Treating injured ankles is old hat to seasoned practitioners of sports medicine.  Many people envision a busy training room with dozens of athletes getting their ankles taped prior to practice or a game when they think of sports medicine or athletic training.  In fact, the treatment and prevention of ankle injuries is central to any sports medicine practice.

This column has focused on the recognition, treatment and therapy for sprained ankles several times before.  Today, the emphasis will be on the functional stabilization of the ankle joint in order to protect the ankle and/or to prevent injury.

As mentioned above athletic trainers have long been skilled in the art of the ankle tape job.  This method of ankle stabilization has served many generations of athletes very well and remains the gold standard in settings with experienced athletic trainers.  However, ankle strapping and taping is definitely an art and is not applied with similar efficacy by all who attempt a tape job.

The purpose of a tape job is usually one of two things.  One possible reason to tape an ankle is to prevent an ankle injury.  Since most injuries occur due to an inversion (turning in of the ankle) most prophylactic ankle tape jobs are applied so that they limit the inversion motion.  Preventative tape jobs are useful in situations of ankle weakness secondary to a remote injury or when the likelihood of suffering an ankle injury is high due to the practice or game conditions.

One theorized disadvantage to preventative ankle taping is that it may weaken the body’s natural protective mechanisms.  Ligaments are the body’s primary structural support and what a tape job tries to augment.  However, there are secondary supports such as muscles, tendons, joint capsules, etc. that naturally augment and supplement the ligaments support.  Many believe that regular use of a prophylactic tape job will cause the secondary supports to become weaker and less effective, so that if the tape job fails or the athlete plays without it, injury is more likely.

A second reason to tape an ankle is to protect a recent injury.  After an ankle sprain, the ligaments and secondary restraints are weak and injured.  In order to resume practice and play safely and swiftly, ankle tape jobs are often applied to protect the injury.  Again, since most injuries are due to an inversion mechanism, these tape jobs often center around preventing inversion.  But since an injury has likely been evaluated by a doctor prior to return to play and the mechanism has been sorted out, the tape job can be modified to protect against the exact mechanism of injury in most situations.

One of the main problems with ankle tape jobs is that learning to tape follows a fairly shallow curve.  In other words, one must complete many tape jobs to become efficient.

Another potential problem is that there is a great deal of variability between tape jobs applied by different people.  A veteran trainer once commented that there are as many different ways to tape the ankle as there are people taping. 

An alternative to ankle taping is ankle bracing.  Most sports medicine practitioners fall into one camp or the other with some advocating taping and others bracing.  In reality, there are probably uses for both.

There are a wide variety of ankle braces available on the market.  Some are designed for an athletic population and others are not.  But they all have in common that their primary function is, like a well applied tape job, to prevent inversion.

One of the more popular and time tested braces is the lace up brace.  Many different companies make lace up braces and some even come with other features like metal supports or horse shoe cushions.  These are generally fine for prevention and stabilization following a minor ankle injury, but should be used with caution following a moderate or severe ankle injury.  Additionally, they should be worn fairly snugly and re-laced frequently during practice or play.

Stirrup braces are another popular style of ankle brace.  Aircast and gelcast are two of the more popular versions of the stirrup brace.   While these braces do effectively prevent inversion, they are quite bulky and may interfere with athletic performance more than some other brands.

Rocket-soc is another ankle brace that many consider to be one of the more “top-of-the-line” braces.  It is a neoprene sleeve that has several straps that secure the ankle from different angles and effectively reduce inversion.  They also allow for relatively full ranges of motions in other ways and minimally effect performance when worn properly. 

For those interested in learning more about ankle injuries, taping, strapping, and bracing techniques there will be a basic sports medicine course dealing with the lower body tomorrow (26 August 2000).  The course is offered free of charge to anyone who is interested and will be presented at the Regional Orthopaedic and Sports Medicine Center in Waxahachie.  The course begins at 9:00 am and will conclude between 3:00 and 4:00.  Lunch will be provided.  Please call (972) 937-8900 if you have any questions.