BrJ Sports Med 1997;31:102-108

Role of ankle taping and bracing in the athlete

Michael J Callaghan

AbstractAdhesive tape is often used to help athletesrecover from ligament sprains ofthe ankleor to prevent further injury. The choice oftaping technique or material is oftendecided by personal preference, supersti-tion, or anecdote. More recently, the use ofankle braces has become more prevalent,but reasons for their use are similarlyvariable. As ankle sprains are a majorcause ofan athlete's disability and time offsport, the choice ofthe method ofsupportshould be more scientifically reasoned.This paper attempts to review the litera-ture concerning the effects of variousmethods ofankle support on swelling, sta-bility, range of movement, propriocep-tion, muscle function, gait, andperformance tests. There is still somecontradiction in the literature about theeffects of taping and braces in both theacute and chronic phases of ligamentsprains ofthe ankle.(Br J Sports Med 1997;31:102-108)

Royal LiverpoolUniversity Hospitaland VelodromePhysiotherapy andSports Injuries Clinic,Manchester,United KingdomM J Callaghan

Correspondence to:Department ofPhysiotherapy, RoyalLiverpool UniversityHospital, Prescot Street,Liverpool L7 8XP,United Kingdom.

Accepted for publication4 February 1997

Athletes from many sports consider taping andbracing to be important in the acute andchronic phases ofan ankle injury. Indeed, manysportspeople consider ankle support to beessential to their performance, with the corol-lary that their performance may suffer withoutsuch support. Most published reports on theefficacy oftaping and bracing focus on their useon the ankle joint. This is probably, in part,because ankle sprains are the most common

sports injury,' with the incidence varying from10% to 30% of all musculoskeletal injuries.2 Ina soccer season, players have a 25% chance ofhaving an ankle sprain if they have had a previ-ous sprain, and 1 1% if they were previouslyproblem free.' The focus on the ankle may alsobe because it is easy to measure the effects oftape and braces on range of motion, gait, func-tional and muscle performance.4 Ankle supportis used to control swelling and range of motionin the acute stage, and to provide support or

stability to the ligaments and joint in thechronic stage when the athlete returns to sport.However, the use of different taping techniquesand braces is dictated more by considerationsof cost, comfort, ease of application, personalpreference, age, and the type of sport.5Physiotherapists and other personnel whoapply tape and braces to athletes need to beaware of the evidence for and against the use ofboth these methods. In this way, rehabilitationprocedures after an ankle injury, or prophylac-tic advice, can be applied more scientifically.

This paper sets out to review the literatureon taping and presents the scientific evidenceavailable to suggest why taping helps supportankles and prevents ankle sprains. It alsoconsiders the role of ankle braces, whichincreasingly are being investigated and usedinstead of taping.

MethodsComputerised searches were performed usingMedline, Excerpta Medica, and CINAHL forstudies published between 1966 and 1996.Only English language publications were con-sidered. Keywords used alone or in combina-tion were: ankle sprain, taping, orthosis, brace,inversion injury, rehabilitation, athletic per-formance, proprioception, peroneal muscle.Other references were identified from someexisting reviews and from other papers cited inthe publications searched. There were alsosome other papers found in the author'spersonal collection.

Anatomy and pathomechanicsThe ankle joint receives its strongest supportfrom the medial and lateral collateral liga-ments. The lateral collateral ligament iscomposed of three bands: the anterior talofibu-lar ligament, which attaches from the neck ofthe talus to the tip of the fibula; the posteriortalofibular ligament, which runs from the bodyof the talus to the tip of the fibula; and thecalcaneofibular ligament, which runs from thecalcaneus to the tip of the fibula.Acute lateral ankle sprain is generally

accepted to be the most common sports relatedligamentous injury,6 accounting for 85% of allsprains.2 This results in damage to the lateralligament complex with the anterior talofibularligament being most often damaged; this isprobably because it has the weakest tensilestrength of the lateral complex.6 The mostcommon mechanism for an ankle sprain isexcessive inversion usually accompanied byslight plantarflexion and some internal rota-tion. Some sports like basketball and volleyballhave high ground reaction forces when playersland from a high jump, which accentuates thesprain and the rate of injury. This accounts forthese sports having 79% and 87% of inversionsprains respectively and 2.5 times more ankleinjuries than walking or hiking.7 The incidenceof ankle sprains in football (soccer) is 31%, inAmerican football 17%, and in ballet 17%.

Taping techniqueThe taping technique used by athletes andphysiotherapists is often governed by personalpreference, the experience of the person apply-ing the tape, and a general "feel" as to the

102

on February 22, 2020 by guest. P

rotected by copyright.http://bjsm

.bmj.com

/B

r J Sports M

ed: first published as 10.1136/bjsm.31.2.102 on 1 June 1997. D

ownloaded from

Ankle taping and bracing in the athlete

correct technique. This may be due, in part, tothe lack of comparative studies between thedifferent taping techniques.

