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

Abstract

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and athletes, to identify available literature in the databases (MEDLINE, PubMed, CINAHL, EMBASE, etc.), libraries and unpublished papers.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.

Introduction

As prevention of injury becomes an increasingly important part of practice today, researchers strive to understand and identify what can optimally reduce the incidence of ankle injury and re-injury. Individuals who participate in athletic activities are particularly susceptible to ankle injuries.1, 2, 3 Of these injuries, approximately 86% are sprains.⁴ Ankle sprains have often been reported as one of the most common types of injuries occurring during recreational and full time sporting activities.1, 4 Several epidemiological studies have also shown that about 10–28% of all sports injuries are ankle sprains and as much as 73% of competitive and recreational athletes had recurrent ankle sprain2, 5, 6 leading to the longest absence from athletic activity compared to other types of sports injuries.² Because of this, different interventions such as exercises, ankle taping techniques, ankles braces and orthoses have been identified to reduce the incidence and recurrence of ankle sprains. In the review by Handoll et al.⁷ various methods of prevention are commonly used for active people and these include taping, the use of ankle supports, shoes and coordination training using ankle disks.⁷

Prospective epidemiological studies have shown a decrease in the incidence of ankle injury with external ankle support use.⁸ The effectiveness of this was dependent upon the material properties and application method of the tape or brace, and on the athlete's status of ankle stability or previous injury.⁸

Another study conducted laboratory investigations and some clinical trials to evaluate the effectiveness of external ankle support.⁹ It concluded that external ankle supports are generally accepted preventive practice for ankle sprains. Two of the most common supports used especially by athletes in the prevention of lateral ankle sprains are taping and bracing.⁹ One possible rationale is that the use of ankle tape or a brace increases the kinesthetic awareness of ankle positioning and increases support to the ankle joint by limiting hindfoot motion, specifically inversion.¹⁰

Hume and Gerrard⁸ examined the literature regarding the effectiveness of external bracing in reducing ankle sprains. They reported that little information was available delineating the precise mechanisms through which ankle supports reduce ankle injury.⁸ Conventionally, it has been presumed that the ability of a brace to restrict ankle motion has been the predominant mechanism of action. Other mechanisms of effect were postulated for taping such as enhancing the proprioceptive function of the injured ankle⁸.

This review, aimed to focus on the effectiveness of external ankle supports such as ankle braces and ankle taping in preventing the occurrence and recurrence of ankle sprains among elite and recreational players. It has been noted that in some situations, external supports impair performance and involve risk of possible knee injuries among athletes. The objective of this review was to identify which type of external ankle support is most effective in the prevention of ankle sprain.