Effect of a semi-rigid ankle stabilizer on performance in persons with functional ankle instability

Influence of taping on force sense accuracy: a systematic review with between and within group meta-analysis

Taping is a common technique used to address proprioceptive deficits in both healthy and patient population groups. Although there is increasing interest in taping to address proprioceptive deficits, little is known about its effects on the kinetic aspects of proprioception as measured by force sense accuracy. To address this gap in the literature, the present systematic review and meta-analysis was conducted to evaluate the impact of taping on force sense accuracy. A search for relevant literature was conducted following PRISMA guidelines across seven databases and one register. Eleven studies with 279 participants were included in the review out of 7362 records. In the between-group analyses, we found a significant improvement in absolute (p < 0.01) and relative (p = 0.01) force sense accuracy with taping compared to no comparator. Likewise, a significant improvement in absolute (p = 0.01) force sense accuracy was also observed with taping compared to placebo tape. In the within group analysis, this reduction in the absolute (p = 0.11) force sense accuracy was not significant. Additional exploratory subgroup analyses revealed between group improvement in force sense accuracy in both healthy individuals and individuals affected by medial epicondylitis. The findings of this meta-analysis should be interpreted with caution due to the limited number of studies and a lack of blinded randomized controlled trials, which may impact the generalizability of the results. More high-quality research is needed to confirm the overall effect of taping on force sense accuracy.

Time measurement validity and reliability of the 4 × 10-m shuttle run test in adult population: The ADULT-FIT project

OBJECTIVES

The purpose of this study was to analyze the time measurement validity and reliability (between raters and test-retest) of the 4 × 10-m shuttle run test to assess motor fitness in adults, according to gender, age, and physical activity levels.

DESIGN

Cross-sectional. A total of 230 adults (86 women) aged 18-64 years participated in the study.

METHODS

The time taken to complete the 4 × 10-m shuttle run test was recorded simultaneously by a trained and an untrained rater (inter-rater reliability) and by photoelectric cells (time measurement validity). 48-72 h later, the test was repeated under the same conditions (test-retest reliability).

RESULTS

The systematic error for trained rater vs. photocell was close to zero (0.0125, p < 0.01), with an effect size of 0.006; and for both, untrained rater vs. photocell and trained rater vs. untrained rater was ∼0.2 s (p < 0.001) with an effect size of 0.09. For the test-retest reliability, the systematic error was 0.05 s (p < 0.001), with an effect size of 0.26, the intraclass correlation coefficient was 0.998 and the coefficient of variation reported a variability of 0.73 %. Results were not influenced by gender and age, while these improved for active vs. non-active participants.

CONCLUSIONS

Findings indicate that measurements with trained raters are a valid and reliable method for assessing the 4 × 10-m shuttle run test in adults. It is highly recommended that raters be trained to minimize the measurement error.

Effect of Braces on Performance in the Context of Chronic Ankle Instability

Ankle braces are commonly recommended for prevention of ankle sprains, especially secondary sprains, rehabilitation, and return to normal activity or sport after injury. One common resistance to use is the feeling that braces will impede functional performance. For people with chronic ankle instability, the limited research indicates that the use of semirigid, lace-up, or soft-shell braces will not affect, and in some cases, may enhance performance. Activities that could be enhanced are jumping, hopping, and dynamic balance.

Current Concept Review: State of Acute Lateral Ankle Injury Classification Systems

Acute lateral ankle sprain (ALAS) is one of the most frequent musculoskeletal injuries, with a great impact on health and socioeconomic factors. There are few consensuses on this subject and multiple therapeutic options that are difficult to compare due to the lack of a universally adopted classification system. The objective of this study is to is to report the actual knowledge on how ALAS are classified and reported and not to make any therapeutic recommendation. A comprehensive literature review of the literature was carried out through a search in the MEDLINE, Cochrane Library and Google Scholar databases, with identification of articles that describe ways to classify lateral ankle sprains or with relevant content for their classification. Twenty-five different classification systems were identified. The majority of articles referring to ALAS use an unspecific classification. Most classification systems divide sprains into 3 degrees. The most used parameters are the anatomy of the injury, clinical parameters, functional loss and the presence of instability. No articles were found to verify the validity of the systems used, namely regarding their association with therapeutic proposals or prognostic predictions. Based on the available evidence, recommendations cannot be made regarding the most appropriate classification system. The considerable heterogeneity of the existing literature makes it difficult to compare studies and to optimize the treatment and follow-up of these injuries. Future research in this area is necessary to define a practical and rigorous system that can be used universally.

