About a month ago a friend of mine emailed me an article featuring a study done advocating the use of ankle braces for basketball players. He wanted my thoughts because he was well aware of my ‘anti-ankle brace’ philosophy.
Prior to giving my thoughts on why I am still opposed to them, here is an overview of the study:
Ankle Braces May Help Teenage Basketball Players (ChicagoTribune.com)
Reporting by Amy Norton at Reuters Health; editing by Elaine LIes
The ankle braces many basketball players strap on to prevent injuries may actually work, according to a study of teenaged basketball players.
Of the nearly 1,500 basketball players followed for a season, those assigned to wear ankle braces during games and practice were 68 percent less likely to suffer an ankle sprain or fracture, the authors wrote in the American Journal of Sports Medicine.
"Ankle braces could be a cost-effective way to prevent ankle injuries in basketball players, but they're not a panacea," said Timothy McGuine, at the University of Wisconsin-Madison, who led the study.
"There are advertising claims that they'll do wonderful things."
Conversely, there have been concerns that limiting the ankles' mobility with a brace could set basketball players up for knee injuries, including tears of the anterior cruciate ligament. (ACL).
But in the study, which looked at the effects of "lace-up" ankle braces, which are made of synthetic fabric and secured with Velcro, found no evidence of higher knee injury risks.
Of the 740 players randomly assigned to wear lace-up ankle braces, 27 suffered an ankle sprain or fracture over one basketball season.
In contrast, there were 78 ankle injuries among the 720 teenagers who played and practiced brace-free.
That translated into an injury rate of just under 0.5 for every 1,000 practice sessions and games in the brace group. The rate in the brace-free group was about three times higher, at 1.4 per 1,000.
There was no significant difference, though, in the two groups' risk for knee injuries: there were 15 in the brace group, and 13 in the comparison group.
It's likely, McGuine said, that the softer, flexible lace-up brace does not put the knee at risk in the way that a semi-rigid plastic brace might.
But the braces do not seem to reduce the severity of ankle injuries when they do occur. McGuine's team found that injured players in both groups needed the same recovery time -- about a week.
There are other ways to reduce basketball players' injury risk.
Studies have found, for instance, that training regimens focused on balance, coordination and jumping technique seem to cut ankle injuries to the same degree that braces did in the study -- but of course these are more involved than simply strapping on a brace.
Still, the advantage of training is that it also seems to reduce the risk of knee injuries, meaning that a mix of training and ankle bracing may be best.
"The more we can do to prevent these injuries in kids, the more we'll save in healthcare costs in the long run," McGuine said.
That concludes the summary of the article.
Now, here are my thoughts. I see several problems with this study:
1. I admit I am far from a scientist or a statistics major… but 1,500 players is a very small sample size. I would like to see this study with 15,000 or 150,000 players. The smaller the sample size, the less legitimate the data.
2. There are too many other variables that contribute to ankle injuries to conclusively blame or credit the ankle braces alone. Age, gender, fitness level, pre-existing injuries,
style of play, and footwear are just some of the variables.
3. This study simply compared wearing ankle braces to not wearing ankle braces. What about comparing players who wear them to players who participate in a progressive ankle/foot strength & mobility program (such as barefoot training, proper landing/deceleration training, balance training, etc.)? In other words, do a follow up study with 3 groups:
a. Have one group wear ankle braces
b. Have one group not wear ankle braces and do nothing
c. Have one group not wear ankle braces and properly train their ankles/feet.
4. While the study did note that wearing an ankle brace didn’t increase acute knee injuries, in my opinion, restricting the ankle’s mobility over time, will eventually cause additional and unnecessary stress to the knee, which could potentially be a problem. I would like to see the results of this study done over a much longer period of time (all 4 years in high school?) to see if ankle braces actually do effect the knee.
5. This study doesn’t measure the effect of limiting a player’s active ankle range of motion and mobility. Does wearing a brace make a player slower and less explosive? Absolutely! If the ankle can’t go through a full range of motion… players can’t run as fast or jump as high as possible. I am NOT big on testing, but I would be curious to compare the results of an agility test and a vertical jump test – with the same player tested on the same day, performing each test with and without ankle braces.
As you can see, this study certainly doesn’t sway my anti-ankle brace philosophy!
I still feel very strongly that ankle braces and tape:
· Are unnecessary for the vast majority of players. The only exception being if they are prescribed by a medical professional to help rehabilitate a previous injury.
· Weaken the feet and ankles, make them less mobile, and limit a player’s functional range of motion.
· Can lead to knee issues and injuries. If the ankle can’t flex and absorb the impact from a plant & cut or from a jump, then all of the impact gets absorbed in the next closest joint – the knee.
· Reduce a player’s ability to run and jump as high and as fast as they can.
I know some of you have a smirk on your face and are thinking, “But Derrick Rose wears ankles braces.”
Yes, I am aware that Derrick Rose, one of the most explosive players in the game, wears ankle braces. However…
1) To the best of my knowledge, D-Rose hasn’t had any fewer ankle injuries than Steve Nash – a player who doesn’t wear ankle braces (and wears low top basketball shoes!). And Nash’s career has been 3 times longer.
2) As hard as it is to believe, there is a chance D-Rose could be slightly more explosive and agile if he didn’t wear them! Imagine that?!
3) D-Rose is the exception, not the rule. He is borderline super-human. If you are reading this, trust me, with all due respect… you are not D-Rose! (please read the PSS)
Here are 4 additional resources to develop foot and ankle strength/mobility:
Ankles & Feet (Blog): http://blog.strongerteam.com/post/2010/05/17/NEW-Ankles-Feet.aspx
Ankle Training for Basketball (Video): http://youtu.be/p8g7UeSw95A
Ankle & Foot Injury Prevention Program (PDF): http://shop.strongerteam.com/p-38-ankle-and-foot-injury-prevention-program-for-basketball.aspx
Barefoot in Boston by Arthur Horne (Book): http://tinyurl.com/BarefootTrainingBook
I would love to know your thoughts, whether you agree with me or not, on ankle braces as well as this study. Please feel free to post on Twitter (make sure you tag @AlanStein so I don’t miss it) or on our Stronger Team Facebook page (www.Facebook.com/StrongerTeam). Or of course, email me, at Alan@StrongerTeam.com. I am particular interested in the professional opinions of doctors, physical therapists, or athletic trainers.
Keep your ankles and feet strong, mobile and healthy this pre-season!
PS: I know it's been a while since I've posted a new video. I'm getting footage of several DeMatha pre-season workouts and will post ASAP!
PSS: If you are reading this and you are D-Rose… ankles braces or not… I am a big fan!