To Brace or Not to Brace…
November 17, 2014

Basketball season is in full swing in area schools and clubs. With any new sports season comes the potential for injuries, especially of the knee and ankle. Nearly half of all ankle sprains (49.3%) occur during sporting activities, with 41.1% occurring during basketball. Athletes, ages ten to nineteen experienced the highest rate of ankle sprains. Males, between fifteen and twenty-four, are more likely to suffer from an ankle sprain than females of the same age. Ankle sprains are common in basketball due to the sudden stops and cutting movements necessary to help crush the opponent. Ankle sprains can affect an athlete long after the season is over, resulting in chronic ankle instability and an increased chance of osteoarthritis. With such a high risk for injury, many people question whether prophylactic ankle bracing will help decrease the incidence of ankle sprains.

Here are some things to consider when determining whether prophylactic bracing is appropriate or not:

• Has the athlete suffered a previous ankle sprain?
• How does the brace affect balance, proprioception, and forces on other joints?
• What style of brace is appropriate?
• Is the athlete compliant with wearing the brace?

Braces, such as a hard shell ankle brace, have been shown to decrease the incidence of first time sprains in athletes who have not previously sprained their ankle. They have not been shown to decrease the risk in athletes who have had previous sprains. Lace-up braces have been shown to decrease the incidence, but not the severity, of sprains in athletes who have and have not had a previous history of sprains.

Braces limit the lateral movement of the ankle, which can affect balance and proprioception, especially when landing from a jump. It has been questioned whether bracing transfers more force up the leg, causing more acute knee injuries. This has been shown to be truer with hard shell braces compared with lace up braces. However, in one study, more lower extremity injuries occurred in the lace-up brace group compared to the non-braced group, which may be attributed to the decreased motion at the ankle. More research is needed in this area to determine if bracing causes a higher risk of injuries in other joints.

Other neuromuscular programs, similar to Sportsmetrics to prevent ACL injuries, have been shown to reduce the incidence of ankle sprains in athletes. One thing to consider is whether your athlete is going to be more compliant with wearing a brace or participating in a neuromuscular program to prevent ankle sprains. Participating in both would be most beneficial.

Before placing your athlete in a brace, make sure to consult with a physician, certified athletic trainer, and physical therapist to determine if it is appropriate based on history, strength, neuromuscular control, and sport performance.

Jordan Davis, PT, DPT

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