Dr. Koutures analyzes use of braces for inevitable volleyball ankle sprains

Editor’s note: If you play volleyball, eventually you will sprain an ankle. It’s not if but when. So we asked Dr. Chris Koutures, who writes regularly for VolleyballMag.com, to take on ankles.

By Dr. Chris Koutures for VolleyballMag.com

There’s little doubt that ankle sprains are the most common acute injury in indoor volleyball. The debate typically begins when making recommendations either for or against the use of volleyball ankle braces.

I’m going to review this subject by first listing some studies about volleyball ankle braces. More importantly, I will tap the awesome collective wisdom of my USA Volleyball sports medicine colleagues Aaron Brock, ATC and Jill Wosmek, ATC. Aaron works with men’s national teams and Jill was with the women’s for two Olympic cycles.

I am not going to review ankle taping, since many athletes do not have access to proper ankle tape applications by athletic trainers. Also, even when taping is done well, the most protective effect is lost after 30 minutes of application.

The majority of ankle sprains occur when the ankle inverts (rolls in). This most often occurs with play at the net where athletes make contact with another player’s foot when landing from a jump. 

The theory behind volleyball ankle braces is to reduce abnormal ankle motion. Some professionals fear that depending on volleyball ankle braces might weaken lower leg muscles and increase knee injury risk.

I do not endorse or have any investment in particular types of volleyball ankle braces. I will only list particular brands and makers if they were mentioned in studies. All expressed opinions are our own.  They do not represent official policy of USA Volleyball or any other group or employer.

What does the medical literature say about volleyball ankle braces?

• A prospective study of high school players concluded that two types of volleyball ankle braces (Active Ankle Trainer II and Aircast Sports Strirrup) protected players who never had ankle sprains. They however did not prevent subsequent sprains in players with a past history of sprain.
• Moving up to the collegiate ranks, prophylactic use of double-upright padded volleyball ankle braces significantly reduced the injury rate.
• Focusing more on female volleyball players, technical and proprioceptive training were effective methods on preventing ankle sprains in athletes with four or more ankle sprains.  Volleyball ankle braces were more effective only in those with less than four past injuries
• Elite volleyball players with recurrent sprains who underwent technical training (emphasized proper take-off and landing technique for blocking and attacking) and balance board work enjoyed a twofold reduction in new ankle injury
• Limited evidence suggests that ankle braces do not increase the risk of knee injuries. Addressing strength of leg and hip muscles along with limited ankle dorsiflexion may be a sensible prevention strategy.

What do my expert volleyball medicine colleagues have to add about volleyball ankle braces?

As director of sports medicine and performance and head men’s athletic trainer for USA Volleyball, Aaron Brock has the following insight:

• The great majority of ankle sprains seen with the U.S. men’s national team have been to the unprotected ankle.
• No conclusive evidence exists that ankle braces adversely effect on court performance.
• It is still possible to sprain an ankle while wearing ankle braces but the risk is significantly diminished. Also, ankle sprains while wearing braces usually result in a less severe sprain.
• The best way to prevent ankle injuries is the use of ankle braces.

As the former head trainer for the USA women’s national team, Jill Wosmek offers her professional recommendations:

• The type of shoe is also important.  Find a proper heel position that isn’t “too high” as lower heels reduce side to side ankle motion.
• For younger players, braces are recommended. The type of volleyball play is more chaotic, and the athletes are not as strong.
• Many college teams have bracing/taping as team rules that influence decisions.
• On the USA women’s national team, the majority do not tape or brace. One must realize that level of play is higher, under-net collisions are limited, and more time is spent in strength and proprioceptive training.

Does this information make you more or less interested in using volleyball ankle braces to reduce the risk of ankle sprains?

How to approach a volleyball ankle injury

Despite using tape or a brace (or not), landing on an opponent’s foot at the net or landing wrong after a bad jump causes an ankle to roll and pop.

What are some sensible steps to keep in mind when dealing with a volleyball ankle injury?

• If you can’t jump, approach, or even walk without a limp, it’s time to leave the court. You are not going to be of help to your team, and continuing to play may increase risk for a longer period before full return to volleyball.
• Try to elevate an injured ankle as soon as possible. While some swelling is part of the natural healing process, too much swelling limits ankle motion, increases pain and can slow recovery.
• So, how about putting some ice on an injured ankle? Yes, many have (and still do) apply ice to reduce pain and swelling. However, the days of “everyone gets ice” are numbered as some evidence shows that not all athletes benefit from ice/cold after an injury. One recommendation is to give ice a try. If there is indeed less pain and swelling, then continue using the ice. If ice doesn’t seem to help, then there is no need to continue using it. 
  • If you are using ice, try 15-20 minutes per session and have something (like a bag, towel, etc.) between the ice and skin to prevent ice burns.
• Now, who needs X-rays? Guidelines can include not being able to walk and localized finger-tip areas of pain around the ankle/foot. Getting good medical advice can help with ankle injuries and deciding if x-rays are part of that first evaluation. Most ankle injuries do not require emergency department visits. Often, visits with urgent care facilities or seeing your trusted primary physician or sports medicine specialist are sensible first steps after an ankle injury.
• I’m a big fan of “horseshoe” compression with ace wraps. For those that are equine challenged, these “U-shaped” pads fit around the inside/outside of the ankle and can greatly assist in reducing swelling. 
• In those first few days, don’t be afraid to work on ankle motion. A favorite exercise is to draw the alphabet with the big toe.
• Once reduced swelling and increased ankle motion allow walking without limp/pain, a player can begin simple pass/pepper and standing hitting drills.
• To return to jumping, diving, and slides/approaches, players should have no pain with basic hopping, jogging and running.
• After an ankle injury, the muscles in the back of the hip and upper leg can quickly lose full function. Strengthening muscles above the ankle is key in the recovery process.
• A certified athletic trainer or physical therapist can be a big assist in the return to play process.
• The biggest risk for future ankle injuries is incomplete rehabilitation of a current ankle injury. Rushing back to the court when maybe 80-85% of full strength may initially make you a comeback hero, but can increase the risk of a repeat injury.

Dr. Chris Koutures is a dual board-certified pediatric and sports medicine specialist who practices at ActiveKidMD in Anaheim Hills, CA. He is a team physician for USA Volleyball (including participating in the 2008 Beijing Olympics), the U.S. Figure Skating Sports Medicine Network, Cal State Fullerton Intercollegiate Athletics, Chapman University Dance Department, and Orange Lutheran High School. He offers a comprehensive blend of general pediatric and sport medicine care with an individualized approach to each patient and family. Please visit activekidmd.com or follow him on twitter (@dockoutures).

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