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Am Fam Physician. 2000;61(10):3153

The ankle sprain is one of the most common injuries in athletes and often results in days or weeks lost from practice and competition. Efforts have been directed at preventing such injuries by ankle wrapping, taping or bracing, selecting proper shoes and altering the sports environment to better protect the athlete. Thacker and associates conducted a systematic review of the literature to determine the effectiveness of various recommendations for the prevention of ankle sprains in athletes.

A total of 113 articles reporting ankle sprain risk were identified, and a scoring instrument was developed to grade the strength of the interventions used and their effect on athletic performance. Of these articles, 10 reports compared alternative methods of preventing ankle sprains. The most common risk factor for ankle sprain in sports is a history of a previous sprain.

Methods of external ankle support include tape or cloth wrapping, and use of orthotic devices and high-top shoes. Inversion of the ankle is substantially restricted with these interventions. To address the concern that these restrictive measures might compromise performance (in terms of running, jumping and cutting), 20 studies measured the effects of taping or bracing. Although most studies indicated that appropriately braced or taped ankles do not adversely affect performance, several studies report a small but significant decrease in performance.

Taping the ankle has been the preventive method of choice for coaches and trainers in many sports. Taping has been shown to prevent ankle sprains despite the fact that tape loosens in approximately 10 minutes and provides little or no measurable support of the inverting ankle within 30 minutes. It is postulated that the residual protection is associated with increased proprioception that allows the peroneal muscles to react more rapidly to inhibit extreme ankle inversion. There is no evidence that elastic wrap or bandages support the ankle effectively. The use of high-top shoes alone does not appear to reduce the risk of ankle sprain. However, the use of high-top shoes with inflatable support chambers results in a slightly (but not statistically significant) lower risk of ankle injury. The combination of taping and high-top shoes was particularly effective in players with previous injuries. The protective effect was not significant among players without a history of ankle injury.

There is widespread use of several semirigid orthoses made of cloth or plastic to prevent ankle sprains. Ankle taping was not as effective as an orthotic stabilizer. Semirigid orthoses may be most effective in preventing reinjury in athletes with a previous ankle injury. Intensive, sustained conditioning reduced the occurrence of ankle sprains over a six-month period. Like ankle taping and bracing, the effect most often occurred in athletes with a history of ankle sprain.

The authors found a general lack of uniform, consistent and ongoing approaches to monitoring for occurrence of injuries. Actions that are often endorsed for injury prevention could not be supported in this review of the literature. Despite the unanswered questions, Thacker and associates were able to make one clear recommendation to coaches, trainers and athletes: athletes with a sprained ankle should complete supervised rehabilitation before returning to practice or competition, and athletes with a moderate or severe ankle sprain should wear an appropriate orthosis for at least six months. The benefit of the orthosis seems to persist up to one year after injury. Preseason conditioning may optimize performance and prevent ankle injury.

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