Rarick et al investigated the resistanceprovided by different zinc oxide techniques onplantarflexion and inversion of the ankle.8 After10 minutes of vigorous exercise they found thegreatest tensiometer readings of mean resist-ance were offered by a basketweave with stirrupand heel lock technique, closely followed bybasketweave and heel lock. Frankney et al com-pared four zinc oxide taping techniques("Hinton-Boswell"; basketweave; "basic";"Gill") with an unspecified brace and anuntaped group.9 They analysed their resistanceto mechanical inversion and concluded that theHinton-Boswell method (in which the ankle istaped in a relaxed plantarflexed position)provided greatest resistance to inversion. Theyspeculated that this may be due to a combina-tion of factors, such as mechanical limitation,kinaesthetics, and the subconscious effect onthe athlete. Whereas these two studies could beclassed as "in vivo" work, Pope et al used amodel construction of an ankle to perform, ineffect, an "in vitro" study of different tapingtechniques.10 They measured the ability of the2.5 cm zinc oxide tape to resist applied torque,angular deflection, and "stiffness"-the lastbeing calculated by dividing torque by angulardeflection. They found angular deflectiongreater than 80 was prevented by a figure ofeight plus stirrup technique; torque load to 420Nm was withstood by a figure of eight withthree wraps technique; the stiffest configura-tion was a figure of eight plus stirruptechnique. Although the authors conceded thatthere were many dangers in extrapolating theirresults to the human ankle, it indicated theamount of force needed to make tape fail.

BracingAnkle braces have advantages over tape inbeing self applied without needing the exper-tise of qualified personnel, convenient to applyand remove," reusable, readjustable, andwashable. Also, skin problems are less com-mon, especially among those athletes who havean allergic reaction to Elastoplast or zinc oxide.These ready made braces are of various mate-rials, thus providing varying amounts ofsupport and stability and are broadly differen-tiated as "non-rigid" or "semirigid". The non-rigid braces are often made of canvas or aneoprene-type material, which can easily beslipped on and off, some with additional lacing.The semirigid braces mostly consist of bi-malleolar struts made of thermoplastic materi-als attached by Velcro straps. A number ofstudies have established the role of braces inrestricting the amount of movement, especiallyinversion at the ankle, on healthy uninjuredathletes. These studies have measured theeffects of braces such as the non-rigid "Nessaankle support" and "Leuko functional anklebrace" on inversion in 420 plantarflexion after40 minutes' exercise"; the non-rigid "subtalarstabiliser" on calcaneal inversion after 15 min-utes' vigorous exercise'3; and on inversion/eversion total motion using the semirigid

Aircast airstirrup""; the semirigid DonjoyALP1-18; the non-rigid canvas Swede-O-universal brace. 16 All these studies foundsignificant reduction of ankle movement afterapplying a brace to an a level of 0.05 or greater.However, it is important to note that theSwede-O-universal brace could be convertedto a semirigid type by sliding plastic struts inthe side pockets on the brace. The authors donot stipulate which version they used.

Taping and bracing for acute ankle sprainAfter an acute ligament sprain compressivestrapping is often recommended and applied tocontrol oedema.'9 Few studies have beenperformed or published to evaluate the efficacyof taping to achieve limb or joint compression.Hall (unpublished data) used volumetry tostudy the control of ankle joint swelling withtreatment after an acute ankle lateral ligamentsprain. He found that ice and compression tap-ing (which included a horseshoe shaped feltpad around the lateral malleolus) achieved bet-ter control of swelling than ice and ultrasoundover a period of 10 days.

Capasso et al compared the effect of adhesiveand non-adhesive tape on swelling.20 Theyconcluded that non-adhesive tape should berenewed after three days owing to insufficientcompression, but that adhesive tape could lastfive days before renewal. This study measuredthe compressive forces of each type of tape byusing a sphygmomanometer cuff included inthe taping. However, this has been criticised inearlier work by Viljakka as being an inexactmethod of measurement.2' The latter studyused a plastic fluid chamber as measurementand compared Elastoplast and Tensoplast withvarious padded and elastic bandages.2' In ankletaping the most significant decrease in pressurewas found after 15 minutes' walking and there-after stayed constant, indicating that either thepadded adhesive or the elastic bandage was themost suitable for bandaging the ankle.The role of an ankle brace in controlling

oedema after acute ankle sprain was investi-gated by Stover using the Aircast airstirrup.22Wishing to highlight the brace's "milking effecton oedematous tissues", he noted that thebrace with its inner airbag exerted 25 mmHgpressure, which increased to 50 mmHg whenweight bearing and 75 mmHg in full dorsiflex-ion.

