To tape or brace
Some sports medicine pros prefer taping. Others prefer bracing. Which is better for your athlete?
By John R. Storsved, HSD, ATC/L, & Matthew Cronin, MS, ATC, CSCS
JOE, A 6-FOOT-8-INCH BASKETBALL PLAYER, jumps to the net, tipping the ball in with a flick of the wrist. As he goes up, he's the proverbial poetry in motion, his muscles glistening and working like those of a racehorse straining toward the finish line. But as he comes down, poetry turns to pain. His ankle twists awkwardly, and he hobbles off the court.
Joe doesn't have a catastrophic injury, merely an ankle sprain. Should you tape or brace the ankle? Unfortunately, there's no clear answer because taping vs. bracing is one of the most debated issues in sports medicine. In this article, we examine the literature to help you make an appropriate choice for your athletes.
Before doing so, however, we first must comment on the vast information in this area. Many articles support using prophylactic taping/bracing for an injured ankle, while others
describe the detrimental effects of ankle support. The majority of these articles, however, are merely descriptive observations of personal experience. Why do some coaches require all athletes to tape their ankles even if they've yet to experience an ankle/foot problem?
In addition, numerous studies point to the detrimental effects to postural stability with taping and bracing, and others claim that tape loses its benefit following 10 minutes of play. Several years ago, it was common practice to fit every anterior cruciate ligament (ACL) injury, pre- and post-surgery, with a custom-fit functional knee brace. Now this application is the exception rather than the rule. As this indicates, great diversity exists in treating ankle/foot injuries.
One thing is clear, however. Ankle sprains are the most common injuries that require bracing or taping, according to recent reports from the National Athletic Trainers Association (NATA). For example, foot and ankle injuries accounted for nearly 43 percent of injuries to high school basketball players, NATA stats show from 1986 to 1988. The most common is the lateral ankle sprain.
The mechanism for a lateral ankle sprain is inversion combined with plantar flexion of the foot. Bahr et al. followed 318 volleyball players during one season of play.1 Of the 63 ankle injuries reported, 86 percent occurred at the net when players landed--a time when the ankle is most vulnerable to injury. Taping and bracing the ankle attempts to reduce range of motion, increase stability and improve the proprioceptive function of the ankle ligaments and all other segments in the kinetic chain.
In choosing which support is appropriate for your athlete, consider factors such as the injury, severity, product availability, cost of the materials, availability of a qualified person to apply the tape, and the sport in which the athlete participates.
Taping Pros and Cons
In most cases, athletes prefer taping because it's customized and less bulky. Although taping may be the method of choice, drawbacks exist, one of which is cost. If an athlete needs repetitive taping over an extended time, costs can be considerable.
What's more, a qualified person needs to apply the tape appropriately. If it's applied incorrectly, ankle joint support will be inadequate and other problems, such as blisters, tape cuts and biomechanical problems may occur. If taping is the chosen method of support, the athlete must have a quality tape job that's applied by a qualified person.
Another disadvantage is that taping loses its effectiveness shortly after play begins. Studies have shown that taping support decreases between 40 percent and 50 percent anywhere between five and 20 minutes into the activity.2 Shapiro et al. also showed that quality of support deteriorated with use when athletes taped their ankles.3 But taping does help prevent ankle injury. A landmark study by Garrick and Requa (1973) concluded that taping did have a significant role in preventing ankle sprains vs. ankles without protective taping.4
In addition, taping can assist in preventing ankle sprain injuries by assisting with proprioception. Heit, Lephart & Rozzi assessed the proprioceptive effects of ankle taping of 26 subjects by evaluating ankle joint position sense.5 This study demonstrates that ankle taping improves joint position sense in the stable ankle. Robbins, Waked, & Rappel studied 24 healthy subjects and the effects of taping on foot position awareness.6 This study suggests ankle taping improves proprioception before and after exercise.
Pros and Cons of Ankle Braces
Like taping, ankle braces also offer advantages. First, athletes can reuse the brace each time they participate in an activity. In the long run, this is a financial advantage.
Second, athletes can apply the ankle brace themselves after they've been properly instructed on doing so. Third, ankle braces restrict the range of motion for a longer period than taping.2 And fourth, a study has shown that ankle braces do a better job of preventing or reducing the recurrence of ankle sprains.7
Other studies have looked at the effects of prophylactic braces and tape on an inversion moment force applied to the ankle. Many of the braces helped resist inversion at a level comparable with or exceeding the capability of the freshly applied tape. Braces that were not as effective as the tape could be readjusted and their effectiveness restored.3
Taping and bracing have positives and negatives, but do they impede athletic performance? In a study that looked at both taping and bracing on athletic performance, taping only had a minimal negative effect on physical activities, such as vertical jump, shuttle run and a 200 meter run in comparison to ankle bracing and a control group.8 This indicates that taping and bracing wouldn't interfere with the athlete's performance.