Effect of Combined Balance Exercises and Kinesio Taping on Balance, Postural Stability, and Severity of Ankle Instability in Female Athletes with Functional Ankle Instability

Ankle sprain is a common musculoskeletal injury, and recurrent ankle sprains often lead to ankle instability. This study aimed to examine whether a 6-week balance training on a wobble board (WB) combined with kinesio taping (KT) is effective in improving balance, postural stability, and ankle stability among female athletes with functional ankle instability (FAI). Twenty-four female athletes with FAI were randomly assigned to study (SG) or control groups (CG). SG attended a 6-week training protocol of combined balance training on the wobble board with KT applied to ankles during exercise. CG only went through a 6-week balance training procedure that was the same as the SG. Before and after the training program, balance and postural stability and the severity of ankle instability were assessed by single-leg Biodex Balance system and Cumberland Ankle Instability Tool (CAIT), respectively. The analysis revealed that the scores of balance and postural stability decreased after the 6-week training for CG (p = 0.002) and SG (p = 0.001), which indicates an improvement for these variables, and the score of CAIT increased, which means the severity of instability reduced (p = 0.001 for both groups). Significant between-group differences were found for balance and postural stability (t = 2.79, p = 0.011, g = −1.99) and the severity of instability (t = 2.082, p = 0.049, g = 1.36), favoring SG compared with CG. This study showed that the addition of KT to balance training is more effective than balance training alone in improving balance, postural stability, and severity of ankle instability in female athletes with FAI. Our findings could provide a preliminary reference for designing combined balance and KT programs for delivering health benefits to females with FAI.

The Influence of Ankle Braces on Functional Performance Tests and Ankle Joint Range of Motion

CONTEXT

The lateral ankle sprain is one of the most common lower-extremity injuries in sports. Previous research has found that some prophylactic ankle supports reduce the risk of recurrent ankle sprains and provide extra support to the joint. However, there is a continued concern that these supports may negatively influence performance.

OBJECTIVE

To determine if wearing an ankle brace influences athlete performance and ankle kinematics during functional performance tests.

DESIGN

Repeated measures.

SETTING

University gymnasium.

OTHER PARTICIPANTS

Male and female recreational or competitive athletes (n = 20).

INTERVENTION

Participants performed 3 trials of a standing long jump, vertical jump, 40-yard sprint, and T-drill under each of the following 3 conditions: wearing traditional lace-up brace (brace 1), modified lace-up brace (brace 2), and no-brace.

MAIN OUTCOME MEASURES

A 2-dimensional motion capture camera was used to measure ankle range of motion (ROM) in the sagittal plane during the vertical and standing long jumps and in the frontal plane during the cutting phase of the T-drill. Performance of each test and ankle ROM were compared between each of the braced conditions.

RESULTS

Ankle braces did not influence performance in speed or agility functional performance tests (P > .05). Ankle braces negatively affected performance of the standing long jump (P = .01) and vertical jump (P = .01). There was no significant difference between brace or no-brace conditions in ankle inversion ROM during the T-drill (P > .05). Both brace conditions restricted ROM in the sagittal plane during the vertical and standing long jumps (P < .05).

CONCLUSIONS

Braced conditions restricted sagittal plane ROM during the vertical jump and long jump. This decrease in ROM explains the decline in functional performance also seen during these tests.

Early functional outcome of two different orthotic concepts in ankle sprains: a randomized controlled trial

INTRODUCTION

Purpose of the study was the evaluation of the early functional outcome of patients with an acute ankle sprain treated either with a semirigid, variable, phase-adapted modular ankle orthosis or an invariable orthotic reference device.

