Comprehensive testing of 10 different ankle braces: Evaluation of passive and rapidly induced stability in subjects with chronic ankle instability
Introduction
Injuries to the lateral ligaments of the ankle joint complex are among the most frequent injuries in sports and activities of daily living that mostly affect young physically active individuals [1], [2]. For rehabilitation after injury or prevention of re-injuries a proprioceptive training program has been recommended throughout the literature [3], [4], [5]. Furthermore, ankle braces are commonly used for the treatment and rehabilitation of acute injuries and bracing is common practice among individuals with chronic ankle instability to prevent recurrent injuries. There is evidence that the use of braces in these subjects can reduce ankle sprains in high risk sporting activities like soccer or basketball [6]. Braces have to meet different requirements, e.g. in sports applications an optimal brace should ensure the necessary stability without limiting performance and also meet subjective demands like comfort or ease of application [7]. A wide variety of products are commercially available and consist of rigid or flexible materials in combination with special systems of straps. This diversity of products leads to a dissatisfactory situation for clinicians, physiotherapists and coaches to recommend or consumers to choose the most appropriate model for individual requirements on a basis of objective information.
Ankle sprains often occur in a combination of inversion, plantar flexion and internal rotation. Excessive motion in these directions should primarily be restricted by braces whereas the other directions may also be of importance [8]. In general, it has to be considered that stabilization against inversion is probably the major function of ankle braces [9].
Several studies have been performed in the past to evaluate the stabilizing effect of different ankle braces under passive [7], [8], [10], [11] or rapidly induced conditions [12], [13], [14]. Passive condition refers to a situation where the ankle joint complex is moved passively in different directions in an unloaded situation (e.g. supine position). The advantage of this test is to obtain information of the stability characteristics in different directions, e.g. inversion–eversion, plantar–dorsiflexion. The disadvantage is that it is not a realistic representation of the potentially traumatizing situation, because of the lack of dynamics in the application of the torques and the neglected potential influence of the muscles that stabilize the ankle joint. Rapidly induced stability refers to a situation where subjects are subjected to a fast inversion event on a tilting platform simulating an ankle sprain. This method reflects a more realistic condition because the foot is loaded with bodyweight and the inversion instant is unknown to the subjects. The disadvantage of this test is that it is mainly limited to inversion. However, these two tests provide objective information about the stabilizing effects of various ankle braces either under laboratory or more realistic conditions. Results of both tests combined would provide even more valuable information for the evaluation of braces. However, braces have not been tested for stability with both test procedures and the relationship between passive and rapidly induced conditions has not been investigated, yet. Most investigations focused only on few braces and differences between braces were not described so that no recommendations for the specific use of different braces are available. Furthermore, no subjects with recurrent ankle sprains were used. This is of special interest when focusing on prophylactic use of braces in sports because subjects with a history of ankle sprains may be expected to have different anatomical and/or functional preconditions and therefore, may react differently to test conditions compared to healthy subjects.
Therefore, the aim of the present investigation was to provide an overview of the characteristics of 10 different ankle braces that were tested for passive and rapidly induced stability in order to help clinicians, physiotherapists and coaches to recommend or consumers to choose the most appropriate model for individual requirements. It is of special interest to what extent different braces stabilize the ankle joint complex against passively induced inversion and eversion, plantar and dorsiflexion and internal and external rotation as well as against rapidly induced inversion movements on a tilting platform. In addition, correlation between passive and rapidly induced inversion and amount of restriction for both tests are of interest to understand relation between test conditions.
Section snippets
Subjects
Twenty-four subjects (15 females, 9 males) with chronic ankle instability participated in the project. Subjects who had endured an injury to the ankle joint complex within the last three months prior to testing were excluded from the study. Inclusion criteria were repeated ankle inversion sprains and a self-reported feeling of instability or giving way. Talar tilt and anterior drawer sign were not used as an inclusion criterion because of the variability of these parameters across subjects and
Results
A comparison between test and retest showed high correlation coefficients for the parameters of both measuring systems (Table 2).
In the no-brace condition the following mean angles for passive stability were determined: 39° (SD 9) inversion, 23° (SD 7) eversion, 43° (SD 5) plantar flexion, 25° (SD 2) dorsiflexion, 36° (SD 6) internal rotation and 37° (SD 6) external rotation. The corresponding mean torques were 6.7 Nm (SD 1.8) inversion, 8.1 Nm (SD 2.0) eversion, 7.2 Nm (SD 2.9) plantar
Discussion
A comprehensive test of passive and rapidly induced stability in 10 different ankle braces was performed in a population suffering from chronic ankle instability. The results of the present investigation identify large differences between braces and provide an objective basis to recommend or choose models for individual requirements. Combined testing of passive and rapidly induced inversion revealed important and new information about the characteristics of ankle braces.
Subjects with unstable
Acknowledgements
The authors wish to thank all brace manufacturers who contributed to this investigation. We would also like to thank Dipl. Ing. D. Klein and Mr. A. Zscheile for designing and manufacturing the testing apparatus and the goniometer system. Finally, we thank Nike, Inc. for providing the shoes.
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