Management of ankle sprains Research Paper
Athletes Review: Ankle Tape or Ankle Brace
The human foot has an extremely complex structure of bones, joints and muscles. Meadows (2006) points out, “The human foot has 26 bones, 33 joints, and more than 100 tendons, muscles, and ligaments. With such a complex structure, a lot can go wrong. While some foot problems are inherited, many occur because of years of wear and tear.”
In addition, Meadows points out a number of signs and symptoms that can lead to foot injury. These signs include:
“Excessively dry skin,
Thickened or discolored nails,
Redness, and Unusual sensations (Meadows, 2006).”
Foot injury is significant and cannot be overlooked. Even the initial signs should not be treated lightly. However, research has shown that most doctors overlook feet inspection during routine patient visits (Meadows, 2006). Ankle sprains are perhaps one of the most frequently occurring foot injuries in America. A number of studies have shown that taped ankles cause less injury while other studies have concluded that by wearing braced ankles, athletes can minimize foot injury (Reeves and Emel, 2009).
This paper provides an in-depth analysis on the differences between ankle tape and ankle braces and player satisfaction between the two. It presents information about the different types of tape and braces. The tapes discussed here include white/cotton tape, power-tape and elastikon. Similarly the braces discussed here include lace up ankle braces and rigid ankle braces. The research study also looks into what athletes prefer amongst bracing or taping.
Variations in tape
Reeves and Emel (2009) synthesized peer-reviewed studies on ankle injuries. They found that many athletes are starting to prefer the power-tape. They write, “Power tape has a higher tensile strength and is more water resistant than traditional white tape. However, it has the disadvantage of being harder to tear (Reeves and Emel, 2009).”
Athletes look for stability and elastic tape gives them the comfort they need in their heels. Reeves and Emel (2009) report, “Elastic tape may be used for the heel locks, or it may be used to reinforce the normal heel locks. This is often reported as both more comfortable for the athlete or to give the athlete a sense of more stability (Reeves and Emel, 2009).”
Sometimes athletes start games with a minor foot injury and demand that the injury does not get worse. An athlete who is previously injured, “uses 1.5-in (3.8-cm) moleskin strips for stirrups and is referred to as power-strapping (Reeves and Emel, 2009).”
A number of studies have shown that athletes are now turning to flex tape and moving away from white-cotton tape also known as pre-wrap. Reeves and Emel (2009) note, “The most recent variation in ankle taping is to replace pre-wrap white-cotton tape with “flex” tape. This tape is more durable than pre-wrap and resembles elastic tape, but flex tape is adherent only to itself and not to skin. In some training rooms, this type of tape is being incorporated more and more into the ankle application with less use of white athletic tape (Reeves and Emel, 2009).”
Variations in bracing
A number of studies have shown that ankle bracing gives a lot more advantages than the traditional ankle taping. In fact, braces are considered to be a modified form of taping. Reeves and Emel (2009) report, reveal, “The concept of ankle bracing evolved from ankle taping. Braces are being used instead of traditional taping by many athletes at all levels of competition. They offer several advantages in that they are self-applied, reusable, and readjustable (Reeves and Emel, 2009).” With thinking long-term, bracing is considered to be more cost-saving and productive than taping (Pedowitz et al., 2008; Ivins, 2006).
Braces generally come in 2 types: (1) non-rigid, and (2) semi-rigid. Both have different purposes and benefits. Between these 2 variations, there exists other smaller variations; however, the most commonly used types are non-rigid and semi-rigid. With regards to non-rigid ankle bracing Reeves and Emel (2009) write that it, “resembles a thick canvas or nylon lace-up sock. Some non-rigid braces are also made of neoprene. The non-rigid style imparts some compression to the ankle and may help in injury prophylaxis but provides little medial or lateral stability to the ankle (Reeves and Emel, 2009).”
Similarly with regards to semi-rigid bracing Reeves and Emel (2009) assert, “Its construction is similar to the non-rigid but with the added feature of molded plastic struts or air cushions. These are incorporated into the medial and lateral sides of the brace, similar in orientation to the stirrups used in ankle taping. These braces provide more stability and are often are chosen during the rehabilitation and return-to-play phases of ankle injury (Reeves and Emel, 2009).”
Research Studies on the benefits of ankle taping and bracing
A number of studies have been carried out on the shoe gear, taping and bracing with regards to ankle injuries. The significance of ankle injuries can be gauged from the fact that every day thousands of athletes get ankle related injuries. Mickel (2006) writes, “It has also been estimated that over 25,000 ankle sprains occur per day in the United States, and ankle sprains have been shown to account for 10% to 15% of all injuries sustained in American football (Mickel, 2006; pg 360).”