MATERIALS AND METHODS

Forty-seven patients with acute ankle sprain grade II or more were included. In addition, 77 healthy controls as a reference were investigated. The injured subjects were treated with one of the two devices by random for 6 weeks. Ankle scores (FAOS, AOFAS) were taken at baseline after injury, 1 and 3 months after injury. Functional performance tests (balance platform, zig zag run, shuttle run, vertical drop jump) were performed at 1 and 3 months after injury.

RESULTS

No significant score differences could be found between the two intervention groups except for achieving a preinjury activity level after 3 months only in the modular orthosis group. Postural functional performances (balance test) also showed no significant differences whereas the results of the agility tests revealed small but significant better results in the modular orthosis group in comparison to the invariable orthosis group. Cohen's effect sizes were high.

CONCLUSION

Differences between the two intervention groups were marginal and very small but significant and--regarding Cohen's effect sizes--effective. Especially relating to functional performance, this might be a careful indication that a more effective strategy for promoting a protected, rapid recovery to physical activity after ankle sprains might be achieved by applying a phase-adapted ankle orthosis. Especially in athletic patients, phase-adapted orthosis should be further investigated and considered to ensure fully protected ligament healing as well as to regain early functional recovery.

Influence of Mulligan Ankle Taping on Functional Performance Tests in Healthy Athletes and Athletes With Chronic Ankle Instability

Context:

Ankle sprains or chronic ankle instability (CAI) is common in athletes and a common method for decreasing the effects of ankle instable is using tape.

Objective:

To determine whether Mulligan ankle taping (MAT) influenced the functional performance (FP) tests in athletes with and without CAI.

Design:

A cross-sectional study using a within-subject experimental design between four ankle conditions (taped and untaped, athletes with and without CAI).

Setting:

Research laboratory.

Participants:

Sixteen professional athletes with unilateral CAI (10 men and 6 women; age 23.2 ± 3 years, height 175.4 ± 10.3 cm, weight 73 ± 14.5 kg, and body mass index 23.8 ± 3.6%) and 16 uninjured professional athletes (10 men and 6 women; age 22.8 ± 1.7 years, height 173.6 ± 12.2 cm, weight 66.4 ± 11.4 kg, and body mass index 22.2 ± 3.3%) volunteered to participant in this study.

Intervention:

Mulligan ankle taping.

Main Outcome Measures:

FP tests including single leg hopping course, Figure-of-8 hop and side hop were measured for both the groups in two conditions: taped and untaped.

Results:

There were significant differences between injured and uninjured athletes in all FP tests (P< .05). MAT significantly improved FP tests in both groups (P< .05).

Conclusion:

We found that MAT can improve FP tests in athletes with CAI and uninjured athletes. Therefore, it seems that MAT can be an effective method for enhancing athletes’ performance in sports that require lateral movements.

Gait kinematics after taping in participants with chronic ankle instability

CONTEXT

Chronic ankle instability is characterized by repetitive lateral ankle sprains. Prophylactic ankle taping is a common intervention used to reduce the risk of ankle sprains. However, little research has been conducted to evaluate the effect ankle taping has on gait kinematics.

OBJECTIVE

To investigate the effect of taping on ankle and knee kinematics during walking and jogging in participants with chronic ankle instability.

DESIGN

Controlled laboratory study.

SETTING

Motion analysis laboratory.

PATIENTS OR PARTICIPANTS

A total of 15 individuals (8 men, 7 women; age = 26.9 ± 6.8 years, height = 171.7 ± 6.3 cm, mass = 73.5 ± 10.7 kg) with self-reported chronic ankle instability volunteered. They had an average of 5.3 ± 3.1 incidences of ankle sprain.

INTERVENTION(S)

Participants walked and jogged in shoes on a treadmill while untaped and taped. The tape technique was a traditional preventive taping procedure. Conditions were randomized.

MAIN OUTCOME MEASURE(S)

Frontal-plane and sagittal-plane ankle and sagittal-plane knee kinematics were recorded throughout the entire gait cycle. Group means and 90% confidence intervals were calculated, plotted, and inspected for percentages of the gait cycle in which the confidence intervals did not overlap.

