Aug 13, 2024Considerations for ankle bracing
When an athlete injures an ankle, it is usually either a fracture of one of the bones or a sprain – which there are three distinct types – Grade 1,2, or 3 of any ligaments surrounding the ankle joint. Once an injury has occurred and is accurately diagnosed by a healthcare professional (MD, DO, PA, AT, PT, NP, RN), an ankle brace is usually prescribed for sprains. Fractures are usually immobilized.
Debate
One question that often arises is, “How long should I wear the brace?” It depends on many factors such as the severity of the injury and which specific structures were injured. Most licensed healthcare professionals agree that ankle braces are necessary for supporting injured structures – at least in the short term until full strength and mobility can be regained through physical rehabilitation.
Here is where decisions vary. Depending on the sport and athlete, after rehab has been completed, this may be the time to transition to taping or stop using the brace if the athlete feels comfortable, passes a post-rehab strength and agility test, and keeps the ankle joint strong with proper conditioning. This is debatable in sports rehab.
Using a brace for too long may have negative effects as some have said. Tara Hackney, PT, DPT has said that there is concern that bracing can reduce proprioception (joint awareness) and muscular strength over time. (Feb. 11, 2019). In addition, an article from Total Sports Therapy in 2018 says if an ankle brace is used excessively (overused) then it can weaken the structures it is designed to support because the muscles, tendons, and ligaments no longer must do the work needed for balance and support.
Another statement is from the website hemanklerehab.com in 2021 which says ankle braces, wraps, and tape make your ankle weaker. Early movement is the key, and any immobilization is counterproductive because injuries naturally swell, and bracing the joint weakens ligaments and reduces ROM – and your ankle will not heal properly or fully. They go on to say they are against people using an ankle brace to help heal a sprained ankle or protect a weak ankle. They do promote a solid rehab program. Part of this debate is for us – as healthcare professionals – to use our knowledge to help educate athletes, coaches, and parents on the pros and cons of using ankle braces for extended periods.
Opinion
I continue to believe that for most injuries, there comes a point in time when normal physiological function – strength, stability, and range of motion -has returned, and a brace is no longer needed.
There are a few exceptions where an athlete has undergone extensive surgery and rehabilitation and may need added support for their entire career.
Making an educated decision with all parties involved will help decide if wearing an ankle brace is right for the individual athlete. Ankle braces should never replace a sound rehab program.
The challenge comes into play when these braces are used prophylactically on healthy, non-injured ankles in hopes of preventing injury. As Kurt Jacobson, LAT with the Mayo Clinic said in his article, Brace for it: when to use an ankle brace, he reminds us that “wearing an ankle brace is not a 100% guarantee against injury”. If an athlete feels comfortable wearing braces for extended periods without any history of injury – it is unlikely and may even be counter-productive for me to try to change their mind.
Pros and Cons of Bracing
Pros of Ankle Braces
- Provide stability in rehab and sport
- Decreases pain in the joint
- Limits available movement and helps speed recovery
Cons of Ankle Braces
- They do not replace a rehab program
- Wearing a brace too long can make one over-reliant on the support it gives us
- Can result in muscle atrophy and loss of proprioception
*From peak-physio.com ‘To Brace or not to brace.’
Conclusion
As you can see, opinions and research vary on the use of ankle braces. You must know what the diagnosis and extent of the injury is. How long does the healthcare professional recommend a brace be worn and what type? Understand braces do not replace a rehab program, and a professionally designed rehab program should be completed for most ankle injuries. Also, know the pros and cons of wearing an ankle brace.
If a brace is being considered after rehab is completed, make an educated decision with all parties involved on what type of brace will be most beneficial for the athlete, their sport, and how long it should be worn. Wearing an ankle brace is not a guarantee against injury.
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Wearing ankle braces prophylactically or extensively to prevent injury should be thoroughly discussed with the athlete, parents, coaches, and healthcare providers to decide the best course of action to keep the athlete safe in their sport. The result should be what all parties feel is best and safest for the athlete to continue playing their sport at the highest level with comfort and confidence.
