees ) and 0.8 degrees (standard deviation, 0.2 degrees ), respectively, in the healthy players to 1.4 degrees (standard deviation, 0.7 degrees ) and 1.1 degrees (standard deviation, 0.5 degrees ) in the injured group. A significant increase in the amount of postural sway in the injured subjects was also found in conditions 1, 2, and 5 of the Sensory Organization Test (P < .05). Furthermore, there were positive associations between averaged errors in repositioning both ankles and postural sway angles in conditions 1, 2, and 3 of the Sensory Organization Test (r = 0.39-0.54, P < .05). CONCLUSIONS: Ankle repositioning errors and postural sway in stance increased in basketball players with multiple ankle sprains. A positive relationship was found between these 2 variables. CLINICAL RELEVANCE: Such findings highlight the need for the rehabilitation of patients with multiple ankle sprains to include proprioceptive and balance training.     

The effect of three degrees of elevation on swelling in acute inversion ankle sprains

The use of elevation is a central tenant in the treatment of acute soft tissue injuries, the most appropriate degree of elevation for swelling reduction is yet to be established The aim of this study was to determine the acute effect different degrees of limb elevation on the amount of swelling present in patients with acute first and second degree anterior Talo-fibular ligament sprains. Thirty patients with a diagnosed grade 1 or 2 anterior Talo-fibular ligament (ATFL) sprains (injuries 24 to a maximum 72 h old) participated in the study. Subjects were randomly allocated to one of three groups, either 0°, 20° or 60° elevation. Each subject was elevated to the group angle for 30 min, following 30 min elevation the patients undertook two sets of 20 repetitions full (available) range dorsi to plantar flexion at 0° elevation. Volumetric measurement of the foot and ankle (water displacement method) and girth measurement of ankle (using a tape measure) were made pre-elevation, post-elevation and post-exercise. MANCOVA analysis revealed a significant effect for treatment on post elevation girth and volume measurements (p<0.0001) and post exercise girth and volume measurements (p<0.0001). Post-hoc stepwise comparisons revealed post-elevation and post-exercise volume and girth measurements to show a significantly greater reduction in 60° vs. 20° (p<0.0001), 60° vs. 0° (p<0.0001) and 20° vs. 0° (p<0.003). The results of this study would indicate that in acute ATFL sprains 60° of limb elevation provides the most effective acute means of swelling reduction.     

Effectiveness of taping for the prevention of ankle ligament sprains.

The effectiveness of taping in the prevention of sports injuries has only been studied in detail with regard to the lateral ligaments of the ankle. It appears that taping can protect against injury. The mechanism by which taping works is not certain, but mechanical factors play a role which decreases with exercise. The major effect of taping may be its proprioceptive effect on underlying muscle groups.     

Looking for the evidence: a systematic review of prevention strategies addressing sport and recreational injury among children and youth

OBJECTIVES: To examine evidence on the effectiveness of current injury prevention strategies in selected sport and recreational activities, determine the applicability of the evidence to children and youth and discuss the implications related to policy, programming and future research. METHODS: Research questions and relevance criteria were developed a priori. Potentially relevant studies were located through electronic and hand searches. Two independent assessors assessed articles for first relevance and then quality. Relevant articles were abstracted and synthesised for activities that had three or more relevant articles. RESULTS: A total of 21,499 articles identified through database and manual searching yielding 117 that met inclusion criteria. The majority of the studies (93 or 89%) involved eight activities: baseball, basketball, cycling, football, ice hockey, rugby, alpine skiing and soccer. Children and youth were identified as the specific target group in 45% of the studies and another 12% included children in their sample. Studies addressed a range of intervention strategies and varied on quality of evidence. CONCLUSIONS: Surprisingly few well-designed and controlled studies investigating strategies to prevent injuries were found and an even smaller number evaluated strategies to reduce injury in children and youth. As governments in developed countries continue to focus on increasing physical activity among children and youth, thought must be given to the issue of risk of injury and the relative lack of evidence of effective preventive measures.     