RESULTS

During walking, participants were less plantar flexed from 64% to 69% of the gait cycle (mean difference = 5.73° ± 0.54°) and less inverted from 51% to 61% (mean difference = 4.34° ± 0.65°) and 76% to 81% (mean difference = 5.55° ± 0.54°) of the gait cycle when taped. During jogging, participants were less dorsiflexed from 12% to 21% (mean difference = 4.91° ± 0.18°) and less inverted from 47% to 58% (mean difference = 6.52° ± 0.12°) of the gait cycle when taped. No sagittal-plane knee kinematic differences were found.

CONCLUSIONS

In those with chronic ankle instability, taping resulted in a more neutral ankle position during walking and jogging in shoes on a treadmill. This change in foot positioning and the mechanical properties of the tape may explain the protective aspect of taping in preventing lateral ankle sprains.

Análise do pico de ativação do glúteo máximo na marcha em mulheres com instabilidade do tornozelo

INTRODUÇÃO: O risco de recidiva após a entorse de tornozelo pode estar associado com modificações da estabilidade postural e do recrutamento muscular das articulações do quadril e do tornozelo. OBJETIVOS: Avaliar o pico de ativação muscular do glúteo máximo durante a marcha em esteira, em mulheres, comparando voluntárias com história de entorse grau II de tornozelo, com um grupo de voluntárias sem história de entorse. MATERIAIS E MÉTODOS: Participaram 26 mulheres, jovens, sendo 13 voluntárias com história de entorse unilateral de tornozelo e 13 sem história de entorse. A ativação do músculo glúteo máximo foi avaliada por meio do eletromiógrafo de superfície EMG System do Brasil durante a marcha em esteira. RESULTADOS: No grupo com história de entorse não houve diferença significativa na medida percentual de ativação normalizada do glúteo máximo durante a marcha, quando comparou-se membro acometido e não acometido (p > 0,57). No grupo sem história de entorse houve diferença significativa entre os membros direito e esquerdo na medida percentual de ativação normalizada do glúteo máximo durante a marcha (p = 0,01). Quando comparados os grupos, não houve diferença significativa entre membro acometido e membros direito e esquerdo do grupo sem história de entorse (p > 0,51). CONCLUSÃO: Pela ausência de diferença entre os grupos pode-se supor que existam fatores adaptativos, como musculares, neuromusculares e dominância dos membros, que determinam uma adaptação após a entorse do tornozelo, possibilitando uma atividade da marcha adequada.

Interventions for treating chronic ankle instability

BACKGROUND

Chronic lateral ankle instability occurs in 10% to 20% of people after an acute ankle sprain. Initial treatment is conservative but if this fails and ligament laxity is present, surgical intervention is considered.

OBJECTIVES

To compare different treatments, conservative or surgical, for chronic lateral ankle instability.

SEARCH STRATEGY

We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL and reference lists of articles, all to February 2010.

SELECTION CRITERIA

All identified randomised and quasi-randomised controlled trials of interventions for chronic lateral ankle instability were included.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed risk of bias and extracted data from each study. Where appropriate, results of comparable studies were pooled.

MAIN RESULTS

Ten randomised controlled trials were included. Limitations in the design, conduct and reporting of these trials resulted in unclear or high risk of bias assessments relating to allocation concealment, assessor blinding, incomplete and selective outcome reporting. Only limited pooling of the data was possible.Neuromuscular training was the basis of conservative treatment evaluated in four trials. Neuromuscular training compared with no training resulted in better ankle function scores at the end of four weeks training (Ankle Joint Functional Assessment Tool (AJFAT): mean difference (MD) 3.00, 95% CI 0.3 to 5.70; 1 trial, 19 participants; Foot and Ankle Disability Index (FADI) data: MD 8.83, 95% CI 4.46 to 13.20; 2 trials, 56 participants). The fourth trial (19 participants) found no significant difference in the functional outcome after six weeks training programme on a cyclo-ergometer with a bi-directional compared with a traditional uni-directional pedal. Longer-term follow-up data were not available for these four trials.Four studies compared surgical procedures for chronic ankle instability. One trial (40 participants) found more nerve injuries after tenodesis than anatomical reconstruction (risk ratio (RR) 5.50, 95% CI 1.39 to 21.71). One trial (99 participants) comparing dynamic versus static tenodesis excluded 17 patients allocated dynamic tenodesis because their tendons were too thin. The same trial found that dynamic tenodesis resulted in higher numbers of people with unsatisfactory function (RR 8.62, 95% CI 1.97 to 37.77, 82 participants). One trial comparing techniques of lateral ankle ligament reconstruction (60 participants) found that operating time was shorter using the reinsertion technique than the imbrication method (MD -9.00 minutes, 95% CI -13.48 to -4.52). Two trials (70 participants) compared functional mobilisation with immobilisation after surgery. These found early mobilisation led to earlier return to work (MD -2.00 weeks, 95% CI -3.06 to -0.94; 1 trial) and to sports (MD -3.00 weeks, 95% CI -4.49 to -1.51; 1 trial).

