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MCSM Athletic Training Services Team
MCSM — Texas Medical Center/San Jacinto
Jeff Collins, LAT
Jace Duke, ATC, LAT
Emery Hill ATC, LAT
Michelle Leget ATC, LAT
Lashelle Brown Okonkwo ATC, LAT
Scott Tidwell LAT
MCSM — Sugar Land
Angela Byrd, LAT
Jerry Meins, ATC, LAT
Brandon Roberts, ATC, LAT
Bill Wissen, ATC, LAT
MCSM — West Houston
Richard Gregoire ATC, LAT
Layne Schramm ATC, LAT
MCSM — Willowbrook
Dwight Adsit, ATC, LAT
Paula Douglas, ATC, LAT
Keith Jahn, ATC, LAT
Mike Pace, ATC, LAT
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Ankle Bracing vs. Ankle Taping
An ankle sprain is the most common athletic injury suffered by athletes. According to The Journal of Foot and Ankle Surgery, 25,000 ankle sprains occur in the United States each day, causing significant loss of game and practice time. Traditionally, ankle taping has been the standard for the prevention of ankle injuries, but ankle bracing has gained recent popularity. Some studies indicate that bracing may be slightly more effective than ankle taping. However, the body of research investigating ankle taping and/or bracing is limited. Recent research does shed some light on taping and bracing's ability to provide proprioceptive feedback when an ankle is inverted. However, most studies lack large subject numbers, or do not investigate athletes with chronic ankle instability.
Ankle sprains most commonly occur with the foot/ankle inverted and plantar flexed (See Figure 1). Ankle sprains occur in most sports that demand running and abrupt changes of direction. Frequently the anterior talofibular ligament and the calcaneofibular ligaments are the common recipients of the impact (See Figure 2).
A wide variety of ankle braces are commercially available. Braces consist of various rigid and flexible materials in combination with special a system of straps. Advantages of ankle bracing include self application, re-useable and cost effective. Disadvantages: they are less comfortable, feel less "stable" and the brace materials can degrade over time. If the sports medicine professional should decide on ankle bracing, here are factors to consider:
- If restriction under passive and rapidly induced conditions was the primary goal then a semi-rigid brace with straps should be recommended.
- For pure restriction of eversion, a pure semi-rigid stirrup brace with lateral and medial plastic stabilizer should be recommended.
- For prophylactic purposes in sports, the clinician should choose a brace that will provide stability without limiting performance. Stirrup braces may wear out the shoe and be uncomfortable to the athlete, therefore a nylon strap-lock type brace may be preferred.
Taping consists of various strengths of tape and methods of application. Traditionally prophylactic ankle taping has been the mainstay for prevention of ankle injuries. Criticisms of ankle taping include loss of as much as 40-50 percent of the original support after as little as 30 minutes of exercise. If the sports medicine professional should decide on ankle taping, here are some factors to consider:
- Ankle taping with adhesive tape is used to limit range of motion, especially in athletes with chronic ankle instability.
- Ankle taping with elastic tape may provide enough proprioceptive feedback to help prevent an injury in healthy athletes.
- Manually applying adhesive tape affords the ability to "customize" a taping for a specific injury, or to limit a specific range of motion.
Cost is a factor when choosing which method is best. One author notes that the average cost of materials for an ankle taping on one player was approximately $1.75. This figure did not include cost of time spent applying the tape. Over the course of a football season, ankle taping a single player can cost in upwards of $400.
Both taping and bracing have been demonstrated to be well tolerated by athletes. Budgetary concerns are a significant factor when choosing which method to adopt. Mickel, et al, in his study for The Journal of Foot and Ankle Surgery found that bracing was significantly more cost effective. Research in The Journal of Athletic Training also found that taping costs on average three times more than bracing over an entire season.
Athletic trainers and sports medicine physicians should carefully analyze the best course of action for an individual athlete or team. Cost, time and expected outcomes are determining factors in choosing an ankle stabilization method. Choosing the best method of stabilization depends on a multi-factorial decision on the best application for an individual athlete.
Shoulder impingement syndrome, also called swimmer's shoulder or thrower's shoulder, is the result of a narrowed subacromial joint space. The acromion, or tip of the shoulder, forms a protective "hood" over the top of the shoulder joint. Between the humeral head, or "ball" of the shoulder, and the acromion process lie two very important structures: the rotator cuff tendon, which connects the supraspinatus muscle to the greater turbercle of the humerus, and the subacromial bursa, which lies in the subacromial space and protect sthe tightly spaced structures from friction and wear. True impingement of these structures can cause swelling of the bursa and, if a boney subacromial spur is present, damage to the rotator cuff tendon is possible.
In healthy athletes who throw or swim, forceful repetitive abduction and external rotation of the shoulder can cause narrowing of the subacromial space and "impinge" the bursa and superior rotator cuff tendon. The impingement can cause an inflammatory reaction of the bursa and cause it to swell. The resulting swelling reduces the joint space and can increase friction of the rotator cuff tendon, referred to as primary impingement.
In most young athletes, treatment with ice, rest and modification of activity to avoid abduction and external rotation of the shoulder will resolve the symptoms in a matter of days. Athletes with prolonged pain or repeat impingement symptoms need evaluation by a sports medicine physician along with diagnostic studies to determine if the rotator cuff is torn or frayed, or if a subacromial spur is present.