Ankle Sprains - To brace or not to brace after injury (or tape!)
Over the past few months one of the more common questions I have been getting is about if strapping/bracing is worthwhile when ret
urning to sport from an ankle injury. For such a common injury there is a lot of debate as to which one is better. So for the sake of simplicity, I’ll walk you through the decision making process if taping/bracing is for you.
The first thing to keep in mind is that don’t ask “old mate” what they did when returning from their ankle injury as there is no one size fits all approach for ankles rehabilitation. There are however a number questions that come down to the individual that need to be answered to help direct where the person goes with their rehabilitation. A couple of examples are outlined below.
What sport or activity is being played and at what competitive level (lawn bowels is different to A-grade netball!)
Has the ankle been injured previously (previous ankle injuries increase the risk of experiencing another one)
Are they allergic to tape?!
How severe the ankle sprain is?
As mentioned previously, there is more to it that this, but for the sake of not sending you to sleep that’s a quick look at some of the variances that impact making an informed decision. As many of you who are reading this article will know, ankle sprains are one of the most common injuries that occur in sports whether it is basketball, football, netball… the list goes on. It is SO common that people often overlook them and just write them off as something minor. Whilst some ankle sprain are minor, one of the biggest risk factors for experiencing an ankle sprain is a previous ankle sprain which can make a small sprain a big one later on.
Will taping affect running performance?
There is a school of thought that by taping an ankle for stability it changes the biomechanics around the ankle significantly enough to alter running performance. In an effort to assess if this is the case Paulson & Braun (2014) conducted a trial on the impact of ankle taping on energy expenditure whilst running on a treadmill. The results of this study concluded that taping did not interfere with the biomechanics to enough of a degree that it altered energy expenditure. The drawback from this study is that it was straight line running on a treadmill as opposed to directional change and cutting movements that many sports include. However, some conclusions can be made from the study.
Should I tape or brace my ankle?
When deciding on if taping/bracing is for you it helps to understand the biomechanics on how ankles are designed to prevent themselves from getting sprained in the first place. There are a number of ligaments on the outside and inside of the ankle joint that provide support to the ankle when rolling outwards or inwards (these are known as static stabilisers). Overlying these ligaments are other muscle tendons that also help provide dynamic support to the ankle (dynamic stabilisers). The major dynamic stabilisers for the outside of the ankle is fibularis longus and brevis (otherwise known as peroneus longus and brevis).
Due to the nature of basketball it has one of the highest incidences of ankle sprains in sport. A study conducted by Jeffriess et al (2015) looked into the effects of taping on agility performance, planned direction change and energy requirements of Peroneus Longus. It concluded that preventative ankle taping did not impact agility performance or planned directional change, what it did impact however, is reducing the demand that was placed on Peroneus Longus. The reason that this is clinically significant is that by reducing the demand on this muscle it helps prevent it from fatiguing prematurely allowing it to provide better lateral ankle support when needed for cutting or directional change movements. This is even more interesting when taking into consideration that the majority of non traumatic ankle sprains are experienced after the halfway point of the game where muscle fatigue begins to be felt.
Another symptom that people who have long-term ankle instability/multiple sprains is that the ankle feels like it is continually going to give way. Kobayashi et al. (2014) assessed the impact that taping/bracing had on ankle joint mechanics of individuals who experience instability. The results from the study concluded that during weight bearing activities taping/bracing did not provide any significant changes to joint mechanics. From this perspective it could then be argued that in this scenario the benefits from taping/bracing are related to a sense of security.
So whilst taping/bracing does not necessarily alter joint mechanics, it can impact the body’s ability to determine where the joint is in space. A study conducted by Jahjah et al. (2018) looked into the effects of taping on joint position sense to determine if this was a valid reason for taping. What it confirmed is that when muscle fatigue is experienced, taping can assist in joint position sense, and by doing so, the body’s ability to (or ankle in this case) automatically correct movements that would have otherwise caused injury.
As I have mentioned previously taping or bracing the ankle does not improve/hinder performance. However as investigated by Halim-Kertanegara et al. (2016), and as many of you would know/have experienced, taping does increase confidence and belief in performing dynamic tasks (sport!). For this reason alone it can be argued that taping/bracing facilitates an earlier return to sport participation or as a stepping stone to advanced dynamic rehabilitation.
Will taping/bracing help prevent ankle injury?
Is a very good question. According to some of the more recent research in the area semi-rigid bracing has shown better results in recurrent ankle injuries as opposed to just neuromuscular training (Janssen, Mechelen and Verhagen 2014). So, whilst this investigation did indicate that wearing a brace reduced the chances of spraining the ankle again, the brace didn’t reduce the severity of the injury.
So… Should I or shouldn’t I?
So, in saying all of that, in preventing recurrent ankle sprains bracing/taping is supported by the literature. There are also arguments to be made that this approach to ankle rehabilitation improves joint position sense and muscle endurance. However, long term taping/bracing can build a reliance on it. The problem with this situation is that if for some reason the athlete does not have the brace they are more likely than normal to injure their ankle. Taking all of that into consideration there is no one best approach. It comes down to the expectations of the athlete, physiotherapist and type of sport.
Janssen, K. W., Mechelen, W. V., & Verhagen, E. A. (2014). Bracing superior to neuromuscular training for the prevention of self-reported recurrent ankle sprains: a three-arm randomised controlled trial. British Journal of Sports Medicine,48(16), 1235-1239. doi:10.1136/bjsports-2013-092947
Halim-Kertanegara, S., Raymond, J., Hiller, C. E., Kilbreath, S. L., & Refshauge, K. M. (2017). The effect of ankle taping on functional performance in participants with functional ankle instability. Physical Therapy in Sport,23, 162-167. doi:10.1016/j.ptsp.2016.03.005
Jahjah, A., Seidenspinner, D., Schüttler, K., Klasan, A., Heyse, T. J., Malcherczyk, D., & El-Zayat, B. F. (2018). The effect of ankle tape on joint position sense after local muscle fatigue: a randomized controlled trial. BMC Musculoskeletal Disorders, 19, 8. http://doi.org/10.1186/s12891-017-1909-2
Kobayashi, T., Saka, M., Suzuki, E., Yamazaki, N., Suzukawa, M., Akaike, A., . . . Gamada, K. (2014). The Effects of a Semi-Rigid Brace or Taping on Talocrural and Subtalar Kinematics in Chronic Ankle Instability. Foot & Ankle Specialist,7(6), 471-477. doi:10.1177/1938640014543357
Jeffriess, M. D., Schultz, A. B., McGann, T. S., Callaghan, S. J., & Lockie, R. G. (2015). Effects of Preventative Ankle Taping on Planned Change-of-Direction and Reactive Agility Performance and Ankle Muscle Activity in Basketballers. Journal of Sports Science & Medicine, 14(4), 864–876
Paulson, S., & Braun, W. A. (2014). Prophylactic Ankle Taping. Journal of Strength and Conditioning Research,28(2), 423-429. doi:10.1519/jsc.0b013e3182a1fe6f