AUTHORS' CONCLUSIONS

Neuromuscular training alone appears effective in the short term but whether this advantage would persist on longer-term follow-up is not known. While there is insufficient evidence to support any one surgical intervention over another surgical intervention for chronic ankle instability, it is likely that there are limitations to the use of dynamic tenodesis. After surgical reconstruction, early functional rehabilitation appears to be superior to six weeks immobilisation in restoring early function.

Inclusion criteria when investigating insufficiencies in chronic ankle instability

INTRODUCTION

The development of chronic ankle instability (CAI) is the primary residual deficit after ankle joint sprain. It has been proposed that CAI is characterized by two entities, namely, mechanical instability and functional instability. Each of these entities in turn is composed of various insufficiencies. Research of functional insufficiencies to date has shown large variances in results. One particular reason for this could be discrepancies in inclusion criteria and definitions between CAI, mechanical instability, and functional instability used in the literature. Thus, we endeavored to undertake a systematic investigation of those studies published in the area of CAI to identify if there is a large discrepancy in inclusion criteria across studies.

METHODS

A systematic search of the following databases was undertaken to identify relevant studies: Cochrane Central Register of Controlled Trials, PubMed, CINAHL, SportDiscus, PEDro, and AMED.

RESULTS

The results of this study indicate that there is a lack of consensus across studies regarding what actually constitutes ankle instability. Furthermore, it is evident that the majority of studies use very different inclusion criteria, which leads to a nonhomogenous population and to difficulties when comparing results across studies.

CONCLUSIONS

Future studies should endeavor to be specific with regard to the exact inclusion criteria being used. Particular emphasis should be given to issues such as the number of previous ankle sprains reported by each subject and how often and during which activities episodes of "giving way" occur as well as the presence of concomitant symptoms such as pain and weakness. We recommend that authors use one of the validated tools for discriminating the severity of CAI. Furthermore, we have provided a list of operational definitions and key criteria to be specified when reporting on studies with CAI subjects.

Prophylactic ankle brace use in high school volleyball players: a prospective study

INTRODUCTION

The purpose of this study was to determine the effect of prophylactic ankle bracing on the incidence of ankle injuries in a high school population of interscholastic volleyball players followed prospectively for one season.

MATERIALS AND METHODS

The study was designed to evaluate the effect of different types of ankle braces on the incidence of ankle sprains in high school volleyball players. There were 957 players in the group that wore braces and 42 in the control group who did not wear a brace. Information was collected on age, sex, previous injury, incidence of injury, and time off from play. Only the dominant ankle was studied.

RESULTS

Overall, the use of a prophylactic ankle brace did not significantly alter the incidence of ankle sprains in high school volleyball players. However, in players without a previous ankle sprain, the use of an ankle brace did make a significant difference in two of the braced groups. The Active Ankle Trainer II and the Aircast Sports Stirrup protected volleyball players from a sprain only if they had not had a previous sprain. If the player had a history of a previous ankle sprain, these two brace groups did not protect the ankle from another ankle sprain (p < 0.05). In addition, there were significantly more injuries in the female group of players who wore a non-rigid brace versus those who wore a more rigid brace.

CONCLUSION

This information may be helpful in deciding whether to recommend prophylactic ankle braces in volleyball players.

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.

