27 January 2014

Ankle braces better than neuromuscular training

To prevent a second sprained ankle, wearing a brace may be more effective than neuromuscular training, but neither method is foolproof.

To prevent a second sprained ankle, wearing a brace may be more effective than neuromuscular training, but neither method is foolproof, say Dutch researchers.

They found that study participants who had sprained their ankles were about half as likely to suffer a second sprain when they wore a brace, compared to those who only got neuromuscular training.

This doesn't mean people with sprained ankles should go for braces and forget about neuromuscular training, the study's senior author Dr Evert A L M Verhagen said.

The results could be due to chance, he told Reuters Health. And since past research shows that both the braces and the training offer some protection, the researchers couldn't ethically include a test group that got neither measure, said Verhagen, who studies public and occupational health at VU University Medical Centre in Amsterdam.

Cost and effectiveness 

Originally Verhagen's team thought both methods would be equally effective, and only wanted to see which cost more money in the long run, he said. Ankle sprains represent one quarter of all sports injuries, the researchers note in the British Journal of Sports Medicine.

In The Netherlands, costs associated with every sprained ankle are close to 390 euros ($500), which translates to nearly 208 million euros ($286 million) spent annually just in that country, they write.

For the study, 380 adult athletes under age 70 who played a sport for at least one hour weekly and had recently sprained an ankle were separated into three groups: one group got a two-month neuromuscular training program, one wore a semi-rigid ankle brace for 12 months and the third group tried both training and a brace at the same time for two months.

Read: Foot and ankle exercises

People in the training group performed special ankle exercises at home for 30-minute sessions three times a week. The training includes using a balance board and watching an instructional DVD that demonstrated the exercises.

The brace group was given an Aircast A60 Ankle Support, available online for between R450 and R 550. In the yearlong study, 69 participants reported another sprain of the same ankle. Those who wore a brace were less likely to suffer a sprain than the training group, with 15% of the brace wearers and 27% of the training group reporting a sprain.

Of the group that got both training and a brace, 19% had a second sprain in the same ankle.

Surprising results

No one group lost more time or spent more money on their sprain injuries – all "second sprains" seemed to be roughly as severe in all groups. "Based on my experiences I assumed that a combination of bracing and exercise would be best," said Timothy A McGuine, senior scientist in the department of Orthopaedics and Rehabilitation at the University of Wisconsin School of Medicine and Public Health in Madison.

Though the results are surprising, McGuine, who was not involved in the research, said he believes them since the study was well done and the authors are quite respected in the field.

Verhagen cautioned, "We have only established an effect on the prevention of secondary injury." His group also did not consider other important complaints like pain, instability or performance. Other studies have found that neuromuscular training might help with those other aspects of recovery, he said.

Preventative measures

"Each injury and patient situation is unique, and a good therapist or athletic trainer will tailor post injury treatment for a particular situation," McGuine said. "You have to remember that neuromuscular training has the potential to also lower the risk of other knee and lower leg injuries – bracing affects the ankle but will not reduce the risk of injury to other leg structures."Past research suggests the risk of a second ankle sprain goes up by 50% in the year following a first sprain.

Sports with lots of jumping, and certain positions like playing at net in volleyball are especially prone to sprains.

Certain individuals suffer from many recurrent ankle sprains and researchers still can't say for sure why, Verhagen noted. In his study, those with many past sprains had basically the same recovery, but did seem to follow directions – for the brace or the training program – a bit better than others, he said.

For all preventive measures, braces or training, they can only work if you actually use them, Verhagen said.

Read more:

•             Foot and ankle injuries

•             Save yourself





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