Epidemiological studies have tried to estab-lish the ability of tape and braces to prevent anacute ankle injury over a playing season or year.The most commonly cited study on injury pre-vention is that of Garrick and Requa,' whichstudied the effect of taping on 2563 basketballplayers with previous ankle sprains over twosuccessive seasons. They observed that a zincoxide stirrup with horseshoe and figure of eighttechnique in conjunction with a high supportbasketball shoe gave an injury incidence of 6.5/1000 games. The untaped players with thesame shoe had an incidence of 30.4/1000games. Taping with a low support shoe gave aninjury incidence of 17.6/1000 games. Fromthese data they concluded that taping had a

103

on February 22, 2020 by guest. P

rotected by copyright.http://bjsm

.bmj.com

/B

r J Sports M

ed: first published as 10.1136/bjsm.31.2.102 on 1 June 1997. D

ownloaded from

Callaghan

protective influence for preventing anklesprains, though the role of high or low topshoes in helping stability is unclear.23Ankle braces may also reduce the incidence

and severity of acute ankle sprains incompetition," as has been examined, forexample, in basketball players.25 The use of anAircast stirrup in a control group and in 1601players was compared over two years. It wascalculated that the brace significantly reducedthe frequency of ankle injury; the players with-out the orthosis had three times the risk ofankle injury. Tropp et al studied the effect of anankle brace compared with a proprioceptionprogramme in 450 soccer players and a controlgroup over a six month period.' In previouslyuninjured players the incidence of ankle sprainwas 3% for bracing, 5% for proprioceptiontraining, 11% controls. However, if a playerhad previous ankle injuries, the incidences were2% for bracing, 5% proprioception, and 25%controls. This indicated that both propriocep-tion training and bracing had significantly low-ered the incidence of ankle sprains, especially ifthe ankle had been previously sprained. Thepreventive effect of braces on sprains in soccerplayers was confirmed by a later prospective,randomised study using a large sample of 600players.26 This finding (also noted in laboratorystudies27) was thought to be due to improvingthe defective stabilisation of the peroneii mus-cle group. Although the studies reviewedprovide important information about theefficacy of tape or a brace, the study design,external validity, confounding variables, andsample size have been criticised.28 Thesefactors should also be considered before select-ing the appropriate technique or device.

Other studies have directly comparedtraditional taping methods and ankle braces inthe prevention of acute ankle sprain. Rovere etar9 conducted a retrospective study over aseven year period on 297 American footballersand concluded that, compared with taping, anapparently non-rigid (but not specified) lace upankle brace halved the risk of ankle spraininjury. They speculated that this may bebecause the athletes can readjust the tension ofthe brace regularly during exercise. Anklebracing also provided greater socioeconomicbenefits as shown when comparing compres-sive bandaging with a semirigid Aircastairstirrup.'0 Two matched groups were treatedfor three weeks by either method after an acuteankle sprain. The group treated with theAircast airstirrup was more mobile in the initialphase of rehabilitation and had a shorter sickleave. They also calculated that the cost of thesemirigid brace was regained after a half dayearlier return to work.

Taping and bracing for chronic anklesprainThe paucity ofwork published on the effects oftape and braces on acute ankle injury is in con-trast with the volume of research into theeffects of taping on the chronically sprainedankle. Tape and braces are applied at this stagewhen the athlete has recovered from the acute

phase and is returning to sport. Their use in thechronic phase addresses the problem of ankleinstability, which may be mechanical orfunctional."

MECHANICAL INSTABILITYPreventing extremes ofrange ofmovement andreducing abnormal movement of the ankle isthe most obvious role of ankle taping. Re-searchers measure non-weight-bearing (NWB)range ofmotion or mechanical instability in thefrontal plane (the talar tilt) using x rays. Tapereduced extremes of range of movement onnormal subjects after 15 minutes' running overa figure of eight course.'2 On patients withproven mechanical ankle instability, a zincoxide Gibney basketweave technique signifi-cantly decreased the amount of NWB talartilt." '4 Those patients with the greatest insta-bility received the greatest benefit from thetape. Taping also limited talar tilt in full weightbearing (FWB) in four judo players withchronic instability after 90 minutes' training.'5However, these results should be regarded withcaution as, unlike other studies, they claim tohave recorded zero degrees talar tilt withtaping.FWB investigations using kinetic and kin-

ematic assessment showed that ankle tape didnot alter loading patterns but did affect sagittalankle range of motion, causing increased rota-tion about the metatarsal heads.'6Although taping does seems to improve

mechanical instability, the restricting effect islost after varying periods of exercise. Rarick etal claimed that 40% of the effect of taping waslost after 10 minutes ofvigorous general circuitexercises.8 Frankney et al found similar reduc-tion of about 50% after 15 minutes of standardvigorous exercises including jumping, pivoting,and running.9 Larsen recorded a 20% decreaseafter 20 minutes' start/stop running on unevenground and jumping.'4 Greene and Hilmanfound that a basketweave with heel lock andfigure of eight technique resulted in 37% loos-ening in total passive range ofmotion (P<0.01)after 20 minutes of volleyball training"7; afterthree hours of training the loosening worsenedto 63%. Myburgh et al measured a 10-20%restriction loss in all movements except dorsi-flexion after 60 minutes of squash.'7 One studymade a direct comparison between traditionaltaping methods and ankle braces,'7 which usedan electrogoniometer to measure and compareNWB restriction of ankle motion with zincoxide tape or Elastoplast against a simple non-rigid elastic stocking-type support. The zincoxide tape restricted plantarflexion/inversionmovement after 10 minutes of squash. How-ever, after one hour of squash there was no sig-nificant difference between the tape or support.Studies comparing the semirigid Donjoy ALPbrace on normal subjects with tape showedcontrasting results.'7 '8 Gross et al performedNWB measurements of the foot after 10minutes' running and showed that both meth-ods provided equal and significant restrictionsof inversion and eversion." Interestingly, theyreported that most of the subjects found thebrace more comfortable than the tape.

