Debunking the Ankle Braces Impairment Myth

To Brace or Not To Brace: Part 2

By Jane Steger, First Aider Staff

In the June 2018 issue of The First Aider, we debunked many ankle bracing myths, i.e., ankle braces impair performance. Through conversations with two clinicians involved in studies conducted on range of motion (ROM), functional performance and/or characteristics of ankle braces, this article looks further at the “impairment” myth; specifically that ankle braces impair athletic function.

Jena Etnoyer-Slaski, ATC, M.S.Ed, of Sport & Spine Rehab, led two studies, “A comparison between single and double upright ankle braces on ankle range of motion, functional performance, and satisfaction of brace characteristics in female and male collegiate soccer players” and “The effect of progressing ankle brace restriction on walking and running gait characteristics in healthy individuals”. Tony Brosky, PT, DHSc, SCS, of Bellarmine University, also led two studies, “A comparison between single and double upright ankle braces on ankle range of motion, functional performance, and satisfaction of brace characteristics” and “Effects of Single Upright, Double Upright and Lace-up Ankle Braces on Vertical Jump Performance in Female College Volleyball Players”.

Jena Etnoyer-Slaski: “Some athletes, like soccer players, prefer not to be taped or wear ankle braces, but due to an injury, they find it necessary. And then there are other athletes who like to wear a brace for prevention. Because we’re catering to varying reasons for needing a brace as well as the athlete’s personal preference, we compared the ROM, functional performance and satisfaction between an Active Ankle® lace-up, a single upright and a double upright brace. Our soccer player study concluded that the type of brace did not significantly affect performance, but the level of satisfaction was significantly greater for the Active Ankle AS1Pro lace-up.

“Appreciating the nationwide incidence of ankle sprains—estimated at 1,016,000 in 2010—we wanted to understand the differences in gait and user satisfaction when walking and running while wearing four different types of Active Ankle braces; compression, lace-up, single upright and double upright.The results of this study supported previous literature in finding that the semi-rigid brace allows normal sagittal ankle motion while limiting frontal plane ankle range of motion when running. However, as in the other study, the least bulky of the braces, the compression sleeve in this study, had the greater satisfaction than the other braces when walking and running. Therefore, a brace should be chosen based on the level of restriction needed as well as the comfort.

“A brace’s impact on performance is critical, but as important is the user’s comfort and satisfaction.A brace is only effective if it’s used. If someone needs a lot of restriction due to a recent ankle sprain, they’re going to have to wear a brace. But a successful recovery is dependent on using a brace that doesn’t affect performance and is comfortable.”

Dr. Tony Brosky: “The comparison study, which looked at three conditions; no brace, the Active Ankle Eclipse single upright brace (E1) and the double upright brace (E2), showed that ankle braces had minimal effect on limiting ROM, and overall satisfaction of the brace characteristics was comparable. As our ROM comparison study was done on recreational athletes, not a sport-specific athlete, we elected to do a second study on collegiate female volleyball players. Believing that high school and college volleyball players are some of the biggest users of braces for injury prevention, we knew they would be familiar with bracing and would provide relevant feedback.

“In the volleyball players study, we looked at vertical jump performance across three different types of braces; lace-up, single upright and double upright. We didn’t see any significant impact on jumping. A small trade off (in performance such as speed or height) of a 100th of a second for a team sport like volleyball is worth it in reduction in severity or prevention of an index injury. And that’s the name of game. If we can prevent an injury or minimize its severity, it’s the most important thing we can do as rehabilitation professionals.

“In both studies, we discovered there was very little impact on functional performance. And these results are important because some athletes and coaches still buy into the urban legend about braces slowing them down or impairing their ability, even though a brace might keep them from spraining or re-injuring an ankle.

“Although you don’t often see braces in other sports such as tennis, cross country or golf, they can be used for getting someone back to activity or play post-injury. For example, if you’re working with a tennis player, start them off with some lateral slides on the court while wearing a brace. You want to get them back in their environment holding a racket. The psychology of wearing a brace can be under-recognized and underrated. And often times, that’s the most important piece, along with being able to get back into a familiar environment and begin to feel confident that they will get back to the level they were before the injury.

“Two of the three tenets of evidence-based care are personal—patient preference and clinical experience. So regardless of the third tenet—use of current best evidence—the athletes’ preferences and clinical experience play strongly into choosing the best brace. What the athlete thinks does matter and we’re crazy if we don’t recognize that.”