Prophylactic Ankle Taping and Bracing: A Numbers-Needed-to-Treat and Cost-Benefit Analysis.

OBJECTIVE: Taping and bracing are thought to decrease the incidence of ankle sprains; however, few investigators have addressed the effect of preventive measures on the rate of ankle sprains. Our purpose was to examine the effectiveness of ankle taping and bracing in reducing ankle sprains by applying a numbers-needed-to-treat (NNT) analysis to previously published studies. DATA SOURCES: We searched PubMed, CINAHL, SPORT Discus, and PEDro for original research from 1966 to 2002 with key words ankle taping, ankle sprains, injury incidence, prevention, ankle bracing, ankle prophylaxis, andnumbers needed to treat. We eliminated articles that did not address the effects of ankle taping or bracing on ankle injury rates using an experimental design. DATA SYNTHESIS: The search produced 8 articles, of which 3 permitted calculation of NNT, which addresses the clinical usefulness of an intervention by providing estimates of the number of treatments needed to prevent 1 injury occurrence. In a study of collegiate intramural basketball players, the prevention of 1 ankle sprain required the taping of 26 athletes with a history of ankle sprain and 143 without a prior history. In a military academy intramural basketball program, prevention of 1 sprain required bracing of 18 athletes with a history of ankle sprain and 39 athletes with no history. A study of ankle bracing in competitive soccer players produced an NNT of 5 athletes with a history of previous sprain and 57 without a prior injury. A cost- benefit analysis of ankle taping versus bracing revealed taping to be approximately 3 times more expensive than bracing. CONCLUSIONS/RECOMMENDATIONS: Greater benefit is achieved in applying prophylactic ankle taping or bracing to athletes with a history of ankle sprain, compared with those without previous sprains. The generalizability of these results to other physically active populations is unknown.

Effect of mild brain injury on an instrumented agility task.

OBJECTIVE: To identify an objective evaluation technique to guide return-to-play decisions following mild brain injury (MBI) using an agility task that incorporates cognitive and motor performance. DESIGN: Prospective, controlled, repeated measures study. SETTING: Collegiate athletic training facility. PARTICIPANTS: 84 athletes (25 male rugby players, 34 female rugby players, 25 male ice hockey players) from 3 intercollegiate club teams participated. 9 athletes who suffered MBI during their competitive seasons and 9 matched controls completed the entire study protocol. MAIN OUTCOME MEASURES: Time to complete an agility task on the Cybex Reactor and a postconcussive symptoms scale score were assessed in all subjects during the preseason. Injured subjects and matched controls were also assessed 1, 3, 5, and 10 days postinjury. RESULTS: Repeated measures analyses of variance revealed significant differences between injured subjects and controls in postconcussion symptoms, but not agility performance. Post hoc testing revealed that injured subjects reported significantly more postconcussion symptoms on Day 1 after injury. CONCLUSION: The methods of agility assessment used in this study appear to not be sensitive enough to detect functional impairment following MBI.

Efficacy of the Star Excursion Balance Tests in Detecting Reach Deficits in Subjects With Chronic Ankle Instability.

OBJECTIVE: Chronic instability after lateral ankle sprain has been shown to cause balance deficits during quiet standing. Although static balance assessment in those with ankle instability has been thoroughly examined in the literature, few researchers have studied performance on more dynamic tasks. Our purpose was to determine if the Star Excursion Balance Tests (SEBTs), lower extremity reach tests, can detect deficits in subjects with chronic ankle instability. DESIGN AND SETTING: We performed all testing in a university athletic training facility. We tested lower extremity reach using the SEBTs, which incorporates single-leg stance with maximal reach of the contralateral leg. SUBJECTS: Twenty subjects with unilateral, chronic ankle instability (age = 19.8 +/- 1.4 years, height = 176.8 +/- 4.5 cm, mass = 82.9 +/- 21.2 kg) and 20 uninjured subjects matched by sex, sport, and position (age = 20.2 +/- 1.4 years, height = 178.7 +/- 4.1 cm, mass = 82.7 +/- 19.9 kg). MEASUREMENTS: We measured the reach distances in centimeters (cm) and averaged 3 reaches in each of the 8 directions while the subjects stood on each leg for data analysis. RESULTS: The group with chronic ankle instability demonstrated significantly decreased reach while standing on the injured limb compared with the matched limb of the uninjured group (78.6 cm versus 82.8 cm). Additionally, subjects with chronic ankle instability reached significantly less when standing on their injured limbs as compared with their uninjured limbs (78.6 cm versus 81.2 cm). CONCLUSIONS: The SEBTs appear to be an effective means for determining reach deficits both between and within subjects with unilateral chronic ankle instability.