ANKLE BRACING: A STEP FORWARD OR A STEP BACK?

Ankle Bracing

Forward or a Step Back?

What are the different types of ankle braces and wraps and how do I pick which to use?

Answer: Ankle bracing can vary widely depending on the severity of the injury and it’s intended use. Bracing can vary by (1) degree of support, (2) degree of compression, and (3) materials used for ancillary utility. To envision how the ligaments of the ankle are affected, you can compare the ligaments of the ankle to hold similar properties of taffy. When the ligament is overstretched beyond it’s tolerance, some fibers can tear and other fibers can over-stretch without recoil, similar to the properties of taffy.

Types of Braces and Wraps:

Boots are bulky and do not allow for use inside of a shoe. They provide complete immobilization during acute injury or when significant tissue healing needs to occur with or without surgery. Immobilization allows the overstretched ligaments to heal back in a shortened position.

Lace-up and Strapping braces are used for moderate support, allowing some degrees of freedom for the ankle to move and reintroduce motion safely while wearing a shoe. These braces are made with rigid materials that restrict excessive ankle turning or rolling caused by weakness or instability.

Soft sleeves and compression wraps provide the lowest level of support, used primarily for compression of the ankle to help reduce swelling and increase proprioception. Some are even infused with special materials that create a magnetic field around the ankle to improve blood flow, facilitate the healing process, and decrease pain.

What are the key benefits of using ankle support, especially for high impact sports like football, soccer, volleyball, etc?

Key Benefits: In most cases, ankle support is meant to be used as a short-term response to acute injury. Once healing occurs, degrees of external support should decrease as you go through the rehab process, making the ankle stronger and able to react to unexpected changes of terrain. “Chronic ankle sprainers” usually become so by returning to high-level activity before the ankle is ready to tolerate it. 

Those who engage in consistent high-risk activities (i.e., basketball, volleyball, may benefit from the short-term added stability they get from bracing, but ultimately should be strengthening and improving their balance to decrease dependence on such devices. 

Are there any potential drawbacks or limitations of over-reliance on ankle support?

Potential Drawbacks: Excessive use of external ankle support can eventually lead to an array of subsequent problems: (1) weakening of the surrounding musculature, (2) psychological dependency, and (3) decreased proprioception, which is your body’s ability to detect where it is in space and positional awareness.

How does strengthening around the ankle contribute to stability and balance? How do strong muscles help absorb impact and prevent unwanted movement, and reduce risk for injury?

Answer: Ligaments of the ankle provide “primary stability” to the joint. Ligaments attach from bone-to-bone and are not able to contract like muscles do, instead they provide the glue necessary to keep the ankle together.

Muscles crossing the ankle joint provide “secondary stability” by contracting when there is damage to the ligaments nearby. Therefore, it is important to incorporate an ankle strengthening routine so the muscles can stabilize the joint, absorb impact, allow smooth motion of the ankle joint, then produce the necessary force again to run, jump, cut, etc. 

What are some examples of effective ankle-strengthening exercises that target different aspects of ankle strength? How are they modified for different fitness levels?


1.Single plane strength:
 

  • 4-way ankle with a band (dorsiflexion, plantarflexion, inversion, eversion)

  • Overcoming isometrics is the application of force against an immovable object. Since you're working against absolute resistance, you can exert maximum effort safely, increasing muscle fiber recruitment at different joint angles. This also helps build tendon stiffness allowing the muscle to absorb, then exert force quickly.

  • Yielding isometrics is simply holding your position against gravity, preventing movement (think holding the bottom of a squat position). This technique is excellent for identifying unwanted compensation and building muscle endurance.


2. Balance/Proprioception: 

  • Surface progression: Progress these exercises from double leg to single leg, then progress the surface from stable (floor, turf) to unstable (foam blocks and BOSU balls)

  • Vestibular Progression: Improve proprioception by removing or distorting vision to force your body into positional awareness with varying degrees of muscle tension

  • Cognitive Progression: Add outside tasks such as auditory or visual reaction to increase mental focus and concentration as thebody must tune into other senses to maintain balance

How important is consistency in performing these exercises for long-term benefits?

Answer: Consistency is key to returning the ankle back to its pre-injury state. Initial rehab should be performed at 3-4x/week with varied intent for each day. Once the ankle has reached a status ready for return-to-sport, corrective exercises are still required 1-2x/week for lasting results and to prevent re-injury. The protocol itself can vary widely based on your injury severity and participation in high-risk activity.

General guidelines I use when progressing exercise include:

  1. No movement or loading pattern should ever produce more than 2/10 pain. If it is, you can be doing more harm than good. 

  2. No task should ever be so difficult that you cannot complete the assigned number of sets and reps. If you can’t do it, regress, practice, and return later

  3. Variables that you can manipulate to progress any exercise include decreasing rest breaks, increasing volume, increasing intensity, and frequency

  4. Rest and recover. Use hot and cold contrast baths, near infrared light therapy, Vaso pneumatic compression, and electrical stimulation to assist with pain, blood flow, and facilitate healing

How crucial is it to consult with a healthcare professional for personalized guidance and exercise selection when it comes to ankle support and strengthening workouts?

It’s important to understand there is no “one size fits all” protocol when it comes to ankle sprains and rehabilitation. Also, timing to make sure you are on the correct path to recovery is essential so you don’t become a chronic ankle sprainer. Consult a healthcare professional right away when you sprain. Everything you find on the internet is context-dependent.

The right clinician will help you create a plan to rehabilitate based on the injury severity, your degree of impairment, activity goals, and timeline for return to-sport.

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Flat Feet and Implications on Performance