Preventative Ankle Taping and Bracing

Lauren C. Olmsted, MEd, ATCEATA 2004

Philadelphia, PA

Background

• Ankle sprains are among the most common injuries that occur in athletic participation

• Treatment strategies may be ineffective in preventing re-injury

• Residual disability after ankle sprain has been reported in as many as 70% of people suffering lateral ankle sprain

Background

• Preventative measures such as taping and bracing were developed to lower the incidence of sprain and decrease residual symptoms

• Several studies have shown that taping and bracing may decrease ROM, increase proprioception, decrease pain, and improve function

• BUT WHAT ARE THE PROBLEMS???????????

The problems are…….

• Although taping and bracing affect neuromuscular characteristics, do they really lower the incidence of injury?

• Is the cost of taping and bracing and the time required by athletic trainers to tape athletes beneficial?

• Which athletes should be taped or braced?

A quote….• “ as the status of the athletic trainer increases

and the true value of his services are fully recognized, it becomes essential that members of the profession recognize the paucity of scientific evidence to support many of it’s traditional practices…Today’s demands on the athletic trainer’s time and budget no longer warrant the retention of practices which fail to survive the critical scrutiny of a controlled study” (Simon, 1969)

Penn State Project

• Purpose 1: To review the literature to examine the effectiveness of taping and bracing using a medical model for injury prevention known as Numbers Needed to Treat (NNT)

• Purpose 2: To apply a cost-benefit analysis to the NNT values to examine the advantages and disadvantages of taping and bracing

Literature Review

• Original research papers were examined from 1966-2002

• Papers were excluded if they did not examine the effects of taping and bracing on injury rates

• Our search produced 8 articles which reported injury rates but only 3 allowed us to calculate NNT

5 Excluded Articles

Methodological Problems• No control group• No random assignment of subjects• Groups were not similar at baseline• No exposure or injury data collected• Compliance was not monitored

Using NNT

• Statistic used when trying to ascertain the clinical benefit of a treatment1,2,3

• Defined by the number of treatments necessary to prevent one injury

• Calculation: 1(P2-P1)

– P2 = injury rate in control group– P1 = injury rate in treatment group

What is needed for NNT

• Injury incidence– Athlete exposures– # of injuries

• Control group

• Treatment Group

• Injury History

Cost Benefit Analysis

Cost of Prophylaxis• Tape: $1.37/roll of J&J Zonas (Medco)• Brace: $35.00 for Air Cast (Medco)

Interventions• Tape: 78 (6 practices/week x 13 weeks)• Brace: 1 (same brace for entire season)

Cost Benefit Analysis

Cost per Ankle Sprain• NNT x cost of prophylaxis

Total Cost per Season• Cost per Ankle Sprain x # of interventions

Garrick and Requa4

• 2562 intramural basketball players at the University of Washington from 1972-1973

• Intervention: ankle taping

• ATC’s and ATS at UW taped all athletes and recorded athlete exposures

Garrick and Requa4

NNT Results• Incidence (History)

– Control: 24 sprains/434 exposures = .0553– Treatment: 13 sprains/794 exposures = .0164– NNT = 26

• Incidence (No History)– Control: 12 sprains/670 exposures = .0179– Treatment: 4 sprains/367 exposures = .0109– NNT = 143

Garrick and Requa4

Cost Benefit Results (Season)History• Taping: $2779• Bracing: $910No History• Taping: $15,281• Bracing: $5005

Sitler5

• 1601 intramural basketball cadets at the USMA in West Point, NY from 1990-1991

• Intervention: Ankle bracing (Aircast Sports Stirrup)

• Research Team member assured compliance before each game

Sitler5

NNT Results• Incidence (History)

– Control: 6 sprains/90 subjects = .067– Treatment: 1 sprain/87subjects = .011– NNT = 18

• Incidence (No History)– Control: 29 sprains/722 subjects = .040– Treatment: 10 sprains/702 exposures = .014– NNT = 39

Sitler5

Cost Benefit Results (Season)History• Taping: $1924• Bracing: $630No History• Taping: $4168• Bracing: $1365

Surve6

• 504 male soccer players from 4 divisions in the Western Province of South Africa

• Intervention: Ankle bracing (Aircast Sports Stirrup)

• Coaches monitored compliance

Surve6

NNT Results• Incidence (History)

– Control: 42 sprains/131 exposures = .321– Treatment: 16 sprains/127 exposures = .126– NNT = 5

• Incidence (No History)– Control: 33 sprains/129 exposures = .256– Treatment: 32 sprains/117 exposures = .274– NNT = 57

Surve6

Cost Benefit Results (Season)History• Taping: $534• Bracing: $175No History• Taping: $6091• Bracing: $1995

Conclusions

• Taping and bracing are beneficial in reducing the incidence of ankle sprains in people WITH a previous history of sprain

• Bracing may offer a more cost-effective and time sensitive preventative measure

Limitations

• All three studies used different calculations of exposures making comparisons across each study difficult

• Although the studies we used for calculation of NNT revealed meaningful findings, it is difficult to generalize these results across all sports and all age groups

What is needed

• Large Scale Research Project Examining:– Large number of athletes (1000’s)

• Group 1: ankle sprain history • Group 2: control group

– Different sports represented– Different age groups represented– Different preventative measures– Exposure data collected across seasons

Thank you

References

1. Bandolier Extra. Calculating and using NNTs. Available at http://www.ebandolier.com. Accessed February 2003.

2. Chattellier G, Zapletal E, Lemaitre D, Menard J, Degoulet P. The number needed

to treat: a clinically useful nomogram in its proper context. BMJ 1996;312:426-429.

3. Cook RJ, Sackett DL. The number needed to treat: a clinically useful measure of

treatment effect. BMJ 1995;310:452-454.

4. Garrick JG, Requa RK. Role of external support in the prevention of ankle sprains. Med Sci Sports Exerc. 1973;5:200-203.

5. Sitler M, Ryan J, Wheeler B, McBride J, Arciero R, Anderson J, Horodyski M.

The efficacy of a semirigid ankle stabilizer to reduce acute ankle injuries in basketball. Am J Sports Med. 1994;22:454-461.

6. Surve I, Schwellnus MP, Noakes T, Lombard C. A fivefold reduction in the

incidence of recurrent ankle sprains in soccer players using the sport stirrup orthosis. Am J Sports Med. 1994;22:601-606.