Friday, March 6, 2009

Brace yourself: ankle braces hurt knees


BY DR. PHIL WAGNER, M.D.

Subtalar joint inversion, a fancy word for ankle sprain, and the enemy of most basketball and volleyball players. Combine tall athletes landing blindly after huge jumps, and rolled ankles are bound to happen. In response, athletes start bracing their ankles with various lace-up and semi-rigid braces to avoid rolling their ankles. What they don't know is that all of the "safe" landings they had while wearing the braces put them at risk for serious traumatic, as well as chronic knee injuries.




Many studies have been done examining the athletic performance effects of wearing ankle braces. Research from the Division of Orthopedic Surgery at the University of Utah showed that ankle braces decreased vertical jump height and broad jump distance, and slowed the time of a sprint.

While most research agrees that wearing braces helps prevent ankle sprains, not many studies have been done on the effects wearing braces can have on an athlete's knees. Recently, a few studies have come out specifically addressing the stress ankle braces can put on an athlete's knee joint. Research by Kandy Venesky at Indiana University showed that wearing ankle braces increased the twisting forces about the knee by 10%, increasing the potential for knee ligament injuries. It is important to note that this study was published in The Journal of Athletic Training, a population that is usually the most adamant about wearing ankle braces. In addition, research from The University of Kansas Medical Center concurred, showing that wearing ankle braces significantly increased torque at the knee joint during trunk rotation movement while standing on one leg (the same motion that happens during a one leg landing).

So why does an ankle brace put your knees at risk? You have to think of your legs as complex shock absorbers. When you land after a jump, your ankle, knee and hip joints all play a role in absorbing the shock of the landing. Ankle braces, while stabilizing the joint, also decrease your ankles range of motion, essentially taking out your first shock absorber. This places more stress on the joint next in line, the knee.

So what can you do to prevent sprains and keep your knees healthy? First, a training program that reinforces proper landing technique and strengthens necessary ligaments and muscles is essential. SPARTA athletes that compete in jumping sports complete exercises that specifically target the muscles and connective tissues needed to withstand the rigors of high impact landings. Second, try ankle taping instead of braces. The tape will provide some lateral support, without significantly hindering essential range of motion in the ankle joint, keeping the torque off of your knees.

21 comments:

  1. Hey, I sprained my ankle even with a great tape job, but never with an ankle brace on. I never had a knee injury.

    ReplyDelete
  2. Knee injuries aren't necessarily acute (happening on one jump), and can build over time with repeated landings on an ankle with compromised range of motion.

    ReplyDelete
  3. What about higher cut shoes? Would this be an appropriate compromise?

    ReplyDelete
  4. Higher cut shoes tend to be more similar to ankles braces, though it always depends on the tightness of the laces.

    ReplyDelete
  5. I thank you for posting this comment on ankle braces. As a volleyball coach, I've been very concerned about the use of stiff ankle braces. I did quite a bit of independent research on the subject and posted a blog entry on my website. It was met with some interesting comments on both sides of the issue however, the rudest attacks came from those in the ankle brace industry. I had to take the blog entry off due to the rude comments.

    ReplyDelete
  6. Thanks Steve for the post. How unfortunate the ankle brace industry responded this way, but I am not surprised as there is an obvious financial bias in their end. Especially since this brace solution is a slippery slope; research indicates ankle braces cause knee stress so why not just slap on a knee brace as well!! Where does it end?

    Cheers, Phil

    ReplyDelete
  7. This goes hand in hand with what Mike Boyle is putting out on his new DVD series. We have begun more barefoot training to help strength the ankles while adding mobility in them.

    ReplyDelete
  8. Glad you've found a way to improve the ankles. Be careful of Boyle, as he just put out information against using squats during training, which violates every scientific study and all of my own practical coaching experience

    ReplyDelete
  9. I actually tore my acl, lateral meniscus, and the cartilage in my knee because I was wearing ankle braces. I play high school volleyball and the ankle braces we wear have the two side panels on them. So like the article said, I landed from a jump one-legged, and it caused my ankle to attempt to roll, but because of the ankle brace, it went to my knee. I was out for more than half my school season and I'm missing club season right now. I had to have surgery and I've been in Physical Therapy for almost 5 months. I was injured in October and I can't play volleyball again till June, at the earliest. So this article is correct. I never wore ankle braces till this year, and it ended up causing me injury.

    ReplyDelete
  10. My daughter made the JV volleyball team and everyone that made the team had to wear an ankle brace. You mention that there has been research done on the effects of wearing the ankle brace and knee injuries. Do you know where I can locate those articles - I would love to share them with my daugters coach, so she can make an inform decision about having the girls either wear or not wear an ankle brace.

    ReplyDelete
  11. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1569548/

    ReplyDelete
  12. My knees have bothered me before, but they hurt even more now that I wear ankle braces. I went to the doctor and she said I need to strenghten my quads, but I think there's more too it. Any solutions?

    ReplyDelete
  13. I play basketball and I'm scared to hurt my knees. But a lot of girls I play with wear ankle braces. (the ones that lace up and are not plastic)I'm pretty sure none of them have knee issues. I've also heard that if you wear ankle braces, it weakens your ankles. Is that true? And should I get braces?

    ReplyDelete
  14. Yes, the ankle stabilizers are not recruited as heavily when ankle braces are worn. We would never recommend braces of any kind, except in extreme cases, like playing basketball with an ACL tear.

    ReplyDelete
  15. My daughter never had ankle problems but she was required to wear ankle braces by her high school and club team. She landed wrong from a jump and tore her ACL. She told me that her ankle tried to roll but couldn't then she felt a pop in her knee. That was before we knew of any possibility that the ankle brace could weaken her knee. She knew what the problem was. After 9 months out from surgery she has just started back to high school volleyball and her coaches are pressuring her to wear an ankle brace but we are both refusing. A rolled or sprained ankle is way better than a torn ACL.

    ReplyDelete
  16. how do you recommend athletes to learn how to wrap their own ankles because of lack of access to a trainer

    ReplyDelete
  17. A stated in the article, we do not believe in ankle braces, taping or wrapping

    ReplyDelete
  18. so essentially you are trading potential serious knee injures for a few minor ankle rolls/sprains?

    ReplyDelete
  19. Sparta Science, will knee BRACES and/or knee COMPRESSION sleeves equalize the torque off your knees while wearing ankle braces?

    ReplyDelete
  20. Likely no because the knee braces/compression does not fix or address the underlying problem which is making a hinge joint (knee) behave like a ball and socket.

    ReplyDelete