Furthermore, ankle injuries can turn out to gravely affect the performance of athletes if they are not treated promptly. Mickel (2006) reveals, “When an ankle sprain occurs, the anterior talofibular ligament is most commonly injured, followed in frequency by the calcaneofibular ligament. Moreover, inversion sprains of the ankle can significantly affect performance and result in lost practice and game time, and they can lead to the development of chronic ankle instability and pain (pg 360).”
The use of bracing and taping varies from one sport to another. Athletes in one sport, for instance cricket would prefer taping while in another sport, such as football, where ankle sprains take place more frequently, athletes prefer bracing. Mickel (2006) assets, “The prophylactic use of semirigid ankle braces appeared to be warranted, especially for athletes who participated in activities that had the highest risk of ankle injury (Mickel, 2006; pg 361).” Similarly research has also shown, “ankle braces reduced the incidence of initial and, in particular, recurrent ankle sprains (Mickel, 2006; pg 361).”
While ankle bracing seems to be a popular choice for athletes who are into high risk sports, ankle taping seems to benefit athletes who are into either medium risk or low risk sports. For instance, in one study researchers used 2526 basketball athletes as their subjects over a period of 2 years. The purpose of the study was to analyze the benefits of taping. The results showed, “ankle taping reduced the incidence, severity, and long-term complications of ankle sprains, and that this resulted in less time lost from athletic performance (Mickel, 2006; pg 361).”
In another study, the use of ankle taping amongst 297 college football players is compared with the use of laced ankle stabilizers. The purpose of the study was to investigate which is better amongst the two. Results showed, “laced ankle stabilizers were significantly more effective than taping in preventing ankle injuries (2.56 sprains per 1000 exposures vs. 4.91 sprains per 1000 exposures) (Mickel, 2006; pg 361).”
Similarly, in another study researchers analyzed the benefits of ankle orthosis on 439 male football players and found, “the orthosis group demonstrated a 3% incidence of ankle sprains, whereas the control group demonstrated a 17% incidence, and this difference was statistically significant (Mickel, 2006; pg 361).”
In another study, impact of semi-rigid ankle bracing was investigated. Researchers choose 1601 basketball players as their subjects. The study lasted for nearly 2 years. The results showed, “the brace group demonstrated a contact-related ankle injury rate of 1.6 sprains per 1000 athlete-exposures, whereas the control group demonstrated a statistically significantly greater injury rate of 5.2 sprains per 1000 athlete exposures (Mickel, 2006; pg 361).” However, Mickel notes that there was no statistically significant difference for non-contact-related ankle injuries.
In a similar research, researchers investigated the impact of semi-rigid ankle bracing on 504 football players. These players had been divided into 2 groups. Both groups consisted of players (1) with a history of ankle injuries, as well as, (2) no experience of any previous ankle injuries. The first group was randomly given semi-rigid orthosis. Whereas the second group, the control group, was treated with prophylactic ankle support. The results revealed, “athletes with a history of previous ankle injury who were braced showed a statistically significantly lower incidence of ankle sprains (0.46 per 1000 playing hours) in comparison with those who were treated without any form of ankle support (1.16 per 1000 playing hours). Furthermore, these investigators did not observe a statistically significant difference in the overall incidence of ankle sprains between the treatment groups (Mickel, 2006; pg 361).”
Researchers have also investigated the impact of traditional taping on ankle injuries. The most common benefit associated with traditional taping measures is that it prevents twisting of ankles and provides athletes added stability. Mickel (2006) notes, “Traditionally, prophylactic ankle taping has been the mainstay for prevention of ankle injuries. Proper ankle taping is generally understood to reduce plantarflexion and inversion of the ankle, and this has been shown to be the most common mechanism associated with ankle sprain injuries.”
Nonetheless, the benefits of taping are reduced after about an hour of sporting practice. Researchers assert that taping becomes loose and cuts down the support to nearly negligible levels (around 40%). This is further decreased after a couple of hours of sporting activity. Furthermore, researchers have also criticized the cost associated with using tape in the long run. Mickel (2006) compares the cost-effectiveness of both ankle taping and bracing and concludes, “One study reported a cost of $1.75 per ankle when taping was used to prevent ankle sprains, resulting in a cost of more than $400 per athlete over 1 college football season. For these reasons, a number of ankle braces, both laced and semi-rigid with Velcro straps, have been developed. Such braces can be applied by the athlete, retightened during play, and present a one-time cost to the athlete or athletic program.”