104

on February 22, 2020 by guest. P

rotected by copyright.http://bjsm

.bmj.com

/B

r J Sports M

ed: first published as 10.1136/bjsm.31.2.102 on 1 June 1997. D

ownloaded from

Ankle taping and bracing in the athlete

Table 1 Comparison of orthoses and tape

Author Orthosis Taping techniquet Conclusionst

Rovere et al9 Laced ankle z.o. clb/w fig 8 Risk of injury halved usingbrace HL orthosis rather than tape

Myburgh et al" Elastic stocking z.o. b/w St HL z.o. tape better than orthosis andElastoplast to restrict NWBROM

ElastoplastGross et all' Aircast airstirrup z.o. b/w fig 8 HL Aircast airstirrup better than

tape to restrict NWB ROMGross et al8 Donjoy ALP z.o. subtalar sling No difference in NWB ROMGreene and Hilman" Donjoy ALP z.o. b/w fig 8 HL Donjoy ALP better than tape to

restriqt NWB ROMParis et al" Swede-O- z.o. clgb/w Swede-O-universal better than

universal subtalar brace and tape torestrict NWB ROM

Subtalar braceMackean et alr Aircast airstirrup z.o. clb/w Active ankle brace showed least

overall performance impairmentSwede-0-universalActive anklebrace

Frankney et at' Laced ankle Hinton-Boswell Hinton-Boswell better thanbrace orthosis and other taping

techniques to restrict NWBROM

b/wGill

Lindley and Aircast airstirrup z.o. clb/w St ALP showed decreasedKernozek" functional NWB ROM

Active anklebraceDonjoy ALP

Fitzgerald and Vulcan z.o. gb/w fig 8 No difference in kinetic gaitCallaghan* HL parameters between braces or

tapeSwede-O-universalAircast airstirrup"Tubigrip"Laced anklebrace

Verbrugge" Aircast airstirrup z.o. gb/w St HL No difference in motorperformance

* Unpublished data.t z.o. = zinc oxide tape; b/w = basketweave; clb/w = closed basketweave; gb/w = Gibneybasketweave; fig 8 = figure of eight; HL = heel locks; St = stirrups; NWB = non weight bearing;ROM = range of movement.

However, earlier work recorded no differencesbetween the same brace and tape.17 Thecontradiction may be explained by the differenttaping techniques used in each study. Incontrast, the semirigid "Swede-O-universal"and non-rigid "subtalar support" braces pro-vided better NWB restriction on plantarflex-ion, dorsiflexion, inversion, and eversion thantaping after 15 minutes of activity.39 Similarsuperiority over taping was recorded for thesemirigid Aircast airstirrup on normal subjectsfor passive inversion/eversion"5 and for an indi-vidually moulded orthosis (described as semi-rigid) on inversion after 20 minutes' exercise(table 1) .40 Similarly, in injured athletes, a"strong" thermoplastic semirigid ankle bracesignificantly reduced talar and subtalar mo-tions of plantarflexion, inversion, and adduc-tion of 14 subjects with symptoms of chronicankle instability.4' Kinetic and kinematic analy-sis has been performed to examine the Aircastairstirrup, which was found to reduce themediolateral force component and maximumcalcaneal eversion angles. This moderation ofgait was considered to be within normal valuesfor walking.4"

It is this inability to maintain mechanicalstability during exercise that raises fundamen-tal questions about the efficacy of taping andbracing. It seems that tape and braces, however

well applied, cannot withstand the huge forcesinvolved in an inversion ankle sprain.

]FUNCTIONAL INSTABILITYMore recently, researchers have become moreinterested in the concept of functional instabil-ity of the ankle and the role of taping and brac-ing to alleviate it. Freeman et al describedfunctional instability as "a term...to designatethe disability to which the patients refer whenthey say that their foot tends to 'give way'"(page 678).43 Taping and bracing may helpthrough their effect on the neuromuscularmechanisms via cutaneous input, which im-proves the muscular responses. The most com-monly investigated muscle group is the per-oneii owing to their role in preventing ankleinversion, a position which causes most lateralligament ankle sprains.Two studies have been performed on nor-

mal, healthy subjects that indicate the im-portance of peroneii function and its role inpreventing lateral ankle sprain.44 Konradsenand Hojsgaard used electromyographic assess-ment of peroneus longus and brevis in ninepatients running on a treadmill.44 They con-cluded that the foot-ankle complex requires aninversion (supinated) position at the pre-heelstrike phase of the running cycle to stimulatethe peroneii to correct for inversion strain. Afurther study simulated an ankle sprain by localanaesthetic regional block.45 It established thatwhereas passive joint angle reproduction was"virtually impossible" after the anaesthesia,active angle reproduction and peroneal reac-tion time were far less affected. It wasconcluded that a mechanically unstable anklecan be helped by the peroneii and other muscleactivity. Later work by Feuerbach et al madesimilar observations about active angle repro-duction of the ankle joint after anaesthetisingtwo components of the lateral ligamentcomplex.46