Interventions for treating chronic ankle instability

BACKGROUND

Chronic lateral ankle instability occurs in 10% to 20% of people after an acute ankle sprain. The initial form of treatment is conservative but if this fails and ligament laxity is present, surgical intervention is considered.

OBJECTIVES

To compare different treatments, both conservative and surgical, for chronic lateral ankle instability.

SEARCH STRATEGY

We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialized Register (to July 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2005, Issue 3), and MEDLINE (1966 to April 2006), EMBASE (1980 to April 2006), CINAHL (1982 to April 2006) and reference lists of articles.

SELECTION CRITERIA

All randomised and quasi-randomised controlled trials of interventions for chronic lateral ankle instability were included.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed methodological quality and extracted data. Where appropriate, results of comparable studies were pooled.

MAIN RESULTS

Seven randomised trials were included and divided into three groups: surgical interventions; rehabilitation programs after surgical interventions; and conservative interventions. None of the studies were methodologically flawless. Only one study described an adequate randomisation procedure. Only two studies, both about rehabilitation programs after surgery, had a moderate risk of bias; all other studies had a high risk of bias. Due to clinical and methodological diversity, extensive pooling of the data was not possible. Surgical interventions (four studies): one study showed more complications after the Chrisman-Snook procedure compared to an anatomical reconstruction, whereas another study showed greater mean talar tilt after an anatomical reconstruction. Subjective instability and hindfoot inversion was greater after a dynamic than after a static tenodesis in a third study. The fourth study showed that the operating time for anatomical reconstructions was shorter for the reinsertion technique than for the imbrication method. Rehabilitation after surgical interventions (two studies): both studies provided evidence that early functional mobilization leads to an earlier return to work and sports than immobilisation. Conservative interventions: the only study in this group showed better proprioception and functional outcome with the bi-directional than with the uni-directional pedal technique on a cyclo-ergometer.

AUTHORS' CONCLUSIONS

In view of the low quality methodology of almost all the studies, this review does not provide sufficient evidence to support any specific surgical or conservative intervention for chronic ankle instability. However, after surgical reconstruction, early functional rehabilitation was shown to be superior to six weeks immobilisation regarding time to return to work and sports.

Ground reaction force in basketball cutting maneuvers with and without ankle bracing and taping

CONTEXT AND OBJECTIVE

In basketball, the most common injuries are ankle sprains. For this reason, players frequently use external ankle devices or taping as prophylactic and rehabilitation measures. The purpose of this study was to evaluate ground reaction force (GRF) responses in basketball players while performing typical cutting maneuvers with and without ankle bracing and ankle taping.

DESIGN AND SETTING

Comparative study with experimental design of single-group repeated measurements, at Medical Rehabilitation Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo.

METHODS

Vertical (Fy) and medial-lateral (Fz) GRF measurements were made under three conditions (taping, Aircast-type orthosis and basketball shoes alone), with analysis of peak forces at foot contact (Fymax1, Fzmax1, Fymax2 and Fzmax2), growth gradient (peak/time) (GG Fymax1, GG Fzmax1, GG Fymax2 and GG Fzmax2) and impulse after foot contact.

RESULTS

Bracing significantly reduced Fymax2 and GG Fymax2. GG Fzmax1 was significantly higher for the sport shoe condition than for the taping condition. Taping increased Fy in relation to the sport shoe at foot contact, but over a longer time interval, without increasing excessive ankle loading. Fz reached a peak in less time, which might generate greater inversion/eversion loading on a player's foot. The Aircast exerted better shock-absorbing effect than did the other two conditions, since it generated less vertical force over longer time intervals and smaller medial-lateral forces in relation to taping.

CONCLUSIONS

Ankle bracing and ankle taping action mechanisms are still unclear and therefore should be carefully prescribed. More studies are needed to clarify taping and bracing effects on sporting activities.

Effects of ankle support on lower-extremity functional performance: a meta-analysis

Clinicians surmise that the application of external ankle support reduces the ability to perform functional skills and movements, but the outcomes from some of these studies have been inconclusive.

PURPOSE

To meta-analyze studies regarding the effects of external ankle support on lower-extremity functional performance measures.

