Sports Performance: Should I wear an ankle brace to prevent ankle injury?
By Dr. John Mishock, PT, DPT, DC
Ankle sprains are one of the most common reasons to visit an emergency department. Ankle injuries are the most common injury sustained by basketball players accounting for 54% of all injuries. Seventy-six percent of these injuries occur in basketball practice. Ankle injuries lead to a significant loss of playing time, with 55% of these injuries being moderate, with 7-21 days of lost playing time. (Babins, Clin J Sport Med, 2012) Once the ankle is sprained, there is a 60-70% chance of re-injury in that given year. (Mungo, Stat Perls, 2023) Up to 85% of all injuries respond well to physical therapy treatment; however, 20% will have ligament damage that leads to ankle instability, prompting surgical intervention. (Verhagen et al. Br J Sports Med. 2020)
What is injured during an ankle sprain?
Almost 85% of ankle sprains involve the outside ankle ligaments (3 lateral ligaments: anterior talofibular, calcaneofibular, or posterior talofibular). The mechanism of injury is an inversion movement in which the foot is forcefully turned inward, often during a change of direction movement or stepping on another athlete’s foot. In most cases, (65%), isolated injury occurs in the anterior talofibular ligament (front outside ligament). In 20%, injury of both the anterior talofibular and the calcaneofibular ligaments (front and side ligaments) occurs. (Doherty et al. Sports Med, 2014)
Can ankle braces reduce ankle sprains in healthy athletes who have never had an ankle injury?
There is a belief that wearing ankle braces prophylactically (preventively in healthy individuals) will cause the ankles to become weak and stiff, thus increasing the chance of injury when braces are not worn. However, scientific evidence refutes this common belief. In healthy athletes without a previous ankle injury, ankle braces can significantly improve dynamic postural control and single-limb stability and reduce the incidence of ankle sprains. (J Sport Rehabil. 2015, AM J Sports Med 2011) In multiple studies, the prophylactic use of ankle braces in healthy athletes can reduce the incidence of ankle injury by 70% without causing weakness or limited range of motion. (Dison et al. J Sci Med Sport, 2010; Richie et al. Clin Podiatr Med Surg, 2015)
Remember, unlike the walking boot that eliminates ankle movement and function, the figure 8 lace-up brace allows a full range of motion but prevents extremes of end-range motion that damage the ankle ligaments during inversion. A study showed that this ankle brace significantly reduced maximum ankle inversion by almost 2-4 degrees compared to the unbraced condition, reducing the strain on ligaments and muscles around the ankle during the ankle sprain event. (Dewar, The Foot, 2019)
Will wearing figure ankle braces increase my risk of an injury to the knee or hip?
According to a study by Babins, knee or hip injuries while wearing ankle braces were similar to a control group not wearing braces. However, the use of overly restrictive hinge ankle braces or Aircast ankle brace, although significantly reducing ankle motion, does increase internal rotation and adduction of the knee with trunk turning movements while standing on one leg. Overly restrictive ankle braces may, in turn, increase the potential of knee injury in some individuals. To combat this, a figure 8 lace-up brace that allows ankle mobility reduces strain at the knee while preventing injurious end rage ankle stress. (Santos Clin Biomech, 2004)
Will ankle braces reduce my running speed and agility or prevent me from jumping high?
Although some athletes do not like wearing ankle braces due to the perception that they reduce speed, slow first-step quickness, and impair vertical jump, studies refute this theory. Biomechanical studies show that the figure 8 lace-up ankle brace increases the medial-lateral mechanical protection by decreasing the shear force exerted on the athlete’s body without changing the application of propulsive forces in the take-off during running or jumping. (Castro, Rev Bras Med Esporte, 2017)
Is ankle taping just as good as ankle braces for preventing ankle injury?
Ankle taping can be as effective as braces to prevent ankle injury. A 6-month study comparing ankle taping, semi-rigid braces, and lace-up braces showed no difference in the injury rate. (Bekerom, Arthroscopy, 2015) However, a trained individual must do the taping techniques to optimize prevention. Also, the taping must be done every time the athletes plays both practice and games.
Will ankle braces make me weaker leading to more ankle injuries?
There is a misconception that figure 8 lace-up ankle braces will weaken your ankles if you wear them consistently; however, this is not true based on science. In a 16-week basketball study, players that wore prophylactic ankle-brace showed significant improvements in balance, proprioception, and dynamic postural control when re-tested at the end of the study. (Crockett, J Sport Rehab, 2023) Counter to popular belief; ankle braces improve strength and motor control when worn over time.
How does high-top or low-top shoes affect ankle injuries?
High-top basketball shoes do not prevent ankle injury. A study of 622 college intramural basketball players who wore either high-top or low-top basketball shoes during all games for a complete season showed that the ankle injury rate was similar with either shoe (4.80 × 10-4 in high-top shoes, 4.06 x 10-4 in low-top shoes). (Barret, AOSSM, 1996)
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Dr. Mishock is one of only a few clinicians with doctorate-level degrees in both physical therapy and chiropractic in the state of Pennsylvania. He has authored two books; “Fundamental Training Principles: Essential Knowledge for Building the Elite Athlete”, and “The Rubber Arm; Using Science to Increase Pitch Control, Improve Velocity, and Prevent Elbow and Shoulder Injury” both can be bought on Amazon and train2playsports.com.