Experimental work on patients with me-chanically unstable ankles and on control sub-jects has shown differences in peroneal func-tion between the groups. Trends, but nostatistically significant differences, have beenfound between the peroneal response times ofpatients with ankle instability and controlgroups.47 48 Comparisons between injured andgood sides of patients with chronic instabilityshowed reaction times of 68 ms v 84 ms'7 and49 ms v 65 ms,49 with the injured side having alonger reaction time. The differences betweenthe figures in the two studies were probably dueto dissimilar recording methods. Recent inves-tigations discovered that peroneal reaction timerather than peroneal strength was a discrimi-nating factor after ankle sprain.50

Taping and bracing for ankleproprioceptionAs has already been mentioned, although somelimitation of ankle range of movement can beachieved with taping and bracing, it is doubtfulwhether tapes and braces will withstand theforces of an inversion sprain. As a result, someauthors have investigated the protective role oftaping and bracing in the chronically injured

105

on February 22, 2020 by guest. P

rotected by copyright.http://bjsm

.bmj.com

/B

r J Sports M

ed: first published as 10.1136/bjsm.31.2.102 on 1 June 1997. D

ownloaded from

Callaghan

ankle against injury through proprioceptionand awareness offoot position.27 51-54 Glick et al,using electromyographic analysis of runners,found that ankle taping allowed the peroneiimuscle group to contract for a longer period oftime at the pre-heel strike stage in fourmechanically unstable ankles.50

Karlsson and Andreasson used a trapdoormechanism on 20 subjects with chronic ankleinstability and found that the Gibney basket-weave technique significantly shortened thereaction time of the peroneii muscle group,thus bringing it closer to times on the normalside.27 They also noted that the more unstablethe ankle, the greater the improvement. As wellas the peroneii muscle group, deficits can alsobe shown in tests for proprioception, such aspassive joint angle reproduction. This givesfurther insight into the complexity of func-tional instability of the ankle and the effect oftape. Jerosch et al compared two types of braceand a closed Gibney basketweave tapingtechnique with figure of eight supplementationon 16 unstable ankles.5' Although they foundsignificant differences in angle reproductionbefore the test between stable and unstableankles (thus concurring with Lentell et a 2),taping did not significantly improve this; theauthors were unable to offer an explanation forthis finding. Proprioception has also beenevaluated by postural sway and single legbalancing tests. Robbins et al evaluated tapingon estimation of perceived direction andamplitude on surface slope in FWB.5' Incontrast with Jerosch et al,5 they concludedthat ankle taping did improve foot positionawareness and so may have a role in theprevention of ankle sprain in athletes.The Aircast airstirrup has also been shown

to facilitate joint proprioception in uninjuredankles with an anaesthetised lateral ligamentcomplex. This improvement in joint positionsense was thought to be due to the stimulationby the brace of the cutaneous receptors in thefoot and shank, which might have increased theafferent feedback.46

Table 2 Effect of orthoses on performance on tests of verticaljump, sprint and agility

Effect of orthoses on:

Author Orthosis Verticaljump Sprint Agility

Paris57 Swede-O-universal No effect No effect No effectMcDavid No effect No effect No effectNew Cross Detrimental No effect No effect

Burks et al59 Swede-O-universal Detrimental No effectKallassy Detrimental No effect

Bocchinfuso et al58 Aircast airstirrup No effect No effect No effectActive ankle brace No effect No effect No effect

Robinson et al' "Plastic stiffeners" DetrimentalGreene and Hilman"7 Donjoy ALP No effectMacPherson et al'0 Aircast airstirrup No effect No effect

Donjoy Rocketsoc No effect No effectMacKean et al6 Swede-O-universal Detrimental No effect

Active ankle brace No effect No effectAircast airstirrup No effect No effect

Greene and Wight'6 Swede-O-universal No effectDonjoy ALP No effectAircast airstirrup Detrimental

Pienkowski et al62 Aircast airstirrup No effect No effect No effectSwede-O-universal No effect No effect No effectKallassy No effect No effect No effect

Verbrugge" Aircast airstirrup No effect No effect No effectWiley and Nigg64 Malleoloc No effect No effect No effect

These studies assume that assessing ankleproprioceptive function with NWB or openkinetic chain position indicates that suchmethods of support will prevent trauma to theankle and foot in the FWB or closed kineticchain position. Some studies have addressedthis problem by comparing braces with tapingin the FWB position.

Hamill et al using kinetic and kinematicanalysis compared a Gibney basketweave withan unspecified brace and found no significantdifferences between the two types of support,concluding that neither tape nor brace affectedfoot motion.54 Functional FWB outcomemeasures were recorded on healthy subjectscomparing a lace up brace, the Aircastairstirrup, and a taping technique.5' Bracesimproved the proprioception and functionalability of the injured and normal ankles,whereas the taping technique had no effect.FWB video analysis has been used to comparethe effect of a zinc oxide tape with variousbraces on dorsiflexion and plantarflexion of theankle.55 Only the Donjoy ALP brace affectedsagittal range of motion.

