Should I tape or brace my ankle after an ankle sprain?
There are two questions I often get asked when I see someone that has had an ankle sprain. The first usually is “should I strap or brace for sports?” and the second “which one would be best?”.
I personally believe these questions to be best answered at the individual level. There are many factors to consider and I will regularly ask my clients, as well as asking myself, a few questions before making any recommendations such as: What is your sport or activity? How often do you play or participate in your chosen sport? At what level? Have you had previous ankle sprains? Have you had any allergic reaction to taping before? What is the severity of their injury? Is this a short or long term strategy? Where are they in relation to their rehabilitation journey?
The above are just a few examples of real World questions that happen in clinical life. I will dive into the research in a bit, which may assist us in making an informed decision but by no means is definite. Contrary to the current trend, the best use of research happens in context of the individual, his or her expectations combined with a practitioner’s clinical expertise.
First, one must know an ankle sprain is NOT just another ankle sprain. Unfortunately, ankle sprains are one of the most overlooked musculoskeletal injuries. The number of people who develop chronic ankle instability is pretty high. Also, the incidence of ankle sprains across many sports and activities, particularly if involving running, pivoting, jumping and cutting movements is enormous.First, one must know an ankle sprain is NOT just another ankle sprain. #performbetter @pogophysio Click To Tweet
Severity may range from a very low grade lateral ankle sprain having minimal consequences for the lateral ligaments and capsule of the ankle to extensive injury. The latter may involve multiple ligaments, bone bruising, cartilage defects and fractures. Rehabilitation and time to return to sport will also vary greatly and will be based on an accurate diagnosis. Nasty ankle injuries and very low grade ones are often not a big threat. The first is usually not missed given its nature and limitations imposed by pain and swelling, the second does not offer long term repercussions. The ones that lie somewhere in the middle are the real issue because they tend to be neglected and mismanaged.
Runners, especially trail runners or those involved with adventure races are some times concerned about having their ankles strapped. Firstly they are not sure if it is going to be secure enough and, secondly and more importantly, if it is going to interfere with their performance. Paulson & Braun (2014) decided to look into prophylactic ankle taping of running on a treadmill. Their analysis was concerned running kinematics (movement of joints) and running economy (energy expenditure). They found that ankle strapping did not interfere with running economy or movement. In other words, strapping an ankle for running will not have a negative impact in your ability to run. Unfortunately, trail running and adventure racing are hard to be replicated in a laboratory environment. However, we can safely assume running economy or the amount of energy you spend whilst running, as well as running kinematics, are likely to remain unchanged in trails or adventure racing with ankle strapping.
The more crucial question for these groups is different. Will taping or bracing prevent an ankle sprain if I am running trails or obstacle racing? Hold that thought. I will get to it soon.
Another group of scientists set out to investigate the effects of preventative ankle taping on planned change of direction, agility performance and muscle activity in Basketball players. Mind you Basketball is one of the sports with the highest incidence of ankle sprains. This group concluded that there were no changes in change of direction or agility performance in players with strapped ankles. Nevertheless, when looking at the Peroneus Longus, one of the lateral leg muscles which dynamically supports the lateral ligament complex of the ankle, they found taping may assist by decreasing the demand for that muscle. This interpretation lead us to believe that in activities with cutting movements taping could be helpful in decreasing fatigue of the peroneus longus. That can represent a positive advantage given that the majority of non-traumatic ankle sprains happened halfway onwards of a game, rather than at the start, suggesting fatigue to be a factor. Be aware, I am just speculating here. The main message from this study was: no adverse effects were observed. (Jeffriess et al 2015).
For those with chronic ankle instability, taping or bracing has been advocated and is routinely used in practice to alleviate giving-way symptoms. Kobayashi et al. 2014 investigate if the application of either taping or brace actually have any effect on joint mechanics of those who report instability. They conclude that under weight bearing neither taping or bracing were enough to significantly change joint mechanics. Hence, some suggesting the benefits reported by patients and athletes to be related to a perceptual change rather than a change within the joint mechanics.
Following that reasoning, Jahjah et al. 2018 conducted a randomised controlled trial to investigate the effect of ankle taping on joint position sense after muscle fatigue. The principle is that once muscles are fatigued, the risk of an ankle sprain injury increases. Therefore, taping could help the brain, via sensory feedback through the skin, to activate certain muscles when the joint moves in certain direction against the tape. That self-awareness regarding the position of a joint in space is called joint position sense and its part of a self regulating mechanism called proprioception or ‘own perception’. Proprioception exists to stop joints, muscle and tendons to move further from their biological capacity, leading to injuries such as tears, strains and sprains. It is a complex mechanism reliant on the nervous systems and its many monitoring strategies.
