Dan Foster, ATC; Jennie Hartgrave, ATC; Graduate Students

October 9, 2003

Objectives for Conference

l   risk factors in ankle sprain injury

l   consensus use of taping and bracing

l   literature about effectiveness

Ankle Sprains

l   What is your experience about the frequency of ankle sprains in sports?

l   What sports are at most risk?

Ankle Sprains - Frequency

l    Most common injury

l    High School

l    College

l    U Iowa

l    Other high frequency sites: upper thigh, knee, shoulder (NCAA)

l    Garrick 1997 AJSM

l    10-38% 1995-7 NATA

l    8-28% 1984-03 NCAA

l    0-47% 8/02-5/03 in 448 participants

Sports at Most Risk for Ankle Injury

l    WBB (47%)

l    WVB (43%)

l    FB (32%)

l    MBB (32%)

l    Other Colleges

l    MBB (28%)

l    WBB (26%)

l    VB (23%)

Sports at Most Risk

l    Jump & land on one foot

l    Sharp cutting maneuvers

l    BB, FB, SC, VB

(Garrick & Requa Clin Pediatr 1989)

Predictive Factors

l   Do we know what predictive factors place athletes at most risk of ankle sprains?

Predictive Factors

l    Previous sprain

l    Gender

l    Height/weight

l    Limb dominance

l    Anatomic foot type & size

l    Generalized laxity, alignment, ROM

l    Strength

l    Muscle reaction time

l    Postural sway

Cordova M, et al. JAT; 2002

l    Shoe type

l    Duration and intensity

l    Player position

l    Bracing and taping

Benyon B, et al.  J Orthop Res; 2002

Injury Prevention

l   What has been done to prevent these frequent injuries?

What has been and should be done to prevent these frequent injuries?

l    Better shoes

l    Alter surfaces

l    Revise rules

l    Improve playing fields

l    Instruction by coaches

l    Strength and proprioceptive training

l    Taping and bracing

Taping and Bracing

l   When would you use one strategy over the other or combine them?

l   Are there any contra-indications to using them?

Taping vs Bracing

l   How effective is taping or bracing in preventing or treating common ankle injuries?

Literature Review

l    1966-2000

l    No papers without primary data

l    No treatment only papers

l    621 citations initially

l    113 screened

l    10 compared alternative methods to prevent ankle sprains, 14 randomized trials

l    Thacker SB, et al.  Am J Sports Med; 1999 (CDC)

l    Handoll HH, et al.  Cochrane Database Syst rev; 2001.

Literature Review

Methods

l    8279 participants

l    12 trials involved young adults, participating in organized, high-risk activities – other 2 were injured patients

l    Used external ankle supports

–    Semi-rigid orthosis

–    Air-cast brace

–    High top shoes

–    Taping

l    Other factors investigated

–    Ankle disc training

–    Muscle stretching

–    Health education

–    Controlled rehab

Literature Review

Results – Cochrane Rev

l    Reduced rate when using external ankle support (RR 0.53, 95% CI 0.40-0.69)

–    Greater effect for people with prior Hx

–    Still effective for people w/ no Hx

–    No change in incidence for other leg

l    All other factors were limited in interpretation including taping

l    Conclusion:  good evidence for benefit from semi-rigid orthoses or air-cast to prevent ankle sprains

Literature Review

Results - CDC

l    Taping has a protective effect

l    Taping not as effective as orthoses

l    Specific training reduces injury rate

Conclusion:  athletes should undergo appropriate rehabilitation with specific proprioceptive training and wear external orthoses for at least 6 mo