METHODS

A total of 93 effects from 17 randomized controlled trials utilizing predominantly crossover designs with recreationally active participants and competitive athletes were subjected to a random-effects meta-analysis. The treatment variable was external ankle support with three levels: adhesive tape, lace-up style, and semirigid style. Differences between mean changes in treatment and control groups were computed as standardized effect sizes for sprint, agility, and vertical jump performance with their 90% confidence intervals (CI). Effect sizes >0.20 were considered substantial.

RESULTS

The greatest effect of ankle support on performance was a negative effect of lace-up style brace on sprint speed (effect size -0.22, 90% CI -0.47 to 0.03), equivalent to approximately 1% impairment of speed. The other effects of external ankle support on performance were insubstantial, though most were negative, and their lower confidence limits allowed for realistic chances of impaired performance. Substantial true variation between studies, although poorly defined, was also present for some effects, further increasing the likelihood of performance impairment in some settings.

CONCLUSIONS

More research is needed to reduce the uncertainty in the effects of external ankle support on performance. In the meantime, it is our opinion that the benefit in preventing injury outweighs the possibility of substantial but small impairment of performance when athletes use external ankle support.

Influência de implementos para o tornozelo nas respostas biomecânicas do salto e aterrissagem no basquete

FUNDAMENTOS E OBJETIVO: O segmento mais freqüentemente lesado no basquetebol é o tornozelo, sendo a entorse por inversão a lesão mais comum. Para evitá-la, é comum o uso de implementos. O objetivo deste estudo foi avaliar a força reação do solo (FRS) em jogadores de basquete durante execução do salto em três situações: uso de tênis, bandagem e tênis, e tênis e órtese tipo Aircast. MÉTODOS: Oito atletas foram analisados durante o salto, através de uma plataforma de força, nas três situações citadas, para análise das componentes vertical e horizontal médio-lateral da FRS. RESULTADOS E CONCLUSÃO: Não houve diferença estatística significativa entre as três situações na componente vertical da FRS durante o salto, embora o uso de bandagem tenda a apresentar, na impulsão, maiores valores do pico de força vertical (3,10 ± 0,46PC; 3,01 ± 0,39PC; 3,03 ± 0,41PC) e do gradiente de crescimento (GC) (12,33 ± 12,21PC; 8,16 ± 3,89PC; 8,46 ± 3,85PC), e durante a aterrissagem, menores valores de pico de força vertical (5,18 ± 1,35PC; 5,56 ± 1,31PC; 5,49 ± 1,44PC) e do GC (88,83 ± 33,85PC; 95,63 ± 42,64PC; 94,53 ± 31,69PC). Durante a impulsão, a força medial do salto com Aircast foi significativamente menor que com tênis (p = 0,0249) e apresentou valor semelhante ao do uso da bandagem, enquanto a força lateral foi significativamente maior com a bandagem do que com tênis (p = 0,0485) e tendeu a ser maior do que o Aircast. Na aterrissagem o componente médio-lateral da FRS ficou inalterado nas três situações. Concluiu-se que a bandagem potencializou a força direcionada ao salto vertical durante a impulsão, porém não estabilizou tanto quanto o Aircast os movimentos de inversão e eversão do pé. Durante a aterrissagem, os implementos não foram efetivos para reduzir a força médio-lateral, mas com a bandagem, houve um tempo maior para absorção do impacto.

