Rachel Bellows, PT, DPT, OCS, Christopher Kevin Wong, PT, PhD, OCS
International Journal of Sports Physical Therapy,13(3), 379-388.
JACO Editorial Reviewer: Alec Schielke, DC
Published: March 2019
Journal of the Academy of Chiropractic Orthopedists
March 2019, Volume 16, Issue 1
The original article copyright belongs to the original publisher. This review is available from: http://www.dcorthoacademy.com ©2019 Schielke and the Academy of Chiropractic Orthopedists. This is an Open Access article which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: Ankle sprains are common musculoskeletal injuries in the athletic population that have been addressed with prevention strategies that include bracing and balance training. Many authors have examined ankle sprain incidence after bracing or balance training in athletes at different levels of competition and in various sports. No systematic review has analyzed the results of both interventions.
Purpose: The purpose of this review was to compare the effect of balance training and bracing in reducing the incidence and relative risk of ankle sprains in competitive athletes, with or without prior injury, across different sports.
Design: Systematic review, with meta-analysis
Methods: A literature search of four databases was conducted for randomized control trials that reported ankle sprain incidence published from 2005 through 2016. Included articles studied high school, college, or professional level athletes with or without a history of a prior sprain, who received bracing or balance training as an intervention compared to a non-intervention control group. Methodological study quality was assessed by two reviewers using the PEDro scale, with scores ≥5 considered
moderate quality. Group incidence and relative risk were determined to assess the preventative effect of bracing or balance training compared to control.
Results: From 1832 total citations, 71 full-text articles were reviewed, and eight articles were included in the study. Methodological quality of the available evidence contained in the systematic review was moderate. Five studied the effect of balance training, two studied the effect of bracing, and one studied the effect of bracing and balance training compared to the control condition. In all eight studies, athletes in the control condition did not receive any intervention. Athletes who wore braces had fewer ankle sprains (p=0.0037) and reduced their risk of sprains by 64% (RR=0.36) compared to controls, based on analysis of 3,581 subjects. Athletes performing balance training had fewer ankle sprains (p=0.0057) and reduced their risk by 46% (RR=0.54) compared to controls, based on analysis of 3,577 subjects.
Conclusion: The findings of the current systematic review and meta-analysis support the use of bracing and balance training to reduce the incidence and relative risk of ankle sprains in athletic populations. Clinicians can utilize this information to educate their patients on wearing a brace or performing balance training exercises to decrease the risk of an ankle sprain.
Level of evidence: Level 1A???
Keywords: Athlete, ankle sprain, balance training, bracing, incidence, prevention
JACO Editorial Summary:
- This review was performed at Stanford Health Care, Ortho-Sport Physical Therapy in Redwood City, CA where the corresponding author is from.
- Prior to this review, bracing and balance exercises were individually examined in regard to ankle sprain incidence, but not the results of both interventions. Ankle sprains are common a musculoskeletal injury with prolonged recovery times ranging from 6 weeks to 1 year which can sometimes be a recurring issue resulting is subsequent ankle sprains. Thus, understanding appropriate prophylactic intervention is vital as a clinician and a patient.
- The purpose of this review was to compare the effect that balance training and bracing may have on reducing the incidence and relative risk of ankle sprains in athletes, with or without prior ankle sprain.
- This review encompassed English language publications from 2005-2016 from four different major databases initially returning over 1,832 articles. However, following exclusion/inclusion criteria there were eight remaining studies included, resulting in 7,195 subject athletes.
- It is noteworthy that: lateral, medial and high ankle sprains during athletic participation were included; balance training was not consistent across studies and could include proprioceptive training, static or dynamic exercises, with or without perturbations, and with eyes open or closed; that taping was not considered bracing in this review; and that in one study, self-reporting of prior ankle sprain by athletes did occur.
- The effect of balance training and bracing compared to no-treatment control was assessed with ankle sprain incidence per season/year and relative risk.
- In general, athletes with or without a prior sprain with bracing or balance training intervention established reduced incidence and relative risk of ankle sprains compared to no-treatment controls. Following statistical analysis, the results established that for both interventions there was a significantly lower incidence of ankle sprains and a reduced risk of a sprain by 64% with bracing and 46% with balance training.
- Subgroup limitations of this review include inability to demonstrate whether bracing or balance training was more effective, whether there were different effects among different levels of competition, and whether or not predisposition of previous ankle sprains had any effect on outcome
- The authors did point out that due to restriction of ankle joint mechanics inherent to bracing, other lower extremity injuries may occur secondarily as reported in other studies, but further discussion was beyond the scope of this review.
Although it is inconclusive which ankle intervention, bracing or balance exercises, is superior, this review demonstrated that there is moderate quality evidence supporting both interventions decrease the incidence and the relative risk of ankle sprains in athletes. Along with other appropriate diagnostic, treatment and management procedures for ankle sprains, clinicians may consider one, if not both intervention as part of their rehabilitation protocols, while also considering the potential unintended consequences of prolonged ankle bracing.