Recreational Injury Interventions

Recreational Injury Effectiveness of Bracing or Taping in Prevention of Sports Injuries

Background

In the US, 25% of girls and 50% of boys aged 8-16 participate in sports. More than one-third of all injuries to children and adolescents occur during sports, with about one-third of these being lower extremity injuries.

One method to avoid injury, or to avoid re-injury, which has been proposed is bracing and/or taping of knees or ankles. Many athletes use these methods and a large amount of money is spent on them. We review the evidence for their effectiveness. In this review, we include data on both children and adults, since relatively few studies have been done on children alone.

Ankle Injuries

The most common mechanism of ankle injury is inversion of the plantar flexed foot. Injury occurs to the anterior talo-fibular ligament, followed to a varying degree by the calcaneofibular ligament. Injury to the ankle is associated with a five fold increased risk of subsequent injury, McKay GD, Goldie PA, Payne WR, Oakes BW. Ankle injuries in basketball: injury rate and risk factors. British Journal of Sports Medicine 2001;35(2):103-8.).


Review of ankle bracing & taping studies:

Author

Handoll, et al., 2001

Study design and target population

Meta analysis of interventions to prevent ankle injuries.

Population: all physically active individuals from adolescence to middle age.

Intervention

Ankle brace or orthosis compared to control.

Outcomes

Ankle ligament injuries.

Results

Summary RR for 5 studies: 53 (95% CI 40 to 69).

Study quality and conclusions

Very strong meta-analysis.


Author

Handoll, et al., 2001

Study design and target population

Meta analysis of interventions to prevent ankle ligament injuries.

Data analyzed by prior history of ankle sparin.

Intervention

Ankle brace of orthosis compared to control.

Outcomes

Ankle ligament injuries.

Results

History of prior sprain, effect of bracing: RR=33 95% CI .20 to .53.

No prior history of sprain, effect of bracing: RR=.73, (.52, 1.03).

Study quality and conclusions

4 studies looked at this effect by prior history.


Author

Handoll, et al., 2001

Study design and target population

Meta analysis of interventions to prevent ankle ligament injuries.

Intervention

Taping vs. cloth wrap.

One study of 148 people.

Outcomes

Ankle ligament injuries.

Results

RR= 1.03 (.27, 3.95).

Study quality and conclusions

No effect of taping.


Author

Sharpe, et al., 1997

Study design and target population

Retrospective cohort study.

Population: 38 collegiate soccer players:.

Intervention

Taping and/or bracing.

Outcomes

Prevention of re-injury Ankle sprains.

Results

No injuries in the braced group, 25% in the taped group, 25% in group which sued both and 35% in group which used neither.

Study quality and conclusions

Poorly done study.

Historical control.

Summary of ankle bracing & taping interventions

There appears to be good evidence that ankle bracing/orthosis is effective in prevent ing ankle ligament injuries, although the effect appeared to be confined to those with prior injury. Although a smaller benefit is likely for those who have no prior history of ankle injury, this remains to be proven.

It is instructive to use the data in the studies to calculate a Number Needed to Treat (NNT). To prevent one ankle sprain, the device would need to be worn for 280 athletic exposures (one practice or at least one half of a basketball game), 3000 hours of soccer playing (practice or game), or 300 parachute jumps. There are no good data on how acceptable these devices are for athletes, particularly those playing at a high level in their sport.

Bot and van Mechelen (1999) recently reviewed the effect of ankle bracing on performance. They concluded that ankle bracing has little or no effect on performance in vertical jump height, running speed, broad jump and agility in persons with stable ankles. The effect of ankle bracing on performance after a prolonged time of use is unknown. It has the potential to have an effect on ankle musculature and ligament function.

Recommendations on ankle bracing & taping programs

There is good evidence that external ankle supports can reduce the risk of ankle ligament injury in high risk sports such as basketball and soccer, particularly am ong those with a prior injury to the ankle. These can be recommended although their use must be balanced against acceptability, possible effects on performance, and effects from long term use.

 

Review of shoe and ankle injury studies:

Author

Barrett, et al., 2001

Study design and target population

RCT.

Population: 622 college aged intramural male basketball players.

Intervention

High top vs. low top shoes.

Outcomes

Ankle sprains.

Results

Rate in high top shoes was 4.06/10,000 player minutes compared to 4.8 in low top shoes, not significantly different.

Study quality and conclusions

No effect of high top shoes in basketball.

Summary of shoe and ankle injury interventions

The one available study appeared to show no protective effect of high top shoes in preventing ankle sprains in basketball.

Recommendations on shoe and ankle injury programs

High top shoes cannot be recommended as a method to prevent ankle sprains.

Knee injuries

Knee injuries are relatively common and often result in significant long term impairment. One study form Switzerland (de Loes) found that the sports with the greatest risk of knee injuries for both males and females were: ice hockey, handball, soccer, basketball, alpine skiing. Knee injuries accounted for 10% of all injuries in males and 13% in females, but they accounted for 27% and 33% of the medical costs per hour of particip ation.

Unfortunately, we could find no randomized studies that have examined the effect of braces on primary prevention of knee injuries.