Potentially negative effects of taping andbracingAlthough, to date, there has not been a specificstudy on the subject, there is little evidence tosupport the view that long term use of bothforms of ankle support may result in detrimen-tal effects to the tissues around the ankle orjoints within the kinetic chain. Garrick andRequa found no increase in the frequency ofknee sprains occurring as a result of using ahigh topped shoe and prophylactic taping.'They further commented that the increasedlikelihood of an ankle support causing a kneeinjury was overshadowed by the protection thatthe ankle support offered. A similar claim wasmade by Glick et al50 but with few supportingdata. Other studies have used kinetic andkinematic analysis to evaluate the potentiallynegative effects of taping of the ankle. Contra-dictory results have shown that ankle tapingcan have disadvantageous secondary effectsaround the metatarsal heads in walking,36 orthat neither taping nor bracing causes anyalteration in foot motion in running.54

In addition to adverse effects on the lowerextremity, it has been the opinion of someresearchers that the potential benefits of wear-ing ankle braces to prevent ankle injury mustbe weighed against the possible detrimentaleffect on actual performance of the athlete.56The consensus is that the various braces avail-able have little detrimental effect on sprint oragility tests, but the results for vertical jumptests are contradictory (table 2). These contra-dictory results may be due to between studydifferences of sample size, types of sports ana-lysed, age and proficiency of the athleteselected.MacKean et al56 considered functional per-

formance between zinc oxide tape and threetypes of semirigid brace: Aircast airstirrup;Swede-O-universal; active ankle training brace.It was one of the few studies to assess metabolic

106

on February 22, 2020 by guest. P

rotected by copyright.http://bjsm

.bmj.com

/B

r J Sports M

ed: first published as 10.1136/bjsm.31.2.102 on 1 June 1997. D

ownloaded from

Ankle taping and bracing in the athlete 107

cost of these types of support and found thatthe Aircast airstirrup increased both Vo, andenergy expenditure.

SummaryThe studies reviewed suggest that both me-chanical and functional stability of the anklecan be improved with taping. The restrictiveeffect is lost after short bouts of exercise, whichindicates that the mechanical restriction ofmovement may be less important than theneuromuscular and sensory mechanisms; theperoneii muscle group, in particular, has beenimplicated. Ankle braces are being usedincreasingly by sportspeople as these devicesare more convenient and cost effective thantape. Most studies have shown that bracesrestrict ankle movement less than taping with-out affecting performance. Furthermore, theyretain their restrictive properties for longerperiods after exercise, but have also beenshown to have a proprioceptive role. Both tap-ing and braces have been shown to preventankle sprains in basketball and soccer players,though the study design should be consideredbefore applying tape or recommending a bracefor the prevention of ankle sprains.

Key pointsANKLE TAPE AND BRACES* Restrict range of movement* Reduce reinjury rate* Improve proprioception* Limitation of movement is lost after exercise* No negative effect on most performance tests* Little negative effect on other joints.BRACES* Minimal expertise needed* Reusable* Readjustable* Washable* Non-allergic.TAPE* Individually applied* Less bulky than brace* Athletes' preference* Caters for unusual anatomy.

1 Garrick JG, Requa RK. Role of external support in the pre-vention of ankle sprains. Med Sci Sports 1973;5:200-3.

2 Miller EA, Hergenroeder AC. Prophylactic ankle bracing.Pediatr Clin North Am 1990;37:1175-85.

3 Tropp H, Askling C, Gillquist J. Prevention of ankle sprains.AmJISports Med 1985;13:259-62.

4 Firer P. Effectiveness of taping for the prevention of ankleligament sprains. BrJ Sports Med 1990;24:47-50.

5 Bennell K, McCrory P. The role of ankle support in the pre-vention of ankle injury. Sport Health 1992;10:13-16.

6 Hollis JM, Blasier RD, Flahiff CM. Simulated lateral ankleligamentous injury. Am Jf Sports Med 1995;23:672-7.

7 Lowe MK. Basketball injuries to the ankle. Medicine andExercise Nutrition and Health 1993;2:247-5 1.

8 Rarick GL, Bigley G, Karst P, Malina RM. The measurablesupport of the ankle joint by conventional methods of tap-ing. J Bone joint Surg [Am] 1962;44:1183-90.

9 Frankney JR, Jewett DL, Hanks GA, Sebastianelli WJ. Acomparison of ankle tape methods. CGin J Sport Med 1993;3:20-5.

10 Pope ME, Renstrom P. Donnermeyer D, Morgenstern S. Acomparison of ankle taping methods. Med Sci Sports Exerc1987;19: 143-7.

11 Muwunga CL, Quinton DN, Sloan JP, Gillies P, Dove AF. Anew treatment of stable lateral ligament injuries of theankle joint. Injury 1988;17:580-2.

12 Tweedy R, Carson T, Vicenzino B. Leuko and Nessa anklebraces:effectiveness before and after exercise. Aust J SciMed Sport 1994;26:62-6.