Bracing and rehabilitation—what's new

Based on the recent evidence, ankle bracing and taping do appear to have positive effects on ankle support. For example, both bracing and taping restrict inversion range of motion, with tape and stirrup-style braces providing the best support. Although exercise reduces this restriction, the range remains consistent with levels considered to be within the normal range. Ankle supports also appear to improve the strength of the muscular response to perturbation, potentially providing a stronger muscular contraction. In contrast, ankle supports fail to improve the neuromuscular response time to unexpected perturbations. Thus, it appears that the stronger response may occur too slowly to protect the joint. This slowness of the neuromuscular response, however, may be offset by the support's ability to slow the inversion motion. The slowing of inversion appears to allow the neuromuscular system to respond at or before the point of ligament damage. Finally, ankle supports appear to improve balance only in individuals with previously injured ankles. This suggests that supports may have a selective effect in protecting injured but not uninjured individuals. Despite these positive effects, some cautions should be emphasized. First, most of the studies cited have been performed in the laboratory setting with joint velocities and loads much below what are encountered in the athletic and daily activities. Whether tape and braces can maintain their effectiveness under the more extreme conditions of functional activities remains unclear. Additionally, some evidence suggests that ankle supports may transfer loads to other joints putting them at risk for injury. Thus, further study is needed to determine the risk-to-benefit ratio of ankle supports. Finally, much of the research presented has been done only on uninjured ankles. Based on the current evidence, it seems possible that the effectiveness of ankle supports may differ depending on the population, and it seems clinically important to know whether we can expect the same results for injured and uninjured ankles. Proper and early rehabilitation is important in preventing residual ankle symptoms. Reports indicate that up to 73% of people who sustain a lateral ankle sprain have recurrent sprains, but it is unknown how many of these participants partake in rehabilitation. Proper immobilization and acute care of the injured ankle is imperative. An immobilization boot or strapping that can be removed during early non-weight bearing exercises seems to be most effective. Strength and balance training of the uninjured contralateral limb can be used to assist reaching full recovery in a shorter period of time. Functional exercises can also be performed earlier in the rehabilitation process by reducing the gravitational forces so patients can perform in a pain-free range and still receive the benefits of early activity. Evidence shows that daily ankle disk training assists in preventing ankle sprains, and is a relatively inexpensive and easy alternative to traditional rehabilitation protocols.

The role of ankle bracing for prevention of ankle sprain injuries

Lateral ankle sprains are one of the most common injuries incurred in recreational and competitive athletics. These injuries have a significant impact in terms of cost, athletic participation, and activities of daily living. Prophylactic ankle braces are often used to reduce the risk of injury recurrence when individuals return to athletic participation. The purpose of this clinical commentary is to review the literature and provide our own experience relative to the use of prophylactic ankle bracing. Relatively high incidence rates of ankle sprain injury have been reported for basketball and soccer athletes, military trainees, and individuals with a previous history of ankle sprain injury. Semirigid and laced ankle braces have significantly reduced the incidence of initial and recurrent ankle sprain injuries in athletic and military samples. With few exceptions, these braces do not appear to affect functional performance adversely. The prophylactic use of semirigid ankle braces appears warranted to reduce the incidence of initial and, in particular, recurrent ankle sprain injuries for individuals who participate in activities that have the highest risk for these injuries. Additional research is needed to evaluate the many new braces that are available and in use and their influence on the incidence of ankle sprain injury and functional performance.

Effect of ankle taping and bracing on vertical ground reaction forces during drop landings before and after treadmill jogging

STUDY DESIGN

Single-group repeated-measures experimental design.

OBJECTIVES

The purpose of this study was to evaluate the effects of prophylactic ankle stabilization on vertical ground reaction forces before and after treadmill jogging.

BACKGROUND

Previous research has demonstrated acute effects of ankle taping and bracing on ankle joint kinematics and vertical ground reaction forces during drop landings. Based on the number of investigations demonstrating increased range of motion of the braced or taped ankle following exercise, it may be plausible that the aforementioned landing alterations may return to normal following an exercise bout.

METHODS AND MEASURES

Fourteen healthy recreational participants performed stiff and soft drop landings before and after a 20-minute treadmill exercise bout under 3 different ankle stabilizer conditions (no stabilizer, ankle brace, and ankle tape). A forceplate was used to collect ground reaction force data under the dominant foot. The first and second peak impact force, as well as the time to each of the 2 peak forces, were determined for each trial and used as dependent variables.

RESULTS

The time to reach peak forces were significantly less under the ankle brace and tape conditions in comparison to the control (no-stabilizer) condition.

CONCLUSIONS

It appears that ankle taping and bracing decrease the time to reach peak impact forces. These alterations indicate that during dynamic activity the musculoskeletal structures of the body may be subjected to loads within shorter time periods. Whether these effects are detrimental over time remains speculative at this point and requires further research.