The effect of braces on restricting weight-bearing ankle inversion in elite netballers

The aim of this study was to investigate whether the Standard 02-Air stirrup brace and the McDavid brace are effective in restricting ankle inversion when measured in weight-bearing (WB) before and after exercise in elite netballers. A sample of 18 female active players in elite netball league in South Australia with no history of lower extremity injury or surgery was used. Ten female volunteers took part in reliability trial without the exercise program. After an initial 10 min of warm-up on a stationary bicycle, the FootTrak (T.M.) a commercially available motion analysis system was used to measure the angle of calcaneal inversion in the frontal plane, prior and following application of the braces, following a functional exercise protocol and without any brace. An ANOVA indicated that the two braces significantly restricted ankle inversion in WB both before and following exercise. In addition, no significant differences were found between the actions of the two braces over the time measurement periods. As well, no significant difference was found between the measurements of ankle inversion in WB without braces, indicating that the true effectiveness of the braces was tested and that the maximal end range of ankle inversion was reproducible by the subjects over the time measurement periods. We therefore concluded that the effect of braces on restricting ankle inversion in WB is significant both prior to and following functional exercise.     

Beach tennis injuries: a cross-sectional survey of 206 elite and recreational players

ABSTRACT

Objectives

Although a million people regularly play beach tennis (BT) through the world there is no published information on BT injuries. The aim of this study was to describe the epidemiology of BT injuries, and to identify differences between injured and non-injured players.     

The effect of ankle braces on the prevention of dynamic forced ankle inversion

BACKGROUND: Athletes often employ prophylactic braces to reduce the risk of ankle injuries. HYPOTHESIS: Ankle braces do not significantly decrease the risk of forced inversion on a standardized one-footed jump landing. STUDY DESIGN: Controlled laboratory study. METHODS: Fourteen healthy men with a mean age of 25.1 years were tested. Three braces, two semirigid (Aircast and Bledsoe) and one lace-up (Swede-O), were fitted to each subject. Forced dynamic ankle inversion of 24 degrees was to be resisted as the subjects landed on one foot with a force of two body weights on a stimulus presented randomly in 5 of 15 jump trial blocks onto a hard, level force plate. Subjects first completed 1 no-brace block of 5 trials to establish baseline performance, then 3 randomly ordered 15-trial blocks testing performance with each of the braces, and then finally a no-brace 5-trial block. RESULTS: The average no-brace success rate was 24%, which demonstrated the challenging nature of the task. All three braces increased the success rate (average, 44%); however, only the two semirigid braces proved to be significantly better than the unbraced state. CONCLUSION: This test holds promise for evaluating brace efficacy when landing with one foot unexpectedly on an object that acts to forcibly invert the ankle.     

The effect of ankle supports on lower limb biomechanics during functional tasks: A systematic review with meta-analysis

ObjectivesTo systematically review the literature on the effects of ankle supports on lower extremity biomechanics during functional tasks.DesignSystematic review with meta-analysis.MethodsEight electronic databases were searched from inception to July 2019. Studies of biomechanical outcomes during functional tasks that used a within-participant (repeated measures) design were included. Two independent reviewers screened studies, extracted data, assessed the methodological quality of the included studies and rated the quality of evidence. Meta-analysis was performed and reported as standardised mean differences and 95% confidence intervals.ResultsA total of 8350 studies were identified in the electronic search and 42 studies involving a total of 761 participants were included in the review (21 studies included for qualitative reporting and 21 studies in the meta-analysis). Most individual studies and the meta-analyses demonstrated no effect of ankle supports on ground reaction force or ankle inversion angle. However, there was high quality evidence that ankle taping decreased plantarflexion angle at initial contact during landing from a height (P = 0.0009, standerdised mean differences = 0.72, 95% confidence intervals = 1.15, 0.03, I ² = 3%). The effect of ankle supports on transverse plane ankle biomechanics has not been adequately investigated.ConclusionsAnkle taping only decreased plantarflexion angle at initial contact during landing from a jump. Ankle supports did not affect inversion angle or forces in linear and multiplanar tasks. There was insufficient evidence on the effect of ankle supports on ankle transverse plane biomechanics.