Another study conducted by Verbrugge compared the effects of taping vs. bracing on 26 male athletes during an agility run, a 40 yard dash and a vertical jump.9 Their study suggests that bracing and taping don't impede athletic performance.
As we mentioned earlier, the decision to tape vs. brace is one of the most debated issues in sports medicine. Many of the articles commonly referred to as "definitive treatment" are merely descriptive observations gathered from empirical observation and from what we experienced as athletes ourselves.
After a lateral ankle sprain, we brand a person as having an increased risk of reoccurrence. Why? Are we sufficiently looking at issues, such as altered hip muscle recruitment patterns? Are we placing athletes in "crutches" for prolonged periods, inhibiting their ability to interact in complex environments that require efficient patterns of neuromuscular control?
If we, as clinicians, knew the best way to do something, then we'd all follow the same approach. We must carefully review the literature, listen to those who require intervention and be willing to change when we need to. *
1. Bahr, R., Karlsen, R., Lian, O., & Ovrebo, R.V. (1994). Incidence and mechanisms of acute ankle inversion injuries in volleyball. American Journal of Sports Medicine. 22(5), 595-600.
2. Paris, D.L., Varadaxis, V., & Kokkaliaris, J. (1995). Ankle ranges of motion during extended activity periods while taped and braced. Journal of Athletic Training, 30(3), 223-228.
3. Shapiro, M.S., Kabo, J.M., Mitchell, P.W., Loran, G., & Tsenter, M. (1994). Ankle sprain prophylaxis: an analysis of the stabilizing effects of braces and tape. American Journal of Sports Medicine. 22(1), 78-82.
4. Garrick, J.G. & Requa, R.K. (1973). Role of external support in the prevention of ankle sprains. Medicine and Science in Sports and Exercise, 5, 200-203.
5. Heit, E.J., Lephart, S.M, & Rozzi, S.L. (1996). The effect of ankle bracing and taping on joint position sense in the stable ankle. Journal of Sport Rehabilitation. 5(3), 206-213.
6. Robbins, S., Waked, E., & Rappel, R. (1995). Ankle taping improves proprioception before and after exercise in young men. British Journal of Sports Medicine. 29(4), 242-7.
7. Sharpe, S.R., Knapik, J., & Jones, B. (1997). Ankle braces effectively reduce recurrance of ankle sprains in female soccer players. Journal of Athletic Training. 32(1), 21-24.
8. Metcalfe, R.C., Schlabach, G.A., Looney, M.A., & Renehan, E.J. (1997). A comparison of moleskin tape, linen tape, and lace up brace on joint restriction and movement. Journal of Athletic Training. 32(2), 136-140.
9. Verbrugge, J.D. (1996). The effects of semirigid air-stirrup bracing vs. adhesive taping on motor performance. The Journal of Orthopaedic and Sports Physical Therapy. 23(5), 326-331.
John R. Storsved, HSD, ATC/L, is assistant professor and undergraduate curriculum coordinator of athletic training at Illinois State University. Matthew Cronin, MS, ATC, CSCS, is outreach coordinator for Fox Valley Physical Therapy in Oshkosh, Wis.
Poroneal tendinitis, anterior tibialis tendinitis, posterior tibialis tendinitis, Achilles tendinitis and turf toe are other injuries that may benefit from support with bracing or taping. The majority of posterior tibialis tendinitis (shin splints), can be treated favorably with arch taping, manual soft tissue techniques to the volar aspect of the foot, and movement pattern reprogramming of the posterior tibialis muscle. Having the athlete perform slow repeated closed-chain heel raises to full plantar flexion can help you determine whether the posterior tibialis may be injured.
If the calcaneous fails to invert at end range, and the athlete reports pain on palpation of the medial aspect of tibia when the foot is dorsi flexed and everted, suspect posterior tibialis involvement. The calcanious must invert on heel off for optimal neuromuscular control, efficiency of function and proper force attenuation.
This allows the axis for the talus/navicular and calcanial/cuboid (transverse tarsal joint) to cross, resulting in the forefoot becoming a rigid lever permitting proper force attenuation throughout the gait cycle. The posterior tibialis has a broad insertion on the volar surface of the foot, assisting in forming a rigid lever at the fore foot as well as eccentrically controlling subtalar eversion and internal leg rotation during the early contact phase.
When an athlete experiences posterior tibialis tendinitis, the calcaneous cannot fully invert at end range on repeated heel raises. A simple support to the arch, along with reprogramming the movement pattern of the posterior tibialis, will put most of your athletes back in the game.
--John R. Storsved, HSD, ATC/L, & Matthew Cronin, MS, ATC, CSCS