13 Anderson DL, Sanderson DJ, Hennig EM. The role ofexternal nonrigid ankle bracing in limiting ankle inversion.Clin J Sport Med 1995;5:18-24.

14 Kimura IF, Nawoczenski DA, Epler M, Owen MG. Effect ofairstirrup in controlling ankle inversion stress. J OrthopSports Phys Ther 1987;9:190-3.

15 Gross MTS, Bradshaw MK, Ventry LC, Weller KH. Com-parison of support provided by ankle taping and semirigidorthosis.J Orthop Sports Phys Ther 1987;9:33-9.

16 Greene TA, Wight CR. A comparative support evaluation ofthree ankle orthoses before, during and after exercise. JOrthop Sports Phys Ther 1990;11:453-66.

17 Greene TA, Hilman SK. Comparison of support providedby a semirigid orthosis and adhesive ankle taping before,during and after exercise. Am J Sports Med 1990;18:498-506.

18 Greene TA, Roland GC. A comparative isokinetic evalua-tion of a functional ankle orthosis on talocalcanealfunction. _J Orthop Sports Phys Ther 1989;11:245-52.

19 McCluskey GM, Blackburn TA, Lewis T. A treatment forankle sprains. Am J Sports Med 1976;4: 158-61.

20 Capasso G, Maffulli N, Vesta V. Ankle taping:supports givenby different materials. BrJ Sports Med 1989;23:239-40.

21 Viljakka T. Mechanics of knee and ankle bandages. ActaOrthop Scand 1986;57:54-8.

22 Stover CN. Air stirrup management of ankle injuries in theathlete. Am J Sports Med 1980;8:360-5.

23 Barrett J, Bilisko T. The role of shoes in the prevention ofankle sprains. Sports Med 1995;20:277-80.

24 Bahr R, Karlsen R, Ovrebo RV. Incidence and mechanismsof acute ankle inversion injuries in volleyball. Am J SportsMed 1994;22:595-600.

25 Sitier M, Ryan J, Wheeler B, McBride J, Arciero R. Ander-son J, et al. The efficacy of semirigid ankle stabiliser toreduce acute ankle injuries in basketball. Am J Sports Med1994;22:454-6 1.

26 Surve I, Scwellnus MP, Noakes T, Lombard C. A fivefoldreduction in the incidence of recurrent ankle sprains insoccer players using the sport stirrup orthosis. Am J SportsMed 1994;22:601-5.

27 Karlsson J., Andreasson GO. The effect of external anklesupport in chronic lateral ankle joint instability.Am J SportsMed 1992;20:257-61.

28 Sitler MR, Horodyski M. Effectiveness ofprophylactic anklestabilisers for prevention of ankle injuries. Sports Med1995:20:53-7.

29 Rovere GD, Clarke TJ, Yates SC, Burley K. Retrospectivecomparison of taping and ankle stabilisers in preventingankle sprains. Am J Sports Med 1988;16:228-33.

30 Leanderson J, Wredmark T. Treatment of acute anklesprain. Comparison of a semirigid brace and compressionbandage in 73 patients. Acta Orthop Scand 1995;66:529-31.

31 Anonymous. Residual disability after ankle joint injury (edi-torial). Lancet 1989;1:1056.

32 Laughmann RK, Carr TA, Chao EY, Youdas JW, Sim FH.Three dimensional kinematics of the taped ankle beforeand after exercise. Am Y Sports Med 1980;8:425-3 1.

33 Vaes P, De Boeck H, Handelberg F, Opdecam P. Compara-tive radiological study of the influence of ankle joint strap-ping and taping on ankle instability. J Orthop Sports PhysTher 1985;7:110-14.

34 Larsen E. Taping the ankle for chronic instability. ActaOrthop Scand 1984;55:551-3.

35 Yamamoto T, Kigawa A, Xu T. Effectiveness of functionalankle taping for judo athletes: a comparison between judobandaging and taping. BrJSports Med 1993;27:110-12.

36 Carmines DV, Nunley JA, McElhanley J. Effects of ankletaping on the motion and loading patterns of the foot inwalking subjects. J Orthop Res 1988;6:223-9.

37 Myburgh KH, Vaughan CL, Issacs SK. The effects of ankleguards and taping on joint motion before, during and aftera squash match. Am Y Sports Med 1984;12:441-6.

38 Gross MT, Batten AM, Lamm AL, Lorren JL, Stevens JJ,Davis JM, et al. Comparison ofDonjoy ankle ligament pro-tector and subtalar sling taping in restricting foot and anklemotion before and after exercise. J Orthop Sports Phys Ther1994;19:33-41.

39 Paris DL, Vardaxis V, Kokkaliaris J. Ankle ranges of motionduring extended activity periods while taped and braced.Journal ofAthletic Training 1995;30:223-8.

40 Hughes LY, Stetts DM. A comparison of ankle taping and asemirigid support. Phys Sports Med 1983;11:99-103.

41 Lofvenburg R, Karrholm J. The influence of an ankle ortho-sis on the talar and calcaneal motions in chronic lateralinstability of the ankle. A stereophotogrammetric analysis.Am J Sports Med 1993;21:224-9.

