Remix: Ankles and Feet (original concept posted in May of 2010)
A basketball player’s feet are important. Let me rephrase that. A basketball player’s feet are extremely important. There are approximately 26 bones and 20 muscles in the feet. That fact alone should shed some light on their significance.
Basketball is (supposed to be) played standing upright on two feet. Therefore, every movement a player makes on the court is initiated through their feet. Everything starts with the feet. Similarly, can you guess what the most common injury is for basketball players at every level?
Strong and mobile ankles and feet will lessen the occurrence of injury, decrease the time lost if an injury does occur, and will improve performance on the court.
As obvious as these statements sound, most players and coaches put very littler priority on training the feet properly. The goal of this blog is to change that. So please, share this with every coach and player you know!
Before I go further, let me make it crystal clear that this is not a research project or case study. This is my blog. My stance on training the feet and my opposition to ankle braces (and tape) is purely my opinion. I am in no way trying to refute the advice of a qualified athletic trainer or podiatrist or any legit study that has been conducted. However, my opinion is based on 10+ years of experience in the field, thousands of hours of observations, a firm understanding of the human body and efficient movement, and numerous conversations with colleagues.
Basketball shoes are designed to be rigid (with stiff soles) to create as much stability as possible. To further increase stability, many players also wear ankle braces or get their ankles taped. Here lies the problem. By creating so much stability, you drastically limit mobility. Severely limiting mobility will weaken the muscles of the ankles and feet. What happens to a person’s forearm muscle when their arm has been immobilized in a cast from a broken wrist? It atrophies (weakens). So do the muscles of the feet when they are confined to rigid shoes and ankle braces for long periods of time. I know players who wear basketball shoes and ankle braces 20+ hours per week!
I am not opposed to wearing basketball shoes when you are playing. The stability and support is a necessity. But you don’t need to wear them when you are training. And ankle braces? Tape? With the exception of a player who suffered a previous ankle injury, or someone taking a direct recommendation from a qualified professional… ankle braces (and tape) are absolutely unnecessary when playing and when training.
Still not convinced? The other day I flipped on ESPN Classic and saw the 1973 NBA Finals (Game 4) between the Knicks and the Celtics, featuring Hall of Famers Willis Reed, Walt Frazier, and Dave Cowens. In addition to wearing shorts that looked like boxer briefs, every single player was wearing low top Adidas sneakers. No braces. No tape. And guess what? No injuries!
What did players wear before Adidas? Chuck Taylors! Thin canvas and a flat rubber sole. Talk about no ankle support! Despite the archaic footwear, I doubt there was a higher rate of ankle injuries in the 60’s and 70’s than there is today. You know why? Because players back then had strong, mobile ankles and feet.
Ankle braces weaken ankles and limit mobility (not to mention natural movement). Given how important the feet and ankles are, why would you do something that makes them weaker and less mobile?
Every time you run or jump, you do what is called triple extension. That is extension at the ankles, knees, and hips. If any one of those joints is not working properly (weak or tight), it limits the function of the other two. So weak, tight ankles limit a player’s ability to run and jump to their potential. Having weak, tight ankles will also cause the body to compensate in a variety of ways during movement… which can lead to knee and back issues. Remember, everything starts with the feet.
So how do you strengthen your ankles and feet? By setting them free and taking off your shoes!
When you work out in your bare feet (or with socks) you can feel all of the intrinsic muscles of your toes, feet, and ankles. At first, this will feel liberating (and probably awkward) because you rarely get to feel these muscles when wearing basketball shoes and ankle braces.
NOTE: I am only suggesting barefoot training for players with healthy feet and no pre-existing conditions (unless cleared by a doctor). Players with excessively high arches, previous stress fractures, or ankle sprains should avoid barefoot training (or at least make severe modifications) to reduce the chance of injury.
How much is the right amount of barefoot training? Once a player has has been acclimated to some rudimentary barefoot exercises, they should do as many things barefoot as they can in the confines of a safe, controlled training environment. For most players, 5-15 minutes per workout is a good rule of thumb.
If you have been wearing ankle braces regularly for an extended period of time, you need to gradually wean yourself off of them. Don’t go from wearing them all the time to not at all. Your ankles and feet aren’t ready for that. You are begging for an injury. You need to begin a progressive, structured ankle and foot strengthening program, while at the same time slowly decreasing your dependence on the braces.
What should you do in your bare feet? Many of the same things you do with shoes on! Squats, lunges, dynamic flexibility movements, and low level hops are all great to do shoeless.
Most of the folks who support wearing ankle braces all reference this one 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.
Keep your ankles and feet strong, mobile and healthy this pre-season!