New Approach to Preventing Ankle Sprains

by Mitch Hauschildt, MA, ATC, CSCS

According to NCAA reporting, ligament strains to the ankle are the most common injury across 15 sports with a rate of 14.8% of all injuries.  They can be annoying, nagging and even debilitating.  Everyday I work with a large number of high risk athletes in sports such as basketball, volleyball, soccer and football.  Because of the high risk nature and high rate of ankle injuries, it is common at NCAA institutions to tape or brace their athletes in order to prevent as many injuries as possible.

According to the same NCAA report, teams that combine prophylactic taping or bracing with proprioceptive training see a reduction in their ankle injury rates by as much as 50%.  So, it makes sense to look hard at taping for injury prevention if you are an athletic trainer working with a high risk team.

The traditional approach to taping and bracing is to restrict ankle motion.  While this has proven to be helpful over time, there are some limits and/or problems to traditional ankle taping and bracing:

• Cost:  Taping an entire team every day prophylactically is cost prohibitive for a lot of teams and institutions.
• Time:  The manpower required to tape a team every day is extensive.  Many of us are short handed as it is, and spending an hour every day taping is a big drain on staff.
• Restricted Range:  The point of traditional taping is to restrict motion in order to prevent a sprain.  This is problematic because we also know that decreased range of motion at the ankle oftentimes leads to an increase in chronic pain elsewhere, usually the knee.  So, preventing an ankle injury can cause injury elsewhere.  This is especially true of bracing because they don’t stretch like tape does.
• Tape Stretch:  Even though the point of taping is to restrict motion, research tells us that with most traditional ankle taping techniques the tape stretches within about 15-20 minutes, thus we aren’t restricting motion nearly as much as we think we are.
• Bulk:  Many athletes don’t like the bulkiness of tape in their shoe.  And if they don’t like the bulkiness of tape, forget about a brace.  Braces are thick and don’t fit into shoes well at all.

All of these issues leaves a lot of us searching for better answers on ways that we can prevent ankle sprains for our athletes in the future.  As we look for clues, I think the answers actually lie right in the issue that we’re trying to improve upon.

As I said early in this post, NCAA reporting shows that prophylactic taping combined with training improves injury rates by as much as 50%.  I’m going to go ahead and assume (I know that isn’t a very safe assumption, but I’ll go with it), that everyone is already performing some sort of proprioceptive neuromuscular education training as part of their athlete’s offseason training, so for the rest of this discussion, we can narrow things down to just the taping issue.

If we know that taping helps, but we also know that because of the relatively quick stretch that occurs with our traditional ankle taping techniques, then what explains why it works?  If we aren’t restricting range of motion, then why is it that taping reduces injury rates?

The answer is the nervous system.

We now know that by placing tape on the skin, we stimulate mechanoreceptors that are imbedded within the skin and fascia which feed information directly to the brain.  The simple act of stimulating the skin increases the volume and frequency of the conversation between the brain and the part of the body with tape on it.

When we improve this conversation, we improve body awareness, balance, and motor control (among other things).  I now believe that while it is great that we have worked hard over the years to find the perfect heel lock, basket weave or stirrup placement to prevent an ankle sprain, the reality is that the most important factor to preventing injuries is simply having tape on the skin.  Of course this may not be true for all athletes in all situations, but I believe this is true when talking about relatively healthy athletes who are looking to prevent a sprain before it happens.

If we assume that all that I just said is true, then it makes perfect sense to use Kinesiology tape as an injury prevention strategy over traditional tape or bracing.  Kinesiology tape solves all 5 of the issues that I presented above with traditional taping or bracing.  It doesn’t restrict motion, it is designed to stretch, it fits nicely in a sock and shoe, and because it can be applied with a very small amount of tape and stay on for several days, it solves the cost and time issues as well.

So, in my mind, it makes perfect sense to use kinesiology tape on all athletes prophylactically, but does it really work when the shoes hit the court (or field)?  One place we can look to is a study released in 2016 in the Journal of Athletic Training that looked at kinesiology tape on the lower leg to improve balance in chronically unstable ankle patients.  They used 3 strips of tape on the lower leg to improve function of the muscles that support the ankle and found that the tape group had significantly better balance scores at the 48 hour mark than the control group.  They also found that many of the improvements were retained up to 72 hours after the tape was removed, which is an interesting find.

After seeing this study, our staff began working to test their findings with real athletes in real situations.  Last fall, we began taping some of our chronically unstable female athletes within our high risk sports and one our entire men’s team that competes in a high risk sport throughout the winter months with the taping technique described in the article.  We found that the results were good and our athletes have remained healthy.  Our staff loves it because as a general rule, they are only taping 1 day per week, operating under the premise that the tape will stay on 3-5 days and the athlete will retain many of the effects for up to 72 hours after the tape is removed.  By the time you build an off day into your week, taping 1 day per week seems to suffice.

But, we didn’t stop there, because not all of our athletes loved the look and feel of the 3 strip technique the 3 strips did take a lot of tape.  So, wee began playing with different options, listening to our most trustworthy athletes’ feedback and working under the premise that the most important thing is that we have tape on the skin.

Where we have currently settled with our prevention taping techniques is simple and easy and only takes one small piece of tape.  We are placing the ankle into plantar flexion and putting a basic decompression strip, without stretch, over the anterior ankle and running the tape over both the medial and lateral malleolus.  Our athletes state that they feel stable and in control and they love the way that it feels in their shoe.  It doesn’t take much tape at all, and it is saving our staff a ton of time, making it very attractive to everyone involved.  And, the most important thing to report is that we have had 0 time loss over the course of an entire collegiate volleyball season and 2/3 of a collegiate basketball season due to an ankle injury.

When compared to the large studies that are produced by the NCAA and NIH, our numbers are small and the results are a bit anecdotal.  But, I personally love what we’ve learned and where we’re headed with this strategy.  I invite you to try the same or similar techniques and let me know how your athletes do.

References:

Hootman, Jennifer M; Dick, Randall; Agel, Julie.  Epidemiology of Collegiate Injuries for 15 Sports: Summary and Recommendations for Injury Prevention Initiatives.Journal of Athletic Training; Dallas (Apr-Jun 2007): 311-9.

Jackson K, Simon JE, Docherty CL. Extended use of Kinesiology Tape and Balance in Participants with Chronic Ankle Instability. J Athl Train. 2016 Jan;51(1):16-21. doi: 10.4085/1062-6050-51.2.03. Epub 2016 Jan 11.

Looking for more help?  Schedule a consultation today!