Ankle Sprains: Improved Outcomes through Physical Therapy and Bracing

Ankle injuries are common in running and jumping sports, with ankle sprains being the most common orthopedic injury in basketball players. In a study of NCAA Division 1 athletes, it was determined that 27% of all musculoskeletal injuries occur in the ankle. Many of these ankle injuries result in considerable missed time from sports and often require treatment including surgical intervention. Studies show that following an ankle injury the athlete will lose on average 12 to 20 days of playing time with up to a 70% chance of re-injury in that given year. (Am J Sports Med 2016, Phys Ther Sport 2016).

Following an ankle sprain, the ligaments and soft tissues are stretched beyond their normal limits. This leads to pain, swelling, and difficulty walking or running. Beyond the soft tissue injury there is also injury to the joint proprioceptors. These joint proprioceptors are tiny nerve endings that send messages to the brain to tell where the body is in space. Proprioception also helps the body to react quickly and appropriately to movement. When the ankle joint is injured, the sense of proprioception is injured which leads to poor balance and coordination. This is why the re-occurrence rate of ankle injuries is so high.

Physical therapy can retrain the joint proprioceptors by using specific hands on techniques, exercises and activities that challenge balance and reaction time of the injured joint. This rehabilitation will strengthen the ankle, improve proprioception and quickly return the athlete back to play. Physical therapy has been shown to reduce the risk of future ankle injuries by up to 60%. (Int J Risk Saf Med 2015)

When returning the athlete back to play following ankle injury, ankle braces are often recommended. It has been shown that figure-eight, lace-up ankle braces improve dynamic postural stability, increase ankle joint stiffness and reduce ankle joint excursion during landing. (Am J Sports Med 2016, Phys Ther Sport 2016). Wearing ankle braces protects the ankle allowing the athlete to return from injury and prevent subsequent ankle re-injury.

Can ankle braces reduce ankle sprains in healthy athletes? It is often thought 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 it has been shown that ankle braces can significantly improve dynamic postural control, single-limb stability and reduced the incidence of ankle sprains. (J Sport Rehabil 2015, AM J Sports Med 2011) The prophylactic use of ankle braces in healthy athletes can reduce the incidence of ankle injury by as much as 67% without causing weakness or limited range of motion. (Am J Sports Med 2011) Physical therapy and ankle braces can play a significant role in the treatment and prevention of ankle injuries.

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