Prevention of ankle sprains in sports : an update : review article

Objective: This paper updates a previous assessment of the published evidence regarding the effectiveness of different approaches to preventing ankle sprains among athletes. Data sources: Citations were identified from textbooks, searches of electronic databases (MEDLINE 1966-2003), Current Contents 1996-2003, Biomedical Collection 1993-2003, and dissertation abstracts 1993-2003) were updated in all languages by using the following subject terms: ankle sprain, ankle injury, and sports injury. The searches were limited by using the terms prevention and control, aetiology, and epidemiology. Citations from reference sections of papers retrieved, from contacting experts, and from the Cochrane Collaboration, were identified. Study selection: From 650 citations identified in the search, 143 relevant articles were identified that reported the risk for ankle sprains in sports, methods for providing support, the effect of interventions on performance, and a comparison of prevention efforts. Papers that did not provide primary research data, that addressed treatment or rehabilitation only rather than prevention, or that provided previously published data, were excluded. Data extraction: Two authors independently extracted data from the analytical studies and randomised controlled trials. Three authors assessed the quality of the randomised controlled clinical trials and cohort studies by using a previously published rating instrument. Data synthesis: The most common risk factor for ankle sprains in sport is history of a previous sprain. Twenty studies involving athletes in basketball, football, soccer, or volleyball compared alternative methods of prevention, including wrapping the ankle with tape or cloth, semi-rigid braces, high-top shoes, balance boards, or a combination of methods. The majority of studies indicate that appropriately applied braces or tape do not adversely affect performance. Evidence from the same studies indicate that conditioning that focuses on agility, balance, and flexibility decreases injury risk, as does use of high-top shoes and use of ankle bracing to prevent recurrence. Pooled data from five randomised controlled clinical trials demonstrated that use of balance board training substantially reduced the risk for ankle sprains. Conclusions: Carefully structured pre-season conditioning, with special emphasis on proprioception and ankle strengthening using balance boards or their equivalents, is likely to decrease the occurrence of ankle injuries. Warming up should precede all intensive practices or games. Athletes with sprained ankles should complete rehabilitation before competing, and those suffering a moderate or severe sprain should wear an appropriate brace for at least 6 months. Research should focus on methods for primary prevention, especially assessing the effectiveness of conditioning programmes that emphasise agility, balance, and flexibility.