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To Brace or Not to Brace: That is the Question!

June 1, 2018

By Phil Page PhD, PT, ATC, CSCS, FACSM

According to a 2017 study [1], lateral ankle sprains were the most common injury in US college student athletes, with men’s and women’s basketball having the highest rates. In addition, the authors reported that athletes were 3 times more likely to sprain their ankle in competition compared to practice, although most ankle sprains occurred during practice. Researchers [2, 3] have also reported that athletes were 2 to 3 times more likely to sprain their ankle when not wearing an ankle brace. Several systematic reviews confirm that ankle braces can prevent recurrent ankle sprains [4-6].

Despite these facts, ankle bracing remains a controversial topic. Some believe that ankle bracing may impair performance or even increaseinjuries! There is so much information out there. Athletes, coaches, parents, and athletic trainers often want to know, “Should we wear ankle braces?” And if the answer is “yes,” the daunting task of choosing the appropriate brace begins.

First, we need to address some myths about ankle bracing. Let’s start with the facts:

Myth: Ankle braces prevent all ankle injuries.

Truth: No brace can ‘prevent’ an injury (or really anything for that matter!). All we can do is reduce the risk or incidence of ankle sprains. The fact is ankle braces do not protect against initial ankle sprains very well. There is minimal reduction in first-time ankle sprains with a brace, but the real benefit of ankle braces is preventing recurrent ankle sprains [4-6].

Myth: Ankle braces increase knee injuries.

Truth: While researchers in a lab setting have demonstrated changes in landing forces and knee kinematics during jump landing while wearing an ankle brace, there is no evidence of increased knee injury while wearing ankle braces during the season [2, 3, 5, 7, 8]. Furthermore, research on sport-specific tasks such as volleyball has shown no impact on knee forces or functional performance [9].

Myth: Ankle braces cause muscle weakness.

Truth: Prolonged immobilization is associated with muscle weakness because of disuse. However, those wearing ankle braces are not immobilized, and generally only wear braces during their sport. There is no evidence that ankle muscles are weaker after wearing an ankle brace during the season. While there is some evidence of delayed activation of muscles associated with wearing an ankle brace, researchers found no effect on muscle activation with prolonged use [10].

Myth: Ankle braces impair performance.

Truth: Although braces restrict motion, they don’t significantly impede performance. Several studies have shown that ankle braces do not affect performance, speed or agility even after long-term wear [11-13].

Now that you know the truth, it’s time to decide if your athlete should wear an ankle brace, and which one they should choose. First, answer these 3 questions:

  1. Is there a history of an ankle sprain?
  2. Does the athlete have residual ankle instability?
  3. Does the athlete participate in a high-risk sport or position?

If you answered “yes” to at least 2 of these, you should consider recommending an ankle brace.

So, which is right brace? They come in a variety of types, each balancing stability and mobility: more mobility provides less stability and vice-versa. Generally, there are 3 types of ankle braces: Rigid/Semi-Rigid, Lace-up, and Sleeve/Wrap. Each is designed to reduce ankle range of motion (ROM) in the frontal plane (inversion/eversion) and sometimes in the sagittal plane (dorsi-/plantarflexion).

  • Rigid/Semi-Rigid: (See the Active Ankle Eclipse II below) Offer maximal protection from inversion sprains, while offering mobility in dorsi- and plantarflexion for jumping sports. These braces are usually hinged at ankle joint.
  • Lace-up: (See the Active Ankle AS1 Pro below) Offer protection in all 4 ranges of ankle motion, but may decrease sagittal plane mobility, restricting jumping. Easy to apply and adjust.
  • Sleeve: (See the Active Ankle 329 below) Low profile, easy to put on. Offers least amount of support with maximal mobility.

Rigid/Semi-Rigid Hinged

According to researchers [10], semi-rigid braces restrict more inversion and eversion before and after exercise than lace-up braces or tape, and are less restrictive in dorsi- and plantar flexion, which are motions associated with jumping sports. Other researchers [14]recommended the Active Ankle semi-rigid brace for those with residual ankle instability, and a lace-up brace for those with less instability and risk. In addition, a recent study with female basketball players found the Active Ankle reduced inversion ROM and knee forces during a cutting maneuver significantly more than a lace-up brace [15].

The decision to use one ankle brace or another is on an individual basis. Factors such as amount of protection and level of risk should be considered. There is no ‘one-size-fits-all’ answer! Now that you know the truth about ankle bracing, you’ll be able to make better evidence-based recommendations.


1. Roos, K.G., et al., The Epidemiology of Lateral Ligament Complex Ankle Sprains in National Collegiate Athletic Association Sports.Am J Sports Med, 2017. 45(1): p. 201-209.

2. McGuine, T.A., A. Brooks, and S. Hetzel, The effect of lace-up ankle braces on injury rates in high school basketball players.Am J Sports Med, 2011. 39(9): p. 1840-8.

3. McGuine, T.A., et al., The effect of lace-up ankle braces on injury rates in high school football players.Am J Sports Med, 2012. 40(1): p. 49-57.

4. Verhagen, E.A. and K. Bay, Optimising ankle sprain prevention: a critical review and practical appraisal of the literature.Br J Sports Med, 2010. 44(15): p. 1082-8.

5. Handoll, H.H., et al., Interventions for preventing ankle ligament injuries.Cochrane Database Syst Rev, 2001(3): p. CD000018.

6. Doherty, C., et al., Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis.Br J Sports Med, 2017. 51(2): p. 113-125.

7. Surve, I., et al., A fivefold reduction in the incidence of recurrent ankle sprains in soccer players using the Sport-Stirrup orthosis.Am J Sports Med, 1994. 22(5): p. 601-6.

8. Sitler, M., et al., The efficacy of a semirigid ankle stabilizer to reduce acute ankle injuries in basketball. A randomized clinical study at West Point.Am J Sports Med, 1994. 22(4): p. 454-61.

9. West, T., L. Ng, and A. Campbell, The effect of ankle bracing on knee kinetics and kinematics during volleyball-specific tasks.Scand J Med Sci Sports, 2014. 24(6): p. 958-63.

10. Cordova, M.L., et al., Long-term ankle brace use does not affect peroneus longus muscle latency during sudden inversion in normal subjects.J Athl Train, 2000. 35(4): p. 407-11.

11. Jerosch, J. and R. Schoppe, Midterm effects of ankle joint supports on sensomotor and sport-specific capabilities.Knee Surg Sports Traumatol Arthrosc, 2000. 8(4): p. 252-9.

12. Bocchinfuso, C.S., M. R.; Kimura, I. F., Effects of Two Semirigid Prophylactic Ankle Stabilizers on Speed, Agility, and Vertical Jump.J Sport Rehabil, 1994. 3(2): p. 125-34.

13. Dierker, K.L., E.; Brosky, J. A.; Topp, R. V., Comparison Between Rigid Double Uprightand Lace-up Ankle Braces on Ankle Rangeof Motion, Functional Performance, andUser Satisfaction of Brace Characteristics.J Perform Health Res, 2017. 1(1): p. 39-48.

14. Gross, M.T. and H.Y. Liu, The role of ankle bracing for prevention of ankle sprain injuries.J Orthop Sports Phys Ther, 2003. 33(10): p. 572-7.

15. Klem, N.R., et al., Effect of External Ankle Support on Ankle and Knee Biomechanics During the Cutting Maneuver in Basketball Players.Am J Sports Med, 2017. 45(3): p. 685-691.

Posted in: Braces & Support