In their study, Dizon and Reyes (2010) found that approximately 30% of all sports related injuries had been ankle sprains. These ankle sprains can sometimes be critical as they can lead to athletes being absent from sporting activities for a long time. Most athletes prefer to wear an ankle support before their match in order to prevent any sprains from taking place. Dizon and Reyes investigated the effectiveness of the ankle sprains and in addition, also assessed the best quality ankle sprain out there. The research strategy developed for this study was a research synthesis was carried out of medical literature available in online libraries (such as MEDLINE, PubMed, CINAHL, EMBASE, etc.) (Dizon and Reyes, 2010).
The inclusion and exclusion criterion for this study was that the researchers chose only those studies where subjects were either (1) adolescents; (b) adults; (c) elite and/or (d) recreational players. Furthermore, only those studies had been investigated where either ankle taping and/or bracing had been used to either prevent or treat injuries. The researchers measured the frequency of sprained ankles (Dizon and Reyes, 2010).
The results of the study showed, “reduction of ankle sprain by 69% (OR 0.31, 95% CI 0.18 — 0.51) with the use of ankle brace and reduction of ankle sprain by 71% (OR 0.29, 95% CI 0.14 — 0.57) with the use of ankle tape among previously injured athletes.” The researchers concluded, “No type of ankle support was found to be superior than the other (Dizon and Reyes, 2010).”
In another study researchers investigated the use of ankle bracing vs. taping amongst 50 athletes and found, “The use of an Aircast ankle brace for the treatment of lateral ligament ankle sprains produces a significant improvement in ankle joint function at both 10 days and one month compared with standard management with an elastic support bandage (Boyce, Quigley, and Campbell, 2005).”
In another study, Nagao (2002) investigated three inter-related characteristics of the ankle injury. Firstly, he measured the “initial fit;” secondly he measured “the degree of mobility” whilst exercising; and thirdly he measured the total cost of treatment. He used 6 kinds of ankle bracing methods and one ankle taping method for the “initial fit” and “degree of mobility.” Furthermore, he also calculated the total cost incurred during the test.
The tests were carried out amongst 10 subjects who had been suffering from “lateral ligament injuries” in one of their ankles. X-ray of both ankles had been taken to figure out the “degree of mobility.” The researcher found, “The results of measuring between the injured ankle before and after using a brace or taping showed an overall difference of five degrees in the polar tilt of the injured ankle.” Similarly, “Overall results show the more expensive braces provide both a better fit and better stability during exercise. Taping, however, provided the best fit and the least instability during exercise when compared to the braces. The question of cost also plays a role in the overall results of our research. Braces are inexpensive when compared to the costs of taping.” He concluded that taping had been more effective and the athletes have to choose between effectiveness and cost issues (Nagao, 2002).
This paper provided an in-depth analysis on the differences between ankle taping and ankle bracing and player satisfaction between the two. It presented information about the different types of tapes and braces. The tapes discussed here included white/cotton tape, power-tape and elastikon. Similarly the braces discussed here included lace up ankle braces and rigid ankle braces. The findings of this paper are that both taping and bracing are more or less equal in terms of effectiveness. However, ankle taping is far more expensive than ankle bracing. Furthermore, while treating ankles with braces, this study found that semi-rigid bracing had been more popular than non-rigid bracing.
Boyce, S.H., Quigley, M.A. And Campbell, S. (2005). Management of ankle sprains: a randomised controlled trial of the treatment of inversion injuries using an elastic support bandage or an Aircast ankle brace. British Journal of Sports Medicine.39:91-96
Dizon, J., & Reyes, J. (2010). A systematic review on the effectiveness of external ankle supports in the prevention of inversion ankle sprains among elite and recreational players Journal of Science and Medicine in Sport, 13 (3), 309-317.
Ivins D. (2006). Acute ankle sprain: an update. American Family Physician. 74(10):1714-20.
Meadows, M. (2006). Taking Care of Your Feet. FDA Consumer. 40: 2.
Mickel, T.J. et al. (2006). Prophylactic Bracing vs. Taping for the Prevention of Ankle Sprains in High School Athletes: A Prospective, Randomized Trial. The Journal Of Foot & Ankle Surgery. 45(6):360 — 365.
Nagao, M. (2002). An Analysis of Ankle Braces and Taping for Preventing Injuries of the Lateral Ligaments of the Ankle. Medicine & Science in Sports & Exercise. 34: 5.
Pedowitz D.I., Reddy S., Parekh S.G., Huffman G.R., Sennett B.J. (2008). Prophylactic bracing decreases ankle injuries in collegiate female volleyball players. American Journal of Sports Medicine. 36(2):324-7.
Reeves, D.A. And Emel, T.J. (2009). Ankle Taping and Bracing. Medscape Publications.
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