Prophylactic Ankle Bracing in Military Settings: A Review of the Literature.

BACKGROUND: Within athletics and the military, ankle sprains are one of the most common injuries with the potential for long-term functional deficits. Incidence rates for ankle sprains within the military are one of the leading causes of limited duty days, especially during basic combat training, parachute training exercises, and in cadet populations. In 2008, the Department of Defense U.S. Army Center for Health Promotion and Preventative Medicine report recommended that military personnel should wear semirigid ankle braces during parachuting, basketball, soccer, and other similar high-risk activities to reduce ankle sprain injuries. This recommendation was developed using a majority of athletic references with limited data stemming from military works. Of these included military studies, none presented data on ankle braces and their effects on performance, especially in military-specific environments. The purpose of this review was to provide an up-to-date account on the use of ankle braces in military populations and effects on performance measures. METHODS: A comprehensive online systematic review of the literature was conducted to delineate the current use of ankle braces in the military and how they specifically affect functional performance measures. The scope of this study eliminated military studies that were not prospective in nature or did not incorporate subjects wearing military equipment (i.e., combat boots). FINDINGS: It was determined that little progress has been made in validating the use of semirigid ankle braces in military populations other than in instances such as parachuting and only in reducing the number ankle injuries. To date, only one study has looked specifically at the use of ankle braces and its effects on performance measures in a military sample. DISCUSSION: With the high incidence rate and increased risk for subsequent reinjury, ankle sprains are an economic and force readiness burden to the U.S. Armed Forces. This study was conducted to determine whether additional literature was available for the use of ankle braces on performance measures in the military. It was determined that there is a scarcity of information currently available on the use of ankle braces in military populations, outside of parachuting activities. The Department of Defense recommendation of using semirigid ankle braces may ultimately be beneficial to a multitude of high-risk military activities, but further research must be conducted to determine possible detrimental performance effects.

Differential Sensitivity Between a Virtual Reality Balance Module and Clinically Used Concussion Balance Modalities.

OBJECTIVE: Balance assessments are part of the recommended clinical concussion evaluation, along with computerized neuropsychological testing and self-reported symptoms checklists. New technology has allowed for the creation of virtual reality (VR) balance assessments to be used in concussion care, but there is little information on the sensitivity and specificity of these evaluations. The purpose of this study is to establish the sensitivity and specificity of a VR balance module for detecting lingering balance deficits clinical concussion care. DESIGN: Retrospective case-control study. SETTING: Institutional research laboratory. PARTICIPANTS: Normal controls (n = 94) and concussed participants (n = 27). INTERVENTIONS: All participants completed a VR balance assessment paradigm. Concussed participants were diagnosed by a Certified Athletic Trainer or physician (with 48 hours postinjury) and tested in the laboratory between 7 and 10 days postinjury. Receiver operating characteristic curves were performed to establish the VR module's sensitivity and specificity for detecting lingering balance deficits. MAIN OUTCOME MEASURES: Final balance score. RESULTS: For the VR balance module, a cutoff score of 8.25 was established to maximize sensitivity at 85.7% and specificity at 87.8%. CONCLUSIONS: The VR balance module has high sensitivity and specificity for detecting subacute balance deficits after concussive injury. CLINICAL RELEVANCE: The VR balance has a high subacute sensitivity and specificity as a stand-alone balance assessment tool and may detect ongoing balance deficits not readily detectable by the Balance Error Scoring System or Sensory Organization Test. Virtual reality balance modules may be a beneficial addition to the current clinical concussion diagnostic battery.

Differences in Postural Control During Single-Leg Stance Among Healthy Individuals With Different Foot Types.

OBJECTIVE: To identify differences in postural control among healthy individuals with different architectural foot types. DESIGN AND SETTING: We compared postural control during single-leg stance in healthy individuals with cavus, rectus, and planus foot types in our athletic training research laboratory. SUBJECTS: Thirty healthy, young adults (15 men, 15 women; age, 21.9 +/- 2.0 years; mass, 71.6 +/- 16.7 kg; height, 168.4 +/- 13.6 cm) had their feet categorized based on rearfoot and forefoot alignment measures. The right and left feet of a subject could be classified into different categories, and each foot was treated as a subject. There were 19 cavus, 23 rectus, and 18 planus feet. MEASUREMENTS: Subjects performed three 10-second trials of single-leg stance on each leg with eyes open while standing on a force platform. Dependent measures were center-of-pressure (COP) excursion area and velocity. RESULTS: Subjects with cavus feet used significantly larger COP excursion areas than did subjects with rectus feet. However, COP excursion velocities were not significantly different among foot types. CONCLUSIONS: Clinicians and researchers assessing postural control in single-leg stance with measures of COP excursion area must be cognizant of preexisting differences among foot types. If individuals' foot types are not taken into account, the results of clinical and research investigations assessing COP excursion area after injury may be confounded.