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Methods for Preventing Ankle Sprains in High School Athletes

By Tim McGuine, Ph.D., ATC on February 03, 2021 hst Print

Introduction

Ankle sprains are the most common musculoskeletal injury that occur in sports with estimates that they comprise 15 to 20 percent of all sports injuries. While ankle sprains can occur in any sport, these injuries occur most often in sports that involve cutting movements or jumping and landing such as basketball, football, soccer and volleyball.

In the short term, a typical ankle sprain causes pain, swelling and limited movement that can keep the athlete out of sports for several days to several weeks. If not fully rehabilitated, 25 to 30 percent of these sprains can cause the athlete to experience repetitive or “chronic” giving way and pain that makes it difficult to be a healthy and active individual long after the sports season ends. High school coaches need to recognize that implementing programs to reduce the number of ankle sprains that occur is a crucial component to a successful high school athletic program.

Prevention

Various strategies to reduce the number of ankle sprains have been developed and implemented for decades. The methods can be divided into two broad categories: 1) external support or 2) exercise based.

External support methods primarily include utilizing ankle taping or wearing an ankle brace. Exercise-based methods can include a structured warm-up, core strengthening and/or balance training. In general terms, both the external support and exercise- based methods can prevent ankle sprains to some degree. However, coaches need to be aware that these methods have different attributes (cost, mechanism, ease of use, time to effectiveness, potential impact on other injuries) that need to be considered before they are utilized by their high school teams. Further, coaches need to recognize that a “one size fits all” approach may not be appropriate for every sport team and athlete at their school.

External Support

Historically, tape and braces were utilized to provide a means to limit excessive foot and ankle motion. The main advantage of ankle taping is that it can provide immediate support and compression that conforms to the athlete’s foot, ankle and lower leg. In recent years, sports medicine providers often cite the growing evidence that these external support measures enhance neuromuscular function through tactile stimulation equal to or greater than an effective mechanical restriction of foot and ankle motion.

The disadvantages to taping include: 1) a traditional tape job (utilizing anchor strips, stirrups, heel locks and figure eights) requires the time and expertise of a trained provider; 2) the taping loosens in as little as 20 to 30 minutes of activity, possibly negating some of its protective effect; and 3) taping costs several dollars per application, translating to several hundred dollars spent per ankle over an entire sport season. To date, there is limited evidence that ankle taping significantly reduces the risk of an ankle sprain.

Soft ankle braces are a popular method to provide support for the ankle. Most models are made of fabric, secured by straps and or laces and are designed to be worn over a pair of socks. The advantages of ankle braces include: 1) they are applied by the athletes themselves, 2) they are tightened periodically throughout the session to provide continuous support to the ankle, 3) the braces can be re-used throughout the entire season and 4) they do not need a skilled coach or athletic trainer to be on hand to apply it for the athlete.

As a result, ankle braces can be used in the off-season or when the player exercises individually. A disadvantage to bracing is that braces are essentially designed to fit every ankle in the same manner. This can translate to various levels of tension, support and stress depending on the specific shape of an athlete’s lower leg, ankle and foot. There is good evidence to show that lace-up ankle braces can reduce first-time and recurrent ankle sprains by 40 to 50 percent. 1 In addition, there is evidence that wearing an ankle brace does not increase the risk for other lower extremity injuries such as knee sprains.

Exercise

Exercise interventions can include simple techniques such as balance (proprioceptive) training or other programs that include multiple exercises. Exercise-based prevention programs work to improve neuromuscular control and joint stabilization to the foot and ankle. Research shows that the rate of ankle sprains can be reduced by 50 to 60 percent if exercise interventions are performed two to five times per week for 10-30 minutes a session. 

An example of proprioceptive training includes balancing on a single leg on an ankle disk or wobble board. As the athlete becomes more accustomed to this activity, the task can be made more difficult by having the athlete close his or her eyes or perform a sport activity such as dribbling or catching a ball.

The advantages to using balance training include: 1) low cost, 2) minimal space needed to perform the exercises and 3) training can be done individually. A disadvantage to this technique is that the protective effect develops over time (6 weeks to 3 months), so a balance program needs to be started well before the season begins.

Comprehensive exercise programs – sometimes called neuromuscular training programs (NMTPs) – usually incorporate a variety of activities that are designed to improve both lower extremity and core muscle strength, flexibility, agility and speed. An example of a popular NMTP is the ‘FIFA 11+” program developed for soccer but which has also shown to be effective to reduce injuries in basketball. The major advantage to an NMTP is its potential to prevent a variety of injuries including muscle strains, ankle sprains and ACL tears. The disadvantages to these programs are they can be difficult to perform individually, they often require supervision to ensure the program is performed correctly, they need more court or outdoor space to perform all of the components and they need to be implemented well before the start of the season (6 weeks to 3 months) to be most effective.

Conclusion

Ankle sprain injuries are common in high school sports. Coaches need to be aware, however, that the number of ankle sprains can be reduced by using external support or exercise programs. Coaches need to consider the advantages and disadvantages of the methods to determine what will work best for their teams.

References

1. Barelds I, van den Broek AG, Huisstede BM. Ankle Bracing is Effective for Primary and Secondary Prevention of Acute Ankle Injuries in Athletes: A Systematic Review and Meta. Analyses. Sports Medicine. 2018 Dec 1;48(12):2775.
2. Doherty C, Bleakley C, Delahunt E, Holden S. Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis. Bri J Sports Med. 2017 Jan 1;51(2):113-25.
3. FIFA Medical Network. The FIFA 11+ Programme. https://www.fifamedicalnetwork.com/wp-content/uploads/cdn/11plus_ workbook_e.pdf. Accessed 12/06/20.
4. Herzog MM, Kerr ZY, Marshall SW, Wikstrom EA. Epidemiology of ankle sprains and chronic ankle instability. J Ath Train. 2019 Jun;54(6):603-10.
5. McGuine TA. (2015). What effect does prophylactic bracing and/or taping have on reducing lateral ankle sprain risk? McKeon P and Wikstrom E. (Eds.) in: Quick Questions in Ankle Sprains: Expert Advice in Sports Medicine. Slack. Thorofare NJ, USA.
6. Rivera MJ, Winkelmann ZK, Powden CJ, Games KE. Proprioceptive training for the prevention of ankle sprains: an evidence- based review. J Ath Train. 2017 Nov 1;52(11):1065-7.
7. Swenson DM, Collins CL, Fields SK, Comstock RD. Epidemiology of US high school sports-related ligamentous ankle injuries, 2005/06-2010/11. Clin J Sport Med. 2013 May;23(3):190.