So these authors found that taping can actually improve joint position sense, at least when fatigued. They advocate taping as a good prophylactic strategy for those playing sports or participating in activities who are considered to have a higher risk of sprain and ankle. To clarify that message, the biggest risk factor for an ankle sprain is have suffering a previous ankle sprain.
Following the same lead, Halim-Kertanegara et al. 2016 also highlighted in their study that despite not increasing performance, ankle taping did increase self efficacy and perceived confidence in dynamic tasks. A good point made by these authors is that based on their findings, ankle taping can be utilised as a tool to allow for early return to sport participation or as a rehabilitation tool towards more dynamic protocols.
Janssen, Mechelen and Verhagen (2014) took a different approach and decided to compare an ankle bracing group, a neuromuscular training group and a combined group over 1 year follow up. The aim was to evaluate if any of these groups would present with significantly less recurrence of ankle sprains during sport participation. A self-reported measure was used to evaluate the outcomes of recurrence and the bracing groups yield the best results.
Hence, in terms of secondary prevention, a semi-rigid brace seems the best strategy to prevent recurrence of an ankle sprain. The other interesting point was, despite the less recurrence rate in the bracing group, wearing a brace did not reduce the severity of the sprain on those who still had one. Therefore, we cannot assume wearing an ankle brace will decrease the chances of one having a more severe ankle sprain, only a lesser chance of recurrence can be expected.
Last but not least, a systematic review by Doherty et al. (2017) summarises some of the previous studies. These authors concluded the both bracing and exercise therapy have the support of the literature in preventing chronic ankle instability. At the same time, early mobilisation and non-steroidal antiinflammatory drugs have good indication in the acute stage of an ankle sprain.
Back to our real World scenario, either bracing or taping are positive strategies to be used after an ankle sprain. There are circumstances that prevent an athlete from wearing an ankle brace such as rules of the sport, tight boots etc. Nevertheless, in terms of prevention of recurrence of an ankle sprain an in accordance to the current literature, ankle bracing is the best strategy. Your health professional will be able to assist you with that decision. As I mentioned at the start of this blog, it is my opinion that such decision should happen at the individual level.In terms of prevention of recurrence of an ankle sprain an in accordance to the current literature, ankle bracing is the best strategy #performbetter @pogophysio Click To Tweet
Thanks for taking an interest in the topic and for sticking with me till the end. Please, feel free to share this blog with your peers.
Bruno Rebello (APAM)
Featured in the Top 50 Physical Therapy Blog
Doherty, C., Bleakley, C., Delahunt, E., & Holden, S. (2016). Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis. British Journal of Sports Medicine,51(2), 113-125. doi:10.1136/bjsports-2016-096178
Janssen, K. W., Mechelen, W. V., & Verhagen, E. A. (2014). Bracing superior to neuromuscular training for the prevention of self-reported recurrent ankle sprains: a three-arm randomised controlled trial. British Journal of Sports Medicine,48(16), 1235-1239. doi:10.1136/bjsports-2013-092947
Halim-Kertanegara, S., Raymond, J., Hiller, C. E., Kilbreath, S. L., & Refshauge, K. M. (2017). The effect of ankle taping on functional performance in participants with functional ankle instability. Physical Therapy in Sport,23, 162-167. doi:10.1016/j.ptsp.2016.03.005
Jahjah, A., Seidenspinner, D., Schüttler, K., Klasan, A., Heyse, T. J., Malcherczyk, D., & El-Zayat, B. F. (2018). The effect of ankle tape on joint position sense after local muscle fatigue: a randomized controlled trial. BMC Musculoskeletal Disorders, 19, 8. http://doi.org/10.1186/s12891-017-1909-2
Kobayashi, T., Saka, M., Suzuki, E., Yamazaki, N., Suzukawa, M., Akaike, A., . . . Gamada, K. (2014). The Effects of a Semi-Rigid Brace or Taping on Talocrural and Subtalar Kinematics in Chronic Ankle Instability. Foot & Ankle Specialist,7(6), 471-477. doi:10.1177/1938640014543357
Jeffriess, M. D., Schultz, A. B., McGann, T. S., Callaghan, S. J., & Lockie, R. G. (2015). Effects of Preventative Ankle Taping on Planned Change-of-Direction and Reactive Agility Performance and Ankle Muscle Activity in Basketballers. Journal of Sports Science & Medicine, 14(4), 864–876.
Paulson, S., & Braun, W. A. (2014). Prophylactic Ankle Taping. Journal of Strength and Conditioning Research,28(2), 423-429. doi:10.1519/jsc.0b013e3182a1fe6f