42 Hamill J., Morin G, Clarkson PM, Andres RO. Exercisemoderation of foot function during walking with a reusablesemirigid ankle orthosis. Clinical Biomechanics 1988;3: 153-8.

43 Freeman MAR, Dean MRE, Hanman IWF. The etiologyand prevention of functional instability of the foot. Y BoneJoint Surg [Br] 1965;47:678-85.

44 Konradsen L, Hojsgaard C. Pre heel strike peroneal muscleactivity during walking with and without external support.ScandJ3Med Sci Sports 1993-3:99-103.

45 Konradsen L, Ravn JB, Sorensen AI. Proprioception at theankle: the effect of anaesthetic blockade of ligament recep-tors. JBone Joint Surg [Br] 1993-75:433-6.

46 Feuerbach JW, Grabiner MD, Kohi TJ, Weiker GG. Effect ofan ankle orthosis and ankle ligament anesthesia on anklejoint proprioception. AmJf Sports Med 1994;22:223-9.

on February 22, 2020 by guest. P

rotected by copyright.http://bjsm

.bmj.com

/B

r J Sports M

ed: first published as 10.1136/bjsm.31.2.102 on 1 June 1997. D

ownloaded from

108 Callaghan

47 Nawoczenski DA, Owen MG, Ecker ML, Altman B, EplerM. Objective evaluation of peroneal response to suddeninversion stress. J Orthop Sports Phys Ther 1985;7:107-9.

48 Johnson MB, Johnson CL. Electromyographic response ofperoneal muscles in surgical and non surgical injuredankles during sudden inversion. J Orthop Sports Phys Ther1993;18:497-501.

49 Lofvenberg R, Karrholm J, Sundelin G, Ahlgren 0.Prolonged reaction time in patients with chronic lateralinstability of the ankle. Am J Sports Med 1995;23:414-17.

50 Glick JM, Gordon RM, Nishimoto D. The prevention andtreatment of ankle injuries. Am 7 Sports Med 1976;4:136-41.

51 Jerosch J, Hoffstetter I, Bork H, BischofM. The influence oforthoses on the proprioception of the ankle joint. Knee SurgSports TraumatolArthrosc 1995;3:39-46.

52 Lentell G, Baas B, Lopex D, McGuire L, Sarrels M, SynderP. The contributions of proprioceptive deficits musclefunction and anatomical laxity to functional instability ofthe ankle. J Orthop Sports Phys Ther 1995;21:206-15.

53 Robbins S, Waked E, Rappel R. Ankle taping improves pro-prioception before and after exercise in young men. Br JSports Med 1995;29:242-7.

54 Hamill J, Knutzen KM, Bates BT, Kirkpatrick G. Evalua-tion of two ankle appliances using ground reaction forcedata. J Orthop Sports Phys Ther 1986;7:244-9.

55 Lindley TR, Kernozek TW. Taping and semirigid bracingmay not affect ankle functional range of motion. Journal ofAthletic Training 1995;30:109-12.

56 MacKean LC, Bell G, Burnham RS. Prophylactic anklebracing vs. taping: effects of functional performance in

female basketball players. J Orthop Sports Phys Ther1995;22:77-81.

57 Paris DL. The effects of Swede-O-, New Cross andMcDavid ankle braces and adhesive ankle taping on speed,balance, agility and vertical jump. Journal ofAthletic Train-ing 1992;27:253-6.

58 Bocchinfuso C, Sitier M, Kimura IF. Effects of twosemirigid ankle stabilisers on performance involving speed,agility and vertical power. Journal of Sports Rehabilitation1994;3: 125-34.

59 Burks RT, Bean BG, Marcus R, Barker HB. Analysis of ath-letic performance with prophylactic ankle devices. Am JSports Med 1991;19:104-6.

60 MacPherson K, Sitler M, Kimura I, Horodyski M. Effects ofa semirigid and softshell prophylactic ankle stabiliser onselected performance tests among high school footballers. JOrthop Sports Phys Ther 1995;21:147-52.

61 Robinson JR, Frederick EC, Cooper LB. Systematic anklestabilisation and the effect on performance. Med Sci SportExerc 1986;18:625-8.

62 Pienkowski D, McMorrow M, Shapiro R, Caborn DNM,Stayton J. The effect of ankle stabilisers on athleticperformance: a randomised prospective trial. Am J SportsMed 1995;23:757-62.

63 Verbrugge JD. The effects of semirigid aircast airstirrupbracing vs. adhesive ankle taping on motor performance. JOrthop Sports Phys Ther 1996;23:320-5.

64 Wiley JP, Nigg BM. The effect of an ankle orthosis on anklemotion and performance. J Orthop Sports Phys Ther1996;23:362-9.

on February 22, 2020 by guest. P

rotected by copyright.http://bjsm

.bmj.com

/B

r J Sports M

ed: first published as 10.1136/bjsm.31.2.102 on 1 June 1997. D

ownloaded from